Thursday, August 20, 2009

More Rant and More From Docs...

Please pardon me for veering so far off the green path, but... honestly, aren't we part of the flora and fauna? Isn't it all one? Doesn't caring for the ecosystem and all of its creatures include caring for humanity? And isn't the health care reform debate a perfect opportunity to visit the way we've botched and commercialized our health care system, and in doing so violated our own human integrity, displacing much of our personal health, longevity, and well-being in the name of healthy corporate America (e.g. pharma, insurers, hospitals, medical equipment manufacturers, not to mention fast food enterprise)? Side-tracked so much of our time, money and energy into dealing with unnecessary illness, job disruption, family stress? We need a balance between preventative care, like accessible prenatal care, well check-ups and nutrition counseling, and treatment for illness. We need completely accessible up-front care, which although not as profitable for health care purveyors over-all, is far more profitable from a human ecology perspective.

Before I go on, please, I beg you, spend the 2 minutes and 58 seconds listening to Woody Tasch simplifying the reality about how the economy uses us for its benefit, instead of the other way around.


Please understand: I know not all economic activity is destructive, but economic growth is not synonymous with well-being. Part of what's happened to our health care system is that people being sick is conducive to the economic growth of the health care industry. Conducive to profitability of all those businesses that serve the medical market. Like war - always tragic - is economically healthy for ammunitions and weaponry manufacturers. We should make war only as a last resort, and we should never let the weapons industry drive us toward war because it is good for their profitability.

From an absolute Gross National Product (GNP) perspective, human illness is a good thing. It contributes to economic growth. But from a moral perspective, even if you believe economic growth is a good thing, the health care industry must serve the health of America, not the profitability of the health care industry. Where it cannot - where it's not profitable for private insurers to cover people with pre-existing conditions, or people who cannot afford insurance premiums at all - government must step in. It is immoral, even if practical, to determine health care policy based on what is good for the health care industry. We need to put the kabosh on immoral drivers.

Oh, I warned you it would be a rant!

Now, yesterday's post, wherein I shared the personal experiences of my doctor friend Howie and videos from other docs on the impact of current insurance practices on their patients, led to something of a vigorous debate on my facebook page.

Loving honest debate (as opposed to the screeching we've witnessed in some of these town halls), I've presented a couple more views from the medical arena. They don't jive with each other. But in the name of issue dissection, and for what they're worth, I offer them up.

First up, the First Doctor, David L. Scheiner, M.D., a practicing physician in the state of Illinois and once personal family doctor to President Barack Obama, originally published on Thursday, July 30, 2009 by

"I write today because years ago I was practicing medicine in an office on the South Side of Chicago with my partner and friend, Dr. Quentin Young, when a young community organizer came to see me as a patient. I became his personal physician for 22 years and he became president of the United States. I support and admire him and consider him to be the most promising president of my lifetime, which stretches back to 1938. But I respectfully differ with him on his approach to health care reform.

I speak to you today as an advocate for the single-payer approach to health reform, an expanded and improved Medicare for all, but I am hoping that President Obama and Congress will hear me also. As some of you may know, I was supposed to be at the recent town hall meeting at the White House where I was to ask a question of the president, but my visit was cancelled at the last minute, presumably to prevent the national airing of my views on health reform. Is the single-payer message so dangerous that it cannot even be discussed by Congress and the administration?

Yes, there are parties who stand to lose out under a single-payer program - the private, for-profit health insurance companies and their multimillionaire CEOs in the first place. The head of Aetna, for example, received $18.6 million in compensation last year. That's obscene.

Investor-owned, for-profit hospitals won't benefit from single-payer either. Neither will the big pharmaceutical companies, who will no longer be able to sell their drugs at such outrageous prices. A single-payer system will be able to buy drugs in bulk and negotiate prices.

Some critics attack single-payer, arguing that under such a program, government bureaucrats will be between the patient and the physician. In the 40 years I have been practicing under Medicare, I have never encountered an instance where Medicare has prevented proper medical care. On the other hand, insurance companies frequently interfere and block appropriate care.

There are multiple problems with the present congressional health reform proposals, but allowing private insurance to continue being involved is the most egregious. The insurance companies actually like many of the proposed reforms, including the requirement that every American purchase insurance or suffer a tax penalty, which would be a windfall to the insurance industry. That alone should be a warning.

I mentioned who will lose out under a single-payer program. But who benefits? The American people. But do they matter? Do we really care about the 50 million without health insurance as long as the rest of us have our own coverage? Do we think about the additional tens of millions who are underinsured, who face economic hardship or bankruptcy when serious illness strikes? Single payer will offer secure, comprehensive and quality care to all.

A single-payer program could be implemented comparatively easily, without disruption, as was the case with traditional Medicare. And there are other advantages: with single payer, we can discontinue Medicaid, which is bankrupting states and treats a large number of individuals as second-class citizens.

This is a moral obligation, and we are all responsible for seeing that health care is a right. That's the view of Physicians for a National Health Program [1].

Opponents of single-payer say that if the government pays for health care, the system will deteriorate. But we have two single-payer programs already operating that work superbly - Medicare and the Veterans Administration hospital system. Medicare overhead is 3 percent. Private insurance overhead is five times that. Forty years ago, I worked in a public health service hospital in Boston, which delivered excellent care to all comers. Sadly, the system was closed down.

I grew up as a child during World War II and loved my country then as I do now. I grew up revering the ideals of this country. Although there were unsettling periods, our country remains a beacon of hope for life, liberty and the pursuit of happiness. I believe that quality universal health care falls under these watchwords.

Our nation is at a crossroads. We must not squander the opportunity of this momentous time. We must not give in to the insurance and drug companies and instead do what is right for all Americans. Please, Mr. President and Congress - enact an expanded and improved Medicare for all."

I basically agree with Dr. Scheiner, but I will make this point: It would be devastating to the economy generally if we were to suddenly dismantle all the Aetnas of the country, and replace them with a single payer sytem. In the same way that AIG was too big to fail, the economic size of our health insurance industry is enormous. We can't immediately move to single payer without creating a vast new pool of unemployed, and without taking another tragic blow to our economy. If we want single payer, we will have to phase out the Aetnas of the world, actually probably buy them out and convert them, maintaining as much of their structural assets and employees, if not their programs and product, as we possibly can, in order to avoid wholesale financial wreckage.

(I should probably note, for the record, that, as a Ph.D student, I happen to have Aetna insurance through University of Missouri, and I have been extremely happy with my plan. But...aren't I lucky? Student premiums are averaged across a lot of young students, so my premium unbelievably low for someone my age. My coverage is excellent, and as far as I can tell, Aetna isn't even asking about pre-existing conditions for students. I'm one of the lucky "haves.")

My second letter today, with a different message altogether, is from Dr. Zane Pollard, a pediatric opthalmologist working in Atlanta. I lifted his words from a website called "The American Thinker," which invites Americans to put forth their views on a variety of topics. Dr. Pollard's story is, like Dr. Scheiner's and Dr. Bernstein's, intimately personal. All three docs seem genuinely dedicated to providing their patients with the best possible care. You immediately understand how their own professional experiences have colored each of their political perspectives. For example, Dr. Scheiner notes that Medicaid has never interfered with his practice, while Dr. Pollard's story is entirely the opposite. But for Dr. Pollard personally stepping up to the plate with financial resources, many of his young patients would be sightless today - and he places the blame squarely upon the Medicaid system. I've excerpted the flavor of Dr. Pollard's article. My comments follow. I also encourage you to go to the site to read the whole article,, and the comments that follow it.

Originally published August 06, 2009
ObamaCare and me
By Zane F Pollard, MD
* * *
I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.

Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.

Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point -- rationing of care.

Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time.

Again, extreme rationing. Solution: I have a foundation here in Atlanta supported 100% by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrants children for free. Again, waiting for the government would be disastrous.

* * *

Why, you might ask, did I not give Dr. Pollard's entire letter the same space I gave the others? I hoped you'd ask. It is a fair question. I did not publish the remainder because it exhibited more fear and extrapolation than fact - fear that we would end up with long lines for health care, like he has heard anecdotally about Sweden. Fear that oldsters will be denied life-saving measures like heart stints, as he has heard happens in Great Britain. Fear that people over 65 will be victimized by the reform bill. Fear that doctors will quit because they will be paid less, and fewer medical students will go through extra training to become specialists if docs all receive the same rate of pay, no matter the number of training years invested. He has personal stories. His wife was not well-served by the V.A. Hospital while he was in Viet Nam. He also claims that we are being lied to about the uninsured. Pointing to the fact that he, personally, provides free surgery to a handful of illegals and uninsured poor (two this year), he feels everyone is, in fact being served. However, I personally know multiple uninsured or under-insured people who avoid health care until their situations are dire, for financial reasons. There is no Dr. Pollard in their lives to take up the slack. So Dr. Pollard's story is personal to his experience. His behavior is laudable, but it is only part and not the whole story of the national healthcare experience; it is his personal experience.

On the other hand, it may be true that Sweden has long lines for health care. It may be true that oldsters in England have to escape to other countries to get cardiac treatment (you'd think the protests would be loud enough to hear across the ocean). Or these may be anomalies in basically sound systems. As much as I love to google, I don't have time to chase down those facts right now. And it is impossible to say, at this point, whether his fears would become America's reality under a new system - as Dr. Pollard himself points out in his statement, the law in its final form is not yet written! But even though we don't know, one thing I don't want to do is to delegitimize his fears. His fears are useful. They help us know what we don't want in reform. They should guide our program development.

Listen: Today in America we have a very rare opportunity to reform our health care system. The momentum is higher than it's ever been. So, everything should be on the table. We should acknowledge the good and bad of both private and public examples. We should find and follow good foreign and domestic program examples, and forego exeriments that have been tried elsewhere and failed. We should not equate failure, propensity to mistake, or horror story with "public-run." For every horror story in a public facility, there is an equal story in a private facility. Millions of oldster Medicare recipients appear to be satisfied with their socialized medicine program, and we've heard from an equal number of dissatisfied Veterans Administration patients. The problem isn't who runs the facility - public or private enterprise. Hundreds of private enterprises go under every month. Private enterprise doesn't have a monopoly on good management practice, and public enterprise doesn't have a monopoly on bad management practice. No, the issue is whether patients have access, whether patients' needs are front and center, whether the facility is well-managed, whether the patient, his or her family, and their doctor have control of the patient's care. Under the current health care system, some of us have some of that, maybe some of us even have all of that. But that level of care is not available now to every American under the current health care system. We need to move toward that.

And if ever there were a time, it is surely now.

By the way, I found the first photo on another blog, called Luke 10:27, and being Jewish (no New Testament handy), I have no idea what passage that refers to. But the blogger posts two more contrary doctor statements on health care. Debate, if nothing else, is alive and well! Read it here.

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