The Health Care “Crisis”

Crisis, literally translated to mean a disaster or emergency, has become a favorite word of the Obama administration. By choosing this word they want to convey to the electorate that there is an impending calamity and, therefore, action must be taken in the blink of an eye to avert certain catastrophe. A more appropriate and telling phrase, that President Obama has used repeatedly is “the stars are aligned.” I translate that to mean he sees, as did LBJ in 1965, the opposition is weak and, without meaningful debate he can power the legislation through. Nancy Pelosi said today that she just received the 1000 page Health bill and she wants it passed before the August hiatus. Does that sound like well thought out governing?   While politically expedient for those with a certain agenda, we who have been living and working within the medical system for up to 35 years acknowledge the growing dysfunction and instead call for healthy, not hurried, debates, that should take place in a completely open forum before crafting a solution.

The Obama administration and his health care team are on record that they are only going to consider a government solution. They were initially willing to compromise and extend this “public option” to only part of the population.  If you believe that the government takeover will fix the medical malaise then let’s revisit the quantitative and qualitative failure of Medicare and Medicaid,  The VA Hospital System, Social Security, The Post Office and Amtrak.  All of these are government run entities that would have failed long ago if they were in the private sector.  Paul Krugman, the recent Nobel Laureate in economics and NYTimes contributor stated in print and in a recent debate that Medicare has been a great success.  Incredibly, he seems to have checked his brain at the door, possibly because it has been crowded out by his expanding heart as he exults in the largess of this government program. However,  he more than most should recognize that Medicare represents a classic, albeit government run,  Ponzi scheme on a scale not even Madoff could have imagined.  At the current rate of spending Medicare is 50-70 trillion dollars in arrears and is projected to go broke by 2020.

In spite of this wanton spending, the government, by their own admission, has not commensurately improved the quality of care and additionally specialist’s reimbursements have been forced down 70% since 1982, not factoring in inflation. For instance, for two to three hours of emergency work, often in the middle of the night, anesthesiologists will be paid 150 dollars to care for a sick Medicare patient undergoing appendectomy and the surgeon will receive 350 dollars for all his/her care including up to 3 months from the time of surgery. Consequently,  some physicians are opting out of Medicare, and long ago opted out of Medicaid.  Between Medicare, Medicaid and SCHIP (children’s programs) the federal government already controls 47% of healthcare spending and all of the private insurance companies use Medicare codes and allowed amounts upon which to base their reimbursements.  In spite of this abysmal track record the political party in control wants to expand coverage to more than a third of the workforce.   Because of the growing deficit, they will do this by arm twisting big Pharma and Hospitals to return some of their “spoils”, and, of course, raise taxes on the “wealthy.” Their not too secret agenda, is to force all of us into a single payer plan.

No, the health care consultants for Pres. Obama are not idiots.  They too realize that the current American practice of medicine is unsustainable on many levels. They have a hidden agenda that would be political suicide should it leak to the populace.  First, they have to frighten Americans into feeling that they will be left without health care any day and only big government can help them.  Once we are in large part federally insured, the Administration will introduce what they euphemistically call “evidenced based medicine”, and “accountable care organizations.” Guess what, the federal largess is history.” Gatekeeper” family physicians will be reimbursed handsomely for limiting access to specialists by using treatment algorithms vetted by the government insiders.  “Accountable care organizations “, government-speak for large collectives of physicians who will be paid to treat diseases using government guidelines  will then divide the dollars as they see fit.   The hidden agenda is to let specialty care involute and the plain fact is, fewer specialist mean fewer healthcare dollars used.  After all, they say, specialist’s care is often unnecessary since they frequently cannot measure differences in outcomes when they review large Medicare databases.  If you genuinely believe that these databases truly measure all the important parameters of outcomes then you probably believe that the originators of these databases didn’t have preconceived notions on how they wanted to use the data.  

Then, inevitably, we will begin to see the long lines waiting for specialty care that we have seen under every government controlled healthcare system in the world.  By the time the American population begins to feel the true effects of health care rationing (yes, that is what this is about) it will be too late.  Have you ever seen the government cancel an unpopular or poorly functioning program?

If you want to begin to understand the, as yet unspoken, agenda peruse the Dartmouth Atlas Project (DAP) and read their White Paper of recommendations to the government.  This report is promulgated by those that sincerely believe family doctors can control healthcare quality and quantity and they just all happen to be family medicine doctors.  Then read the Commonwealth Fund White Paper.   This Fund’s Board contains nonpracticing physician-scientists, investment bankers and  executives of large healthcare “accountable care organizations.”  Read Ezekiel Emanuel’s book: Healthcare Guaranteed…”.  He is Rahm Emanuel’s (Chief of Staff for Obama) brother, an MD, PhD who works at NIH and a key, yet cloaked, consultant to Obama and argues for a 10  percent VAT tax (this tax hits every person) and a government run system which is supposed to coexist with private insurance.  If you saw the ABC White House Health Care infomercial, you heard Obama mention increasing the number and the pay of family medical doctors and you heard him tout the Mayo Clinic system and the “30 %” of the Medicare budget wasted on ineffective care.  This information is directly taken from his health care team that includes those mentioned above. But guess what, Dr. Welby is dead and in spite of all this misinformation, if you call your primary care doctor with a critical health problem you, in most communities, will be referred immediately to a specialist or your local ER. Good luck finding an available specialist under the coming health care plan.

As a practicing physician I recognize the inadequacies in our current system.  I acknowledge unnecessary surgeries and procedures, unreported poor outcomes and duplication of testing.  I see people bankrupted by our current system and agree completely that medical care is too expensive.  On the other hand, there is no country in the world that comes close to offering the general excellence of our care, the availability of the latest technology without harmful delays and we are personally more available than physicians anywhere in the world.  There is no country which innovates as we do, produces more exciting breakthrough drugs and equipment than we do. All of this excellence has been a product of the private sector, not big government.  You simply cannot have both.  There are ways that we can work together to fix the system but it doesn’t require more government, but less. We will continue this part of the conversation another time.