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Obamacare: a Physican's Perspective

Hugh Hewitt published a letter he received from an oncologist practicing in a 22 doctor practice in the Chicago area. In the letter he tells Hugh what many have already predicted would happen and that is if Obama gets his health care reform bill passed in both houses of Congress, disaster awaits:

Make no mistake: most of us enjoy the opportunity to do what we do. After all, we cure cancer for a living. Hard to top that on the "Useful Professions" scale. We also, however endure just the stressors and personal strains that you might imagine. We trade time, and inconvenience, for money. Just like everyone else in the private sector, only more so---after ten years of training after college. With the prospect staring us in the face of working harder than the average internist, and earning less: well, if I were 58, and my kids were grown and my mortgage paid: well, I'd call it a day. At 48, I'm already working on an exit strategy by 55 in anticipation of this scenario. I could go on, but this note is far too long already. Specialists, and underpaid generalists will hang it up years ahead of their planned exit from medicine in just about any system that the Obama administration is likely to devise. They'll scarcely need to ration care: there just won't be anyone around to deliver it. Government will kill the golden goose, and then blame it upon everyone and anyone else. As usual.

In my AIP column last week, I addressed the rationing that will surely follow if we have a single payer health care system. Instead of a system like what Obama and the Democrats are going to introduce, we should be considering a system more like the Netherlands' free market based system. The Republicans have offered a plan that is similar but is based upon tax credits that allows people to purchase insurance. Jeff Emanuel as a column at Pajamas Media that gives some insight into how the bill works:

The Patients' Choice Act of 2009 is an effective alternative to the rationing-based, bureaucrat-run, federal-government-centric proposals being kicked around Washington, D.C., from the White House to Capitol Hill to K Street. The bill is not perfect, a fact exemplified by its citation of the disastrous "RomneyCare" program in Massachusetts and by its reliance on government to step in and fix problems of cost and quality that they largely created by prohibiting interstate competition, imposing mandates, and pushing our health care marketplace further toward a third-party-payer only system.

Despite these drawbacks, though, the PCA is light years ahead of the government-run alternatives being championed by President Obama and his Democrats in the U.S. Senate. The willingness to attack the currently problematic tax treatment of health care and to help poor Americans divorce their medical fates from the whims of state and federal bureaucrats is a giant leap in the right direction and deserves more attention and support.

Unfortunately, the fact that the PCA takes less than a fully government-centric approach to solving the health-care crisis virtually guarantees it will not make it out of committee in the current Congress. However, by putting forth this proposal, Republicans in the House and Senate are effectively showing that they are, in fact, paying attention to policy and paying more than lip service to offering alternatives to the Obama-led Democrats' statist proposals. That in and of itself should be considered a victory for the GOP, even though this legislation won't see the light of day any time soon in either federal legislative body.

That is a real shame, because any health care reform that is government run will destroy our country's world class system.


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Comments (25)

"Reason" and the current go... (Below threshold)
GarandFan:

"Reason" and the current government have nothing in common. Example: This evenings "date night" wherein El Presidente and his wife fly up to NYC for dinner and a show, the obligatory motorcade past adorning crowds, probably a late night coffee before jetting back to DC to call it a night. Animal Farm is alive and well in Washington. Just think of all those 6+ million unemployed who can live vicariously through Barry's night out. But I'm sure he 'feels their pain'.

My father was a doctor. I h... (Below threshold)
tyree:

My father was a doctor. I had to pay my own way through college, and because of his income, no scholarship money was available for me.
Malpractice insurance was the reason, and the year was 1974.

Any "health care reform" bill that doesn't include tort (lawsuit) reform is treating the symptom, not the disease.

Clinton=lawyer, Obama=Lawyer
When you are a hammer, everything starts to look like a nail.

Lets listen to the doctors on this one.

I left oncology private p... (Below threshold)
epador:

I left oncology private practice after 17 years in 1997, and have been practicing primary care ever since in the military and as a salaried Federally Qualified Health Center physician. My salary since 1997 has been about one-half to one third what I was receiving as an oncologist.

This fellow has practiced oncology for about as long as I did and is thinking about retiring in 7 more years. I guarantee he's making more money than any primary care physician. If he stops practicing in 7 years, he'll have a nice retirement fund, and be able to live fairly well as any one else is at that time, after only practicing medicine for 23 years.

I have no pity nor admiration for this doctor. He sees his practice of medicine from an economic perspective. That is what has ruined the practice of medicine more than anything else in this country.

Most of what he does as an oncologist is NOT cure cancer, but treat people in hopes of curing or reducing the chance of recurrence of cancer knowing that the majority of the patients treated with lung cancer, breast cancer, and colon cancer (who make up the bread and butter income for most solid tumor oncologists) do not ultimately live years longer than they would have without the therapy. But they will have made him richer by about $5,000-$15,000 a patient and at a cost to the health care system of about $40-80,000 a patient.

Certainly the cancer care available to folks in our country outshines that available anywhere in the world. Cancer patients have a much better chance of having their lives extended more than anywhere else in the world. But enormous amounts of money are expended increasing lung cancer patient's lives by a few months, or extending cures in colon/breast cancer patients for about one out of 8 to 15 patients treated with adjuvant chemotherapy. While these are amazing strides from where things stood when I began practice, they are not quite as rosy as most people imagine.

Similar costs and benefits can be found in the way cardiology is practiced in this country.

Socialized medicine would be a backlash against the kind of utilization of resource management and, yes, greed, that this and many other physicians have subjected our health care system to. It will be sad but predictable.

Epador said that , "He sees... (Below threshold)
tyree:

Epador said that , "He sees his practice of medicine from an economic perspective.That is what has ruined the practice of medicine more than anything else in this country."

I completely disagree. Lawyers changed medicine from a profession to a business, controlled by insurance companies. It started happening a long time ago. Anyone who looks at medicine the way it is and doesn't ask how it got this way is missing the truth.

Medicare started the real p... (Below threshold)
epador:

Medicare started the real problem with third party payors. The AMA opposed Medicare for this reason. Once they saw the plan as a cash cow, they got on board and have been riding this train to Hell partying in the dining car 24/7. The doctors hold responsibility for allowing money to overtake patient/doctor relationship and patient care as the drivers in medicine since the 60's. Lawyers are simply tools. Don't blame them any more than you blame guns for killing people.

Pun intended.... (Below threshold)
epador:

Pun intended.

Under Obamacare all the exp... (Below threshold)
syn:

Under Obamacare all the experienced doctors will will be privately hired by top 5% Winfrey, Buffett, Gates, Clinton, Gore, Kennedy Klan plus all their friends and the royalty running Kingdom Hollywood.

All the rest of us will be stuck with the drop-outs who are trained to pull plug on sick people.

"Statism, a luxury of the wealthy-to the poor a suicidal creed." (David Hare-A Map of the World)

"Any "health care reform" b... (Below threshold)
groucho:

"Any "health care reform" bill that doesn't include tort (lawsuit) reform is treating the symptom, not the disease."

I would add the pharmaceutical industry and large for-profit HMOs to tort reform.

The problem in trying to fix anything on this scale is that those charged with coming up with solutions, namely Congress, are, by and large, entrenched tools of the corporate interests that have been responsible for setting policy for years.They have been bought and paid for and will do their masters' bidding. Represent the people? Don't make me laugh. Somewhere along the line medicine became more about money and profit and less about patient care.

Regarding Kim's last statement, our system is really only world class in a technological sense, and sometimes I wonder if the fear folks have about any change is that they'll lose a little of the "I want it all and I want it now" mentality we have about so many things. We ant to be able to own a bigger house and more stuff than we can pay for even if it destroys the economy and makes a tiny percent of people insanely wealthy. Who cares? We want to be able to stop at any corner and consume mass quantities of toxic food-like crap, not even leaving our car, that makes us unhealthy, even sick, and then demand that our health care system fix all of these largely self inflicted maladies, sparing no expense. We can't have it both ways.

Unless you read or listen c... (Below threshold)
Mac Lorry:

Unless you read or listen carefully to Obama's healthcare reform speeches you'll likely miss one of the most fundamental and significant changes. No longer will doctors, clinics and hospitals be paid for services, but for results. Obama hasn't shared any of the details, but it seems medical services that don't produce positive results won't be reimburse, or at least not at 100%. Think about how that will change healthcare in the United States.

Healthcare rationing will S... (Below threshold)

Healthcare rationing will START with those who cost the most (older Americans) yet are owed the most (older Americans again!). A TWO-FER


Consdier that the vast majority of our debt is in the form of un-funded entitlements to OLDER Americans

In Chicage mobster terms...if you owe Louey "C-note" Marconi $30,000 you can either (a) find a way to pay Louey enough to keep him from killing YOU, or (b) you can make Louey "disappear".

No "Louey"...no debt!

The answer to "un-funded entitlements to OLDER Americans" is thus simply: FEWER OLDER AMERICANS! Rationing their "health"care is one way to achieve that! Welcome to 1984.

Re: tort reformIf... (Below threshold)
epador:

Re: tort reform

If done correctly, this could make the practice of medicine and dealing with errors much better. That means taking dealing with errors out of the court room and back in the realm of the health care system. Think Air Safety in the 30's versus the 90's.

If done the way our legislators talk about it, it will make things worse for everyone.

Re: results payment scheme

High risk problems won't be handled anymore, as the chance for payment will be too risky. Bad for sick patients who need health care the most. Interestingly, unless a patient is cooperating with their care (weight loss, diet changes, increased activity) they will become an economic liability, and may be unwelcome in a doctor's office. Wonder where that will leave smokers like Obama?

re: groucho's points

Pharm and HMO's are but a symptom of the current reimbursement scheme. Unless you correct the underlying problem (the user, ie patient, is disconnected from how and how much money is spent for their care) you can place all the controls you want on them, and things will still spiral out of control.

I do like your last two paragraphs and gave you a plus for them. The corporate interests I see entrenched are the health insurance (fee for service and HMO) and professional organizations, big pharma being less important in the ultimate degradation of health care to an industry of profit without ethics.

Mac Lorry is correct. The ... (Below threshold)
Imhotep:

Mac Lorry is correct. The "pay for performance" (P4P)plan will force the physicians to ration health care. Physicians will only take on "reasonable risk" patients that guarantee good outcomes, so their payment for services is not reduced. To be clear, positive outcomes will not be paid MORE, only non-positive outcomes will be paid less. It's a win-win for insurers (Gov't backed plan).

Primary care physician's are already posturing this way via "boutique medicine". It is a proactive way of weeding out the sick, to deliver care to the healthy.

Specialists are unable to survive in the current "boutique medicine" world, but economics is a unique driver.....so we'll see what happens.

Also, the GOP is to blame just as much for this slow march to socialized medicine, because the GOP has been "reactive" and not proactive. Both sides (left and right) share significant blame and are not to be trusted with health care decisions.

Here's my take on Obama's p... (Below threshold)
Mac Lorry:

Here's my take on Obama's pay for results proposal. It seems to me that doctors invent new treatment regimes to treat otherwise untreatable and life threatening conditions. A few months ago one such treatment regime was highlighted on network news. The treatment of a women with liver cancer involved changing her plumbing so that 10 times the usual dose of chemotherapy drugs could be injected into the blood going into her liver and then the blood coming out of her liver was ran through a machine that removed most of the chemotherapy drugs. After some hours of treatment the woman's plumping was restored to normal. Sure enough, the otherwise intolerable dose of chemotherapy drugs shrunk the cancer. She was scheduled to undergo this treatment once a month with the hope that it would extend her life by maybe 6 months. They didn't say what the total cost would be, but likely each treatment would run $100 grand or more.

Moving from the specific case to the general, it seems that any doctor wanting to make big bucks, and some do, are attracted to end of life care where patients are likely to die without care and almost as likely to die as quickly with care. Epador cited lung cancer, breast cancer, and colon cancer in post #3 as being such conditions as well as being the "bread and butter income for most solid tumor oncologists". The question is, how should such treatments be reimbursed?

Other than being morally objectionable, one scheme is to place a value on every month of quality life the treatment provides. Quality life being defined a tolerable pain and sufficient stamina and mobility that a person can do the same activities they were doing before the treatment. There are flaws in that definition, but it's sufficient for this discussion. Anyway, in cases like lung, breast, and colon cancer it might be more valuable to treat the patient's symptoms than to treat the patient's disease depending on how long the patient could be expected to live if their disease was cured.

The effect would be to focus on preventative care, care for younger patient's with life threatening diseases and care for chronic conditions for patients of all ages. Overall, that might actually improve healthcare while reducing costs. The focus for older patient with life threatening diseases (not injuries) would be to extend their quality life by treating the symptoms. Yes, there are specific cases on both sides of that argument and moral issues as well. However, the same is true of our current system. We just don't often hear about it because the care decisions are mostly made by the involved parties rather than by the government.

Poltically this issue is going to be an old vs. young tug of war and the sob stories will mostly benefit the old while the economic stories will mostly benefit the young. Unlike Social Security, healthcare reform could cost Democrats the support they have gotten since 1935 from the elderly. See, there really is a silver lining in every cloud.

Our life expectancy here in... (Below threshold)
We die sooner.:

Our life expectancy here in America is 77 years. In other countries that we laugh at like Canada, Japan or the UK it is 79-82. We also spend at least twice what those countries spend, but have an inferior outcome.

I have problems with government run anything, but the facts are clear: Universal public health care does result in a slightly longer, healthier life, even if it achieves these results in a way that some might find inconsistent with their conservative "up by your bootstraps" ideology.

Just as we ask liberals to be intellectually honest about our public school system, so should we be honest ourselves about the massive preventable gaps in our current health care system.

When any person chooses to be uninsured and then needs care, you and I will pay for their $20000+ emergency surgery. The cost of their care will be added to our policies. The freeloader will get free care at our expense. We know that we are being ripped off. Why defend it?

I would prefer that they are required to insure themselves, just like I'm required by law to purchase insurance if I wish to operate a vehicle on public roads. Their "freedom" to go uninsured is really just a scam that allows them to dump their medical expenses on the rest of us. But as soon as anyone suggests mandatory insurance we hear cries of "Socialism!", as if America in the year 2009 might turn into Nazi Germany or something. Please.

With nothing to offer but tax shelters and scare tactics, the conservative health care alternatives will be steamrolled by Democrats. Single payer is coming. The only question is this: Do you want a seat at the table or would rather be ideologically pure, on the outside looking in?

The only question ... (Below threshold)
LaMedusa:
The only question is this: Do you want a seat at the table or would rather be ideologically pure, on the outside looking in?

A seat at the government table means arsenic in your food and water supplies, let alone "rationed" health care. The government is not on our side when it comes to offering benefits. Don't be fooled by stats that talk about the average lifespan of different countries, because that already is government regulated. I can't even believe you used words like "ideologically pure" when it comes to human lives, unless you are in the tank for the shills that think they're getting something out of the deal.

You go ahead at sit at that table, though, see how long it takes before you hear the beloved government tell you whether or not your ailment is important enough to treat. Then you can go through the "treatment" with their phony medicines, you know the ones with side effects like "nausea and vomiting" and "possible fatality".

Single payer is co... (Below threshold)
Mac Lorry:
Single payer is coming.

I don't think you understand Obama's plan because it's not single payer, so unless you think Obama is not going to be at the table, single payer is DOA. The actual plan may require everyone to be insured, but it's already a done deal that private insurance will be available, the question is will there be a public option. Cost is saved through the usual "streamlining", but the most significant part of the plan is the change from pay-for-service to pay-for-results. Basely, medicine goes from being a practice to being a profession like engineering.

Epador said, "Lawyers are s... (Below threshold)
tyree:

Epador said, "Lawyers are simply tools. Don't blame them any more than you blame guns for killing people."

Sorry to be so blunt but you are wrong. Lawyers are human beings, not inanimate objects. Lawyers get rich off doctors who in many cases have done nothing wrong. John Edwards personally made $20 million in 4 years suing doctors, in most cases based on faulty medical research.

In the early 1970s my fathers malpractice insurance doubled about every other year. That permanently changed the way he practiced medicine.

Let's start with tort reform and move up the ladder, a step at a time until the system is fixed.

I agree with Epador that part of the problem is patients are too far removed from the cost of medical care. For example, very few people are exposed to the high cost of illegal-immigrant care.

BREAKING NEWS:Off to... (Below threshold)
G.:

BREAKING NEWS:
Off topic late term abortion Dr. George Tiller has been shot DEAD.

I do not condone Tiller's d... (Below threshold)

I do not condone Tiller's death...but I didn't condone his life either!

He's explaining his "ethics" to Charon, about now...

Lawyers are wielded by peop... (Below threshold)
epador:

Lawyers are wielded by people, in the place of guns, to settle disagreements. They usually don't go off on their own without a client to pay them. Tyree, I suffered through the malpractice issues in Michigan in the 80's and 90's, I have felt the pain. But the lawyers are tools of greed for others (certainly motivated by their own greed), operating in a system that was legislated (certainly by some lawyers) at the behest of the electorate and special interest groups. Organized medicine has opposed real malpractice reform, while supporting protectionist legislation that does not address the real problem. Until doctors are willing to accept independent error investigations that can lead to financial judgments or prosecutions AND the current tort system is abolished for medical errors, the problems will remain.

wie die sooner - "I hav... (Below threshold)
marc:

wie die sooner - "I have problems with government run anything, but the facts are clear: Universal public health care does result in a slightly longer, healthier life, even if it achieves these results in a way that some might find inconsistent with their conservative "up by your bootstraps" ideology."

"Clear" if you mean by only looking at one factor in a longer life span as you have apparently done.

Sure lets ignore all those silly things like diet, among many others, that varies from society to society and does in fact contribute to a longer or shorter life span.

"Up by your bootstraps ideology" my ass, it's looking at any gov run program and deciding pffft, you gotta be kidding me, we don't need health care run by the same nimrods that deliver mail and run a perpetually in red ink and pathetic rail system.

Groucho (#8) -Pret... (Below threshold)
JLawson:

Groucho (#8) -

Pretty soon we won't have it both ways. We may not be able to get it ANY way at all.

(Congress) "Represent the people? Don't make me laugh."

You see them as caught by corporate interests - I see them as stuck in the tar pit of their own educations and prejudices.

We have a massive amount of lawyers in Congress. To a lawyer, everything is a legal matter. Words - they weild words, bending and twisting and shaping them to what they THINK will take care of the problems this country faces. Everything can be solved if just the right laws are enacted, the right words spoken. And they've made REAL good money figuring out the right wording - so what they do MUST be worthwhile... right?

But words describe reality, they don't define it in the first place. Take a glass, put it on a table. Words won't make it stay there - gravity and friction will. A politician can shout at it all day and not move it, because ultimately his words have no meaning, have no effect on reality - it's when those words are accepted as law and acted upon by men that words become reality and have an effect.

Knock the glass off the table - words won't cushion the fall. When the glass breaks on the floor, words will not clean up the mess - a pair of hands willing to pick up the pieces will.

Look at the construction of a skyscraper. Words among men start the idea building - but no amount of words or regulations will change the fundamental engineering principles that determine how much load a design can bear or the failure strength of a steel girder.

We have too many laywers in Congress. We have too many entrenched fools who believe the answer to any problem anywhere is to slap on additional layers of regulation, without bothering to see what's already there.

We have too many lawyers. And we will, ultimately, be destroyed by their disconnection from reality.

"We have too many laywers i... (Below threshold)
groucho:

"We have too many laywers in Congress. We have too many entrenched fools who believe the answer to any problem anywhere is to slap on additional layers of regulation, without bothering to see what's already there."

Agreed. Too many lawyers, for sure, but the addition of more regulation is not always how they do their dirty work. Consider the banking/financial sector, ownership of media outlets, the energy and food packing industries, to name a few, where as little regulation as possible has been achieved by the same bunch of foo...I mean lawyers. Always follow the money.

Groucho -Re bankin... (Below threshold)
JLawson:

Groucho -

Re banking-financial stuff - you probably aren't going to believe me, but it was Barney Frank and his 'friends', and ACORN and the like who got the sub-prime fiasco going, since to NOT lend to minorities who didn't qualify for traditional loans was 'racist'. Fannie and Freddie guaranteed they'd buy the crap loans - which they did. And when more regulation of such crap was proposed, care to guess who made a stink about it, saying emphatically it wasn't needed?

Re food-packing - what's your beef (if you'll pardon the pun) with that?

Re energy - what's your concern?

Here's a series of serious questions for you, and I'm not trying to be snarky or sarcastic.

If your car needed repair - would you take it to a mechanic or a lawyer?

If you needed treatment for a disease - would you go to a doctor or a lawyer?

If you needed a loan, would you go to a bank or a lawyer?

If you need power - do you call the electric company or a lawyer?

I'm thinking that in each case I'd go to the folks most likely to fill the need I've got - because the lawyer wouldn't know how to do it.

Yet we continually put on lawyers the 'responsibility' to oversee the regulatory structure for American business - managing areas where they don't know what's going on. That make sense to you?

"Sure lets ignore all th... (Below threshold)
Oyster:

"Sure lets ignore all those silly things like diet, among many others, that varies from society to society and does in fact contribute to a longer or shorter life span."

Yes. Diets and life-style habits vary with nationality and race. And we have in America a much more diverse population than other countries in regard to nationality and race. One must also take into consideration that reporting methods vary from country to country. Take, for instance, those who tout Cuba's infant mortality rate. And don't forget the methods used in, say, the UK for reporting violent crime. There are numerous ways to skew the numbers for anything you want to report.




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