Let’s practice saying: Americans Want a Free Market Economy for Health Care!

I had a recent discussion over coffee in our cath lab’s break room. I was faced by about 3 or 4 techs and nurses and somehow we got talking about health care reform. It did not go so well for the reform side. “I am from Canada, and my aunt needed to come to the the States to get radiation therapy”; “Have you read the bill – our politicians haven’t, they do not even know what’s in it!” (hey, probably true, but nor did this nurse); “I read that we needed to use our imaging equipment 75% of the time – that means I have to work weekends!?” May I quote H.R 3200, Section 1147: “In computing the number of practice expense relative value units (…) with respect to advanced diagnostic imaging services (…), the Secretary shall adjust such number of units so it reflects a 75 percent (rather than 50 percent) presumed rate of utilization of imaging equipment” – it says nothing about running it 75% of the time.

So, let’s say for argument’s sake that we are switching over the single payer exactly like Canada – wow, we would get 1.5% less infant mortality, on average 2.6 more years of life, for half the money and $300 per capita less (not per case, per capita of the population, including those who never see a doctor!)  in out of pocket spending, according to 2006 data. Just imagine what we could do with what we are spending now!

Then again they went “Canada“, “Canada” and yeah, I almost forgot “SOCIALIZED MEDICINE!” This is when it occurred to me:  while I was busy taking care of American patients that pay  $5000 per year out of pocket and a 20% copay, I missed the Obama/Kennedy/Baucus/Pelosi press conference where Obama seems to  have said “And to end it all, we have a bill that make the United States part of Canada, so we all get the same health care system, and yeah, BTW, we will socialize everything top down…”

I am joking of course, because I am not delusional this may actually work, and I guess I had it all wrong – the government is the problem! They so clearly have an interest to kill you off as soon as you are worthless, count your number of Viagra® pills, and tell you to have to see that doctor – something no insurance companies ever does!

So again for argument’s sake, let’s say we change over to free market economy soon and got rid of  these pockets of government subsidized health care we have. Let’s start with

1. the VA system – it’s gotta go! Single Payer if we ever had one. The system is overrated anyhow. All those vets are in good employment with insurance benefits, right?
2. Medicare – we just change over to Medicare Advantage and Medicare Part D, but let our seniors pay the premiums completely on their own. We’ll call it Medidontcare (Ok, get it? Med – I don’t care?). Who would not want to spend their life savings on health care premiums! Then it does not really matter if we cannot negotiate drug prices for our seniors.
3. Medicaid – please…. as Marie Antoinette allegedly said “if they don’t have bread, let them eat cake?” But let’s just say that we are not completely heartless and we’ll keep it – for now.

Furthermore, my colleagues and I will not see any more patients without assuring they can pay everything, either via co-pay and insurance or out of pocket. There will be a branch of Citi Bank in our office so people can take out the mortgage on their house, hand over the title for their cars. We want to be paid in full, up front,  because we provide a “service” to the “consumer”. If you cannot pay? Well, you would not expect to drive a new car off the lot (or have your broken one fixed) for free, would ya? Just look form someone who is cheaper (note: next cardiology practice is 200 miles south – what, monopoly you say? price gouging? Nah…).

The good side (for me): after people have sold their houses, lost their savings, I will have become very rich (that is if I still have a job), because now my practice is recouping 90 cents on the dollar billed, instead of just 43 (the 10 cents missing are accounted for that some people actually still have insurance, which never pays the billed amount and actually – wow – denies to pay for some services that patients and doctors feel they need, and that some people I sent collectors to actually have nothing left).

Then, health care will become cheaper… a lot. Many people will eventually have Medicaid. The government would want to raise taxes, but can’t, because that would mean certain defeat in the next election by people who give even less about health care (they’ll run on the “At least we are no Soviets and we can carry guns anywhere” ticket).  Can Medicaid reimbursement actually becomes net negative? The dilemma of course is that the states get shafted, but because as of now, August 2009, many are only paying hospitals with play money anyhow, and soon will probably cut payments to those practices that still see Medicaid patients, this issue soon gets solved, too. No one will see Medicaid patients anymore, unless held at gunpoint. So costs will be saved. Life expectancy hopefully will plummet to below 65, because some daring liberals want to revive Medicare once in a while.  Eventually, the nation’s 800,000 physicians will cater to the nation’s richest few million in a concierge doctor fashion. The only way for everyone else to get any care will be emergency rooms, unless EMTALA is  revoked, where wait times will be now up to 36 ot 48 hours. Stabilized patients will be treated and discharged until they end up dying from now incurable diseases such as cervical, prostate and breast cancer, or preventable heart disease, or diabetes, to name a few.

Guess what – there is even a website called freemarkethealthcare.com. But you’re still sure you want it?

“We are one. If we don’t know it, we will learn it the hard way.”
– Bayard Rustin, Civil Rights Activist, Organizer of the 1963 March on Washington

Now is the time to join the National Physicians Alliance at its meeting in Houston, TX. If you have never been to an NPA event, you are truly missing out. Missing out on energy. You may arrive tired and disheartened, but you leave energized and full of momentum to make a difference. Whether you would like to join in NPA’s efforts to ensure the availability of quality health care to all in the US or to explore how big business looks to compromise your practice as a physician and the health of your patients, you can find it with this group.

Certainly, one of the best things about a National Physicians Alliance meeting is finding like minded physicians who are in the struggle to maintain the integrity of our profession, and who strive daily to put their patients first. That is what excites me. It is an exciting time in our country and everyone is talking about change. Now is the time for physicians like us to make a stand and be heard.

When I leave an NPA meeting I truly get what Bayard Rustin was saying. We are truly one!

(link to register for the NPA meeting)

Thanks to Google Reader, I’m able to keep up with an large number of blogs that focus on medical and pharmaceutical topics. Below is a brief tour of the blogs that I find interesting at the moment.

• Hooked: Ethics, Medicine and Pharma is a blog by Howard Brody, extending the topic that he addressed in a book of the same name.
• Health Care Renewal comes from a collections of physicians and others concerned about the concentration of power in medicine. They have many great links to medical issues addressed by the government.
• Movin’ Meat is written by an Emergency Medicine physician who covers his experiences on the front lines, as well as commentary on the political state of health care.
• Over My Med Body comes from Grahamazon, a medical student in California. He is recognized in the blogging community for his excellent posts about his experience becoming a doctor, as well as health care reform. But I know him personally from our college days when we built a bridge in Tennessee on an Alternative Spring Break.
• Panda Bear, MD is another Emergency Medicine physician who currently has a biting post about the pointlessness of drug reps in the ED.
• Pharmalot is one of the newer blogs that I’ve picked up recently. Coming from New Jersey, it covers a large swath of the pharmaceutical industry with 10+ posts per day, ranging from links to news articles to commentary about drug company antics.
• PostScript comes from the Prescription Project, a partner in many of our projects to remove the influence the pharmaceutical industry bias from the practice of physicians.
• Running a Hospital is written by Paul Levy, the President and CEO of Beth Israel Deaconess Medical Center. It’s fascinating to see his perspective as a non-physician, but clearly a fellow traveler in delivering patient-centered care.
• Question Everything has an interest in food, nutrition and physical activity. And also getting fast food out of hospitals.
• Modern Prometheus is an MD/PhD student who is finally coming to the end. He spent time as a leader of the dark side, but there may yet be hope of turning him back.
• And finally, Drug Rep Toys is aptly named. It is nothing more than an inventory of the ridiculous and useless things that drug reps give to physicians in a pathetic (but sadly successful) attempt to curry favor.

Diabetes in Vermont Endocrinologists on the Rise

Burlington, June 27 — A recent survey of Vermont physicians demonstrate that many of the state’s endocrinologists, physicians specializing in diabetes and other metabolic disorders, may not be practicing what they preach to patients, in particular their diabetic patients. The state-wide study, conducted by Vermont’s Department of Health Services and Studies (DHSS), shows a small but startling 2.3% increase in the incidence of diabetes in endocrinologists over the last year. The study was heralded by health advocates, but lambasted by the state’s bustling maple syrup industry.

“I really can’t explain it,” said Dr. Stephen Wardlow, a long-time endocrinologist and diabetes specialist from his Stowe, VT office. “All of a sudden, my waist is 5 inches bigger and my blood sugar levels are through the roof. Well, gotta run – free donut breakfast!”

Cindy Christensen, from Vermont DHSS, noted: “We are as perplexed as many of our concerned physicians suffering from this disease. Actually, my office has received numerous reports of portly psychiatrists as well; we may very well have an epidemic on our hands.” Ms. Christensen denied allegations that the decline in Vermont physicians’ health had anything to do with a recent Times report of significant increases in drug makers’ spending on physicians. Coincidentally, both drug maker spending in Vermont and diabetes in endocrinologists increased by the same 2.3% over last year.

“Good thing I know a thing or two about diabetes,” Dr. Wardlow added.

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P.s. This story is completely and absolutely fictional. For the real story, visit here:
Psychiatrists Top List in Drug Maker Gifts
By GARDINER HARRIS
Psychiatrists earn more money from drug makers than doctors in any other specialty.

Ok this is straight from the Freakonomics blog, but I had to ask this crowd here — What are the worst jobs for a doctor?

My Thoughts:

• A doctor who gives celebrities their “medical excuses” to leave prison and begin house arrest (Paris Hilton’s doctor?)
• A sports doctor for a wrestling death match.
• A doctor working on death row, performing or supervising lethal injections.

And now my own question: What are the best jobs for a doctor?

Go! (click on “comments” and post your thoughts!)

I thought i would make this a lighthearted blog to show you the silly side of some of our members…ok, well me…my personal favorite is actually J.D. on scrubs
here are the options

-JD on scrubs

-other Scrubs Castmember

-McSteamy on Greys Anatomy

-McDreamy on Greys Anatomy

-Bailey on Greys Anatomy

-Other character on Grey’s

-House

-One of House’s Lackeys

-Medical Examiner on CSI

-Trapper John M.D.
-Marcus Welby

-Someone on E.R. (who is left on that show)

-old castmembers of ER- I can only remember george clooney
-other: INSERT YOUR FAVORITE