Jan 13

Please see my prior recent blog on healthcare. On the left sidebar, click on the “Feuchtblog” category or “medicine” tag, and that will take you right to this article and the prior one.

Many people have asked me about my views on ObamaCare, and what I would offer as a reasonable fix to the healthcare “crisis” in our country. I have no hope that our wonderful government will be able to fix the mess of healthcare. This is why I support the Obama health care plan. If it goes through in its entirety, it will destroy medicine. Then, we could start over. Maybe. Unfortunately, too many conservatives blame the government for the health care problems of the USA, while the liberals wish to give the government everything. Neither makes sense, because neither side takes the time to ask what is really wrong with American medicine. My final answer is that everything is wrong. There is no party or group that doesn’t stand innocent of our mess. Specifically, finger pointing must include all parties, including government, the lawyers, big Pharma and the health care industry, physicians, hospitals, insurers and third party payors, and patients themselves. I will be very brief in how each party is making a mess out of medicine.

1) Government. Government would love to control medicine. It is intrinsic in government to have control of the people, whether that government be a democracy or a totalitarian regime. Our constitution was established to restrict the power of government. Now that our constitution has become a “living” document, it may be interpreted and changed at will, usually to the effect of offering the government more power, and us less. I cannot think of a single government in the world and throughout history that I would trust my body and my life to, yet, that is essentially what we are asked to consider with the health care plan of St. Obama, the patron saint of the infirm. Medical ethics will become what is good for the masses, rather than what is good for the individual, since government will always seek global, rather than individual solutions. Decisions will be made that are most politically correct, and not what is most morally correct, or what maintains the highest dignity and honor to the individual. It has been argued that health care delivered by government would be less expensive and more efficient, yet, I cannot bring to mind any federal agency that delivers efficient services without graft and corruption. A simple look at pure government health care systems, the Veterans Administration and military medicine show highly inefficient and expensive systems with shoddy health care delivered in a haphazard fashion, always at the whim of an incompetent and fickle congress. One only need to pause at the countless ways in which the government has made physicians lives currently unbearable, including ever increasing and expanding agencies to regulate and control health care. Need I mention JCAHO and the totally ridiculous demands them make on hospitals, or Medicare and its “fraud” provisions on honest and hard working physicians. To the feds I say, no thanks.

2) Legal. Many conservatives have argued hard for legal reform, feeling that it is the legal system in most part which has destroyed American medicine. Arguments have returned from our legal colleagues of the necessity of our system to safeguard and protect a vulnerable public from increasingly greedy and immoral physicians. In fact, conservatives refuse to look at the breadth of the source of problems of our current health care debacle, and lawyers refuse to accept that we need more protection from increasingly greedy and immoral lawyers than that of physicians. Estimates that suggest that the current legal climate drive up the costs of medicine by 40-50% or more, are off by about 1000%. There is no longer any bang for the buck; the health care consumer has discovered that it is cheaper to fly to India for major heart surgery, and yet receive reasonably equivalent safety in their health care. The lawyers have not protected us, but instead, have stifled creativity, autonomy of physician-patient relations, and made health care unaffordable. Every drug that I purchase, and every medical device that I use, has a cost that tends to be 10x-1000x more expensive than non-medical or veterinary equivalents. Malpractice has driven up the cost of practice of countless physicians who have chosen to switch trades, retire, or sell their soul to an employment situation rather than endure unsustainable malpractice premiums, regardless of whether they have ever been sued. Lawsuits themselves have no correspondence with the personal competence of a physician or hospital. I see quite competent physicians occasionally being sued because they choose to manage riskier cases, and incompetent physicians that have never been sued. Somehow, lawyers don’t connect. When a surgeon goes to trial, they usually try to avoid a jury trial, only in that they know that a jury will be another form of wanton injustice, since juries will always sympathize with the party that can generate the most tears, rather than the party that claims the moral high ground. The practice of our trade lacks absolute control-biological systems, being overwhelmingly complex, can have only partially predictable behaviors. Since physicians can only know limited facts of any given medical case, there always remains the possibility of things going wrong, outside of our control, regardless of how careful we happen to be. The legal system simply cannot correct that. Efforts to build in increased safeguards in hospitals have only served to sweep problems under the rug, and no serious study has ever shown a hospital to be safer with the use  of recently enacted safeguards over those hospitals that do not exercise those safeguards. The driving factor for all this madness is the accusation of the legal system that health care needs to clean up their act. The legal system remains clueless about the true nature of medicine, and will only make healthcare problems worse rather than better with their well-intentioned efforts.

3) Big Pharma and the health care industry – There was an epoch in American history where physicians and health care industry was not permitted to advertise. Physicians felt that advertising would degrade their profession with distraction for economic gain from medicine. Indeed, for the most part, this has happened. With the combination of appeal directly to the public, and government regulations that supposedly protect the public but more importantly protect the mega-health care industry from competition, and protect markets, it is not surprising that big Pharma has erupted into a multi-billion dollar industry. We see how this has led to major corruption, such as the Martha Stewart shady investments in Erbitux, a drug that cost well over a billion dollars to develop and bring to market. Big Pharma naturally has a lot to loose, should a drug like Erbitux suddenly be discovered to have untoward unforseen side-effects, or if it proves to be less effective than originally believed, or less useful than other drugs on the market. Naturally, such pressures would be overwhelming for a large corporation, and easy fudging of the numbers (many ways to do that!!!) tends to protect great investments. In the end, we are all hurt. Are we much better off with Erbitux? Perhaps a little bit, as it is a useful drug in many circumstances, such as in head and neck cancer. Yet, patients truly are not living too much longer with as compared to without the drug. Big Pharma continues to appeal to the general public. You can see elderly people dancing across the tv screen in a proverbial retirement paradise, all thanks to Viagra or Flomax or Arimidex, or etc., etc.. The message is conveyed that the drugs bring a fulfilled life, happiness and joy, peace and prosperity. This advertising is an overt lie, and the advertisers know that. I do not wish to indulge into Big Pharmas’ cozy relationship with Big Government, and their desire to overwhelmingly protect themselves rather than the patient. Notice how little they protest the FDA or the legal climate in the US, even though those two factors so steeply drive up the costs of new medicines. I don’t believe Big Pharma really cares at all about you and me.

4) Physicians – I wish I could say that physicians were not a part of the problem, yet we are as much of the problem as anybody else, but for differing reasons. First, physicians have not stood up to their oaths of morality. The Hippocratic Oath is no longer used anywhere in the US, but entirely replaced by Oaths, sadly, including the Christian Medical and Dental Society Oaths, which focus more on population and societal ills, as a focus on the patient themselves. Physicians are not politicians–we have in our care only one patient at a time, and our morality evolves around that patient. We were historically bound to patients by covenants. The legal binding now is a contract, which in turn diminishes our profession into an occupation similar to that of a garbageman or plumber. Our major Medical societies have rolled over dead when reprimanded by government, rather than standing up for what is right. I refer specifically to government forcing rulings on various drugs, forcing the AMA to remove their restrictions on physician advertising, and forcing the health care community to accept and comply in the murder of unborn children. Now,we are even complying with the murder of the elderly. We have lost our morality, allowed medicine to be turned into a business rather than a high profession, allowed government and Insurance companies to intervene between us and the patient, and then we scratch our heads wondering what went wrong. We did it all to ourselves.

5) Insurers and Third party payors – In the eyes of some people, it is the health care insurors who receive all of the blame. Certainly, Michael Moores’ movie Sicko seems to cast much of the blame for America’s health care woes on the Capitalist pigs that govern the major insurance companies. This might be the only theme in Sicko that Moore has partially correct. Contrary to Moore, it is the act of third-party indemnification, whether that third party be a “capitalist” insurance company, or a government, that creates serious problems. First, it places a fourth player in the game of the covenant between doctors-patient-God, as defined by the Hippocratic Oath. It removes much decision making from the patient, and gives it to the insurance company or to the physician. The patient assumes minimal responsibility on an economic basis for the health care decisions that they make, especially if the funding for the patients’ health care came from an employer insurance policy, to which they paid nothing (save for lower wages). In reality, health care insurance no longer functions as an insurance plan, except for those plans that are high deductible or catastrophic. The contracts that and insuror makes with the patient loose their legitimacy when a patient demands high expense procedures, such as transplants or major cancer therapy, and insurors often are forced to comply regardless of the contract. In some states, there is no “pre-existing” clause, so that patients may obtain insurance whenever they wish, without penalties. Insurance companies have sought for survival, but usually at the expense of higher premiums to all, rather than fighting public and government insanity in court.

6) Patients – I love most of my patients, and so I must be quite careful about what I say about them. All the same, in our state, it was over 50% of my patients that voted against tort reform, even though they deny that in the exam room. It is many of my patients that demand free or almost free care. Co-pays are greeted with disdain. It is many patients that expect me to be available 24 hours a day, 7 days a week, 365-366 days a year, and never make a mistake or error in judgement. It is many of my patients that live a life of wanton self-abuse, and then are angry at me that I can’t miraculously fix them in a day or two. It is many patients who lie to me, abuse me, take advantage of me, expect perfection of me, and have no qualms at suing should an opportunity arise. Ultimately, it is the greater than 50% of patients who allow government to get away with murder, vote in idiots such as Obama and Reid and Pelosi, and demand free health care for all. It is the same patients who are so severely protesting ObamaCare, but who refuse to admit the serious problems in the current system, especially with Medicare. I am grateful to God that a good number of my patients see the problems that exist in health care, though they remain powerless to enact a change.

So, I return to my original statement. I hope that ObamaCare succeeds, since it will destroy medicine. Maybe afterwards, a better system could resurrect. Maybe not. Ultimately, our trust is in God, and not doctors. As I grow older as a physician, I realize how powerless I am to add time onto a patients’ life. It still seems to remain entirely in Gods’ hands. Too heavy of reliance on physicians seems to do as much harm as too little reliance on them. But for now, I simply do not foresee any viable fixes to the healthcare crisis, unless the entire system, from the patient to the government corrects. I doubt that that will happen. To attempt a fix of only one aspect of the health care problem will only make the entire health care crisis worse. I don’t wait with hopeful expectation for a solution.

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One Response to “The Source of All Problems with Health Care”

  1. herbert brother says:

    hey, dear brother,

    did read some minutes – but it is too much.
    certailly very sounded and valid, but my washing mashine is running, arras is feeping for going outside ´gassi ´ – simply down-earth.
    i do wonder anyhow, how you do find all the time needed to post these long messages besides your certainly exhausting job/profession (and i do know you take it really serious), hiking mt reinier with jonny, biking…
    etc

    kep care of your heart!

    yrs hwf

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