The Perfect Storm for Physicians in America

I take the title for this blog from an article in the Journal of the American Medical Association June 18 2008 p. 2789 "The Perfect Storm of Overutilization".

Two Ph.D's in "bioethics" (one with an MD) employed by the government, paid for by your tax dollars, working for the National Institutes of Health wrote an article about what insiders in the drive for socialized health care see as "problems". This paper will hardly be noticed. Most doctors will poo-poo its implications. Many will actually gladly trumpet it as an advance, even though it calls for cutting their pay in half and submitting themselves to total government control.

First of all, as an aside, what the hell is the government doing paying my tax dollars for doctors to sit around thinking about how to limit my freedom? Why should the government be involved in this activity at all? The answer is that since the government provides welfare via medicare and medicaid, then it can decide how to provide this welfare. And you really have no moral standing if you think the government should steal from some to give unearned benefits to others and at the same time say that while the theft is just fine, what you really object to is cutting your pay.

The article notes that the US spends 2.4 times more than the average of other developed countries. The article notes that one reason is that a huge part of this is siphoned off to a massive, government subsidized and created, health insurance system. This industry (medical costs eat up 15% and more of our total GNP if you include insurance skimming) provides no useful service whatsoever other than enriching the elite owners and managers and making care more expensive through direct costs and indirect costs of bureaucracy that make your doctor charge more and have less time because of activities such as filling out forms and electronic medical records that have no use and actually harm patient care.

And by the way, isn't it amazing that these two bright authors never even pointed out that by getting government and insurers out of the way, the administrative costs could be kept by the patient and doctor? Wouldn't you like to take home an extra 800 to 1600 dollars a month that your company sends to rich executives at the insurance company so they can deny payment for your diabetes medications?

Another listed reason was that US doctors make twice what European doctors make. (And if you don't think that isn't a call to cut our pay, you deserve what's coming) They also note our drug prices our a little (10-30%) higher. Realize that these guys are trying their best to make our drugs look expensive and this is the best they could improvise. I note that there are a long list of un-subsidized drugs available for four bucks a month at many pharmacies, a price unable to be matched in any socialized paradise when you realize how much the government subsidizes medicines. Also, in other countries, you simply can't get many drugs and especially many newer drugs. For example, an expensive drug like erythropoetin to boost blood counts, would simply not be given in most of the world.

A third factor was the abundance of amenities in the US making getting health care actually comfortable and pleasant in the US. (OH, THE HORROR!) The authors note we have "more privacy, comfort and auxiliary services" in our hospitals. Damned Americans, why can't they just lie quietly in threadbare sheets on hard beds lined up like criminals like they do in Europe? The nerve of those Americans! Along these same lines the authors note that in decadent America "offices are typically more conveniently located and have parking nearby and more attractive waiting rooms". Damn those Americans again!

Another aside, my parents were Canadian immigrants and when my mother went to a hospital, there was only one wheelchair on the whole orthopedic floor and it was willed from patient to patient when they left and guarded like glittering treasure.

Then the authors get to the "most important contributor" - overutilization. The authors note that our hospitalization rate is lower than anywhere but Japan. France has more than double our rate. And we see doctors half as much as the average in other developed countries. (You might be shaking your head and wondering out loud, "Isn't that a good thing?" Not in socialized medicine world.) But we do more MRI's, heart procedures, dialysis, and use more newer drugs, and these cost money. (Implicit in this, is that if we would just quit whining and die with our heart attacks and kidney failure like a proper EU slave does, we could save a lot of money that could be spent on the survivors, especially those hard-working government workers at the NIH.)

Now a rational individual might look at this and think "so by using better drugs and tests, we get sick a lot less and survive things like heart and kidney disease a lot better than in the socialist EU", and think that that is probably a good trade-off for money. But you would be wrong. Health isn't the point of socialcare - saving money and forcing everyone to get exactly the same inconvenient, sub-standard, cheap care is the point. Damned Americans.

The authors then note "at least 7 factors" that drive overutilization. One is that American Doctors try really hard to get their patient's diagnosis right the first time. You might again be thinking unauthorized thoughts like "Why the hell would I not want my doctor to get the diagnosis right the first time for?" Idiot. Because it costs more. It's much cheaper to assume every infection is viral, give a patient a few "free" government-subsidized aspirin and send them home to die or get better. Most will get better and the odd brain-damaged meningitis patient is just the price we all have to pay for lowering costs. Idiot.

You might think I'm exaggerating. "Medical school education and postgraduate training emphasize thoroughness." Damn those American medical schools!

Secondly, we get paid for working - in the lingo of medicine "fee-for-service". That means that you pay me each time you see me. That means I even like to see patients. That means I treat them well because I want them to come back. According to the authors, this "misaligns incentives." If I got paid the same low salary whether I saw you and sucked up to you or not, I would rip the carpet out my waiting room, work reduced hours, make you wait for hours in metal chairs, and treat you like crap, which is good because this would keep you away from the doctor and save money. We also get paid more if we take your bad appendix out than if we send you home with aspirin. This "reduces physician's inclinations to watch, wait, and communicate". You might again selfishly think, "But I don't want to wait to have my appendectomy until after it gets worse and bursts. That will really hurt, and might kill me". Selfish bastards. Damned Americans, go home and writhe in pain like the rest of the world!

Reason three was that our system is making so many advances that I might occasionally talk to a drug rep who is trained in what the new drug or device can do to save time. I might even take a bright purple pen with writing on it! And that would make me - I don't know what that would make me, but it would be very, very bad. It would be much better if we closed down most of the research so we would stop making drugs to manage diseases like diabetes. Then we wouldn't need a drug rep. And that 10,000 dollars that the pharmaceutical companies spend on educating doctors on new advances wouldn't be spent because there would be less advances. And while that new drug might have saved your life or made you feel better, quit being a selfish pig!

So how to fix these horrendous things like caring, "thorough", doctors with nice waiting rooms, convenient parking, and pleasant manners, who stay open late and take out our appendixes before they burst? The authors despaired at getting us to act like jerks. "Calls for changing physician training and culture are usually ignored." Damn those independent doctors who want to provide the best possible medical care for their patients. Scumbags.

"Realistically, the most effective change would be to alter how insurance pays." Wait, you mean like let patients keep their own money rather than letting insurance companies take a big cut before denying you care? You mean like negotiating price with the doctor? Things like allowing the doctor not to make me pay the co-pay? (Amazingly, this is strictly illegal under current US law and punishable by fine and imprisonment as a racketeering violation. Look it up if you don't believe me.) Wow, that sounds too good to be true.

And you would be right. Rather than the obvious solution of allowing free men to make free choices and contracts without government regulation and government-sponsored skimming by corrupt insurance companies, the authors suggest that we have a lower co-pay if we agree to accept lower quality irradiation of our prostate cancer that will leave us sterile and incontinent. Don't be so selfish! You could pay a lower co-pay!

Now you may think that I'm exaggerating this last part. "For instance, men with early stage prostate cancer who choose radiation therapy might have no co-payment for 3-d conformal radiation but might have to cover the marginal cost if they want more expensive (and safer and better) intensity-modulated radiation". Come on, diapers are cheap and Viagra is expensive anyway! Egomaniac.

Well, since most of us are too lazy to care or shoot our politicians like they deserve, welcome to the future of American Medicine. I note that we are being assaulted on every side. Medicare pay cuts of over 10% go in effect in 10 days. The US medical graduate average debt of over 150k can no longer be put off until after residency. Etc., etc., etc.

All I can say is you were warned, and you deserve exactly what you are going to get. Bend over and quit complaining. The doctor will see you now.

Health Care Reform in Massachusetts

Massachusetts passed a health care bill a few years ago under then liberal Republican Governor Mitt Romney. It was to get everyone on insurance and have "health care." The cost of this program keeps climbing but it is a lot. In today's American Medical New the number of uninsured dropped from 400,000 to 360,000. That's it. Spend a billion dollars and insure a few measly thousand people.

So what happened? First of all the numbers are phony. There aren't really that many uninsured. The US Census looked at their phony number of 40 million and found the real number was 8 million. Some people lied, some were too stupid to fill the form out right, some forgot they had insurance, some didn't count medicare and medicaid as insurance - and nearly half of the total number were criminal aliens who won't have health insurance no matter what because they are here illegally.

There are uninsured, but they are that way for a reason. Now anyone with medical needs that didn't qualify for cheap insurance before would quickly sign up now that others would be forced to foot the bill. What this number shows is that most of the uninsured are uninsured through choice. They're young and healthy and don't want to give $10,000 to some insurance executive when they'll spend only $100 on health care.

And so we have a real life experiment showing Romneycare, Hillarycare, and Socializecare are simply giant feel-good boondoggles that will make little or no difference in the problem they purport to solve. All that will happen is the average person will have less money and less time because the government is stealing more than previously.

Wake up before it is too late. Never mind that socialized medicine has been proven a failure for hundreds of years. It quite simply is a violation of God's commandment "Thou shalt not steal". It is wrong to break into your neighbor's house to steal money for you birth controls so you can sleep around. In like manner, it is wrong to vote to have the government steal your neighbor's money for your immoral lifestyle. It is still stealing and God will surely punish us as a nation for doing it. Vincet Veritas, MEB

Conservative Loser, and proud of it.

The Democrats have kicked Republican butt. No doubt about it. They've taken the House back by pretty much the same margin that the Republicans previously held. It appears that they've taken the Senate or at least tied. That makes GWB a lame duck for the next two years. I don't see any other way to spin it. What does that mean to a conservative?

First of all, conservatism is not the same as republicanism. These two have diverged more widely with each passing year, especially since GWB was elected. Conservatism is for smaller government. Republicanism is not.

How can I say that? Well, actually it's pretty easy to show. Look at the budget for one. It is ballooning worse under Bush than Clinton - even if you subtract out war expenses. Bush removed the conservative plank from the Republican platform about removing the Department of Education first thing. The conservative position on that department, part of the platform since Reagan, was that this kind of fuzzy socialism was wrong, was wasteful, and was not authorized by the Constitution and therefore was un-constitutional

That one action of Bush, accepted by the Republican party hacks, should have forced every conservative to head for the lifeboats and abandon ship (or the Republican party). Because this was a major shift in philosophy. Bush led the Republicans to abandon their strict constitutional constructionism for the vague liberal idea usually described by the politically correct term "living constitution". Living meaning that anyone could interpret the Constitution any way they wanted - basically a moral relativism idea. And once you accept that idea, the floodgates of relativism are opened, the argument of limited government is lost, and the only thing to be settled is how quickly to allow the government to become completely socialized. (Kind of like the old conversation attributed to Churchill or Shaw or others. Churchill asks socialite, "Would you sleep with me for a million dollars" Socialite: "I rather think I would" Churchill "Well here's 10 dollars then" Socialite: What kind of woman do you think I am. Churchill: "We've already established that - now, we're just haggling over price.")

And so, as a conservative, I view the loss of the Republicans with mixed emotions. They haven't really represented me for years. But where else does a conservative go?

Well, I threw my vote away this election on the Constitutional Party. Not that it makes a difference in Republican haven Utah. But at least I voted for candidates whose ideas are conservative. I also enjoyed voting no for the retention of every judge - especially the judge caught on a rant against deer hunters here in Utah. (She actually was turned out of office. You can find a video of her on Youtube.) But third parties stand the proverbial snowball-in-hell chance of winning at present.

The only other thing of interest in the election was a state school board race between a give-more-money-to-the-same-people-who-screwed-up-education candidate, and a candidate who at least gave lip service to "new ideas" - which I assume is code for tuition vouchers. He lost.

But, even though I can't bring myself to shed many tears about Republicans losing, the only argument I could see to voting Republican in a race that mattered was the leadership of the Democratic party that would now be in charge of the House as a whole, and the committees. Intelligence will be headed by Alcee Hastings - yes that Alcee Hastings. The impeached former judge who took bribes. Woo hoo! That-a-way Americans who voted Democratic! I have no words to express my disgust for this guy, and worse for the Americans who put him in this position. I can only comment that anything that happens is exactly what we deserve.

And isn't it fascinating that one of the Democrat election tactics was to point out corruption of Republicans? And then you put a convicted criminal in charge of Intelligence. There are two lessons here. 1. Americans are really, really, really stupid. 2. The Republicans hardly uttered a peep against corruption in the Democrats showing that they were morally bankrupt and worn out.

And then there is John Conyers of Michigan. Read some of his trash. If this is a guy that most Americans want in charge then we deserve the coming disasters.

Henry Waxman of California is another Marxist in liberal clothing.

Ditto Charles Rangel of New York. These guys who will head important committees are so ultra-liberal that even if I'm not heartbroken over the loss of the Republicans, I have this sinking pit in my stomach regarding America and its future.

The list goes on and on. And then there is new speaker of the House, Nancy Pelosi - uber-liberal and head of the socialists in the Congress. She doesn't even hide her socialism as she is head of one of the socialist caucus groups. Who would have thought that a socialist would be third in line for the Presidency of the USA? (Of course, VP Henry Wallace was a socialist under Roosevelt, but that is out of the memory of most Americans.)

And so, just as the Republicans aren't conservatives, the Democrats really aren't Democrats - they're socialists. And for that reason, I have chosen the title "Conservative Loser" because conservatives have lost in such a way that I doubt they will ever, in my lifetime, control all the branches of government (if they ever did in a party with Jeffords, Snow, Collins, and Chafee).

Vincet Veritas (Truth will conquer) MEB