This Will Never Be A Euro-Socialist Country
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1 month ago
Saturday, August 29, 2009
Friday, August 28, 2009
Obamacare and Me
August 06, 2009 ObamaCare and me. By Zane F Pollard, MD
I have been sitting quietly on the sidelines watching all of this national debate on healthcare. It is time for me to bring some clarity to the table by explaining many of the problems from the perspective of a doctor.
First off, the government has involved very few of us physicians in the healthcare debate. While the American Medical Association has come out in favor of the plan, it is vital to remember that the AMA only represents 17% of the American physician workforce.
I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.
Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.
Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point -- rationing of care.
Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time.
Again, extreme rationing. Solution: I have a foundation here in Atlanta supported 100 % by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrants children for free. Again, waiting for the government would be disastrous.
Last week I had a lady bring her child to me. They are Americans but live in Sweden, as the father has a job with a big corporation. The child had the onset of double vision 3 months ago and has been unable to function normally because of this. They are people of means but are waiting 8 months to see the ophthalmologist in Sweden. Then if the child needed surgery they would be put on a 6 month waiting list. She called me and I saw her that day. It turned out that the child had accommodative esotropia (crossing of the eyes treated with glasses that correct for farsightedness) and responded to glasses within 4 days, so no surgery was needed. Again, rationing of care.
Last month I operated on a 70 year old lady with double vision present for 3 years. She responded quite nicely to her surgery and now is symptom free. I also operated on a 69 year old judge with vertical double vision. His surgery went very well and now he is happy as a lark. I have been told -- but of course there is no healthcare bill that has been passed yet -- that these 2 people because of their age would have been denied surgery and just told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously cheaper than surgery.
I spent two year in the US Navy during the Viet Nam war and was well treated by the military. There was tremendous rationing of care and we were told specifically what things the military personnel and their dependents could have and which things they could not have. While I was in Viet Nam, my wife Nancy got sick and got essentially no care at the Naval Hospital in Oakland, California. She went home and went to her family's private internist in Beverly Hills. While it was expensive, she received an immediate work up. Again rationing of care.
For those of you who are over 65, this bill in its present form might be lethal for you. People in England over 59 cannot receive stents for their coronary arteries. The government wants to mimic the British plan. For those of you younger, it will still mean restriction of the care that you and your children receive.< /b>
While 99% of physicians went into medicine because of the love of medicine and the challenge of helping our fellow man, economics are still important. My rent goes up 2% each year and the salaries of my employees go up 2% each year. Twenty years ago, ophthalmologists were paid $1800 for a cataract surgery and today $500. This is a 73% decrease in our fees. I do not know of many jobs in America that have seen this sort of lowering of fees.
But there is more to the story than just the lower fees. When I came to Atlanta, there was a well known ophthalmologist that charged $2500 for a cataract surgery as he felt the was the best. He had a terrific reputation and in fact I had my mother's bilateral cataracts operated on by him with a wonderful result. She is now 94 and has 20/20 vision in both eyes. People would pay his $2500 fee.
However, then the government came in and said that any doctor that does Medicare work cannot accept more than the going rate ( now $5 00) or he or she would be severely fined. This put an end to his charging $2500. The government said it was illegal to accept more than the government-allowed rate. What I am driving at is that those of you well off will not be able to go to the head of the line under this new healthcare plan, just because you have money, as no physician will be willing to go against the law to treat you.
I am a pediatric ophthalmologist and trained for 10 years post-college to become a pediatric ophthalmologist (add two years of my service in the Navy and that comes to 12 years).A neurosurgeon spends 14 years post -college, and if he or she has to do the military that would be 16 years. I am not entitled to make what a neurosurgeon makes, but the new plan calls for all physicians to make the same amount of payment. I assure you that medical students will not go into neurosurgery and we will have a tremendous shortage of neurosurgeons. Already, the top neurosurgeon at my hospital who is in good health and only 52 years old has just quit because he can't stand working with the government anymore. Forty-nine percent of children under the age of 16 in the state of Georgia are on Medicaid, so he felt he just could not stand working with the bureaucracy anymore .
We are being lied to about the uninsured. They are getting care. I operate at least 2 illegal immigrants each month who pay me nothing, and the children's hospital at which I operate charges them nothing also.This is true not only on Atlanta, but of every community in America.
The bottom line is that I urge all of you to contact your congresswomen and congressmen and senators to defeat this bill. I promise you that you will not like rationing of your own health.
Furthermore, how can you trust a physician that works under these conditions knowing that he is controlled by the state. I certainly could not trust any doctor that would work under these draconian conditions.
One last thing: with this new healthcare plan there will be a tremendous shortage of physicians. It has been estimated that approximately 5% of the current physician work force will quit unde r this new system. Also it is estimated that another 5% shortage will occur because of the decreased number of men and women wanting to go into medicine. At the present time the US government has mandated gender equity in admissions to medical schools .That means that for the past 15 years that somewhere between 49 and 51% of each entering class are females. This is true of private schools also, because all private schools receive federal funding.
The average career of a woman in medicine now is only 8-10 years and the average work week for a female in medicine is only 3-4 days. I have now trained 35 fellows in pediatric ophthalmology. Hands down the best was a female that I trained 4 years ago -- she was head and heels above all others I have trained. She now practices only 3 days a week.
Background: Dr. Zane F. Pollard
I did my undergraduate work at Northwestern University in Evanston, Illinois. I graduated Tulane University medical School Alpha Omega Alpha ( medical school's top 10% of graduating class). Internship at the Univ. of Southern California in Los Angeles, one year of General surgery residency at the U. of California in San Francisco. Two years in the US Navy. Residency in Ophthalmology at the U.of S . California in Los Angeles, fellowship in pediatric Ophthalmology at the Wills Eye Hospital in Philadelphia. In practice with Eye Consultants of Atlanta for the past 35 years. Published 90 papers in peer reviewed Scientific Ophthalmology Journals. Member of the American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology and the American Ophthalmological Society. Board certified in Ophthalmology.
I have been sitting quietly on the sidelines watching all of this national debate on healthcare. It is time for me to bring some clarity to the table by explaining many of the problems from the perspective of a doctor.
First off, the government has involved very few of us physicians in the healthcare debate. While the American Medical Association has come out in favor of the plan, it is vital to remember that the AMA only represents 17% of the American physician workforce.
I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.
Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.
Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point -- rationing of care.
Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time.
Again, extreme rationing. Solution: I have a foundation here in Atlanta supported 100 % by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrants children for free. Again, waiting for the government would be disastrous.
Last week I had a lady bring her child to me. They are Americans but live in Sweden, as the father has a job with a big corporation. The child had the onset of double vision 3 months ago and has been unable to function normally because of this. They are people of means but are waiting 8 months to see the ophthalmologist in Sweden. Then if the child needed surgery they would be put on a 6 month waiting list. She called me and I saw her that day. It turned out that the child had accommodative esotropia (crossing of the eyes treated with glasses that correct for farsightedness) and responded to glasses within 4 days, so no surgery was needed. Again, rationing of care.
Last month I operated on a 70 year old lady with double vision present for 3 years. She responded quite nicely to her surgery and now is symptom free. I also operated on a 69 year old judge with vertical double vision. His surgery went very well and now he is happy as a lark. I have been told -- but of course there is no healthcare bill that has been passed yet -- that these 2 people because of their age would have been denied surgery and just told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously cheaper than surgery.
I spent two year in the US Navy during the Viet Nam war and was well treated by the military. There was tremendous rationing of care and we were told specifically what things the military personnel and their dependents could have and which things they could not have. While I was in Viet Nam, my wife Nancy got sick and got essentially no care at the Naval Hospital in Oakland, California. She went home and went to her family's private internist in Beverly Hills. While it was expensive, she received an immediate work up. Again rationing of care.
For those of you who are over 65, this bill in its present form might be lethal for you. People in England over 59 cannot receive stents for their coronary arteries. The government wants to mimic the British plan. For those of you younger, it will still mean restriction of the care that you and your children receive.< /b>
While 99% of physicians went into medicine because of the love of medicine and the challenge of helping our fellow man, economics are still important. My rent goes up 2% each year and the salaries of my employees go up 2% each year. Twenty years ago, ophthalmologists were paid $1800 for a cataract surgery and today $500. This is a 73% decrease in our fees. I do not know of many jobs in America that have seen this sort of lowering of fees.
But there is more to the story than just the lower fees. When I came to Atlanta, there was a well known ophthalmologist that charged $2500 for a cataract surgery as he felt the was the best. He had a terrific reputation and in fact I had my mother's bilateral cataracts operated on by him with a wonderful result. She is now 94 and has 20/20 vision in both eyes. People would pay his $2500 fee.
However, then the government came in and said that any doctor that does Medicare work cannot accept more than the going rate ( now $5 00) or he or she would be severely fined. This put an end to his charging $2500. The government said it was illegal to accept more than the government-allowed rate. What I am driving at is that those of you well off will not be able to go to the head of the line under this new healthcare plan, just because you have money, as no physician will be willing to go against the law to treat you.
I am a pediatric ophthalmologist and trained for 10 years post-college to become a pediatric ophthalmologist (add two years of my service in the Navy and that comes to 12 years).A neurosurgeon spends 14 years post -college, and if he or she has to do the military that would be 16 years. I am not entitled to make what a neurosurgeon makes, but the new plan calls for all physicians to make the same amount of payment. I assure you that medical students will not go into neurosurgery and we will have a tremendous shortage of neurosurgeons. Already, the top neurosurgeon at my hospital who is in good health and only 52 years old has just quit because he can't stand working with the government anymore. Forty-nine percent of children under the age of 16 in the state of Georgia are on Medicaid, so he felt he just could not stand working with the bureaucracy anymore .
We are being lied to about the uninsured. They are getting care. I operate at least 2 illegal immigrants each month who pay me nothing, and the children's hospital at which I operate charges them nothing also.This is true not only on Atlanta, but of every community in America.
The bottom line is that I urge all of you to contact your congresswomen and congressmen and senators to defeat this bill. I promise you that you will not like rationing of your own health.
Furthermore, how can you trust a physician that works under these conditions knowing that he is controlled by the state. I certainly could not trust any doctor that would work under these draconian conditions.
One last thing: with this new healthcare plan there will be a tremendous shortage of physicians. It has been estimated that approximately 5% of the current physician work force will quit unde r this new system. Also it is estimated that another 5% shortage will occur because of the decreased number of men and women wanting to go into medicine. At the present time the US government has mandated gender equity in admissions to medical schools .That means that for the past 15 years that somewhere between 49 and 51% of each entering class are females. This is true of private schools also, because all private schools receive federal funding.
The average career of a woman in medicine now is only 8-10 years and the average work week for a female in medicine is only 3-4 days. I have now trained 35 fellows in pediatric ophthalmology. Hands down the best was a female that I trained 4 years ago -- she was head and heels above all others I have trained. She now practices only 3 days a week.
Background: Dr. Zane F. Pollard
I did my undergraduate work at Northwestern University in Evanston, Illinois. I graduated Tulane University medical School Alpha Omega Alpha ( medical school's top 10% of graduating class). Internship at the Univ. of Southern California in Los Angeles, one year of General surgery residency at the U. of California in San Francisco. Two years in the US Navy. Residency in Ophthalmology at the U.of S . California in Los Angeles, fellowship in pediatric Ophthalmology at the Wills Eye Hospital in Philadelphia. In practice with Eye Consultants of Atlanta for the past 35 years. Published 90 papers in peer reviewed Scientific Ophthalmology Journals. Member of the American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology and the American Ophthalmological Society. Board certified in Ophthalmology.
Thursday, August 27, 2009
Allocating Medical Care
Brant S. Mittler: Oregon ‘allocates’ medical care
01:00 AM EDT on Thursday, August 27, 2009
BRANT S. MITTLER
SAN ANTONIO
WHILE NO ONE wants to pull the plug on Grandma, there are a lot of well-educated folks around the country looking for ways to use “scientific evidence” to do just that. One such place is Oregon, where the state’s Medicaid program has featured a Prioritized List of diagnoses and treatments for the past 20 years. “Prioritized List” is another way to say rationing. So is “allocation of scarce medical resources.”
You may have seen the headlines last summer, when Barbara Wagner, a 64-year-old Oregon great-grandmother with advanced lung cancer, got an unsigned letter saying that the Oregon Health Plan (OHP) would not pay for a $4,000-a-month chemotherapy drug, but would pay the $50 cost of physician-assisted suicide.
That’s because in 1989 Oregon decided to make a comprehensive list of all treatments and diagnoses and rank them by importance to society in preventing disease and doing the most good.
Oregon appoints a panel of 11 experts, called the Health Services Commission, “to rank medical services from most to least important to the low-income population.” Five commissioners must be licensed physicians. Other members include a public-health nurse, a social worker and four medical consumers to construct the Prioritized List.
They use evidence from specialty groups and scientific clinical trials — the kind the Obama administration and Congress want to use — to rank these diseases and treatments from 1 to 679. Then the legislature decides how much care poor people get by drawing a line every two years — lately between treatments 502 (cysts of the vaginal area ) and 503 (a skin condition called lichen planus) based on how much money they have to spend. Everything above the line is covered; everything below the line is not paid for.
In case you’re wondering, the American Academy of Dermatology says, “There is no known cure for Lichen Planus but treatment is often effective in relieving itching and in improving the appearance of the rash until it goes away.” That treatment often requires prescription-strength steroids.
For its 2010-2011 budget, Oregon ranks Pregnancy/Maternity Care at No. 1; Abuse or Dependence of psychoactive substance is No. 5; Type I Diabetes is No. 10; Type II Diabetes is No. 33; and acute heart attack ranks No. 75; Heart Failure is No. 108, only slightly behind Undescended Testicle No. 103.
There are other rules. For example, they don’t pay to treat cancer patients who only have a 5-percent or less chance of living for five years. That’s why Mrs. Wagner didn’t get the chemotherapy — until the drug company that made it sent it to her for free. But she died five months later — as the evidence predicted. But 53-year-old Randy Stroup, of Dexter, Ore., a grandfather of five, managed to live over a year after the OHP denied him chemotherapy for advanced prostate cancer.
Oregon’s treatment of Wagner squares with another approach to rationing advocated by White House medical adviser Dr. Ezekiel Emanuel, a cancer specialist and medical ethicist. Emanuel and co-authors wrote in the Jan. 31 issue of the Lancet that the rationing of scarce medical resources would best use a “completed lives” system that favored those resources — such as hard-to-get donated kidneys and hearts — for those who had the most life to live. That means the very young and the very old are at the end of the line.
How successful has Oregon been with its allocation scheme? Has it been able to care for more poor people than other states? Has it been able to free itself of budget worries?
The answers are mixed. When it first took effect in 1994, Oregon had about 18 percent uninsured. That number dropped to 10 percent but then climbed back up to 17 percent as budget woes in 2004 caused the Oregon legislature to cut back on services and close new enrollment. The latest cuts are in vision care and dental care.
University of North Carolina health-policy Prof. Jonathan Oberlander described the “unraveling” of the OHP over time, brought on by high unemployment and taxpayers’ refusal to fund the program adequately. The Priority List and the managed-care plans that have administered it have been no cure for increasing numbers of uninsured and medical inflation. Oberlander concluded that “rationing is no substitute for revenues, and without that financial commitment, large-scale public insurance expansions cannot succeed, in Oregon or elsewhere.”
Oregon’s OHP is but one of the many state experiments in health reform – along with Massachusetts and Maine — that offer some insight into what’s in store with national health reform. Rationing for the poor may become rationing for everyone if the OHP’s model is adopted nationally.
Brant S Mittler, M.D., is a cardiologist and a lawyer with an interest in health-care reform. He may be reached by e-mail at bsmitt@satx.rr.com.
01:00 AM EDT on Thursday, August 27, 2009
BRANT S. MITTLER
SAN ANTONIO
WHILE NO ONE wants to pull the plug on Grandma, there are a lot of well-educated folks around the country looking for ways to use “scientific evidence” to do just that. One such place is Oregon, where the state’s Medicaid program has featured a Prioritized List of diagnoses and treatments for the past 20 years. “Prioritized List” is another way to say rationing. So is “allocation of scarce medical resources.”
You may have seen the headlines last summer, when Barbara Wagner, a 64-year-old Oregon great-grandmother with advanced lung cancer, got an unsigned letter saying that the Oregon Health Plan (OHP) would not pay for a $4,000-a-month chemotherapy drug, but would pay the $50 cost of physician-assisted suicide.
That’s because in 1989 Oregon decided to make a comprehensive list of all treatments and diagnoses and rank them by importance to society in preventing disease and doing the most good.
Oregon appoints a panel of 11 experts, called the Health Services Commission, “to rank medical services from most to least important to the low-income population.” Five commissioners must be licensed physicians. Other members include a public-health nurse, a social worker and four medical consumers to construct the Prioritized List.
They use evidence from specialty groups and scientific clinical trials — the kind the Obama administration and Congress want to use — to rank these diseases and treatments from 1 to 679. Then the legislature decides how much care poor people get by drawing a line every two years — lately between treatments 502 (cysts of the vaginal area ) and 503 (a skin condition called lichen planus) based on how much money they have to spend. Everything above the line is covered; everything below the line is not paid for.
In case you’re wondering, the American Academy of Dermatology says, “There is no known cure for Lichen Planus but treatment is often effective in relieving itching and in improving the appearance of the rash until it goes away.” That treatment often requires prescription-strength steroids.
For its 2010-2011 budget, Oregon ranks Pregnancy/Maternity Care at No. 1; Abuse or Dependence of psychoactive substance is No. 5; Type I Diabetes is No. 10; Type II Diabetes is No. 33; and acute heart attack ranks No. 75; Heart Failure is No. 108, only slightly behind Undescended Testicle No. 103.
There are other rules. For example, they don’t pay to treat cancer patients who only have a 5-percent or less chance of living for five years. That’s why Mrs. Wagner didn’t get the chemotherapy — until the drug company that made it sent it to her for free. But she died five months later — as the evidence predicted. But 53-year-old Randy Stroup, of Dexter, Ore., a grandfather of five, managed to live over a year after the OHP denied him chemotherapy for advanced prostate cancer.
Oregon’s treatment of Wagner squares with another approach to rationing advocated by White House medical adviser Dr. Ezekiel Emanuel, a cancer specialist and medical ethicist. Emanuel and co-authors wrote in the Jan. 31 issue of the Lancet that the rationing of scarce medical resources would best use a “completed lives” system that favored those resources — such as hard-to-get donated kidneys and hearts — for those who had the most life to live. That means the very young and the very old are at the end of the line.
How successful has Oregon been with its allocation scheme? Has it been able to care for more poor people than other states? Has it been able to free itself of budget worries?
The answers are mixed. When it first took effect in 1994, Oregon had about 18 percent uninsured. That number dropped to 10 percent but then climbed back up to 17 percent as budget woes in 2004 caused the Oregon legislature to cut back on services and close new enrollment. The latest cuts are in vision care and dental care.
University of North Carolina health-policy Prof. Jonathan Oberlander described the “unraveling” of the OHP over time, brought on by high unemployment and taxpayers’ refusal to fund the program adequately. The Priority List and the managed-care plans that have administered it have been no cure for increasing numbers of uninsured and medical inflation. Oberlander concluded that “rationing is no substitute for revenues, and without that financial commitment, large-scale public insurance expansions cannot succeed, in Oregon or elsewhere.”
Oregon’s OHP is but one of the many state experiments in health reform – along with Massachusetts and Maine — that offer some insight into what’s in store with national health reform. Rationing for the poor may become rationing for everyone if the OHP’s model is adopted nationally.
Brant S Mittler, M.D., is a cardiologist and a lawyer with an interest in health-care reform. He may be reached by e-mail at bsmitt@satx.rr.com.
Tuesday, August 25, 2009
Monday, August 24, 2009
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