Dr. Maller’s Blog

When I started blogging a year and a half ago I promised myself I’d steer clear of politics. But politics is coming after me, and you, and everyone who dispenses or consumes that 15% of our economy known as health care. I have enough faith in the common sense of Americans to trust that we can fix what’s dislocated without breaking every bone in our structure as a society.
But the heat is on again from Washington, and the lies and distortions are drowning out more temperate and rational debate. In no particular order, here are ten of the most common lies with some historical references.

1. There is a crisis that must be solved before Labor Day or Halloween or whenever. Really? Since Hillarycare was defeated 16 years ago, what has changed? The figure of “47 million uninsured” is repeated so often but what does it mean? Polls show that 70-80% of Americans are satisfied with their current plan and do not want their taxes raised to make coverage universal. Twenty percent of the uninsured are illegals. Another 20% make over $75,000 a year and choose to do without health insurance. Another fifth are eligible for existing programs but haven’t signed up, and millions of others are young people between jobs or in school. The real “crisis” may be too much care; every emergency department is overloaded with routine cases who can’t or won’t go to a doctor’s office. If the swine flu has its way with us this fall we’ll have a true mess on our hands, but don’t expect the honchos in Washington to help. They’ve got the best insurance plan on the planet, but it’s not for us common folk.

2. Electronic medical records will save tons of money and may save your life.
As they say in the computer world, GIGO. There is no proof that EMR saves money or lives. The VA system uses bar codes to identify IV solutions. Sounds brilliant, except that it took four months for a human to note that the bottles were mislabeled. Nobody died so you didn’t hear about it. Reluctantly I’m beginning to enter that paperless world in my practice. Since I type like I dance, it’ll be slow going. Every minute at the keyboard is a minute not engaging the patient and family. Is that really progress? On the other hand I will recoup my investment in this system by about 2030, Of course the system will be obsolete long before then. I’m not a Luddite; I realize that computerizing a patient’s medical record may reap benefits down the line. But growing pains have been so bad in this area that some hospitals have already scrapped their systems. If you show up in an ER in bad shape don’t expect the doctor to wade through hundreds of pages of mostly unimportant stuff AND save your life. Can’t have both!

3. A public plan will bring down costs. Has that ever happened? We have public plans that account for half of our current “system”of care – Medicare, MedicAid, VA and so on. They are breaking banks in every state capitol as well as Washington, so just what lesson can we take from that? Do you believe that the US Postal Service would perform better if we made FedEx and UPS go away?

4. American business can’t compete with other countries because they have socialized medicine and we don’t. We are suffering to some degree in the world economic arena because of our high taxes, burdensome regulation, and government incompetence. Health care accounts for more of our GDP because we choose to buy it and because it’s usually good.

5. Infant mortality is lower in many other countries with socialized medicine. This lie is perhaps the oldest of the top ten. Other countries don’t count a “birth” until 28-30 days (e.g. Scandinavia) and others exclude the smallest babies. We also have a hard-core mostly inner city underclass of drug-addicted parents, illegal aliens with no prenatal care and other problems that no government scheme has yet unraveled. In fact because Congress is mostly lawyers, no real tort reform is likely and there are increasing areas of the nation with no qualified MD’s to deliver babies. (See Edwards, John).

6. Government experts can decide on the basis of “comparative effectiveness research” that only their approved treatments will be paid for. In England they have such a committee known as NICE (George Orwell must have made that one up!). Like the secret Hillary task force of 1993, it includes not one practicing physician. It is, first and last, a rationing board. Over 65? Kidneys on the way out? Uremic poisoning isn’t so bad – you go into a coma and die quietly, and you’ll be saving the taxpayers oodles of money. Need a bypass? Take a number. MRI? How’s nine months from yesterday work for you?

7. Life expectancy is better in some countries with socialized medicine. Yes, and worse in others. Japan’s is better than ours. They eat more fish, they’re less obese (maybe because they smoke!?), they’re less diverse. Russia’s life expectancy keeps going down; why not blame socialism? Or is it the vodka, the assassinations, the weather, or the sheer misery of living in a nation with so little hope. Point is, life expectancy in the USA is getting better all the time; since 1900 it has jumped an entire generation. All that with no government-controlled “system.” Take away the incentive to develop new cures, vaccines, biotech wonders which only America can do, and the world will pay a huge price.

8. Mandatory health insurance will provide universal access and lower costs. Hawaii tried it – for seven months. Massachusetts continues to try it but the state and hospitals are going broke, and there remains a stubborn minority of folks in John Adams country who just won’t board that train. We’ve had mandatory auto insurance for years now. Ever been in an accident with an INSURED driver? And just what “access” are we talking about. Every squeeze on the provider community costs the public more doctors and hospitals. “Boutique” and “concierge” offices are multiplying all over our once-free country. For old-fashioned cash, usually reasonable without all the third-party interference, care is offered as simply as getting a haircut. But the D.C. crowd won’t let that go unchallenged. It would have been illegal under Hillarycare to give or receive care privately, and I suppose the current incarnation will be no different. It is ironic that countries with socialized care are looking to increased privatization to lessen the strains on their antiquated systems, as in Canada, England and elsewhere.

9. Emphasizing prevention will lower costs. It pains me greatly to deny this because as a pediatrician I spend more time and resources on prevention than any other type of doctor, but there is no evidence that such care really saves money. We do it because it’s right and we will continue to do so. Remember when the cigarette honchos actually reminded Congress that they were saving the country millions in social security benefits by selling their wares? It’s true! Besides, government has always said prevention was great but the reimbursement paradigm is upside-down. As a primary care physician I have no incentive but my personal honor to talk to patients about changes in lifestyle, emotional stresses and a host of other non-diseases. English and Canadian doctors are given ever-increasing rosters of patients to see. Each encounter is so short as to be meaningless; no one gets undressed or properly examined. English dentists (yes they do exist) have a quota of patients to see. If they finish, they go on vacation because they will not be paid another quid (whatever that is) for working longer.

10. A public option is needed to spur greater competition. We already have 1300 companies selling health insurance. As the American Association of Physicians and Surgeons (of which I am a member) has said, adding #1301 doesn’t figure to change the playing field. But of course if it’s “I’m from the government and I’m here to help” those other companies are toast. Now neither I nor any doctor I know will defend the insurance companies. In fact they are so unpopular that most doctors want the government to take over and get rid of them. But be careful what you wish for. Because the government already skews the market so badly in controlling half the market, the private sector cost-shifts by overcharging everyone else. But remember, the government cares not a fig about your health. It is your vote they covet. As a believer in free market principles, I recognize that health care can’t be as unfettered as car or furniture sales (perhaps cars are a poor example right now). But I’d rather see a truly competitive private system that answers to a more enlightened public than one that’s run by the crooks in Washington who are on the power trip to end all power trips.

Just today I read that buried in the thousand pages of the health care bill that no one has likely read is a program to enforce vaccination requirements, including going into private homes with the legal authority to overcome parental objection. If you’ve been following my blog or coming to my office you know how dedicated I am to the goals of vaccination. But have Americans allowed their freedoms to erode to this degree?

On the cover of my favorite political magazine this week is a caricature of our president, grinning menacingly as he slips on a green latex glove, saying “Just relax.”

Please do NOT bend over.

This entry was posted on Thursday, July 16th, 2009 at 8:21 pm and is filed under General. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.