Friday, March 26, 2010

Slightly topical, entirely unsolicited

My general policy is to ignore things that annoy me (I’m going to be such a good psychiatrist) so I haven’t been paying much attention to politics. However, it’s a bit hard to avoid the health care debate when you work in health care.

I’d find the debate more enticing if both sides cut their sensationalism. And I’m not really talking about the actual politicians, though they could certainly benefit from this as well. The following are paraphrases of actual things I’ve heard in the last week:
- This day is going to be remembered just like Pearl Harbor (when the health care bill passed)
- If they’re so opposed, every Republican should pledge not to use any healthcare
- People are just threatening the politicians like they threaten each other behind closed doors (referring to death threats)
- This is the first time we’ve ever taken steps to help the people of America instead of people in other countries

Really? I think this is a bad bill, but it’s not quite the same as a surprise attack on US soil. The fact the Republicans don’t like this bill doesn’t mean they don’t want reform; everyone wants reform, just not this one. I think that shady goings-on did go on behind closed doors to get the votes to pass this, but I’m guessing death threats weren’t involved. And I don’t even know how to respond to the last one. If you like the bill, like it, if you don’t, don’t, but stop being stupid. It changes your argument from a legitimate viewpoint to grating squawking in my ears.

If you like the bill, you’re probably not a doctor. It seems like doctors should be somewhat involved with a bill regarding the nation’s health, but they weren’t really. And no doctor I’ve spoken with has had any confidence that the bill will be efficacious. It’s going to be massively expensive (But Chris it’s going to save money in the long run! No, it’s not. I can’t predict the future and neither can you, but I think the odds of this bill saving any money, short or long term, are very very low) but have a limited impact on health. Sounds like a winner.
Obviously, people paid to argue have been arguing for years over this, so we could go on and on about the different facets of the problem. I’ll just point out one of the biggest problems not remotely addressed in the bill.

We have a doctor shortage. This results in people not being able to see doctors, or having to wait a long time. This also results in worse care when you do see a doctor, because they’re seeing too many patients to try to make up for the shortage. Doctor shortage = limited access, worse care. Sounds like the problem with the system, doesn’t it?

Health care bill comes along. Does it address doctor shortage? No. Does it add more patients trying to see doctors? Yes. So, the problem gets worse, not better. But, it does try to decrease the costs of healthcare by paying doctors 20% less for Medicare visits. (Of course, here’s where personal bias comes in. If I worked for the insurance companies, I’d complain about their cuts. But I’m a doctor so I’m going to say stick it to the insurance companies, but leave me out of it.) Doctors already make almost nothing from Medicare patients, and now will make 20% less. Guess who is going to see even fewer Medicare patients? Some states require you to see those patients. Guess which states are going to have an even worse doctor shortage?

How would I save money in a health care bill? Tort reform. Again, I’m heavily biased. But if you look at why US healthcare costs so much, it’s because of fear of litigation. Doctors order every test under the sun, because they risk getting sued if they don’t. Those tests are extremely expensive, and many don’t add any diagnostic information. But the doctor has to choose between risking a law suit and charging the patient/insurance company/government for tests that didn’t actually help anything. They are going to run the extra tests. If it were harder to sue them, or there were caps on malpractice, they would run fewer tests. This would save a lot of money. And if you look at evidence based medicine and international health statistics, we would be equally as healthy. But no one wants to touch tort reform. Because lawyers make a lot of money from malpractice cases. And lawyers/law firms are the number one contributors to the Democratic Party.

There are a thousand and one problems with insurance companies. The only people that hate insurance companies more than patients are their doctors who have to deal with them day in and day out. But only attacking the problem from that end is going to make the doctor shortage worse, which is going to make health care worse, which is going to make the health care system worse. Yes it will.


anna. said...

biggest problem according to anna: no one REALLY has any idea whats in the bill but everyone complains about it.

i'm not excluding myself...i have a vague idea of what the bill is, but i haven't read / seen / heard enough about it. and it's hard to make a solid judgment when you have no clue what it's all about.

esodhiambo said...

You hang out with a weird crowd--those are totally different complaints than I hear. (I am guessing the death threat reference was in response to several congressional figures who complained that they have received death threats because they voted for the bill [and not just from Sarah Palin]).

I agree that health care reform should be spearheaded by the health care community. What's stopping you? Do it. Of course the reform that I would like to see is for health care to become a non-profit venture (seriously, is it moral to make money off people's illness?). Good luck with that. What do you think of results-based pay rather than procedure-based?

The bill is entirely disappointing--too bad they took such a leaf out of Romney's plan. It deals almost entirely with insurance and not actual care. Whatever--some people are super hard to work with.

That said--better than nothing. Pre-existing conditions alone is worth it.

n/b--please apply the same courtesy to education reform--keep non-educators far far away. Too late.

RE: your new header: EPIC.