Where The Rubber Gloves Meet the Road

In the comments of my last post, Todd off handedly remarked that "The Logician needs to come out of the ideological world and move into reality.". Well I was going to reply in the comments, but I ran into so much "reality" that it evolved rather quickly into it's own post.

Reality #1 - Doctors and health care professionals do not want this. Hugh Hewitt has run a series of letters from practicing physicians who have written to him about just how bad this is going to be for doctors and patients alike. For example we have this from Doctor M.

Hugh,

I am a pediatric neuroradiologist. I take care of children with severe neurological diseases, tumors, trauma, etc. I am an Associate Professor at the University of _________Medical School and practice at Children's Medical Center in ______. I am also a researcher using state of the art MRI. I can tell you that if we go to a single pay system, it will destroy the kind of healthcare and research which has allowed us to lead the world.Currently we have the best subspecialists in the world and free access and referral for state of the art care. As an example, I was on staff at another children's hospital in a large Midwestern city a couple of years ago and had a young boy with a large carotid artery aneurysm. We did not have the pediatric expertise in our city to treat him, but I have world class colleagues in another city who treat these things for a living, so I made some phone calls. The boy went to UT Southwestern Medical Center in Dallas, was treated and now faces a normal life. This kind of subspecialty referral care will end with rationing. This is unacceptable. Rationing would have forced that boy to "take the best available locally" or would not pay for the expensive interventional procedure which was life changing for this boy. Also, if they destroy medicine, what motivation will there be for the best and brightest to enter medicine.

From another doctor we have this...

Dear Mr. Hewitt, I am a physician (M.D.) practicing geriatric psychiatry in Texas for the last 16 years. I am a member of the Association of American Physicians and Surgeons (aapsonline.org) and am so opposed to government intervention in medicine that, although all of my patients are Medicare recipients, I have "opted out" of Medicare which means that all of my patients must pay out-of-pocket to see me and I cannot bill Medicare for any services. I can work with individual patients so that they can afford my services, and I can treat some patients for free! Under Medicare I am not allowed to do that.

From a third we have this....

I am a 66 year old Pediatrician currently transitioning into retirement. I echo the comments made by the Sr. VP for medical affairs. My junior associate who is taking over has already informed me that she will no longer go to the hospital - too much work, too great a risk, too little return for the effort, etc. The 200 bed hospital I attend at has 0NE Pediatrician left on staff my age who just had surgery and walks with a brace. A new Pediatrician hired by the hospital is one month from joining him but has yet to get her state license - ipso facto cannot see patients. There are three other Pediatricians in the community. None have staff privileges except for a half-timer. The hospital has about 700 births a year and a drawing area of 250,000. God help them.

The hospital has critical shortages of all primary care specialties, i.e. Family Practice, Internal Medicine, and Ob-Gyn. Why ? Two reasons. (1)The government artificially distorts the market. 75% of my patients are Medicaid in the first year of life. Who the hell would buy insurance when the government picks up the tab? Many need it, but a lot don't. This is an industrial region, not a farming region, even if it looks rural. My parents work for large corporations. (2) Women doctors.75% of Pediatric residents and 52% of entering medical students are female. They won't move to small towns and rural zones. They won't work as many hours or as many years. It takes 3x as many women as 2 male doctors to do the work.

From a 4th....

I can hardly believe there are that many doctors who want a single payer system. IMO, the only doctors that would want this are either lazy, or do not have what it takes to make it in private practice.

A national health care system WILL BE a nightmare and complete disaster. It will be inefficient on a scale yet not even imaginable. Americans will also be shocked at how poor, rationed, and delayed their care will be. There will be many people who will be permanently injured or allowed to die because the government will establish some bul**hit evidence based criteria on allowing certain treatments.

Finally from a hospital exec....

I listen to your show on pod cast, so I was unable to comment last night. An issue which you did not mention, but is critical to the situation is the accelerating doctor shortage. I am a senior physician executive who spent 31 years in the Air Force and completed my career as commander at ______ Medical Center....I am currently Sr. VP for Medical Affairs at a small hospital system in ___.

The major problem with every effort to "fix" health care is that they focus on controlling the price that the consumer pays. No one ever takes into consideration the cost of producing that care. This will have a major and increasing impact on the way forward.

Currently, the US is short of physicians and is not producing them at a rate of replacement. Add to that the fact that a 30 year old physician is a completely different animal than a 50 year old physician. Most "old" physicians came into the profession at the time it was considered a calling. Yes, they were compensated (monetarily and otherwise) very well. But for that, they accepted 100 hour work weeks and being on call for months at a time. It was part of the social contract and they just accepted it as part of the life of a physician.

The current crop of physicians do not have the same work ethic. Similar to other members of their generation, these docs expect to "have a life." They are unwilling to work the same hours as their elders - at any price. Additionally, 50% of most medical school graduates are women who statistically have a much shorter career. You can see that every time one of the old guys retires, you need more than one new graduate to cover the load.

The proposed changes that are ahead will undoubtedly encourage many of the old docs that there is no point in working beyond the point that they can retire. Yes, the fact that many of them have been hurt badly in the crash will keep some at work. But not a day longer than they have to. Then it will be harder for all of us to find a physician to take care of us.

These doctors all work within the already broken health care system and all agree that the Administrations cure will make the patient terminal. THAT my friend is reality!

Here is a little MORE REALITY for you Todd. Meet Katie Brickell. Katie lives in the UK where they have "universal' insurance. At 19, Katie went to the doctor to get a PAP smear done. She was told she had to wait until she was 20...National Health Service (NH) guidelines. When she turned 20, she went back only to be told that the guidelines had changed and she had to wait until she turned 25 (the American Cancer Society recommends 21 years AT THE LATEST)! At 23, Katie was diagnosed with cervical cancer and she was told that she only had two years to live because the cancer was so advanced! IF she had been able to get at PAP smear done at 19 or 20, doctors could have detected it sooner and possibly stopped the cancer before it had gotten to the terminal stage (as most cancers are).

Now meet Dr. Brian Day - a Canadian physician. Dr. Day is advocating for more patient choice in Canada because the current system is actually KILLING PATIENTS due to the extremely long waits that terminal patients face in the Canadian system. Also meet Dr. Karol Sikora from the UK who is advocating the same in his country.

Meet Rick Baker. Mr. Baker is a Medical Broker in Vancouver. He helps Canadian citizens find life saving medical treatment in other countries that are denied to them in Canada. Listen to the story he tells about a client of his who was given ONE WEEK TO LIVE and was told by the bureaucrats that he had to wait indefinitely for the life saving surgery that he got in the US within 24 hours of contacting Mr. Baker.

Then there is Lindsay McCreith and Shonna Holmes, two people I wrote about earlier. These folks had to come to the US to get lifesaving surgeries that were denied to them under the "compassionate" Canadian Health Care system.

THESE are the realities of "free" government health care...not the utopian pipe dream that the redistributionists would have you believe. So now you tell me....how compassionate is it to tell someone that they have 1 week to live unless they get lifesaving surgery that the government says they can have in 6 months? Is it any more compassionate then telling someone that they can have the surgery for a sum that they can not afford? Personally I don't think either one is too horribly compassionate, but scrappinng the system we have now (where it can be had for a price) for a system where you can't get it when you need it is not the answer. A better answer is to get government out of the equation altogether so that the patient can chose the plan that fits them best and makes sure that the patient and the doctors are the ones in charge - not some bureaucrat in Washington DC.