Tuesday, October 20, 2009

A letter to Michael Wolff of Vanity Fair

Mr. Wolff

I'm a busy physician and respect your writing. I hope that you'll appreciate the time I took to write this to you. I hope you can see a commonsense perspective that the vested interests in DC (both Dems and GOP) are missing.

I read your "I’ve Changed My Mind on the Obama-Fox Showdown" piece on newser.com. As an independent, I didn't vote for Obama, but I admire his concern for health care. And I think he has some good ideas. Of course the Republicans are all up in arms, but they had 6 years with a majority and never got a substantial bill to the table.

Yet, as a physician, I'm perplexed at why you would characterize the public revulsion to nationalized health care as 'perplexing'. Here's my opinion. It's because 'reform' is going the wrong way. It's not reform at all, but a government takeover. A better alternative would be increased government regulation and oversight.

You can cite polls to show public support for something, but this will vary based on how the question is asked. However, a stable trend this year has been seen in Gallup polls on this issue: 80% of Americans are happy (satisfied or very satisfied) with their current health care. A majority are concerned about the costs.

That begs the question of why we would want to muck up something that a super-majority are happy with? What we should be doing is fixing the costs--something that no bill that has made it out of committee in either house of Congress addresses. If you want to know what public opinion is, look at that poll. Most people are happy with their health care. The number one complaint I hear from patients is the cost of insurance. Number two is lack of access to care from my Medicare and Medicaid patients.

That's the essence of my argument. If you care to, please read on...

Everyone today thinks they are an expert in health care. I am an expert and certainly more of one than the people writing the bills. The public is rightly alarmed at what has been proposed as legislation this year. For example, HR 3200 was a slippery slope to a government takeover of health care. Why? If you look at that bill, it was crafted to force all employers with $400,000 or more in payroll to offer the public option or face a fine of 8% of payroll. Lots of businesses would be exempt, but it would move a large number of low wage earners into the public option.

Example: You're an employer like Walmart, McDonalds, etc. with mostly minimum or near minimum wage workers. So round their yearly pay to $20,000. Are you going to pay another $9,000-12,000 per year for commercial insurance, pay $1,600 for the public option or pay the fine. That's a no-brainer. Again, won't affect all workers, but it will entrench the public option (which will be a new entitlement).

In my opinion, what we need is increased regulation of the health insurance industry, rather than a government takeover of our multiple health care delivery systems. The federal government already has a proven track record in health care--a record of failure, namely 1) Medicare, 2) Medicaid, 3) VA and 4) IHS. Medicare and social security will both be bankrupt in the next decade. We don't have the funds to pay for our current entitlements and Congress wants to charge more to our national credit card? The worst part about the current Senate bill is it will add roughly 1 trillion to the budget, but it will still leave half of the currently uninsured still uninsured.

With the economic meltdown, people are realizing that politicians don't have all of the answers they say they do. They look at the bailout that was rushed through without anyone in Congress reading it. They see it hasn't worked where they live and now they see all the pork that was included in it.

There are many common sense solutions, most of which aren't even being discussed:

1. Tort reform--because the biggest driver of increase in expensive tests (other than shift in average age of population) is due to defensive medicine. However, this will probably never get passed since the vast majority of those in Congress are trial attorneys.
2. Make insurance providers compete across state lines--it's baffling that this hasn't been done.
3. Eliminate waiting periods--one of the largest chunks of people commonly lumped in as 'uninsured'.
4. Eliminate exclusion for preexisting conditions--duh.
5. Repeal nonprofit status for hospitals--these hospitals only provide <5% charity care, yet don't pay taxes due to nonprofit status.
6. Eliminate or reform Medicare D.

Thanks for your time.

Jim Webb, MD

Friday, October 16, 2009

More Smoke and Mirrors on Healthcare Reform

There is a current bill in the U.S. Senate, SB 1776, that is being touted as an "18 line bill" that would solve Medicare problems by repealing the Sustainable Growth Rate (SGR). This is being touted by the AMA and state medical associations as a good thing. Unfortunately, it's another game of smoke and mirrors in Washington with the AMA playing along.

What's the SGR?

The bill repeals the Sustainable Growth Rate (SGR) freezes physician payments from Medicare for the next ten years. The SGR is a flawed law that was passed by Congress many years ago to fool the taxpayers into thinking that Medicare funding isn't as bad as it really is--that is, so these fat cats can get reelected. By mandating cuts in physician reimbursement every year, on paper it looks like they are saving money.

On the other hand, these elected criminals vote every year to cancel out the reduction, leaving the payments the same. However, by the law, this decreases each year. This snowballs, such that this year it was scheduled to decrease 21%. Basically, this allows our congressional representatives to vote to prevent the cut so they look good. Yet, they still have this big accounting flaw right there. If you and I did that on our taxes, we'd be in prison.

Isn't the American Medical Association (AMA) the Voice of Doctors?

Most people don't realize it, but the AMA represents less than 20% of physicians nationwide and most of the membership is medical students and residents--that is, a significant amount of them aren't what we would call 'real doctors' yet. We don't know the number for sure, because the AMA won't release the information to the public, but it's estimated that they make up at least 1/3 of the membership.

These doctors in training join the AMA because they're told that the AMA represents physicians in America (and because they get discounted membership rates). That certainly isn't the case today, yet the mainstream media acts as if like the AMA in a unified voice for doctors.

When the media reports that the AMA is backing something, they spin it to imply that almost all physicians are backing it. Nothing could be further from the truth. When I was in medical school, the AMA faced a backlash when it tried to make money by selling it's logo for product placement on silly and unrelated things like kitchen appliances.

Earlier in the year, the AMA pledged its support for President
Obama's healthcare reform in return for a permanent SGR fix. For an organization that is supposed to have the best interests of physicians at heart, this was an utterly idiotic political move. This resulted in alienating many physicians that still were in the AMA. Several thousand more doctors left the AMA this spring after this fiasco.

The Real Reason Behind S1776

From what I have heard from my senators offices is that this bill was offered by
the democratic leadership to buy off the AMA--so that they would stop
pushing for medical malpractice reform.

Medical malpractice reform is probably the number one thing we could do to control healthcare costs. Our current healthcare crisis is largely due to increasing medical costs because of:
1. There are more older people on Medicare now than younger employed people paying into the system.
2. US doctors are forced to order many unnecessary, expensive and potentially harmful tests because of the out of control medical malpractice industry in our country. This is referred to as defensive medicine. As a radiologist I see defensive medicine being practiced on an hourly basis.

In conclusion, SB 1776, with it's patriotic looking bill number will be touted as a quick fix for Medicare physician reimbursement by the media over the next week. However, like most bills originating in Washington DC, it's a bunch of smoke and mirrors hiding yet another empty gesture.

Thursday, October 8, 2009

Dr. Webb will be playing keyboards with the Persuaders tonight, Thursday October 8th, at the historic Cain's Ballroom in Tulsa. The concert starts at 7pm. Tickets are only $8 or $10 at the door. The concert features 6 local bands and is part of the Rock the 918 funderaiser for the Tulsa Area United Way. Hope to see you there.

For tickets, visit:

The Blogs I Read

All posts are copyright Musculoskeletal Imaging of Tulsa.