But I Don't Want To Pay!

There was some big protests over the weekend in California. In fact, at the UC Santa Cruz site there was even take over of one of the buildings for three days. This was just one of several demonstrations across University of California campuses in the wake of a big tuition increase. It seems that students throughout the state are livid that the University of California's regents board approved a 32 percent increase in the cost of going to college. Of course, this will not hit everyone as those whose families make less than $70,000 have their tuition covered. What you have here is a situation of a state - California - that is way in debt from handing out free cash. Now they are running out of OPM (other peoples' money) and the there is no more cash left. I wonder if they will be teaching this point at one of the UC Santa Cruz economics' classes? Probably not.

Stop The Healthcare Reform Train!

I now believe that all the bills going through Congress to reform healthcare should be stopped. They are worthless. Not that I liked them much prior to me writing this but what happened just recently has proven that this whole thing is a sham. I have ALWAYS said that unless Americans can wrap their heads around rationing care than this system is unfixable. There just isn't enough money. And without patients having to pay out of pocket then they would have no incentive to curtail spending or shop around. The U.S. Preventive Services Task Force, which is the most unbiased panel of experts around, made the recommendation to move the age to start getting mammograms from age 40 to age 50. We primary care docs have been using all the USPSTF recommendations for years and I am sure we will use this opinion as well. This recommendation will also save billions of dollars as well. That was before the political uprising by special interest groups trying to denigrate the USPSTF and all that they stand for. What does the present Administration do? Sebelius has made it " clear these recommendations are not ours". WTF! You frauds. This was a litmus test to see how our government could handle the tough calls like mammogram screening and they already failed! This only proves that they will do nothing to slow the cost of healthcare in the future. They will only find new ways to tax others to pay for it.

Oh, by the way, here is what the American College of Radiology (whose members stand to lose a lot of money) says about the USPSTF:

The American College of Radiology (ACR) is pleased to see that Secretary Sebelius has reaffirmed that mammography is a vital and lifesaving tool in the battle against breast cancer. We strongly urge women and providers to continue to adhere to the current American Cancer Society and American College of Radiology policies regarding mammographic screening. Additionally, as the Task Force is referenced in health care reform legislation as a significant factor in determining which preventative services may be offered under government "insurance exchanges" outlined in the legislation, we ask that the Secretary officially ask the Task Force to rescind their mammography recommendations in order to avoid confusion as health care reform moves forward. We also urge HHS to include in the USPSTF experts from the areas on which they will be advising lawmakers and submit their recommendations for comment and review to outside stakeholders in similar fashion to rules enacted by the Centers for Medicare and Medicaid Services. A more inclusive process can only benefit Americans as we seek to improve our health care system.

That's funny because the ACR had no problem with the USPSTF when they recommended abdominal ultrasounds for male smokers for screening for AAAs. Hmmm.

AMA's Seven Guiding Principles For Health System Reform

This comes from November 9th edition of the American Medical News:

1. Cover all Americans


2. Expand choice, eliminate denials


3. Protect the patient-physician relationship


4. Repeal Medicare SGR


5. Reduce defensive medicine


6. Streamline administration


7. Promote quality, prevention, wellness

I think they did a pretty good job with this. I also like to look at the words used by big organizations just to see their motivation for any "small" changes. You will see that the title is called "Health System Reform" instead of Health Care Reform. Not sure why we lose the caring part? You will notice it says cover all "Americans" which makes many anti-immigrant groups happy. You also will see that it is "patient-physician" relationship instead of "physician-patient" relationship. I am sure some marketing guru made the point that the AMA would look better by always putting the patient first and bada bing, there you have it in point #3.

The glaring absence is the charge to direct more students into primary care. Covering all Americans does no good if there are not enough doctors to see them. The AMA is well aware of this fact and they well aware of the reasons why (low pay, high school loans). The AMA is also well aware of who they truly represent (mostly specialists) and therefore made a conscious choice not to put this recommendation into their "guiding principles". Forget all the politics and bickering between specialists and primary care docs, the bottom line is that this new health system is not a system without enough grunts on the front line seeing all these new patients. Once again the AMA proves they don't represent me.

You Dropped The Bomb On Me

There is some buried treasure found in the Pelosi House Bill that you should know about. It is a method to kill all existing tort reform. Not only does the bill do nothing to curb frivolous lawsuits which creates defensive medicine and increases the cost of medicine but now the WSJ has found that the Democrats are using their bill to "subvert reform that is already on the books in many states".

What the bill has buried in it is a provision to supposedly incentivize states if they come up with an alternative medical liability law. However, that law cannot "limit attorneys' fees or impose caps on damages". Holy crap, Batman, can this party be more bought out by the trial lawyers? (Uh...yes...the labor unions). Anyway, back to the story. Without stopping the mammoth contingency fees and ridiculously large damage awards then there is no way to stop this runaway train.

To summarize: the states with malpractice reform may actually lose money from the Feds because they have a great plan in place. This is a backdoor slimy trick to kill the good that has already been done. Again, all this at the behest of the trial lawyers. President Obama, where is all the transparency you promised?

Oh, and if you read the piece you will see all the evidence on how these state malpractice reforms have worked (lower malpractice insurance, more doctors staying or coming to these states, etc). The Congressional Budget Office estimates a $54 billion savings over a decade if we institute proper tort reform. Another consulting group estimates $30 billion annually.

The Senate version, by the way, has NO malpractice reform either. Unbelievable.

Ridiculous Study of the Month: Pot Eases Stress

From the Journal of Neuroscience comes an amazing example of what we used call "no sh&t, Sherlock". Israeli researchers found that by giving stressed rats (via electric shocks) some pot they were, well, less stressed. Uh, duh. Am I the only one who realizes that the reason people smoke weed is because it causes some type of emotional state change?

"The results of our research should encourage psychiatric investigation into the use of cannabinoids in PTSD patients," wrote study author Dr. Irit Akirav of the department of psychology at the University of Haifa. I know a whole lot of people who would start claiming PTSD if this was approved.

On a side note, the same rats amazed the researchers by no longer showing up for the experiments, eating only Cheetos and demanding to play COD4: Modern Warfare 2. Who knew?

Twenty-First Century Preventative Pain Management Program by Michael Gorback MD

Barack Obama wants docs to focus on prevention. Never mind that his doctor can't get him to stop smoking, or that the Surgeon General suffers from Chronic Biscuit Toxicity (a Southern disease). If someone isn't well it's because the doctor failed to keep them well. I'm therefore working on my Preventative Pain Management Program.

Here are some ideas:

• I will deploy teams to go around telling people "Watch out! That floor is slippery!" and "Look both ways before you cross the street!" and "Lift with your knees, not your back - unless you have bad knees in which case you need to hire someone." Maybe ACORN can help me organize this.


• Taking a page from the colonoscopy book, we will offer bi-annual spine MRIs to detect evolving disease at an early stage.


• Everyone over 40 gets RF lesioning from L3 to S1 bilaterally and bilateral Simplicity RF to prevent back pain.


• After the age of 50 everyone gets an ESI every 6 months in case they get spinal stenosis. At age 65 they get a prophylactic 3-level posterior decompression.


• Hydrocodone in the water supply.


• The entire population of the United States will be placed on "light duty".

Missouri No Longer "The Sue Me" State...For Now

News out of the state of Missouri is that their malpractice claims hit a 10 year low. The reason? Well, tort reform measures were passed in 2005. They included a $350,000 cap on noneconomic damages in medical liability cases. It also included restrictions on where lawsuits may be filed and requirements that plaintiffs attach an expert opinion, or certificate of merit, with the initial filing of a case. This has resulted in lower malpractice insurance and an increase of doctors coming to the state. Hooray! A success story for the government to follow! Wait a minute...this just in....lawyers are challenging the reform measures before the state Supreme Court stating they "violate patients' equal protection and jury trial rights". What that last sentence means is that it violates the lawyers' paychecks. And this is why there is no tort reform and may never be any tort reform in the government's new plans. The present administration is beholden to the trial lawyers who backed them for their election. Mr. Obama, where is the transparency and honesty you have talked so much about?

My Maine Peeps

It is relatively refreshing to see the New York Times do a piece about the healthcare system in the state of Maine (where I work). It is nice to be loved. Here are some highlights:

• Maine's health insurance premiums are still among the least affordable in the nation, health care spending per person is among the highest and hospital emergency rooms are among the most crowded.


• Maine has the nation’s oldest population, its poor are among the sickest, and its median income ranks low.


• It has a dominant for-profit insurance carrier, Anthem Blue Cross and Blue Shield in Maine, which has roughly doubled premiums in the last five years and recently appealed in court to get even higher rates.


• Nearly a quarter of the state’s population participates in Medicaid.


• Maine’s poor are among the sickest in the nation, and its Medicaid benefits are relatively generous. Only Alaska spends more per adult Medicaid beneficiary.


• To compensate for such expensive care, the state pays doctors and hospitals relatively skimpy fees for treating Medicaid patients. As a result, doctors are closing solo practices and joining hospitals, which then have the market power to jack up rates to private insurers in a common problem called cost-shifting.


• The state is one of 17 that limit how much insurers can charge people for being older, and it does not allow exclusions for previous illnesses.


• Maine’s Legislature rejected a mandate for everyone to buy insurance so many young people do not or cannot buy insurance — further skewing the insured pool to sicker and older people and making premiums that much higher.

They forgot to mention that Maine has one of the heaviest tax burdens in the country for its population.

I am sure physicians from around the country are salivating to come here after reading the above. Well, there is always the moose and whoopie pies. That should tilt the scale somewhat.

This Is Not Your Father's Medical School

Check out this article in the Washington Post about how medical schools are changing their curriculum to fit the times. It sure looks like they are buying into managing "the patient as the whole" which I think is great but my fear is that a lot of politically correct agendas are being put on the schedule just to make the schools look good. "We came up with a number of drivers that made it clear to us that our curriculum was going to have to change to adapt to future societal developments". If that is true then they need to lower the cost of medical school making it easier to go into primary care. And pay primary care docs more. All the other stuff is just a pretty wrapper that accomplishes very little.

Compassion Fatigue My Ass!

More and more armchair quarterbacks are trying to figure why Maj. Nidal Malik Hasan gunned down 13 people and wounded another 30 at the Fort Hood Army Post in Texas. These type of analyses happen with any mass killing spree. The difference here is that Hasan was a psychiatrist. The issue that I am having with their so-called conclusions is that they are calling it "compassion fatigue". You have got to be kidding me! First of all, you have to prove to me that Dr. Hasan had any compassion in the first place. Second of all, doctors are not like postal workers. They don't go "postal" or "medical", if you will. They don't go on killing sprees! Here is a better article on compassion fatigue in Family Practice Management from 2000. Their definition is quite good:

Compassion fatigue is a deep physical, emotional and spiritual exhaustion accompanied by acute emotional pain. Whereas physicians with burnout adapt to their exhaustion by becoming less empathetic and more withdrawn, compassion-fatigued physicians continue to give themselves fully to their patients, finding it difficult to maintain a healthy balance of empathy and objectivity. Those who have experienced compassion fatigue describe it as being sucked into a vortex that pulls them slowly downward. They have no idea how to stop the downward spiral, so they do what they've done since medical school: They work harder and continue to give to others until they're completely tapped out.

Show me where Dr. Hasan kept giving himself to his patients more and more. Show me how he worked harder and harder with more and more compassion. For the families of the people killed at Fort Hood, please do not give this guy the benefit of being called compassionate. It is disrespectful. He did what he did because he was isolated, he no longer wanted to be in the military, he did not like who we were at war with, and no one would grant him his wishes to get out. Add to this the fact that he was a covert and warped religious zealot and you have the horrific results in Texas.

Doctors with compassion fatigue kill themselves. It is a terrible but sad truth. They don't, however, kill others. Dr. Hasan was a coward and the word compassion should NEVER be associated with his name.

The Physician: Employer or Employee? by Ted Bacharach MD (retired)

Just a few decades ago the physician was an independent small business man. When completing his or her training, he or she was able to open an office. Those days are pf the past for most physicians starting out. Encumbered with debt from prolonged schooling and training the cost of starting an independent practice becomes prohibitive. In a few instances, if the physician is willing to go to a rural area, it may still be possible to be independent, but for most, this is not easily possible. The independent physician does not have a patient base and it may not be easy to contract with health insurance companies.

The result of all this is simple. The physician starting out has to assume a job with a company. The result is that the majority of physicians have become employees. The ethical new physician guided by AMA ethics was supposed to place an ad no larger than a business card in the newspaper. Today the businesses which employ physicians take out full page ads, while most independent physicians could afford to treat the needy patient for nothing or whatever they were able to pay, this is no longer possible. The businesses that employ physicians have no pity and do not feel obligated to provide services for nothing. The physician once upon a time had the luxury of being able to refer patients to the specialist of his choice. This is no longer possible and referrals are determined by the parent organization.

Hospitals that can afford hospitalists are not anxious to see outside physicians come in. They also like to run hospitals without input from physicians. The companies that employ physicians also like to see them stay at their desks and see patients, rather than running off to the hospital, a not so profitable diversion in most instances.

There are of course some advantages for the physician, no night call, regular paycheck, and regular hours.

The question now arises, as employees, doctors have little bargaining power and protection from the Medical Associations is rather skimpy at best. It may well be that organizations that will protect our interests may become necessary.

The physician as a small independent businessman has passed along with the dinosaur.

Mad Cereal Men

Did you know that Cocoa Krispies may help your kids ward off the H1N1 flu? You can see from the above image how their new marketing plan is touting that they have 25% of our needed daily vitamins with some antioxidants which will "support your child's immunity". This is an example of a marketing team going crazy and trying to enter the world of medicine....and failing. The USA Today was all over this on November 2nd and then ripped them again the next day in their opinion piece. This whole thing relates to the new "Smart Choices" program that the cereal industry has locked into and it is something that I have written about earlier (and predicted would cause some controversy). The bottom line is that having non-science people extrapolating medical evidence to make a buck is a bad idea. They have been doing it for years for commercials for weight loss products, etc. and now Kelloggs wanted in. Reminds me of that old SNL bit called "Bad Idea Jeans". I guess Kelloggs got the point because they just pulled the ads. More to come.

The Pelosi Bill

The Wall Street Journal looked at the House's bill for healthcare reform and trashed it. Admittedly the WSJ is a conservative newspaper but I think this piece is an interesting analysis of what the Democrats have dreamed up. Here is a breakdown (my comments in italic):

• The Congressional Budget Office figures the House program will cost $1.055 trillion which is a little more than the $829 billion net cost the Dems have been claiming. ObamaCare will be lucky to cost under $2 trillion over 10 years; it will grow more after that.


• The House is counting on Medicare payments to doctors will be cut by 21.5% next year and deeper after that. Doctors love hearing that one.


• The House will expand eligibility to Medicaid to everyone below 150% of the poverty level, meaning that some 15 million new people will be added to the rolls as private insurance gets crowded out at a cost of $425 billion. A decade from now more than a quarter of the population will be on a program originally intended for poor women, children and the disabled. Few physicians take Medicaid as it is because it pays so little. Maybe in the future physicians will have to actually pay to see these patients instead of getting paid themselves?


• The amount of new taxes will be "European-like" starting with surcharges on the rich and moving lower and lower as more money is needed (think Alternative Minimum Tax). Even if Congress had confiscated 100% of the taxable income of people earning over $500,000 in the boom year of 2006, it would have only raised $1.3 trillion. To quote one of my favorite movies, "Where's the money, Lebowski? "


• The cost of insurance may triple under new burdens to cover "everyone" irregardless of medical history or health status. Private insurers may indeed go the way of the dodo and employee plans would be done as well.


• Mr. Obama's own Medicare actuaries estimate that the federal share of U.S. health dollars will quickly climb beyond 60% from 46% today.


• The new plan may cover more people but in the process will make care even more expensive and rigid than the status quo.

This is going to be a very bumpy ride.

Golf Suspension

For those that don't think golfers use PEDs then think again. Doug Barron, a 40-year-old journeyman who lost his tour card three years ago, became the first player to be suspended by the PGA Tour for testing positive for a performance-enhancing substance. Though the type of substance used was not disclosed it is obvious from the actual picture of Barron above that is was anabolic steroids.