Obama and the Practice of Medicine
Dr. Scott Gottlieb, a practicing physician and fellow at the American Enterprise Institute has an interesting op ed column in today’s Wall Street Journal. In it Dr. Gottleb explores Pres. Obama’s apparent lack of understanding about the practice of medicine and the reasons for rising health-care costs:
On the defensive because of an increasingly skeptical public, President Barack Obama has recently spoken extemporaneously about his health plan. In doing so, he has revealed his lack of understanding about aspects of medical practice and the reasons for rising health-care costs.
One theme the president has focused on is doctors’ motives. During a prime-time press conference on July 22, the president referred to a doctor who muses that she makes “a lot more money if I take this kid’s tonsils out”—even if the child might not need surgery. Responding to a woman whose spry 100-year-old mother was given a needed pacemaker despite her age, the president said a few weeks earlier (at an ABC News town-hall event at the White House) that doctors should let patients know that sometimes “you’re better off not having the surgery, but taking the painkiller.”
Mr. Obama’s clinical scenarios represent an excessive—if not erroneous—take on how doctors are influenced by financial incentives. This jaundiced view on medical decision-making may explain why programs the White House is proposing to lower health-care costs rely on the direct regulation of medical decisions. If Mr. Obama is serious about lowering costs, he’ll need to reform the economic structures in medicine—especially programs like Medicare.
Medicare data shows that for the most part, major surgeries aren’t the source of waste in health care. These kinds of procedures are typically guided by clear clinical criteria and are closely scrutinized by doctors and patients alike. Rather it is in routine procedures and treatments that economic incentives factor heavily into doctors’ decisions.
President Obama’s comments questioning the motives of doctors have been, to say the least, rather disturbing… disturbing enough that they’ve prompted the America College of Surgeons to issue following statement:
The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight.
Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.
Three weeks ago, the President suggested that a surgeon’s decision to remove a child’s tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what’s right for the patient.
We agree with the President that the best thing for patients with diabetes is to manage the disease proactively to avoid the bad consequences that can occur, including blindness, stroke, and amputation. But as is the case for a person who has been treated for cancer and still needs to have a tumor removed, or a person who is in a terrible car crash and needs access to a trauma surgeon, there are times when even a perfectly managed diabetic patient needs a surgeon. The President’s remarks are truly alarming and run the risk of damaging the all-important trust between surgeons and their patients.
We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care.
The bottom line here is simple… the President needs villains to demonize while selling his radical reform of our health care system. Consequently he’s resorting to callous and cavalier distortions questioning the motives of doctors while surrogates like House Speaker Nancy Pelosi demonize insurance companies and question the motives of those who oppose their agenda.
Frankly I have more faith in doctor’s judgment and motivations than I do in President Obama’s.
Related
- Tort Reform Can Lower Costs Without Harming Health Care. So Why Isn’t It in Obama’s Plan? – Pajams Media
- Troubling Questions Remain About Obama’s Health Care Plan – Sarah Palin
- It’s Reasonable To Be Angry – Wizbang
- The Myth of the 46 Million – American Spectator
- Facing health-care oblivion, the left finally wonders: “Who really is Barack Obama?” – Hot Air
- What Sarah Palin Is Fighting: Dispatches from the Health Care Front – Conservatives4Palin
- Orthopedic Surgeons respond to Obama on amputation comment – American Thinker
The Politics of Health care
One of the more important battles of the next few years is going to be health care reform. I’ve mentioned before I’m opposed to any kind of government run socialized health care system. I have relatives in Canada so my perspective on socialized medicine is a little more direct than most… Suffices to say be careful what you wish for, you might get it.
The Wall Street Journal and American Thinker have both published must read essays on health care recently, if haven’t read them you should.
First is Carol Peracchio’s January 7th essay at American Thinker.com:
Take Two Aspirin and Call Your Congressman in the Morning
When President-Elect Obama nominated Tom Daschle to be his Secretary of Health and Human Services, he proclaimed the former Senate Majority Leader: “one of America’s foremost health care experts.” Obama stated Daschle will be the “lead architect” of the administration’s health care plan. As a nurse, I am always concerned when the government announces it has plans for our health care, so I decided to investigate Mr. Daschle’s ideas. I read his book Critical: What We Can Do about the Health-Care Crisis.
Senator Daschle wrote his book with 2 other experts, Scott S. Greenberger and Jeanne M. Lambrew. According to the flyleaf, Greenberger is a reporter and consultant. Lambrew is a senior fellow. Tom Daschle, of course, is a former US Senator and now a visiting professor and Distinguished Senior Fellow. The back cover of the book has advance praise from 3 senators, a former White House chief of staff, yet another senior fellow, and a professor/dean at a public policy institute.
To paraphrase a famous quote by Sam Rayburn, “They may be just as intelligent as you say. But I’d feel a helluva lot better if just one of them had ever emptied a bedpan.” Read the rest…
Second is Congressman Tom Price’s Op Ed in yesterday’s Wall Street Journal:
The GOP Should Fight Health-Care Rationing
Obama’s HMO deserves principled opposition.
By Tom Price, Wall Street Journal, January 7, 2009
Perhaps the greatest missed opportunity of the past eight years was the chance for Republicans to fundamentally reform the terribly broken American health-care system. Access to quality health care has long been a professed priority, yet Republicans have been reluctant to tackle the issue.
As a physician, this is deeply disappointing to me because patient-centered health care is, at its core, conservative. Health care is fundamentally a personal relationship between patients and doctors. To honor this relationship — consistent with Republican ideals — our goal should be to provide a system that allows access to affordable, quality health care for all Americans, in a way that ensures medical decisions are made in doctors’ offices, not Washington.
Republican unwillingness to address the issue, however, has left us facing an emboldened Democratic Party well equipped to push a government-centered health-care agenda. While Democrats are still dangerously misguided in their policies, this time they are prepared to avoid the political mistakes of the Clinton administration. Read the rest…
And finally Scott Gottlieb’s Op Ed from today’s Wall Street Journal:
What Medicaid Tells Us About Government Health Care
Why would Obama want to build on a system with poor outcomes?
By Scott Gottlieb, Wall Street Journal, January 8, 2009
Medicaid provides coverage to poor and disabled Americans, many of whom face the highest burden of chronic disease owing to cultural and socioeconomic challenges. The program beats being uninsured, but it often relegates the poor to inferior care.
Reimbursement rates are so low, and billing the program so complicated, that it is hard for internists like me to get beneficiaries access to specialized care or timely interventions. For my patients as well, many of whom are uneducated or don’t speak English, Medicaid is replete with paperwork, regulations and rejections that make the program hard to navigate.
Now Medicaid is to receive a bolus of federal money, probably as part of the fiscal stimulus plan — the figure whispered in Washington is $100 billion — with no obligation that the program does anything to reverse its decline. Read the rest…
From my perspective one of the problems we face in the health care debate is that a great many people have an unrealistic expectation of what their health insurance should cover. I have private health care insurance and I’m happy with it. It’s not cheap, it costs me roughly $600.00 a quarter and I have to pay $5000.00 deductible in a calendar year.
That’s fine I don’t mind paying out pocket for routine office visits or prescription drugs. All I want from my health insurance is protection from catastrophic expenses and that’s exactly what it provides.
Weekend Recap
For the most part I stayed away from the computer and the news this weekend. I did come across a couple of must reads in the Wall Street Journal though.
The first is Brian Carney’s weekend interview with Anna Schwartz, Ms. Schwartz is well known economist and her views on the current economic crisis are quite interesting.
Bernanke Is Fighting the Last War
‘Everything works much better when wrong decisions are punished and good decisions make you rich.’
By BRIAN M. CARNEY
On Aug. 9, 2007, central banks around the world first intervened to stanch what has become a massive credit crunch.
Since then, the Federal Reserve and the Treasury have taken a series of increasingly drastic emergency actions to get lending flowing again. The central bank has lent out hundreds of billions of dollars, accepted collateral that in the past it would never have touched, and opened direct lending to institutions that have never had that privilege. The Treasury has deployed billions more. And yet, “Nothing,” Anna Schwartz says, “seems to have quieted the fears of either the investors in the securities markets or the lenders and would-be borrowers in the credit market.”
The credit markets remain frozen, the stock market continues to get hammered, and deep recession now seems a certainty — if not a reality already.
Most people now living have never seen a credit crunch like the one we are currently enduring. Ms. Schwartz, 92 years old, is one of the exceptions. She’s not only old enough to remember the period from 1929 to 1933, she may know more about monetary history and banking than anyone alive. She co-authored, with Milton Friedman, “A Monetary History of the United States” (1963). It’s the definitive account of how misguided monetary policy turned the stock-market crash of 1929 into the Great Depression.
Since 1941, Ms. Schwartz has reported for work at the National Bureau of Economic Research in New York, where we met Thursday morning for an interview. She is currently using a wheelchair after a recent fall and laments her “many infirmities,” but those are all physical; her mind is as sharp as ever. She speaks with passion and just a hint of resignation about the current financial situation. And looking at how the authorities have handled it so far, she doesn’t like what she sees.
Federal Reserve Chairman Ben Bernanke has called the 888-page “Monetary History” “the leading and most persuasive explanation of the worst economic disaster in American history.” Ms. Schwartz thinks that our central bankers and our Treasury Department are getting it wrong again.
To understand why, one first has to understand the nature of the current “credit market disturbance,” as Ms. Schwartz delicately calls it. We now hear almost every day that banks will not lend to each other, or will do so only at punitive interest rates. Credit spreads — the difference between what it costs the government to borrow and what private-sector borrowers must pay — are at historic highs. Read the rest…
The Second is Scott Gottlieb’s Op Ed on Drug research, Dr. Gottlieb is a practicing physician and a resident fellow at the American Enterprise Institute, his column examines how government policies are stifling research into drugs to treat common medical problems.
How Obama Would Stifle Drug Innovation
If you want cutting-edge health care, don’t make it a cost-controlled commodity.
By SCOTT GOTTLIEB
Pfizer recently said it’s exiting the development of drugs for common conditions like heart disease. This is part of a shift underway in the pharmaceutical industry to give up on routine medical problems in favor of discovering “specialty” drugs for rare diseases and unmet medical needs like cancer.
The shift is driven in part by the industry’s critics in Washington, who have long maligned drug companies for targeting too many routine medical problems with drugs that were “merely” tweaks on existing medicines. Now these same detractors, led by House Democrats, are proposing controls on access to and eventually pricing of the specialty drugs as well. Under a Barack Obama presidency, this is one way they’ll pay for the candidate’s plan to create a Medicare-like program for the under-65 crowd. These new controls — based on a view of medical care as a commodity to be purchased at the lowest price, with little allowance for innovation — could push drug development over a tipping point.
Specialty drugs offer significant health benefits but for a high price, reflecting the difficulty of developing them. The regulatory process for getting them approved is more uncertain, since the diseases are poorly understood or haven’t been tackled before in clinical trials. Enrolling patients with rare conditions is also expensive; they are harder to recruit and often need to undergo more extensive testing to monitor the progress in trials. It can cost less than $5,000 to enroll a single patient in a trial for a primary care drug such as a blood pressure pill, but up to $70,000 for a big cancer study and more than $100,000 for some very rare diseases. Specialty drugs that were once tested on hundreds of patients are now often required by the Food and Drug Administration (FDA) to be tested on thousands.
Success rates are low. On average, a drug stands an 11% chance of making it through clinical trials and reaching patients. Cancer drugs only have a 5% chance of clearing these hurdles. Specialty drugs are also harder to distribute and by definition have a much smaller market for sales. Read the rest…
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