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Aug 8, 2009

ObamaCare and the Doctor

ObamaCare and Me
08/06/09 - American Thinker By Zane F. Pollard, MD

I quote here this clear and frightening article describing Medicaid, and by extension ObamaCare. Medicaid pays for medical services to the poor, and in this case to poor children who face vision impairment or blindness.

Regardless, Medicaid denies and delays their care.

I have edited for clarity and added subtitles. See also the excellent comments at the original article, many by doctors.

Medicaid in Atlanta

I want to explain many of the problems of nationalized healthcare from my perspective as a doctor. I have practiced for 35 years in Atlanta, Georgia, in the only group there offering pediatric ophthalmology services to Medicaid patients.

The government has involved very few of us physicians in the healthcare debate. The American Medical Association favors Obama's plan, but remember that the AMA represents just 17% of American physicians.

Delay and Denial of Antibiotics

In the past 6 months, I have cared for three young children on Medicaid who had corneal ulcers. Blindness almost surely results if the cornea perforates from the infection. In all three cases, the required antibiotic was not on the Medicaid list.

I was told each time to fax Medicaid for the approval forms. The form came back to me in 48 hours, which I then immediately filled out and faxed back. They told me that I would have my answer in 10 days. By then, each child would have been blind in the affected eye. Each time, I personally provided the antibiotic.

Anyway, each request was denied. This is rationing of care.

Delayed Approval Causes Disability

I have cared for over 1000 children born with congenital cataracts. In older children and in adults, we insert an intra-ocular lens. In newborns, we use very expensive contact lenses. It takes Medicaid over one year to approve a contact lens after cataract surgery. By that time, the child would be close to blind from not focusing his eyes during early development.

Again, this is extreme rationing. I have a foundation supported 100% by private funds which supplies these contact lenses for free to my Medicaid and illegal immigrant patients.

Rationing in Sweden

I saw the child of an American who lives and works in Sweden for a big corporation. The child had developed double vision 3 months before and was unable to function normally. They had money, but would have waited 8 months to see an ophthalmologist in Sweden. Then, if the child needed surgery, they would wait 6 months more.

The mother called me, and I saw her that day. The child had accommodative esotropia (crossing of the eyes) and responded to corrective glasses within 4 days, so no surgery was needed.

Surgery Would Be Denied Due to Age

Last month, I operated on a 70 year old lady with double vision present for 3 years. She responded quite nicely and now is symptom free.

I also operated on a 69 year old judge with vertical double vision. His surgery went very well, and now he is happy as a lark.

I have been told that the current healthcare bill would deny these people surgery because of their age. They would be told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously, cheaper than surgery.

Rationed Care in the Military

I served two years in the US Navy during the Viet Nam war, and I was well treated by the military. But, there was tremendous rationing of care. We were told specifically which things the military personnel and their dependents could have, and which things they could not have.

While I was in Viet Nam, my wife Nancy got sick and received essentially no care at the Naval Hospital in Oakland, California. She went home and went to her family's private internist in Beverly Hills. While it was expensive, she received an immediate workup.

When Stents Are Indicated

This bill in its present form might be lethal for people over 65. People over age 59 in England cannot receive stents for their coronary arteries. The U.S. government wants to mimic the British plan. If you are younger, it will still restrict the care that you and your children receive.

Paying Doctors Less

99% of physicians chose medicine because we love medicine and the challenge of helping our fellow man. But, economics are still important. My rent goes up 2% each year, and the salaries of my employees go up 2% each year. Twenty years ago, ophthalmologists were paid $1800 for cataract surgery. Today it is $500, a 73% decrease in our fees. Few jobs in America have seen this sort of decrease.

There was a well known ophthalmologist in Atlanta who charged $2500 for a cataract surgery. He had a terrific reputation. In fact, he operated on my mother's bilateral cataracts, with a wonderful result. She is now 94 and has 20/20 vision in both eyes. People would pay his $2500 fee.

Then the government said that any doctor that does Medicare work cannot accept more than the government-allowed rate, now $500. The government made it illegal, subject to fines, to accept more. Those of you who are well off will not be able to go to the head of the line under this new healthcare plan, as no physician will be willing to go against the law to treat you.

I trained for 10 years after college to become a pediatric ophthalmologist, plus two years in the Navy to total 12 years. A neurosurgeon spends 14 years after college, and possibly 2 years in the military, to total 16 years.

The new plan calls for all physicians to receive the same fees. I assure you that medical students will not go into neurosurgery, leading to a tremendous shortage.

The top neurosurgeon at my hospital has just quit. He is in good health and only 52 years old. 49% of children under the age of 16 in the state of Georgia are on Medicaid, and he felt he just could not stand it any more, working with the bureaucracy.

Furthermore, how could you trust a physician who works under these draconian conditions controlled by the state? I certainly could not.

Physician Shortages

This new healthcare plan will create a tremendous shortage of physicians. Here are the estimates. About 5% of physicians will quit under this new system, and another 5% shortage will occur because fewer people will want to go into medicine.

For the past 15 years, the government has required gender equity in medical school admissions. 49% to 51% of each entering class are women. This is also true of private schools, because they all receive federal funding.

The average career of a woman in medicine now is only 8-10 years, and her average work week is only 3-4 days. I have trained 35 fellows in pediatric ophthalmology. By far the best was a woman that I trained 4 years ago. She now practices only 3 days a week.

As mostly male physicians retire, it will be difficult to replace their working contribution, given the gender balance and working preferences of new physicians. -ag

Needs and Results

We are being lied to about the uninsured. They are getting care. I operate on at least 2 illegal immigrants each month who pay me nothing. The children's hospital at which I operate also charges them nothing. This is true not only of Atlanta, but of every community in America.

I urge all of you to contact your congressmen/women and senators to defeat this bill. I promise you that you will not like rationing of your own healthcare.

Health-Care Reform: A Better Plan
08/07/09 - Washington Post by Charles Krauthammer

[edited] Today's ruling Democrats propose to fix our extremely high-quality (but inefficient and therefore expensive) health-care system with 1,000 pages of curlicued complexity.

They promise that this massive concoction will lower costs. Their solution is employer mandates, individual mandates, insurance company mandates, allocation formulas, political payoffs, and myriad other regulations and interventions

This is all quite mad. It creates a Rube Goldberg system that multiplies current inefficiencies and arbitrary rules. This will produce staggering deficits, less choice, and lower-quality care. That's why the administration can't sell Obamacare.

The administration accuses critics of being for the status quo. Nonsense. Candidate John McCain and a host of other Republicans have offered alternatives.

Let me offer my plan. Strip away current inefficiencies before remaking one-sixth of the U.S. economy. There are just two parts: radical tort reform, and severing the link between health insurance and employment.

Eight Years of U.S. Military Healthcare
03/13/10 - Comment by LisaM at NeoNeocon

Read the whole thing. Here is an edited summary. All of the rules and attitudes operate to ration care while hiding that policy.

Motto: We care for everyone who calls us. You just have to call at the right time.

I used the U.S. military medical system for 8 years as a family member. The doctors were great and they were only interested in treating patients. However, the infrastructure around them was maddening and dangerous.

You could only call at 7:00 AM on the first Tuesday of the month to schedule an OB/GYN appointment. While trying to call, all appointments were taken by 7:10, and you had to try again the following month.

My sister had ovarian cancer and needed 6 month checkups. She was called selfish when she tried to make more than one appointment per year. She would be dead now if she had not paid personally for extra civilian screenings.

I was at the Portsmouth Naval hospital. They sent me to the lab on the 8th floor. The elevator was broken. They called my name while I was trudging up and down the steps, and I missed my turn. Too bad for me.

I waited 4 hours at the pharmacy for a prescription. I noted that the medication was different than written. They told me I was lucky to get that.

The day I escaped government-run health care was a very happy day indeed.

19 Years of Army Medicine
03/13/10 - Comment by Gray at NeoNeocon

[excerpts] Strep throat. Diagnosed as strep, but only given 7 days of antibiotics: “that is how we do it, soldier.” Violent recurrence with sepsis. Week of IV antibiotics. “Thought we almost lost you there.”

Pneumonia. Incorrectly diagnosed as allergies: “You need plenty of physical training and water. Try some triaminic cough syrup for those allergies.” 103deg fever. Passed out at my desk taken to Army hospital. Days of delerium. IV antibiotics. “Thought we almost lost you there.”

At Kimbrough (nicknamed Killbro) hospital at FT Meade, Maryland, they killed my units’ Sergeant Major following surgery for diverticulitis. He was 40 and passed out during a run, after his ill-sutured bowel leaked into his body. Peritonitis.

1 comment :

Throckmorton said...

The statements about Medicaid hit home for me. I am one of the rare specialists in my area that will take Medicaid. I did this because I promised myself that I would try to see anyone I could regardless of their ability to pay. What I found out is Medicaid pays 60% of Medicare and I had to employ three people just to handle all the extra paperwork that Medicaid entails. Then when I try to take care of the Medicaid patients I have to spend three times as much time becuase of all the hassles with denied medications and paperwork. In all sense, it costs me more to take care of Medicaid patients than it does to just give the care for free!

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