Health Care Reform: Marred by Conflict

This is the third or fourth article I have written about health care reform. There are so many ramifications with this reform struggle, that it lends itself to in depth analysis from innumerable perspectives. I have concerns about being labeled a "spoiler" or a "right wing extremist" but I am neither of these. I am just fascinated with the implications of this battle that come from our American culture and government.

First of all, I believe we do need some health care reform. Obama has said things that are correct such as the costs are one of the factors that are ruining our economy. We need to control costs, but I'm not certain what he recommends will do it. There are two fundamental truths that must give all of us some fear about this debate.

The first is, that all governments,including ours, lie to their constituents. I know this is not what one wishes to say about one's government, but it is simply the truth. History proves it. Take the "withholding tax" on our wages. It was instituted during WWII because they needed the money for the war effort. It was going to stop after the War ended, but it wasn't. Another more applicable example would be the title of the first paragraph of the Medicare law which reads,"Prohibition Against Any Federal Interference." The federal government interferes everywhere with the practice of medicine even though it promised not to. That's just what governments do!

Now,I don't believe that the "good people" up there in Washington would purposefully lie, but once a law is created, events happen that force revisions that frequently make the original concept contain lies that may not have been originally intended. History works that way. The trick is to figure out what might happen, and how a law might change in the future, and do everything to protect all of us from these unintended consequences.

A second, more serious problem with our government's proposals is the understanding that the Congress has a integral conflict of interest with this type of legislation. Without beating around the bush, they have promised too much, and they cannot afford all of their promises: Social security, Medicare, Medicaid, government pensions to name a few. It turns out that the shorter our life spans, the less our government has to pay to meet these obligations. Dead people don't collect Social Security!

Here, our government is walking a thin line. Counseling the elderly about "end of life decisions" approaches this conflict a bit too openly, and explains why this provision was removed from the bill. Unfortunately, this conflict does not go away with that small change. How about cancer therapy, or dialysis, or coronary bypass for the elderly? Does that prolong life and increase its financial obligations to us citizens? Unfortunately, our government, and not our lawmakers, is constructed to benefit when laws are passed that encourage all of us to die early. It's best if our government avoids tampering with laws that directly influence our longevity. Controlling our access to medical care does just that.

Again, we do need health care reform, but ObamaCare it too controlling and raises more conflict than it solves. The hostile reaction of our citizens is directly related to the underlying conflicts just raised, and they will not go away. Tort reform, insurance regulation, and futile care legislation would be a good start to the type of reform we really need. Where is it?

James P. Weaver,M.D.,FACS

Why So Much Trouble with Health Care Reform?

The battle is getting brutally fierce now at the town meetings. Congress folks are seeing the righteous anger of the people. Why, one might ask, is this happening? Don't we have a "broken health care system" and doesn't everyone want health care reform NOW!? Why are people acting so vociferously against this proposed legislation?

I believe that health care reform threatens the indispensable fundamental principles that have formed the foundation of the social structure of the United States: individualism, freedom, and most of all our basic distrust of government. In addition, there is charity. Americans are generous and they resent government stealing from one group of citizens to give to another group, especially when government acts like it deserves all the credit. All of the money that our government possesses has been taken(by force) from us citizens. I think most of us are tirelessly laboring daily to possess a little property, and watching our government throw it around ad lib (without reading the bills) is infuriating to us all.

Individualism runs through America's collective soul. Individualism also represents a quality of what is means to be an American. We are supposed to be FREE. Free to do what we wish, make decisions on your own, and free to face the consequences. Our freedoms define America, and give it the social energy for economic expansion and individual opportunity for success.

The problem with health care reform (and with the dreaded "public option" in particular) is that it threatens everything that represents FREEDOM. Will the government control what kind of medical care we can have? Will it control medical decisions so that we can't trust our doctors? Will it attempt to hasten our demise to lessen the entitlement debt it owes us- and that we were forced to pay for- as we get old? Doesn't our government have a fundamental conflict of interest in this debate anyway? After all, government is looking for ways to control costs, and our death would save the government money? These are genuinely frightening ideas because if they come to pass, and we can imagine they might, our freedoms will be taken away.

What it finally comes down to is our instinctive distrust of government. If this health care reform occurs, we are going to give our government a lot more control over our lives and our personal choices. As that woman in Philadelphia said the other day,"medicaid is broke, Medicare is going broke, Social Security is going broke, and the cash for clunkers program is failing. How can we give you (to Arlen Specter) control over another one-sixth of the economy? No way Senator, no way!"

I think we need to remember that the statue in the New York harbor is called "The Statue of Liberty." It is not the statue of safety through government handouts. The fundamental problem with this movement (appropriate term) is that it threatens the essence of what America is supposed to mean as a country of personal freedom. Somewhere in this demagogic attack on the previous promise of our God given freedoms is the source of the unrest with this Democratic health care push. Yes, we do need change in health care, but not because we have the worst system in the world, but because it needs some changes. What we do not want is the undoing of the essence of our social structure by allowing our government to make all of these personal decisions for us. We can't trust them now, can we?

What we need is tort reform first, but politics is preventing that, and that "prevention" adds to the distrust of this whole movement. Next, we need controls on the insurance companies to make the vast majority of the health care dollars flow into the "care" system, and not into the pockets of the insurance bureaucrats. Finally we need a futile care law that basically says that when three doctors determine that a situation is "futile" that the family has one week to understand or the care is withdrawn in spite of objections. At that point only comfort measures are given.

Oh, there are other things we could do like tamper with the "preexisting condition" problem, or waste and fraud in the system itself. Yes, we do need change but a government takeover is not the way to proceed. I do not believe that, justifiably, there is enough trust in our government to allow sort of change that the liberals are proposing. It threatens too many of our guaranteed freedoms. Remember, life, liberty and the pursuit of happiness?

James P. Weaver, M.D.,FACS

Open letter to the American College of Surgeons

I have been a member of The American College of Surgeons since the mid 1970s, and have watched many decisions by this body that have lessened the professional standing of surgeons in our nation (American College of Surgeons, Where are you?,Mychasecuts,March 2009), but the current health care debate has revealed, unfortunately, another mistake in leadership of our organization that will have far reaching consequences for our collective futures as surgeons.

The College has recently acknowledged that they are supporting this "reform" because they need to have a "seat at the table." Apparently the College is afraid that if it is not "at the table" Congress will not hear its opinions on issues it believes are vitally important. It seems that the College does not understand or value history. First of all, what makes us believe that we can trust the Congress? History proves otherwise. The first paragraph of the Medicare law has a title: "Prohibition Against Any Federal Interference." Does anyone believe that the Federal Government has not interfered with the practice of medicine? Of course they have, and they intend, or rather they MUST continue to do so for Congress has no choice.

In order to stay in office, Congress makes rash promises to voters. This forces them to tell half-truths, and twist ideas while they promise these "gifts." There is no way they can afford these "gifts" as their promises, especially on health care, are economically unsustainable. They promise, however, because they wish to stay in power. In a sense, they are "forced" to lie! I cannot understand why the College fails to see this fundamental truth.

It is clear that our government is tampering with the lives and sweat, in essence the freedoms, of highly trained surgeons, and not considering the details of the "surgical lifestyle," market forces, work environment and need for a surgeon's hope for the future. Surgeons are small minority in this BIG problem of medical care delivery, and the Congress is certainly going to roll over our rights. They will do it slowly, but THEY ARE GOING TO DO IT! After all, is the ruthless intimidation that has been used to "force" us to come to their table the work of a group that will listen to our position?

The College should have refused to sit at a table with this bunch of bureaucrats that, history has shown, are going to smile, and wish us well, and then do exactly what they want to. They have flagrantly violated the promise of "prohibition against any Federal interference."

Does the American College of Surgeons really want to be part of this fiasco? The American people are not and have not been told the truth. Once this plan is in, and time exposes the certain draconian consequences, we will fare better if we are not a part the original planning. Won't we be blamed also if we are "at the table?"

The College surely knows that there are only two ways to control the distribution of any resource: price or availability. In countries where price is excluded by politics, and there is a nationalized system, availability is the means of control of expenditures. That explains why it takes three months to have a MRI in Canada. Do we want the same? It would be appreciated if our representatives would at least admit publicly that we will have to have many objectionable ways to control costs in their incipient system.

Finally, I cannot understand how the College is so far distant from my personal understanding of this movement (appropriate term). I have been a practicing surgeon for almost 40 years now, and have an excellent feel for the essence of medical practice. Where does the leadership get their understanding of the desires of the members? A survey would be helpful. Do they believe that they know so much more than the membership that they can diverge completely from the desires and understandings of the group?

Surgeons, in the past, have been trained to persevere and approach obstacles with quiet courage and unshakable fortitude. Where is this attitude in our current leadership? Have they stood before the Congress and told the TRUTH? I do not believe so. Is the palace of government so intimidating that we cannot articulate the necessity of our personal God given rights to this bunch of charlatans? If the College cannot do it, who then, will? How many of our personal rights are we going to sacrifice by slobbering up to the government trough of handouts? This will inevitably affect our behavior with our patients and with that our professionalism. May God help us all.

James P. Weaver, M.D.,FACS