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

Our Brother's Keepers? Not Quite!

It looks as if ObamaCare is running into snags that may postpone or even stop the passage of this massive health care reform effort. It appears that now even the Democrats are balking at the projected expenditures. But on a purely social level, I think The People are having trouble accepting this idea. It is coming down to a question of exactly how much do we want to to be forced to help our fellow citizens?

This bill will eventually put all of us into the same health care system. After all, the "boss" has said that we are all going to have to "sacrifice" a bit to do this. But how much do we each have to sacrifice? And more importantly, how much are we each willing to sacrifice, and for whom are we going to sacrifice?

Most of us feel we sacrifice each day. We get up, go to work, and "put in our time." Most of us feel that work "gets in the way of living." If we are going to sacrifice, it has to be for a good cause, doesn't it? What then is a good cause?

How about sacrificing for the smokers who have puffed for 50 years and can't stay out of the hospital? And how about the "drugies" who get heart infections from using dirty needles, or even how about for those who eat themselves into enormity, and just can't walk across the room anymore? Do most of us believe that personal sacrifice is worth it for these problems? Don't kid yourself those who are "towing the line," and trying to make their lives decent and fruitful don't believe it is. That's one good reason why this idea is going to fail. The people don't believe it is fair.

I don't think most of us are willing to give to people who just don't try to take care of themselves. It is probably OK for those who run into unfortunate problems that are out of their personal control, because we all have this risk, and would want help if it happened to us.

Then there are more difficult questions. How about sacrificing for the 88 year old with cancer who continues on dialysis for months before death? How about continued feeding for a totally demented person who doesn't even know his own family? All personal choices that we will all pay for under this proposed systems. Why are these questions important? Because if the government (WE) is paying for health care, we will have to pay for these things. Do we want to?

Then there are the proposed taxes on the wealthy. Why should we single out the most successful people in the society, to pay for this. They are paying enough already aren't they? The upper 3% of tax payers pay about 60% of the taxes to start with. What is a fair tax anyway?

I don't think anyone should be forced through taxes to give more of their life to the government than anyone else. Why should one person have to work through May to pay taxes, and other people only have to work through February to pay theirs. I think it is morally questionable to take more "life" from those who have achieved the most in this society, and force them to work through May for the government. This is simply a case of class warfare, and it is not much different than "picking" on a group of people because of another unique characteristic like maybe the color of their skin!

This scheme raises too many questions about the fundamental relationship of our government to its people and the relationship of the people to each other. We are a people who believe in individuality and personal freedom. The collectivist concepts in this maneuver are difficult to sell to us. Thank God they are difficult to sell, for that implies that there may still be hope for all of us for a better future.

James P. Weaver, M.D.

Obama Care. Humbug!

I have been watching the developments in the Obama Care parade, and I have not commented, because he talks about the "nay Sayers" in an effort to discredit us, but I can't keep quite anymore. Too much astute distortion and half truths are flooding the airways that something must be said about this "obamination."I listened to most of his speech to the AMA. Listening to the applause of that bunch of sycophants, hoping that the income of the primary care doctors will be raised, made me nauseated. They don't care what happens to the field of medicine, or the patients, because anyone with half a brain can see that Obama's vision of health care will be a catastrophe.

His first two methods of financing this debacle will be the EMR (electronic medical records), and preventive care. What a joke. I do believe the EMR will help transmit information so it is not duplicated, but that is a drop in the bucket. Who, may I ask, will pay for the installation of this technology into any of the offices? The software people have not had to deal with "maximal allowable charges" as medicine has, so we cannot pay their exorbitant fees.

But the biggest fallacy of Obama cost saving ideas is "preventive care." He thinks we are going to get everyone to eat right, stop smoking, and exercise. I guess if they earn less than $250,000 per year he will pay them to live healthy. He has no idea what the practice of medicine is about. I have been trying to get people to do this for 30 years. They do what they want to. Maybe the government will FORCE people to do these things. His ideas like this make me wonder how unrealistic his other ideas will be about this topic. It's brutally frightening!

As for malpractice reform, physicians didn't get the time of day from this highly trained lawyer. Any physician knows that many dollars are wasted in defensive medicine. I guess the lawyers stick together. More importantly,I worry that the most powerful man in the world cannot get the perspective of physicians that are being robbed by the malpractice insurance companies each year with exorbitant fees. Why don't the patients foot some of this bill? They could purchase a policy prior to any procedure, to cover "insurance." That policy could stipulate that Obama's sacred "caps" would not apply.

Another area which is dubious is the total lack of discussion of the physicians in these plans. After all, our government is about to enslave a group of highly trained,educated, hard working people to "give" their talents to other citizens for a government controlled fee. In controlling these "fees" the government has a fundamental conflict of interest: they're paying the bills and they can't afford it. It doesn't look good for the physicians.

Each time the government puts in another program in place, they split the medical profession along specialist and generalist lines to gain the "support" of medicine. There are many more primary care physicians than specialists; it's easier to get that training, and the lifestyle is easier. I had eight years of training after medical school myself to become a vascular surgeon. Obama has promised the primary care doctors "more" to get their support. The problem is that primary care doctors may be replaced by nurse practitioners and physician "extenders" in the new Obama care. Their work comes cheaper, and, after all, he plans to "save money" to pay for this thing by cutting expenses in the delivery of medical care.

Finally, I agree with him that something needs to be done. But let's first be honest with our citizens. I'm sorry folks, but we cannot all have everything we want from medical care and, I fear, everything we might need to stay alive and comfortable.We will have to ration.

My suggestion for a good start would be to control the third party bureaucracies, cap malpractice awards, tax alcohol, and cigarettes, and continue medical savings accounts, but get the third parties out of them. Finally, the Congress should not have access to any better medical care than the rest of the country.

James P. Weaver, M.D., FACS

No Doctor's Rights in Health Care Reform

There's an interesting article in USA Today on June 1, 2009. It talks about the coming health care reform. It mentions how the insurance industry is lobbying because it has concerns that the government might create a government insurance industry competing with its interests. It also talks about the pharmaceutical industry that is worried about the imposition of price controls, and how it is fighting to prevent that from happening. Unfortunately, there is a notable absence of any mention of an important contributor to medical care delivery- the physician.

It's almost as if the physicians don't matter and, unfortunately, I don't think we do. We are regarded as "workers" in this system. We do what we're told, we continue to "provide" and why does anyone have to shape any of this imminent change to suite our needs? The government has cut our reimbursement for the past 15+ years, and no one has done anything about it. In addition, multiple regulating agencies have "controlled" us from every direction without much more than a peep from any of us. We are pushovers.

Someone better get into this debate that
represents the "interests" of the physicians. Those interests can be satisfied in a simple way. The message is, we need a health care system that considers the needs of the providers, and creates an environment that allows physicians to feel free to take care of patients without government oppression and manipulation. Is that possible? You bet it is, but not with the attitudes I see in the current news.

If it doesn't change, we will have too many disappointed physicians in their 40s who don't like the job situation they are in. They will provide perfunctory care, and neither the doctors nor the patients will be satisfied.

James P. Weaver, M.D.,FACS

Reunion and Change

I went to a 40th Class Reunion this weekend. Its been forty years since I graduated from medical school. It doesn't need to be said, but those years went by in an instant: marriage, children, internship, moving, residency, first job, residency again, moving, and then the long run of my most "productive" years of work. It goes by too, too fast.

Sometimes it was difficult to recognize those classmates who accompanied me on that educational journey of a lifetime- too much time had taken something away from them. Some could hardly recognize me either. We visited the rooms and laboratories that we haunted 40 years ago. I always get an inexplicable feeling about the passage of time when I visit a place I have not been to in years. I just don't understand where the time goes, and why everything looks as if it has not changed much even though all this time has passed. Remembering the chemistry, physiology, anatomy labs with all the struggle, and learning and discovery inspires one to reconsider what actually happened. A lot of growing happened during those years.

During the weekend we went to lectures, and dinners, and visited each other after a 40 year hiatus. I recalled that my medical school filled me with information galore, but it also filled me with a professional ethic that has carried me far into my surgical practice. It's the PATIENT FIRST. That's the "old time" professional ethic. It was a pleasure to be with 35 of my classmates who understood their calling the same way I have understood mine for all these years. I know times are different now, but when we graduated in 1969, the majority of us were not thinking about "life style" we were just going to be physicians-that was our "life style" choice.

The only discouraging experience of the weekend, was the lecture by the person who tried to teach us about "Medical Education in the 21st Century." Why discouraging? The message was that my generation was gone and out of touch. The new generation was concerned about their "lifestyle:" how much time they would have with their family, how much less work they would have to do, how short their work day would be, and possibly how much they would earn. I got the feeling they didn't want to work the same way we did. I worried about their understanding of Professionalism.

Now I don't want to criticise the younger generation, be it x'ers, or the me generation, or whatever, but I worry that this "life style" choice is a reflection of a deeper motivation that threatens the essence of what it means to be a physician.

An essential purpose in all of our lives is the positive effect we can have on others we encounter. Physicians have the privilege of working in a milieu where we can satisfy this need. We do it by becoming "professional."

According to Dr. Edmond Pellegrino, of Georgetown University, professionalism in medicine is played out on the stage of the physician-patient relationship. The patient comes to us vulnerable, frightened, confused, and in need, and for the physician to satisfy that need, we must have an ethic of self effacement, and sacrifice. This is the essence of professionalism. A "life style" choice does not seem like a creditable start towards this goal.

There are many forces in medicine today that are threatening professionalism and driving a wedge between the patient and the physician. I do not know what the result will be if the younger generation of physicians loses sight of the necessity of self effacement and self sacrifice as they enter this special field. Caring medicine cannot survive without a professional commitment of its doctors. I hope the younger generation can learn that professionalism in medicine requires a commitment to the patient that can hamper one's "life style." Unfortunately, that's what it takes to be a doctor.

James P. Weaver,M.D.,FACS