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Like many of you, I watched Obama's press conference on NBC last night. I want to educated the public and clarify some of President Obama's statements last night. In addition, I want to state that I voted for Obama in the Presidential election and that I'm an independent voter who grew up in liberal California. Therefore, my statements are not based out of a partisan Republican allegiance. Okay, let's start
1. With regard to his statement about doctors ordering the same tests from one doctor to another
I'm a Cardiologist. I don't perform the same tests the referring PCP sends to me. In fact, it's a nuisance and I often ask my patients to bring their labs with them or my staff calls the PCP's office and requests their labs be faxed to our office. This is standard practice among all physicians. Doctors don't make any money ordering these tests. The labs that analyze the tests make the money and bill the insurance company. So we have no incentive to repeat tests unless it is medically sound to do so (ie the labs were drawn a year ago). In addition, insurance companies will not authorize multiple lab draws in a given time so even if we want to repeat labs like Obama suggests, we couldn't do so because the insurance company won't pay for it.
2 Regarding the Physician choosing to perform a tonsilectomy because it reimburses higher
Let's ignore the fact that it insults our integrity and our decision making, but based on logic alone, his stance makes little sense. If compensation for treatment options are similar then the patient could suffer. A surgery includes risk, time and energy. Based on Obama's outlook, this same physician that Obama alludes to may have an incentive to undertreat and not provide optimum care because he isn't being paid any more money but assumes great risk, and time. The quality of care would drop considerably and the patients would suffer. This is why wealthy people from other countries come to the United States for health care because they want the highest quality care that isn't affected by financial decisions.
3 Regarding the Mayo Clinic and Cleveland Clinic being the model for health care delivery
The Mayo Clinic and Cleveland Clinic do not represent the majority of hospitals in the United States. Their patients mostly consist of wealthy individuals that pay cash for their services or have the best insurance possible. They receive much higher reimbursement for simple office visits and hospital stays. Furthermore, both clinics are aggressive with regards to testing and intervention so I fail to see how their hospitals operate differently from others aside from the fact they have more money due to their higher clientele. I'm not puttind down these hospitals. They are truly amazing hospitals whose reputation is well deserved. I'm just identifying the reality that they are also privy to the type of patients that most hospitals don't treat.
4 Regarding Obama's statement that the current system should be changed to reward Doctors for improving outcomes and not rewarded for ordering tests
We order tests to improve outcomes. We do colonoscopies to rule colon cancer. I do angiograms to rule out coronary heart disease. Our goal is to improve outcomes but we can't do that unless we order tests. I would not want my patient's healthcare and lives to be jeaopardized because I'm told I cannot order a particular test or peform a potential life saving treatment.
In addition, it is threat of litigation that forces many physicians to perform unwarranted tests. We asked Obama to place caps on punitive damages with regard to medical malpractice suits but he refused to do so. Punitive damages are those that are sought to "teach a lesson" or provide for "pain and suffering" Victims of negligence would still be able recoup all costs of their treatment in addition to future lost wages. In California, the limit on punitive damages is 250K. Other states have higher limits such as 500K for Texas. Trial attorneys are opposed to this because it would reduce the rewards they collect and Obama is an attorney. In a response to a Forbes article regarding the merits of caps on punitive damages, law professor David Hyman stated: "In California that produces a fee of roughly $83,000, not enough to attract most lawyers." Is an $83,000 fee not enough money? Most people are lucky to earn that type of money in an entire year let alone one case. In states like Texas that have adopted tort reform, patient's premiums are significantly cheaper than litigous states like Florida.
5Regarding his stance that Doctors and Nurses endorse his plan
The American Medical Association (AMA) did not endorse Obama's plan. They only supported the idea that they would be involved in the preliminary plans to shape this policy. They have not endorsed any particular plan at this moment and even the AMA President compared the current situation to being in the 2nd inning of a ball game and that a lot of work was still left. The AMA only represents 250K doctors. There are over 1 million doctors in the United States so the AMA represents a quarter of all physicians. I would argue 50K of that 250K AMA membership comprises of medical students and residents who are in the AMA for benefits (discounts on text books, free enrollment at conferences). The majority of physicians in this country have not openly endorsed Obama's plan.
How does any of that insure the 45 million Americans without health insurance?
Why don't you ask Obama? During his campaign, he stated he would pay for this through forcing companies to provide health insurance for employees or pay a fine. When he was running, he didn't definitively state that a government sponsored option and direct regulation of the health care delivery model were primary features of his health care plan.
Like many of you, I watched Obama's press conference on NBC last night. I want to educated the public and clarify some of President Obama's statements last night. In addition, I want to state that I voted for Obama in the Presidential election and that I'm an independent voter who grew up in liberal California. Therefore, my statements are not based out of a partisan Republican allegiance. Okay, let's start
1. With regard to his statement about doctors ordering the same tests from one doctor to another
I'm a Cardiologist. I don't perform the same tests the referring PCP sends to me. In fact, it's a nuisance and I often ask my patients to bring their labs with them or my staff calls the PCP's office and requests their labs be faxed to our office. This is standard practice among all physicians. Doctors don't make any money ordering these tests. The labs that analyze the tests make the money and bill the insurance company. So we have no incentive to repeat tests unless it is medically sound to do so (ie the labs were drawn a year ago). In addition, insurance companies will not authorize multiple lab draws in a given time so even if we want to repeat labs like Obama suggests, we couldn't do so because the insurance company won't pay for it.
2 Regarding the Physician choosing to perform a tonsilectomy because it reimburses higher
Let's ignore the fact that it insults our integrity and our decision making, but based on logic alone, his stance makes little sense. If compensation for treatment options are similar then the patient could suffer. A surgery includes risk, time and energy. Based on Obama's outlook, this same physician that Obama alludes to may have an incentive to undertreat and not provide optimum care because he isn't being paid any more money but assumes great risk, and time. The quality of care would drop considerably and the patients would suffer. This is why wealthy people from other countries come to the United States for health care because they want the highest quality care that isn't affected by financial decisions.
3 Regarding the Mayo Clinic and Cleveland Clinic being the model for health care delivery
The Mayo Clinic and Cleveland Clinic do not represent the majority of hospitals in the United States. Their patients mostly consist of wealthy individuals that pay cash for their services or have the best insurance possible. They receive much higher reimbursement for simple office visits and hospital stays. Furthermore, both clinics are aggressive with regards to testing and intervention so I fail to see how their hospitals operate differently from others aside from the fact they have more money due to their higher clientele. I'm not puttind down these hospitals. They are truly amazing hospitals whose reputation is well deserved. I'm just identifying the reality that they are also privy to the type of patients that most hospitals don't treat.
4 Regarding Obama's statement that the current system should be changed to reward Doctors for improving outcomes and not rewarded for ordering tests
We order tests to improve outcomes. We do colonoscopies to rule colon cancer. I do angiograms to rule out coronary heart disease. Our goal is to improve outcomes but we can't do that unless we order tests. I would not want my patient's healthcare and lives to be jeaopardized because I'm told I cannot order a particular test or peform a potential life saving treatment.
In addition, it is threat of litigation that forces many physicians to perform unwarranted tests. We asked Obama to place caps on punitive damages with regard to medical malpractice suits but he refused to do so. Punitive damages are those that are sought to "teach a lesson" or provide for "pain and suffering" Victims of negligence would still be able recoup all costs of their treatment in addition to future lost wages. In California, the limit on punitive damages is 250K. Other states have higher limits such as 500K for Texas. Trial attorneys are opposed to this because it would reduce the rewards they collect and Obama is an attorney. In a response to a Forbes article regarding the merits of caps on punitive damages, law professor David Hyman stated: "In California that produces a fee of roughly $83,000, not enough to attract most lawyers." Is an $83,000 fee not enough money? Most people are lucky to earn that type of money in an entire year let alone one case. In states like Texas that have adopted tort reform, patient's premiums are significantly cheaper than litigous states like Florida.
5Regarding his stance that Doctors and Nurses endorse his plan
The American Medical Association (AMA) did not endorse Obama's plan. They only supported the idea that they would be involved in the preliminary plans to shape this policy. They have not endorsed any particular plan at this moment and even the AMA President compared the current situation to being in the 2nd inning of a ball game and that a lot of work was still left. The AMA only represents 250K doctors. There are over 1 million doctors in the United States so the AMA represents a quarter of all physicians. I would argue 50K of that 250K AMA membership comprises of medical students and residents who are in the AMA for benefits (discounts on text books, free enrollment at conferences). The majority of physicians in this country have not openly endorsed Obama's plan.
Dr. I appreciate you sharing your side of the story as well as defend those physicians that are the reason why the care in the U.S is the best, however you do have to admit that there are those physicians out there that do not take the same care with their patience and even take advantage of the insurance companies.
On the Tonsillitis front, I have allergies and asthma. I once worked in a town in NJ where the pollen count was extremely high (Bergen County NJ). Every summer i would get the summer flu and the Tonsils would just swell up. One doctor wanted to remove them without first finding out what i was allergic too. I decided to get a second opinion, the new doctor tested me and found that it was the area due to the pollen and i'm allergic to fresh cut wet grass. This Dr. also explained to me the inherit dangers of having my tonsils removed.
Now i'm not saying that everything the President stated last night was all factual, but from my personal experience, there is some validity to some of what he stated.
How does any of that insure the 45 million Americans without health insurance?
The 45 Mil number is another fabricated figure just like "jobs saved or created" BS. Do the research.. How many of that 45 Mil. are legal US Citizens? How many are younger folk who are more concerned with getting the latest I-Phone than having health insurance?
Dr. I appreciate you sharing your side of the story as well as defend those physicians that are the reason why the care in the U.S is the best, however you do have to admit that there are those physicians out there that do not take the same care with their patience and even take advantage of the insurance companies.
On the Tonsillitis front, I have allergies and asthma. I once worked in a town in NJ where the pollen count was extremely high (Bergen County NJ). Every summer i would get the summer flu and the Tonsils would just swell up. One doctor wanted to remove them without first finding out what i was allergic too. I decided to get a second opinion, the new doctor tested me and found that it was the area due to the pollen and i'm allergic to fresh cut wet grass. This Dr. also explained to me the inherit dangers of having my tonsils removed.
Now i'm not saying that everything the President stated last night was all factual, but from my personal experience, there is some validity to some of what he stated.
There are unethical people in any field or industry including politics. However, your case doesn't sound like a case of unethical behavior. Doctors can disagree. It's up to their professional judgement. FYI, tonsilitis is an infection of the adenoids(tonsils). Allergies have nothing to do with infection of the tonsils. Allergies and autoimmune disease like Hereditary angioedema can cause throat swelling but that swelling isn't due to an infection of tonsils. If you were truly sufferring from several infections of your tonsils, having them removed would bring you relief. A physician wouldn't require that you get allergy tested before making a decision to remove your adenoids. That is a fact and no medical textbook would tell you that. It's hard to believe that a true board certified physician in the field of Allergy Immunology advised you of this. Allergists and ENT work side by side and often refer to one another. There are a lot of people who claim to be allergists that are naturopaths or family medicine doctors that practice allergy never formally trained in the field and are not board certified.
You have to understand, there is a reason we had to go through 4 years of medical school and then 3-8 years of residency. There is a lot of information to know and it's easy for patients to misunderstand because they don't know all the facts. I'm a physician but when it comes to automotive repair, I know nothing. Likewise, its easy for me to think autoshop is ripping me off but often times, I usually discover, it's something I didn't know or assumed I knew. I don't know what you do for a living but I'm sure people have misperceptions about what you do. I don't blame people for thinking the way they do because I thought the same prior to going to medical school. And I encourage people to be weary and cautious but they also should trust that there might be things they don't understand.
I wanted to add, people keep using the surgery example. Most physicians are not surgeons. Procedures also encompass CT's, MRI, X-rays and labs. The hospitalist or internal medicine doctor who makes that decision in the ward to order a CT, MRI, X-Ray or Labwork makes no money on that. The hospitals make money but the doctor who orders those tests make no money from that. It's a big misperception among patients. Sure, the radiologist who reads those films make money and the hospital whose equipment is used to do those procedures make money but the doctor makes nothing.
Even in the outpatient clinical setting, when we draw blood, we make no money from that. We send it to a lab and the lab makes money. When we get X-rays, CT's, MRI's or Ultrasounds, when the doctor sends you to an imaging center, he or she makes no money from that. Most primary care doctors only make money on the office visit so when Obama implies that a doctor will order extra tests just to earn more money, well that doesn't apply to most doctors. Except now Obama is going to make hard on your primary care doctor because when he or she wants to order bloodwork, a CT, MRI, X-rays etc, we are going to have to call bureacratic agency and ask for permision and have to provide data to qualify the patient for that image. Then when it's approved, the patient will probably have to wait a long time before they can get in and that's of course assuming they allow me to order a CT for you. They might just say no because they are trying to cut costs.
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