Wednesday, March 03, 2010

Uneventful Post Op Course

My son had surgery yesterday at the Really Big Hospital in the Really Big City hours from our smaller town in the South.  Thanks to God, and the skill of a very fine surgeon, my son is doing quite well.  We are now 30 hours out from the procedure, and he's been up walking around several times already.  His mom and I are thrilled and relieved, and hope and pray for a continued uneventful post op course. 

My son's procedure was neither elective nor emergent per se; it had to be done fairly soon, though not on an emergency basis.  The surgeon and the hospital worked with us to find the time that would impact his schooling the least, which was within a few weeks of the time we decided to go ahead with the operation.  I have nothing but praise for this hospitals' operation (pun intended), especially the first-rate nursing staff doing their thing efficiently and with obvious caring for their patients. 

The experience of course makes me wonder how something like this would go if our friends the Democrats achieve their goal of socialized medicine, and have no doubt, that is their goal.  I am fortunate enough to carry insurance that allows me to go beyond our area, "out of network" as they put it, to seek the best care for my family.  Some policies might have limited us to some extent, but not like one might see in Canada, for example.  Since this wasn't an absolute, life-threatening emergency, the procedure would most likely have been postponed for several months, even a year.  By that point, things could have deteriorated, he might have had to miss even more school, we might not have been able to go to the surgeon or the hospital we wanted.  In other words, our choices would have been made for us, by beaurocrats who neither knew us or cared about our situation.  Argue all you want, this is how I believe it would be, and deep down, you know I'm right (pun intended once more). 

While I am a staunch conservative, and I believe strongly in the free market, the current potential disaster with Merge attempting to swallow the larger AMICAS, points out that at least for health-care, the free-market is far from perfect itself.  Because of the need to please the stockholders, and to handsomely reward the C-suite, profits, and the bottom-line stock-price have become the end all to end all.  This pushes secondary issues, such not allowing company A to be demolished by company B (or G or M) in the course of playing a high-stakes game to bolster their languishing stock.  As a friend of mine put it, whatever happened to "Doing well by doing good?"  (He also suggested, tongue-in-cheek, that GE had put up the funds to back the loan to Merge just to annoy me.)

The same friend wrote this response to Mike Cannavo's piece posted below. 

My dear friend, Mike.

I've just read what may be your magnum opus on Dalai's blog site (thanks, Dalai!). Very well stated and I loved the movie references and quotes.

As I will probably soon pass into what will be early-retirement hell, I look back at the health care companies I've worked for and thoughtfully considered the messages they passed to their hard-working employees: "You do not matter. You are an insignificant cog in a wheel driven by faceless, emotionless investors. We do not care if your wife has cancer or you have heart disease. We will do whatever it takes to produce a profit and/or a return for the few executives who ran the risk for an early buy-out and pay-off. We will burn you out, lay you off and disrupt your family - whatever it takes."

I went into a care-driven health care career many decades ago, an idealistic and naïve hippie wannabee raised by working class parents in a mom & pop wholesale business. Doctors drove beat-up station wagons and charged $5 for office visits. Medicare didn't exist and there was no Humana, HCA, or Tenet. All health care was not-for-profit and driven by good Catholics, Jews, Protestant groups and the state/county. I thought we all worked in a system that didn't make the big bucks, but did good things for people who couldn't help themselves.

But, I fear that whatever may have been an altruistic desire to help others among health care workers is long gone. After my experiences in marketing for HMO, PPO, for-profit hospital, home health, computerized claims payment and imaging companies (which by the way, began out of financial necessity when the recession of the early 80's and prospective reimbursement ran me out of my allied health care career), I have seen the dark underbelly of the health care business. Witnessing the debacle with AMICAS and Merge has been the last straw for me.

I am disillusioned and resigned to sit by the shore and watch the sunset, munching on my ration of cat food and stale potato chips. I am happy that I will not be around in 20 years to see what has happened to our country, our health care system and to the welfare of my children, their children and the poor and elderly. God help us. Amen.
Sadly, the other side of the coin is just as distasteful.  Clearly, the quest for profit can hobble a company like AMICAS, lead physicians to order unnecessary tests, and drive lawyers to file a dozen unnecessary suits hoping to hit "the big one".  But the alternative is worse.  We all know the joke, "I'm from the government and I'm here to help you!"  It's a funny line because we know that help from the government is just not going to happen.  I could go down the list of huge federal programs that don't work well, and I would start with Medicare.  That's the best example, because the elderly (an age I'm fast approaching!) and physicians have become dependent on this particular government dole, and we will vote for anyone who wants to give us more via this pipeline, and boot out those who would dare tamper with the fountain of lucre.  The fact that Medicare is $31 TRILLION dollars in debt doesn't phase anyone as long as they get their share.  And this is about as benign as government gets.  This lesson should not be lost on those who would trade Wall Street greed for Washington's benevolent narcissism. Greed I can understand, but the drive to dominate others because "I know better what you need than you do" is beyond me. Our liberal friends would like to control 1/6 of the economy via an entitlement so massive we would all be completely be dependent upon them for our very well-being.  As I've been saying, if government controls your healthcare, it controls your life, and I believe that now more than ever.

The answer is for each sector to do its thing properly balanced with its counterpart.  When that equilibrium is disturbed, we get an out of control situation.  When the liberal Barney Frank and Christopher Dodd pushed through their liberal plan to force banks to give loans to those who couldn't possibly pay them back, the financial industry found the loophole of derivatives and other shams.  The market reacts in unexpected ways to abnormal pressures.  The US private sector delivers the best healthcare in the world, as evidenced by the fact that anyone who can travels here for high-level care.  When did you last hear about someone going to Canada, or Britain, or Japan, et. al. for care they couldn't get here?  Under total governmental control, this will not be the case, and even if the control is partial, there will be deficiencies, shortages, and all of the other problems manifested in all of the other systems we are supposed to envy.  This isn't the direction to go.  Rather, we need to restore the balance between private and public.  At least in healthcare, the government should regulate, not provide. And the private sector needs to be regulated.  Conservative though I am, I am not so naïve as to think that the market can totally police itself.  But I'm totally convinced that the government is incapable of doing a better job of it.

So, I'm hoping for an uneventful post op course for the US health care system.  It needs a bit of minor surgery, but let us hope that the surgery is far less extensive than Dr. Obama and his liberal partners would recommend.  I'm talking appendectomy vs. brain transplant.  And I'm hoping my son's post op course remains uneventful as well.


I've already received a couple of comments.  One was nothing more than a collection of liberal talking points which we've all heard a thousand times before.  Everything is Bush's fault, from Cain murdering Abel on down.  Read it at your convenience, if for nothing more than a glimpse into liberal thinking.  The second was a bit more brief and bears review.  In reference to the fact that I and my family are insured, Anonymous writes:
And what would the outcome have been if this were not the case? 
In the "every man for himself" world, you'd be out of luck, I guess?
Here we have the honest-to-gosh true-believer liberal incentive for socialized medicine.  (I contrast this with the Leftist political motivation, which is to create an enslaving entitlement to guarantee perpetual power.)  A lot of liberals out there cannot stand the fact that some get more than others, that some have more and some have less, and this discrepancy is especially galling in the realm of healthcare.  Everyone should have the same care, which of course must be provided by the government and funded by spreading the wealth around, i.e. the "rich" should pay for it.  

While I'll be the first to tell you that our system needs some surgery, I do not believe it needs to be completely gutted so as to provide Cadillac care to everyone.  That is not feasible, and to do so at government expense would bankrupt the nation within a year.  

What is never stated anywhere is that the poor, and the uninsured (and they are not necessarily the same group) DO get treatment, from the ER's and from physicians like ME who treat first and ask questions later.  I will not refuse a patient who cannot afford my services.  That is part of my duty as a physician as I see it.  I do not believe in the scenario of "every man for himself".  I believe there should be a safety net of some sort for those who HONESTLY need it, and right now I and physicians like me provide it.  This could certainly be done better, but we don't need to destroy the entire system and gouge "rich" people to do so.  Please tell me, however, why "rich people" pay to insure those who spend their wages on illegal drugs, cigarettes, payments on cars beyond what they need or can afford, iPhones with $100/month data service, bling of various flavors, and so on and so on and so on, instead of health care.  I could go on in this vein, but you get the idea.  Anonymous is upset that I earn a living and have a better insurance policy than someone who doesn't.  It's just not FAIR, and that is why liberals think the government should be distributing my "wealth" all around.  To me, that isn't FAIR, but of course, I'm biased.   

Let me tell you of an incident that occurred within the past 24 hours.  My son is recovering on the surgical floor of the Really Big Hospital in the Really Big City.  Last night, the patient down the hall had a bit of a problem, a creating a disturbance which I won't describe.  This happened again this morning at 6AM.  I promptly called the senior administrator on duty and requested (not so nicely) that the patient be moved.  I was met with a polite response mainly outlining the other patient's rights and needs, and not really acknowledging those of my son.  I elevated my physician-esque distemper to surgeon-level, and suggested that this needed taking care of NOW.  To make a long story short, the other patient was moved, and we were visited by most every administrator who might have something to do with patient-care issues.  We all said the right things, them apologizing profusely for the problem, and me praising the nursing care to the hilt (praise which was well-deserved, by the way).  But in the process of this political dance, one did admit to me that this Really Big (Private) Hospital was having to take on the characteristics of a downtown urban facility, with more and more problem patients coming through their doors every day.

If we were to achieve the Liberal ideal of perfect equality and universal care for all, can you imagine how different things might have gone?  My son might have been on an open ward with the patient in question, rather than in a private room.  There might not have been adequate personnel to deal with the situation.  And you can rest assured that in this totally egalitarian Liberal paradise, the complaints and fears of a parent, even a parent who happens to be a physician, would go unheeded, and would probably be fodder for amusement in the break-room (where the employees enjoy their mandated 15-minute break every half-hour).

Extreme?  An exaggeration?  Maybe.  The British and Australian systems, amongst others, do allow one to purchase extra-cost private care, so there is the option to get away from this terrible situation, much to the chagrin of those who want everyone to be treated EXACTLY the same.  But what about other places where Liberals have totally won the day and truly create a government-funded paradise of equality--equal squalor, but equality none the less?  This link shows you the worst of the public British system, and you cannot deny that this fine example of socialized medicine is anything but a screaming success.  My scenario might be far fetched, but in your hearts, you know I just might be right (same pun, one last time).  


Anonymous said...

> I am fortunate enough to carry insurance that allows me to go beyond our area, "out of network" as they put it, to seek the best care for my family.

And what would the outcome have been if this were not the case?

In the "every man for himself" world, you'd be out of luck, I guess?

Anonymous said...

I consider myself an independent and absolutely not a follower in any way of the "Tea Party" movement.

I sit back and listen to people who are blessed with great jobs, decent finances, health and dental insurance, who criticize the healthcare effort being led by the Obama administration and I ask where was all of this passion during the 8 years when this could have been focused on? Or back in 1990's when Clinton pushed such a focus? I sit back and listen to those who are blessed with great salaries and insurance plans, most of whom have never had to choose between feeding your family or taking your prescriptions and I say, their reality is not reality. I don't know who the Republicans are saying are against this reform and I don't know which polls are polling whom - what I do know is that I have witnessed families go broke, homeless, hungry - because of medical fees. This coming from a person who has been blessed not to have to be faced with a heart-wrenching choice (thanks to GOD). It is hurtful and embarrassing to see this happening in this country, let alone others, and I cannot accept any rationale against forcing a family to suffer because of a cancer diagnosis that they could not prevent or because of preexisting conditions of acne and sinus infections, they were dropped. I am not supporting the mistakes made in this administration - as there have been some made - but how interesting folks forget that Medicare and Social Security have been broken for years, mainly due to the administrations prior to this one, and my generation, my children and their children will be without either program by 2030 - according to recent figures. We are already paying for the mistakes and a out of control deficit way before this administration. Enough already. I am grieved by the hypocrisy of both sides and only pray that those who are critical and say no to the effort being led within this reform never are faced with a lack of insurance or forced to choose between food and medication.

Anonymous said...

Dr. Dalai,

Irregardless of your healthcare views, I'd like to wish your son a refuah shlamah at the Big Hospital, in the Big City, and soon at the comfy confines back home.