I have been asked to give a practicing doctor’s perspective on what is happening to our health care system.
I would like to begin by telling a brief parable about the farmer and his horse:
The Farmer & His Horse
There once was a farmer who had a beautiful farm and a devoted horse. The horse worked long hours, never complained and loved his work. Twice a day the farmer would feed the horse and all was right in the world.
But then the farming business went into a slump and the farmer asked the horse to work longer days and plow more fields just to make ends meet. The horse never complained and loved his work. Once a day the farmer would feed the horse and all was still ok in the world.
Soon the farmer was told that the cost of hay was increasing. There were no more hours left in the day to work harder to pay the increasing costs. So he decided he would just feed the horse a little less hay each day. The horse never complained about his hunger, did his work as best he could but the world was not so good anymore.
This went on for some time. The farmer continued to work his horse really hard, had to lay off his workers and spend less on hay for his horse in order to keep his farm running. The farmer noticed his fields were looking a bit shabby. His harvest was the worst he ever had. He was baffled. Why was this happening?
Finally, he woke one morning before dawn. Dragged himself out to the barn and there was his devoted horse, lying in his stall. Starved to death!
Medical professionals and the patients they serve cannot be squeezed indefinitely. Like the poor farmer and his horse, the story will not end well.
Healthcare is not an inanimate commodity to be treated and bartered like oil or water or even hay, for that matter. It is us! And each and every one is unique.
Centralization is a bad idea and a terrible one for medicine.
What we will see as government and insurance companies continue to micromanage our lives are mandates based on ideological, nanny state one size fits all ideals. You will begin to see laws and commercials and public service announcements, paid for by government stimulus money, really, our tax dollars, which entice you by reward or punishment to follow their advice. Advice based most often on emotion and not science. You will see more brainwashing type curriculum in public schools with the purpose of indoctrinating our children early on towards the “correct” way to think.
Really, this extends far beyond just the healthcare law. What we have now unleashed in our country is a hostage situation to the American legal system. Whether it’s the local restaurateur, the small businessman, the ski resort, your family doctor or your local hospital or school we are all intimidated by a lack of restraint on our legal tort system. Quite frankly, my biased opinion thinks that the biggest obstacle to American values and common sense returning to us is the American civil legal system which promotes victimhood and extortion. If any industry was in need of reform it is that one. Where are the future leaders who are willing to take on the trial lawyers? Now that would show real bravery. Dennis Prager has rightly labeled ObamaCare, “The trial lawyers of America stimulus package”.
Recently, a midwife friendly hospital serving the needy in Greenwich Village closed its doors due to its inability to stay financially solvent while trying to comply with all the mandates, regulations and legal protections required. Many doctors are already at the point where they cannot afford malpractice insurance or continue to take on more patients for ever decreasing reimbursement. As costs inevitably go up reimbursement to providers will be decreased or care will be rationed. MediCal and medicare patients are going to find it harder to make appointments and are going to be waiting longer. Lowering reimbursement further will just devalue the doctor-patient relationship. It will push small community hospitals out of business, as it has in Greenwich Village, and lead to rationing by default. How much more work can you squeeze from a starving horse. Most doctors love our profession but hate what the business of medicine has become.
As for my practice: Carolyn asks whether I would consider giving it up and retiring early. The question is actually can I afford to keep going? This year I will turn 55. I love my work. I could continue to practice for another 20 years. The real question is “Would I be a fool for doing so”? Not only will doctors able to quit consider doing so but who in their right mind will become the future doctors in our country. Years of training and sacrifice of social life lead to a loss of a decade of fun and earning power and massive debt. Only to come out and see your expenses rising and uncontrolled but your earning power capped and regulated. The devastating threat of a career ending law suit hanging over your head like the sword of Damocles is no way to live. Having the authorization for a test or procedure denied by some non-medically trained faceless cubicle worker who can’t spell the diagnosis is maddening to those of us who care. Your medical decisions weighed and scrutinized by faceless utilization review boards, government agencies and hospital committees. None of whom will ever bother to get to know the patient you are advocating for. How many of you would want to live like this? How many of you want your children to live like this?
And I have yet to mention the looming specter of Electronic Medical Records coming by 2014. Every detail of your medical history and that of your children will be mandated to be online for bean counters of all shapes and motivations to see. Do you trust that it will remain confidential and used wisely? I don’t! And there will be a large cost of installing the hardware and mandated annual updates that will not be reimbursable to the practitioner. Adding another undo burden on the small, independent practice of doctor, midwife, chiropractor and therapist. Another not so subtle hammer to force solo doctors like me out of business or submit to joining large impersonal multispecialty groups where the individuality and art of medicine I love will disappear.
Solving this will be a complicated process. Remember, healthcare is not the problem. We have the best in the world. It is more accurate to call this dilemma a problem of healthcare access. I know it sounds radical and probably too late but I don't believe the government has any business being in the business of health care. Evidence based medicine is a simple premise that supposes that medical decisions are based on scientifically proven studies What is most scary to me in an era where we are supposed to rely on evidenced based medicine is this. All these regulations that are being instituted and forced upon us have never, I repeat, never been studied to show that they have actually improved healthcare delivery and outcomes. If anything, other countries that have tried this are backing away from it. These edicts are being rammed down out throats with no science to back them up. They are theoretical only, and the motivation is financial and control, not betterment of health and not individualized care. The canard that is always used is "safety". Albert Camus, the French philosopher, said, "The welfare of humanity is always the alibi of tyrants."
How can the Tea Party help? In my perfect world, first, repeal Obama-care entirely and end the fraud that has been played on America. Then insist on tort reform and insurance reform and demand our elected leaders “Read the Bills”! Stop having insurance companies, lawyers, politicians and hospital administrators dictate medical decision making that belongs by right to patients and their practitioners. Also, encourage states that limit competition from allied health professionals such as midwives, naturopaths and alternative medical practitioners to lessen their restrictions on these caring men and women. Leave pharmaceutical companies alone. They are not the villain. And reign in the FDA and its draconian restrictions on new drug development and patient choice. Let the free market loose and trust the educated consumer to make their own life decisions and accept the consequences of those decisions.
Most doctors are excellent caring professionals. Go after fraud and bad doctors but do not lump us all together. Do not micromanage all of us who mostly want to do good work for those we serve. Confident knowledgeable people do not need micromanagement. I would like to know that when I am sick I am being cared for by someone who is a leader and not a follower.
So, we have come to a place where we have to decide who we trust. No longer can we be passive when it comes to something as important as our family’s health care. We have to take a stand. I trust the relationship I have with my personal physician. I trust my ability to judge him by his actions. I trust that she has my welfare as her primary concern. I encourage you all to educate yourselves and ask questions. You have the right to be truly informed. I trust that if he does not serve me well I can go someplace else. I do not trust big government or big business to have my back. I do not trust the nanny state to make decisions that are in my family’s best interest. I will do that and I want a country that allows me the freedom to succeed or fail. One size does not fit all. We must get away from that mentality. The best and the brightest should be going into noble professions like medicine. Sadly, unless we continue to elect leaders who repeal this horrible health care legislation, medicine will no longer remain an appealing avocation and the best and brightest will seek other interests. Possibly wasting their talents as lawyers or government workers because that’s where the money and lifestyle remain.
Finally, the government should not have the right to take my hard earned skills and demand of me to give them away for what they determine they are worth. I am not a horse to be fed ever decreasing amounts of hay. And, I never dreamed I would be before you all today making empassioned speeches. All I wanted to do was to practice my profession as I was trained to do and love my family. I am lucky. I have the good fortune of collaborating with midwives and the honor of assisting families who desire home birthing. Working outside many of the pressures and restrictions I have discussed today. But, I cannot sit idly by and watch this happen to the profession I love. I want my children to know that their dad stood up for self determination and personal responsibility.
Welcome to DR. STU'S BLOG. Along with my Podcast, I post and share my thoughts on a variety of topics on the birthing world. Advocacy for true informed consent and respect for individual autonomy are the basis for the musings you will read here. I hope you enjoy while you learn and I encourage you to comment.