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Showing posts from May, 2009

Obama's Socialized Medicine Program - Sign Me Up!

Actually, sign me up for Plan B or C instead. Many fear that Obama’s end game for health care reform is a single-payer (read: government) system, despite his denials that this is his objective. Single-payer zealots argue that if government takes over health care, that many of our intractable problems will be solved. We will save tons of money, they argue, from increased administrative efficiencies. Spiraling health care costs will be tamed under the government’s whip. Private insurance companies will no longer gouge the public with rising premiums and unfair exclusions for preexisting medical illnessess. The 46 million uninsured would be covered. Big Pharm can finally be caged by Big Government establishing price controls. And, with the government in charge, the president can submit a bill to congress simply outlawing cancer. I agree that single-payer would resolve many recalcitrant issues, but at what cost? What health care system would we be left with? A guillotine is an effective tr

Medical Corruption and Conflicts of Interest: Shades of Gray

There is a serious and expanding effort to address corruption in medicine. Regulators and lawmakers are addressing cozy relationships between physicians and industry to protect patients from financial conflicts of interests that may skew doctors’ medical advice. This is murky territory since not every potential conflict is corrupt. For example, is it acceptable for an orthopedist to benefit financially by using a particular artificial hip if the physician believes that this is the best product available for his patients? Does this practice become ethical if the physician discloses this financial arrangement? Are his patients entitled to know the actual dollar amount that the doctor receives? Is it proper for a gastroenterologist to receive a generous honorarium by a heartburn drug company to speak to primary care doctors about reflux treatment? Could this physician be trusted to offer truly objective information to his primary care colleagues with the company’s pharmaceutical represent

Obama's Health Care Reform: An Indecent Proposal

We watched the marriage on national TV. Both sides said, ‘I do’, as they faced a fawning audience of the press and government dignitaries. The couple, arm and arm, started ambling toward their parked limousine, festooned with bright Just Married signs. Newlyweds, usually wives, track many of the first events in a marriage. One of the recorded stats is the first argument. When it occurs, savvy husbands should save time and themselves by apologizing profusely and admitting shame and remorse. For most couples, this inevitable post-nuptial event occurs weeks or months after the solemn wedding vows are expressed. In the White House marriage we watched last Monday between Obama and a coalition of health care groups, the sniping started barely after they left the chapel. Wise bloggers had predicted this outcome, but I admit that I was mildly shocked at the speed that the bride pursued an annulment. What went wrong? Did that prankster Cupid dip his arrows into a vat of single-payer elixir poi

Obama's Health Care Reform: Let the Games Begin

Can you feel the love? Cupid ran out of arrows in Washington, D.C. this week. On Monday, several medical industry groups including physicians met at the White House for a health care reform love fest. For as long as I’ve been a physician, the pharmaceutical industry, insurance companies, hospitals, physicians and medical device makers all viewed medical reform as a disease that needed to be vanquished. This week, these erstwhile reform antagonists are sitting around Obama’s campfire in a Kumbaya moment. These health care stakeholders pledged to reduce health care spending (read: their income) 1.5% annually over the next 10 years. What happened? Were they drugged or hypnotized? Is there a secret deal that we don’t know about? Did they drink the Obama Kool-Aide that has intoxicated much of the nation? Did they hear an inspiring sermon at their church services this past Sunday and were inspired to do the right thing for America? The correct answer, of course, is none of the above. These m

Comparative Effectiveness: Sound Policy or Socialized Medicine?

Comparative effectiveness is a new term that’s been pushed into the health care public square. Get to know it since it’s here to stay. The prestigious New England Journal of Medicine published 3 commentaries on the subject in its May 7th issue. More importantly, this new concept in medical quality measurement has also been reported by the lay press to the public. The debates and discussions that will follow in the coming months will be as calm and civilized as the gladiatorial contests were during ancient Rome. Comparative effectiveness (CE) aims to determine which medical treatments truly work and which should abandoned. The federal government will be spending over a billion dollars funding studies to try to objectively demonstrate which medical interventions are effective. It is hard to object to this mission. Nevertheless, comparative effectiveness will polarize the medical world. Opposing camps are already preparing for battle because for many interest groups, this may be an exist

Electronic Medical Records Attack Bedside Manners

Physicians and patients are under more strain than ever before. Electronic medical records (EMR) won’t be a force of healing, but will threaten to divide the parties further apart. We physicians are already under more stress than ever before. We are working harder and earning less. Insurance companies dictate how much (or how little) we are paid and what medicines we may prescribe. We are crushed by an avalanche of absurd paperwork. We worry about being sued even if we haven’t done anything wrong. Patients are more dissatisfied today also. They often feel rushed through appointments without having adequate time to express their medical concerns. They want more communication and softer bedside manners from their doctors. They want more conversation and fewer medical tests. They complain that medicine has become more of a business than a profession. They admire Dr. House’s diagnostic acumen, but they still want Marcus Welby as their own doctor. All of these issues strain the docto