MD Whistleblower

Is Medicaid on the chopping block?.   Will Social Security be trimmed back?  Are the knives out for Medicare? These are huge concerns for Americans who depend upon these entitlements for health care and survival.   Those who have enthusiastically championed massive cuts in the federal government are now reflecting on how critical the Medicaid program, for example, is for their constituents and local economies.   Imagine the harm done medically and economically when rural community hospitals would wither without these federal dollars. A large measure of public angst on these issues is derived from distrust in our politicians.   We have seen them engage in flip-flopping, backtracking, u-turning, ‘evolving’ and other iterations of political gymnastics.   Can we really be reassured by what they are saying today or when on the campaign trail?   (Hint:  W e can’t.)   When they reassure us that there will be no cuts in (insert government pr...

Robert F. Kennedy, Jr. is Trump’s choice to lead the Department of Health and Human Services (HHS).   He will need to have his nomination confirmed by the Senate which I believe will occur.    He certainly fits in with Trump’s rather unconventional choices for various other cabinet leaders and government officials. To refer to RJK Jr. as controversial or eccentric are understatements.   We have all read about the worm in his brain, the dead bear that he deposited in Central Park in NYC and the whale head he attached to the top of his car on their way home, as related by his daughter. Is this a desired profile for HHS secretary who will be overseeing the NIH, CDC, FDA and Medicare and Medicaid?   If confirmed, he would yield enormous power to craft new health care policy in this country, particularly under a president who champions disruption. Kennedy is a known vaccine skeptic, has promoted unproven Covid-19 treatments, supports the consumption of raw milk, ...

Some time ago, I penned a post advocating union membership for nurses.  Increasingly, I expect physicians to seek professional relief by joining unions in the years to come. This is not about the money. There have been pockets of unionized physicians in the United States but efforts to organize physicians writ large have not yet gained widespread traction.   One group of doctors who are overripe to unionize is medical interns and residents.   These professionals work endless hours with sleep deprivation and have insufficient days off to recuperate or recreate.   Of course, they are underpaid for the hours they work but this ranks low on their list of grievances.   Yes, there are reforms put in place, but I have it on good authority that existing loopholes and training program policies have rendered today’s residencies very similar to mine over 3 decades ago.    If you track the evolution of the medical profession over the past 20 years or so, unio...

There is extraordinary medical care being practiced in the United States.  While medical breakthroughs do not occur linearly, there is a clear forward trend of progress.  Naturally, there are setbacks and failures which are learning opportunities in medicine as they are in life.  My own medical journals are increasingly populated with studies examining the use of artificial intelligence.  Endoscopic scope journals present examples of technical wizardry which only years ago would have been thought to be science fiction.   Sooner than we imagine, medicine will be offering widespread personalized or precision medicine when treatments will be customized according to a patient’s genetic profile.   Up to now, most of our treatments follow a one-size-fits-all model which is already recognized as a clumsy tool.  Ten patients might both have rheumatoid arthritis, for example, but these genetically unique individuals would likely benefit from tailored ...

When we are purchasing a product or a service, the marketplace offers us many choices.  Competing wares may have different quality and cost levels.  We experience this if we are renting a car, booking a hotel, hiring an attorney, selecting a restaurant or buying a musical instrument.  All guitars, for example, are not equal. When we decide to purchase at a certain quality and price point, we must accept the realities of this transaction.  We should not purchase a Chevy, for example, and expect a Cadillac experience.   I realize that price and quality may not follow a linear path.   Just because something costs more doesn’t mean it’s better.   There are wrinkles in the marketplace.   Budget hotels, for example, often provide guests with free breakfast free parking and free wifi while high end stodgy hotels gouge guests with resort fees (please explain to me what this is), insane parking charges and crazy minibar prices on top of their exor...

If we ever manage to tame Over-diagnosis and Over-treatment – the twin threats to medical reform - many players in the medical universe would find their status - and their livelihoods- downgraded to critical condition.   Let me offer a single sentence that points out the herculean challenge facing reformers. One man’s wasteful medical spending is another man’s income.  You Need the Strength of Hercules to Reform Health Care The system is riddled with conflicts of interest where various economic interests collide with our health interests. Here are three hypothetical examples to illustrate my point.    Political progressives clamor to sharply reduce drug prices to make them affordable for all Americans.   The pharmaceutical industry uses all means necessary to resist this.   Of course, making all drugs affordable would crush the drug companies economically.   They argue that such a draconian approach would stifle research, d...

I am a conservative practitioner in my specialty of gastroenterology.   Compared to peers, I order fewer scope examinations, prescriptions and CAT scans.   I’ve always believed that a more parsimonious practice of medicine would protect my patients better than would a more aggressive approach.   Sure, this also means that I spend fewer health care dollars on my patients, but this is not my primary motivator.   I practice in this manner because I am convinced that in the medical profession, less is more. I am somewhat of an iconoclast as many of my colleagues for various reasons practice differently.   They might feel that my medical nihilism is depriving my patients of necessary testing and treatment. Patients over time tend to find physicians who share their philosophy.    Patients who believe that more testing and more medication is the pathway to better health will not be comfortable with a doctor like me. But, change is afoot!   I pr...

Some professionals and businesses get paid regardless of their outcome.   They are paid for their time and expertise.   For example, if you hire an attorney, unless you have a contingency fee arrangement, you will be billed regardless of the outcome.    If you sue a business because you allege a product you purchased is defective, but the business counters that you damaged it by using the wrong tools to assemble it, there is no guarantee that you will enjoy a legal victory.   However, if your lawyer has invested 20 hours of labor as your advocate, he or she will certainly enjoy a financial victory if an hourly rate is in place.   Similarly, if your financial advisor, who is paid on commission, advises that you invest in a certain product, and the investment declines 10%, only one of you will take a major hit.   Guess who? If you treat yourself to expensive theater tickets, but you find that the performance was dull and uninspiring, do you expec...

Last week, I presented my discerning readers with arguments supporting Medicare for All.  Here in Part II, I will offer a few rejoinders and caveats to those proposals.   Senator Bernie Sanders deserves credit for advancing this issue into our national conversations.  And, many of his 22 rivals who are angling for the Democratic nomination for president in 2020, have embraced the position in their collective leftward migration.  Indeed, if this leftward drift persists, we may soon be regarding Comrade Bernie as a moderate! First of all, the Medicare for All being proposed now should be renamed as it goes far beyond our current Medicare system.  The New & Improved Medicare for All promises the following additional benefits which are not included in conventional Medicare. Vision coverage Dental coverage Hearing Aids Long Term Care Medical Care for Illegal Aliens Minimal cost sharing, meaning no copays or deductibles I’m surprise...

Brace yourselves.   Over the coming months and longer, you will be hearing presidential candidates and their acolytes proclaiming the moral imperative of a Medicare for All program.   Is this just an electioneering slogan or is this really the Holy Grail of health care reform?   Nearly all Whistleblower posts are stand alone essays.   This  Medicare for All entry, will be a rare departure from this tradition and will be a two-parter.   If you like Part I today, then you will have strong incentive to visit this site next week.   And, if you find today’s post to be disappointing, then I invite you back next week with the hope that you will find the conclusion to be more captivating and riveting than this post.   How's my salesmanship? Let’s try to agree on one thing before we disagree over everything else.   Conceptually, we all support any health care system that provides high quality medical care, with reasonable access into the hea...

Health care costs in America are incinerating nearly 20% of the Gross National Product.    Can you say, non-sustainable?    Folks have been bloviating for decades about reforming the health care system with respect to quality, cost and access to care.   This is quite the quagmire.   If it were easily solved, then it would have been done during the Truman administration. He couldn't get it done.   Here are a few reasons why it has been so tough to crack this case. Cutting costs can threaten medical quality. I know of no player in the Medical Industrial Complex who is willing to sacrifice his own revenue to serve the greater good. Pharmaceutical companies receive federal research dollars but are not subject to reasonable governmental control on their opaque pricing schemes. The public expects every conceivable medical benefit, preferably for free. The fee-for-service model drives unnecessary medical care. Pharmacy Benefit Manager...

A patient came to see me with lower abdominal pain.  Was she interested in my medical opinion?  Not really.  She was advised to see me by her gynecologist who had advised that the patient undergo a hysterectomy.  Was this physician seeking my medical advice?  Not really.   Was this patient coming to see me as her day was boring and she was bored and needed an activity?  Not really. After the visit with me, was the patient planning to return for further discussion of her medical status?  Not really. So, what was going on here.  What had occurred that day was the result of an insurance company practice that I had thought had been properly interred years ago.  The Insurance Reform Hammer - Locked and Loaded. The woman had pelvic pain and consulted with her gynecologist.  An ultrasound found a lesion within her uterus.  A hysterectomy was advised.  The insurance company directed that a 2 nd opinion be so...

Since the infamous memo released this week by the chairman of the House Intelligence Committee has taken up so much oxygen, other newsworthy events were relegated to a lower priority by the media.  In my view, many of these second tier issues deserve Page 1 coverage, but our media in general has decided that potential or actual scandal must lead their coverage.  Can anyone defend, for example, the prominent and repeated coverage that Stormy Daniels has received?   If CNN received a lurid videotape of Stormy and the president on the same day that North Korea declared that it wanted to denuclearize their country, which would be the lead story?  The editors would be agonizing! Tell the truth, would your rather be reading about Stormy?* A bombshell announcement in health care came this week when when 3 titanic corporations stated they aimed to reform health care coverage from within.  Amazon, JPMorgan Chase and Berkshire Hathaway will combine t...

The Graham-Cassidy bill – the latest Repeal and Replace iteration - still has a pulse, but its prognosis is grave.   While we physicians generally avoid predicting outcomes, my sense is that this bill will be buried in the coming days.  I presume that once its passage becomes mathematically impossible, that the bill will be pulled. Of course, failure to Repeal and Replace is a horrendous embarrassment and exposure of the Republicans who have been campaigning and crusading against Obamacare with religious zeal these past 7 years.   These patriots knew they could safely rail against the Affordable Care Act (ACA) – throwing red meat to their base – knowing that the bills would never pass while a Democratic president occupied the White House.   How ironic it is that now that the GOP have congressional majorities that they couldn’t get it done.  Not only could they not run the ball into the end zone, but they repeatedly fumbled at every opportunit...

Each morning, as I read the newspapers in view of 3 birdfeeders, I send excerpts of news morsels to various individuals in an effort to stimulate a dialogue on issues of the day.  I am mindful how deluged we all are with a tsunami of unsolicited material.  I will not contribute to the cyber pile-on.  First, I’ll never forward an article that I have not read in full.  Secondly, I will send an item to an individual only if I have judged beyond a reasonable doubt that this person will feel that the time investment in the material will be judged to be time well spent.  I engage in an active colloquy with one of my good pals, who is among the millions of Whistleblower readers who ponder these posts each week.  To my knowledge, he has never left a comment on the blog, which is somewhat unexpected of this rather voluble individual.   As he has opted to remain anonymous, I will not ‘out’ him here, although perhaps this post may be the catalyst to morp...

Everyone likes R & R.  In fact, I’m enjoying some R & R right now as I sit lounging on the backyard deck.  I have a full frontal of 3 birdfeeders who are all being attacked by avian assaulters.  It’s a microcosm of society – Lord of the Flyers, if you will.  The hummingbirds are working their wings off for a sip of nectar.  The finches politely share space on the feeder.  The male and female cardinals hang together – true love birds. The blue jays bully all the other birds away.  And, the lazy squirrels simply hang out below capturing seeds that the birds above spill to the ground. The Bully Senate Majority Leader Mitch McConnell is trying hard to get some R & R also.  Doesn’t he look like he needs it?  Poor guy.  The R & R on his agenda is not exactly like my backyard, bird gazing Rest and Relaxation.  The senator from Kentucky’s R &  R is R epeal and R eplace! The senator is a trained...

The House of Representatives enjoyed success weeks ago, depending on how one defines success.  Unquestionably, the passage of TrumpCare was a great political success that was not easily achieved.  I can’t fathom the intensity of threats and pressure that was utilized to convert a few ‘no votes’ into TrumpCare supporters.  The president and his team desperately needed a win after so many setbacks domestically and internationally.  And, this is a clear win, at least in the short term.  We will see if this vote becomes one that GOP House members can run on or will try to run from in 2018.  Indeed, the GOP high-fiving and Rose Garden ceremony seemed premature considering that they have ascended only about 20% of their upward trek on an icy mountain as they hope to slog to the summit.  They may never get there.  The Senate, who have been quietly working on their own reform bill, are unlikely to endorse the House bill which contains antagonistic po...

Have you noticed over the past several weeks that reforming the health care system must be slightly more complicated that we were told?  The promise that Obamacare would be repealed and replaced on Day 1 seems to have been met with a few minor obstacles.  In other words, it’s dead in the water. Whose fault is it?  It’s like Agathe Christie’s Murder on the Orient Express [Spoiler alert!] – everyone is guilty! The Freedom Caucus stiff-armed the Speaker of the House.  The GOP House moderates dissed the Freedom Caucus.  President Trump learned that being the leader of the free world is not quite the same as being a CEO of a private company.  If the repeal plan was adjusted to capture a few more hard line GOP members, then moderate GOPers jumped ship.  The Democrats gloated at the GOP’s failure, although their smiles became slightly more taut once Judge Neil Gosruch was confirmed to occupy the GOP’s 'stolen' Supreme Court seat.  Remember Joh...

Am I referring to Obamacare here or Obama himself? I am glad that we have a new president.  Like most of the country, I was ripe for a change of direction and a new approach to foreign and domestic affairs – and we are certainly getting that.  New readers here might erroneously suspect that I voted for Trump.  I didn’t.  For the first time in my presidential voting history, I wrote in my choice for our top two office holders. I have written multiple posts on my unfavorable views of Obamacare since it was jammed through congress without a single Republican vote.  (Do I sound slightly partisan here?)  Interested readers are invited to peruse posts on this blog within the Health Care Reform Quality category, if you dare. There are two kinds of people who oppose Obamacare Folks who believe it is wrong on policy grounds Folks who wield it as a political cudgel to bash Obama. Some opponents are a hybrid of both of the above. I was also...