MD Whistleblower

 Tinkerbell in Bronze I never thought I would have a chance to watch the health care reform summit on live TV this past Thursday. Fate took a U-turn. I didn’t expect to be in a New Jersey blizzard on Thursday morning. I was scheduled to be in the ICU performing an endoscopy examination of the stomach on a patient who I had seen in the emergency room a day before with intestinal bleeding. The plan was to fly to New Jersey on Thursday evening so that we could witness the milestone event of my brother being sworn in as a Superior Court Judge in on Friday afternoon. No human plan, however, can prevail against an Act of God. A torrential blizzard was descending upon the east coast and was threatening to postpone the event that was the result of years of my brother’s work and hopes. Unlike his anonymous gastroenterologist blogging brother, Robert has a deep network of judicial and political luminaries, developed over a career in the U.S. Department of Justice and the U.S. Attorney’s Off

Whistleblower Grand Rounds Submissions! Whistleblower will be hosting Grand Rounds on February 23rd.  All submissions are welcome. Here are some tips to maximize your chances of acceptance, which will guarantee that your blog posting will receive worldwide exposure. Send your posts to MKirschMD@gmail.com Write Grand Rounds in the subject line. Include the URL of the post in the email message. If you do not receive an email confirmation, then I did not receive it. Remember, brevity is the soul of wit.  If you are torn between 2 of your masterpieces, please send me the shorter one. Please include a sentence in the email expressing the point of your post.  This is your opportunity to  wield your razor sharp wit. DEADLINE for submission is Sunday, February 21st at noon.  Earlier submissions are preferred. Please send your stuff at your earliest convenience. In other words, now is not too soon. Now, on to this week's Whistleblower. How many times have we all been issued th

One day a hare saw a tortoise walking slowly along and began to laugh and mock him. The aftershocks from the political earthquake that just occurred in Massachusetts will extend to the first Tuesday this November. Democrats are dazed and reeling from what should have been their easiest electoral victory in the nation. Martha Coakley, their candidate, was 30 points ahead in the race only weeks ago. Look up the word complacency in the dictionary and you may see her photograph alongside the definition. [For younger Whistleblower readers, a dictionary is a large volume that fossilized folks like myself still consult for word definitions and correct spellings.] The hare challenged the tortoise to a race and the tortoise accepted. They agreed on a route and started off the race. After Coakley prevailed in the primary election by 19 points on December 8 th , she vanished. I guess she felt entitled to a Senate seat that Democrats controlled for nearly 6 decades. While she was AWOL, Scott

Blogging now from South Carolina, the cradle of the Confederacy.  This was the first southern state to secede from the Union on December 20, 1860.  We all remember the portentous headline from the Charleston Mercury that rattled the nation and President-elect Lincoln, who was still 3 months away from taking office.  Prior to his inauguration, 6 sister states would join South Carolina to form a confederacy.  They would try by force to form a new nation.  And we think President Obama has a heavy load?   I learned years ago, during one of my yearly historical sojourns, that strong echoes of the Confederacy survive. We came to a Charleston, South Carolina to a Bed & Breakfast and were greeted by the proprietress. We exchanged pleasantries and told her we were anxious to see some of  the area’s civil war treasures.  With a steely demeanor, she admonished me. “Round here,” she said, “we call it the War of Northern Aggression.”  Her statement was much more powerful heard in her slow, s

Would you be comfortable buying a house if you didn’t know the price or weren’t sure you could obtain financing? Of course not, but this is exactly the kind of purchase the government is asking us to support. This past week, the non-partisan Congressional Budget Office threw the Obamians off balance with health care reform cost estimates that were beyond the stratosphere. None of reform plans on the table credibly explain how they will be funded. The public is becoming wary of buying into their Grand Plan on credit. Credit card purchases are easy to make and can seduce us to buy more than we can afford. As many American are learning, these purchases can haunt us and ultimately bury us in debt. President Bush was rightly criticized for signing the Medicare Part D prescription drug program, which deepened our debt. Imagine how reforming the entire health care system could affect the nation’s balance sheet. First, show me the money. Then, show me the whole pie, not a different piece of it

Later today, President Obama will address the American Medical Association (AMA) in Chicago. I suppose that if the administration can make soft overtures to Iran, that it can also present its health care plan to physicians. The organization has already expressed its opposition to the president’s public option proposal, at least in its current form, which is regarded either as a panacea or a poison pill, depending upon your health care ideology. Some have accused the AMA of pursuing its own partisan agenda to protect physicians’ incomes rather than sacrificing a few dollars for the greater good. To this charge, issued by Kool-Aide drinking Obamophiles, I say guilty! Of course, the AMA supports physicians’ interests. Although I am not a member of the organization, I have always regarded it as a physician protector rather than as an advocate for the public interest. It’s history doesn’t inspire confidence that the organization is a paragon of humanitarianism. Recall that over 10 years ago

Obama’s health care reform is moving steadily forward, or backward depending upon your point of view. He has reframed the issue entirely, empowered by his political standing and Democratic majorities in both houses of Congress. It is no longer whether there will be a public option (read: government take over), but only over the extent that the government will control our health care system. The GOP are trying to cry doomsday, but their damage control efforts are drowned out by the din of the Democrats. What a difference an election makes. Senator Kennedy’s new legislative plan will provide health care to all Americans with employers and individuals making mandatory contributions. In this pay or play proposal, if someone does not purchase medical insurance, then the government would extract its pound of flesh through punitive fines. Private insurance companies, like casinos, would be required to pay out a specified percentage of their premiums as health care benefits. So much for the ‘f

Politicians speak out of at least three sides of their mouths. This is not just standard double talk, but represents the polished art form of triple talk. First, they tell us what we want to hear. Afterwards, they offer ‘clarifications and adjustments’ (never a flip-flop!) to their original remarks. Thirdly, they spin their views either to the right or left in order to repackage the policy for successful legislative butchering. All the while, they claim that their views have never changed. President Obama, before the election, assured us that he did not advocate the federal government taking over our health care system, realizing that most Americans would not support this policy. He offered us the safer bromides of expanding health care access, reducing costs and increasing medical quality. Who could oppose these noble objectives? However, campaign slogans such as ‘we need to create the finest public schools in the world’ generate enthusiastic support, but mask the complexity of the is

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

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

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 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

I am flattered that influential U.S. senators must be reading MDWhistleblower for important policy advice. Senator Max Baucus, Democrat of Montana, and Charles Grassley, Republican of Iowa issued proposals that aim to change the Medicare payment system to doctors and hospitals. Payment would be directly linked to quality, rather than to volume of services. Under the present system, if a surgeon operates on a patient 3 times to correct his own complications, he is paid more than a colleague who got it right the first time. However, as discussed in many prior postings on this blog, medical quality is very difficult to measure. One of the senators’ specific proposals receives a 5 Star Whistleblower Award for medical quality. The government will aim to reduce the excessive use of CAT scans, MRIs and other advanced medical imaging techniques that cost a fortune and create unnecessary medical cascades that chase after trivial lesions that will never cause illness. ( Click here for a related