Truth is more absurd than fiction. Mayor Michael Bloomberg’s wacky ban on
certain sizes of sugary beverages, a scheme which was riddled with
inconsistencies and exceptions, was properly squashed by a New York judge. The mayor’s next play was to order all
establishments that sell cigarettes to hide them from patrons. I hope that this policy is examined in the
same courtroom that ruled that the leaky soda ban was illegal. Is this guy a mayor or an emperor? Who can legitimately defend the government
dictating to private businesses how they can display legal products to its
customers? Where would candy, potato
chips and other poisonous snack foods be sequestered?
Speaking of sequestration, which the president warned would
crush the country, the earth still rotates, the sun rises in the morning and
congress has a 15% approval rating. In
other words, not much has changed.
We learned that there was not enough cash to fund White
House tours for school kids. Yet, we
learned that Vice President Biden and his entourage spent $585,000 for a single
night in a Paris hotel last month. The
VEEP & Co. were more frugal when they stayed in London on the same gig when
the price tag for one night was a mere $459,000. This seems a smidgen extravagant during such
economically lean times and conveys a message of prodigal excess to the hoi
polloi. Is it possible that some of the
expense for these 2 nights was excessive?
Was every government official on this junket essential to advance
American interests? While I don’t
suggest that the VEEP stay in a Bed & Breakfast or a youth hostel, I’ll
bet that these obscene hotel costs could have been reduced without jeopardizing
our foreign policy interests.
$585,000 + $459,000 = Lots of White House Tours for Kids
Motel 6 Next time?
I know from my own profession how many zillions of dollars
are wasted that generate income for various constituencies but don’t advance
the greater good. I have admitted
repeatedly that I and my colleagues are one of these constituencies. While the phrase cutting waste is an attractive
populistic utterance, the substitute phrase cutting income is more
provocative. Every dollar of waste is
someone’s income who likely doesn’t view his earnings as wasteful spending. Of course, this is not particular to the
medical arena; it’s true of every profession, trade and institution.
I have railed in this blog about the explosion of
unnecessary radiology testing in medicine.
CAT scans of the abdomen have largely replaced physicians’ examining
abdomens, similar to how echocardiograms have replaced actual physicians
discerning subtle heart sounds and murmurs with the antiquated medical
instrument known as a stethoscope.
While those who overdiagnose and overtreat, including
gastroenterologists, justify their practice patterns as sound medicine, watch
these practice styles screech to a halt once punitive payment policies against
medical overuse are implemented.
This week I saw a patient with abdominal pain who had a normal
ultrasound of the abdomen 2 days prior to hospitalization at another
institution. The dictated report was on
the chart for all to review. The
attending physician had ordered a special gallbladder test, but the radiologist
had insisted that an ultrasound be repeated first. Did we expect that a 2nd
ultrasound 48 hours later would show new findings?
I see this stuff every day and it is these observations that
led to the creation of this blog. There
is waste in the care of every patient, including mine, but the system has been
immobile and immutable. The medical
industrial complex is a lumbering ocean liner whose course extraordinarily
difficult to alter. Every real reform
threatens powerful, highly motivated and well-funded players.
Obamacare has smashed through the barricades and promised to
be the panacea that eluded us for over half a century. I have been a deep skeptic and my skepticism
has deepened with time, along with the rest of the country. Let’s watch what actually happens to medical
costs and quality as the government rules and regulations coerce doctors,
patients and employers. When the myths
of Obamacare are exposed, will the president come clean to our kids when they
are finally allowed to visit the White House?