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Hot Potato, Hot Potato

Hot Potato, Hot Potato.

In 1978, the year I matriculated medical school, if you would have told me that in forty years our country would be profoundly divided on issues related to healthcare delivery to its citizens and non-citizens alike, I would have laughed until I cried. The Viet Nam war had just ended, and our country was healing from the twenty-year conflict. Inflation was about to escalate the interest rates to an all time high. No one could purchase a home.

I was warned during the first week of my medical school experience that the healthcare industry was changing rapidly. The Dean of the Medical spoke loudly about the reforms needed to keep our healthcare system viable in the years to come. As students, we were more concerned about passing from year to year, not healthcare as an industry nor doctors as a profession in whole.

Over the years, I have watched big industry move into healthcare like a tsunami hitting the shoreline of a populated resort island. The sad reality is that in both cases, people are dying and it feels as if they are all dying at once. The tides have risen in both cases, and in healthcare, they have not found their economic ceiling yet.

Many of my fellow physicians are leaving the practice of medicine for other areas of financial gain. Young men and women graduating college who are fiscally responsible are questioning the value of a post-graduate M.D. degree as well as the relatively negative status that it brings to their lives. General practice physicians are valued less now more than ever, giving way to physician's assistant and nurse practitioners to be the front line diagnosticians. I have nothing against nurse practitioners or physician assistant, but if we are going to give them the keys to the diagnostic kingdom, shouldn’t we make sure that they have more experience than two years of post graduate training before guiding the care of young and old alike? If cost savings guide the medical industry, the general practice physician will become an extinct dinosaur, robots will replace surgeons and IBM's Watson will be in every Walgreen's store to assist the pharmacist on prescription writing due to the customer's symptomology.

In the most recent past, the Healthcare Reform Act has helped millions of Americans receive healthcare benefits who would not normally be able to qualify for them. I am one of the minority of medical practitioners that I know that believe that healthcare is a right in this country, not a luxury. We have the right to free speech, the right to vote and the right to have the keys to the courthouse. There is always a cost to the people for us to enjoy a right. Take the right to the keys to the courthouse for an example, I believe the way to stop all of the unnecessary lawsuits in this country would be to make the loser of any law suit carry the burden of its financial cost for both sides. Yep, loser pays everything. Our Shelby County Court House would look like the Memphis and Shelby County Airport. Empty. The poor would have no one to represent them in any case that was not a sure thing.

Sound familiar? Sounds like healthcare. If you cannot afford the drug or the benefit you need, you cannot have it. It is not the medical practitioner who decides what is affordable, it is an insurance company or a third party administrator if you have the privilege of healthcare insurance. Add the pharmacy to the equation here. They mark up the cost of drugs, sometimes one thousand fold or more. Then again, there are many cases were the practitioner over prescribes or wants to use the newest, most expensive drug or therapeutic method to heal someone's ailments without guarantee that the proposed treatment will be successful. Cancer care is one of those areas as well as genetic testing of every variety.

The current political climate appears to be one that wants to dismember the Healthcare Act, also known as Obama Care and replace it with Trump Care. At least some of the politicians are suggesting it. I do not see either of these two options as viable long term. In the long run, whether you support one or the other, healthcare will become so expensive, that no one will be able to afford to have a physician, much less benefit from the advances we make in healthcare. Just read the Healthcare Act or review the ideas behind Trump Care, and you'll be shocked by the expansion of revenue generated by the health insurance companies, hospitals, drug companies and pharmacies. Physicians and nurses have been long left out of the reform, meaning they have to fight for every penny they can. They fight for the scraps.

When health care becomes so expensive that only a select few may receive it, the people will rise up. Americans always do. Regardless of your political views, when your child cannot get medical help for an ailment, or when your mother cannot be treated for her heart disease, or when your dog has more access to sound medical care from their veterinarian more than you do in an emergency room, you will push for a single payer system regulated by the government. But here's the downside of a single payer system: it's as corrupt or even more so than the current system we have.

I spoke to a well respected cardiologist yesterday, who asked me to help him communicate his concerns to a woman we both care for. We have shared the care of this delightful lady for fifteen years. She is an eighty-five years-old Medicare patient afflicted with atrial fibrillation as well as a number of other ailments. She refuses to take anticoagulants of any kind because of their side effects. The cardiologist wants to dismiss her from his practice because she's not following his prescribed therapy. On the surface, he seemed to be troubled about her welfare, since he continued to profess that she had a high stroke risk at eighty-five years-old. Every eighty-five year-old person has a higher than average stroke risk. But the real issue is that if she does not take an anticoagulant medication, he will not be paid by Medicare because he is not providing her the standard care associated with a cardiologist, criterion establish by his fellow cardiologists. He did not believe that an eighty-five year-old woman had the right to make a decision about her health that was not in accord with the standard of care in cardiology. Since when did he decide that his patients did not have a right to make their own decisions about their care or refuse to take a medication for any reason?

In a single payer system, you will most likely lose your right to make decisions for yourself. If you choose against the prevailing wisdom of the specialists who have been paid by the drug companies to sponsor their drug treatments, you will not be cared for by the specialists. That's okay if you have a great generalist who supersedes a specialist, but the medical schools are artificially restricting the number of physicians they're producing and the doctors that are graduating are not going into general medicine or primary care. The politics of medicine is destroying the practice of medicine, all for the sake of multi-million dollar CEO's of hospitals, drug companies, biotechnology firms, commercial clinical laboratories, and pharmacies in drug and grocery stores. But don't fret.

By the time most of this healthcare stuff is worked out, the majority of you reading this blog post will be dead and gone. Your children might be battling for their life, but you will have already lived yours to its greatest extent possible. You will leave this healthcare mess for your children and their children to clean up if they are given the right to re-organize it.

Hot Potato, Hot Potato.

Baker Man, Thief.

Doctor, Lawyer, Indian Chief.

Make a Wish.

Touch the Sky.

Let me Stick a Needle in Your Eye.


I remember those funny rhymes. Do you? Healthcare, the hot potato, isn't funny anymore. I think it never was.



Posted by Amanda Sanders at 10:35 AM
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