The disorganization among opponents of the “government option”/single payer/rationing that is at the heart of the Obama/Pelosi/Reid proposals to radically restructure health care in America is, well, non-existent. Until a specific proposal is on the table, the big interest groups are holding back, in a classic display of the triumph of hope over experience. When the Pelosi bill finally emerges from the House, even then the ostrich approach will continue as the groups tell themselves that the Senate will save them. [# More #]
But the Senate won’t save them because of the rule change that allows health care restructuring to pass with 50 Democratic votes. If a terrible bill gets out of the House, a terrible bill will get out of the Congress. The e-mail below illustrates –again– that voters have no idea that woeful destruction to the amazing American system of medicine that are on the horizon. But if you are one of those who do get it, look through this list of “Blue Dog Democrats” and contact one or more to urge them to reject “the government option”/single payer/rationing. If a blogger has already come up with a comprehensive post with contact info for the Blue Dogs, especially their office phones in D.C. and their districts as well as e-mails, pleas send along the link or the info. I will have my interns work on the contact list next week as well. I think any even remotely aware consumer of health care services has got to realize that the Democrats are on the verge of a massive destruction of the American medicine delivery system. There are problems in health insurance cost and coverage, but not in the quality of care and the innovation instinct, and the Democrats are going to kill the latter in the fruitless quest for improvements to the former. The “government option” is the biggest threat of all, a thinly digusied lurch to Canada-style single payor with the hidden (and increasingly not-so-hidden) rationing and lousy care that canada provides its people with complex diseases and conditions.
Unless enough Democrats get the message that a vote for Obama/Pelosi/Reid is a marker that will attract enormous political payback in 2010. They won’t believe that unless they hear it from enough people, and hear it in such a way as to believe that their correspondents are serious about contributing to the Blue Dog’s opponent in 2010 and even walking a precinct if necessary. Saving health care has to be for Republicans what killing Social Security reform was for Democrats in 2005 –a line in the sand that, if crossed, will never be forgiven.
It is amazing that neither the D.C. GOP or any of the doctors’ groups have yet organized such an effort, but the Beltway creates and reinforces an insiders’ ethic that enervates otherwise sensible people. But the peril to medicine is real, as the e-mail below indicates. So do something about it.
From Dr. L in Illinois:Dear Hugh,As a brief background, I am a board certified medical oncologist in private practice with a 22 physician group in Chicago and the adjacent suburbs. We see patients in ten hospitals, seven offices, and see nearly 5000 new patients per year. I finished training in 1993 and joined my practice that same year. I am a partner and practice manager, responsible for both patient care and ‘nuts and bolts’ financial and organizational management of the practice, along with our other officers.This weekend, the American Society of Clinical Oncologists will hold their annual meeting in Orlando Florida. While it is directed at the American cancer treatment community, it has become the de facto World cancer meeting. Much of that stems from the plethora of companies based in the US that have brought to the market a multitude of groundbreaking drugs, developed in US academic centers and thereafter applied to the American population at large who suffer from cancer.Reading the Meeting Proceedings between [visits with] patients in my office (not my turn to go this year), I’ve rarely seen an annual report that held such promise. There are a multitude of both new drugs, and new applications of established drugs that promise to accelerate the 1-2% annual drop in cancer mortality that we’ve seen since the late 90’s. It’s a better time to have cancer than ever before—if, of course there was ever a good time for such misfortune.Alas, I think many of these advances will be stillborn. And yes, I expect the Obama administration to be the instrument of its destruction.I will be the first to point out that there is enormous waste in American medical care. There’s plenty of blame to go around; physicians are rarely capable economists, and rarely consider the cost:benefit ration of that extra test or that extra day in the hospital; “Nothing’s too good for my patient” is laudable, but is also a screen behind which too many of my colleagues hide their intransigence. Greed is hardly unknown, though I believe far less widespread among physicians than their various suppliers. I admit to something less than objectivity on this. Medicare guidelines are often the perfect example of the adage “there’s no problem that government can’t make worse and more expensive”.Despite the fact that perhaps 15% of healthcare expenditures go to physician compensation, it’s the convenient target. Hospitals, private payors and Pharma are very effective in the political arena. The AMA, looked upon by the uninitiated as the’voice of American medicine’ is nothing of the kind. We, frankly haven’t the time, nor often the inclination to participate in the political wrangling; many of the ‘thought leaders’ in medicine are academics, whose goals are often diametrically opposite the more than 80% of physicians who practice in the private, nonuniversity sector.Every analysis of oncology suggests that we have a 10-30% deficit of trained physicians staring us in the face by 2020. Every academic analysis suggests one or another program, and bemoans the difficulty in attracting qualified medical students and residents to oncology. It’s quite simple, really: very hard work, and declining income. Private practice physicians have seen a fall of approximately 30% since 2004. Worsening economics are right around the corner. Given the extraordinary expense of chemotherapy and supportive therapies, combined with reimbursements that just exceed a wash, it will become impossible to deliver outpatient care in more than half the venues in the United States quite soon. And then, simply put, the senior physicians will quit.Make no mistake: most of us enjoy the opportunity to do what we do. After all, we cure cancer for a living. Hard to top that on the “Useful Professions” scale.We also, however endure just the stressors and personal strains that you might imagine. We trade time, and inconvenience, for money. Just like everyone else in the private sector, only more so—after ten years of training after college. With the prospect staring us in the face of working harder than the average internist, and earning less: well, if I were 58, and my kids were grown and my mortgage paid: well, I’d call it a day. At 48, I’m already working on an exit strategy by 55 in anticipation of this scenario.I could go on, but this note is far too long already. Specialists, and underpaid generalists will hang it up years ahead of their planned exit from medicine in just about any system that the Obama administration is likely to devise. They’ll scarcely need to ration care: there just won’t be anyone around to deliver it. Government will kill the golden goose, and then blame it upon everyone and anyone else. As usual.Sincerely,Dr. L. MD FACP
Read that again. Then go and call/write/e-mail some Blue Dog Democrats. Tell them to stand up to the left wing of their party or stand down in the next election. Promise to support their opponent if they support the destruction of American medicine.