To: [email protected] Subject: Paging Dr. Galt From: [email protected] Date: Wed, 2 Sep 2009 02:49:27 -0400 TIA Daily September 1, 2009 FEATURE ARTICLE Paging Dr. Galt Health Care from the Producer's Perspective by Robert Tracinski Much of the debate over the health-care bill starts and stops in the wrong place. It dwells on the experiences of health-care consumersbut the story actually begins with the producers of health care, the doctors, nurses, hospitals, drug companies. Without these producers, no health care is available for the consumers to buyat any price. So we need to begin by looking at the current legislation from the perspective of the producers. So far, President Obama's efforts in that direction merely betray the inability of a lifelong leftist to see private enterprise in any terms other than the standard Marxist caricatures about "greed" and exploitation. He made that jarringly clear in his attacks on doctors, whom he has characterized as unscrupulous hacks who cut off limbs for lucre. Let's take the example of something like diabetes, one ofa disease that's sky-rocketing, partly because of obesity. Partly because it is not treated as effectively as it could be. Right now if we paid a familyif a family care physician works with his or her patient, to help them lose weight, modify diet, monitors whether they are taking their medication in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000, immediately the surgeon is reimbursed. That part about surgeons being paid fabulous sums of money for amputations turns out to be a total fabrication. The actual reimbursement for such a procedure is less than $1,000. Obama also explained for us the workings of the tonsillectomy racket. So if you come in, and you've got a bad sore throat, or your child has a bad sore throat, or has repeated sore throats. The doctor may look at the reimbursement system, and say to himself, "You know what, I make a heck of a lot more money if I take this kid's tonsils out." Now that may be the right thing to do, but I'd rather have that doctor making those decisions, just based on whether you really need your kid's tonsils out, or whether it might just make more sense just to changemaybe they have allergies, maybe they have something else that would make a difference. Thus speaks our national physician-in-chief to his new apprentice, your doctor. What kind of policies does this outlook lead to? The Obama administration just announced a plan to reduce already low Medicare reimbursement rates for cardiologists and oncologists, deliberately starving out these specialists and decreasing their incomes in order to encourage more doctors to become general practitioners. This is a timely reminder of what the current legislation really means. By deliberately inducing a shortage of physicians in crucial specialties, just as the "silver tsunami" of baby boomers comes roaring into old age, the administration has reminded us that their goal isn't just to cut costs. They seek to impose a kind of central planning on the medical industry through such measures as adjusting reimbursement schedules to reflect the latest decree from Washington, DC, about the proper ratio of specialists to general practitioners. Vilifying physicians is a tactic that has always backfired on advocates of socialized medicine, because the American people have an enormous and well-earned respect for their doctors. The average person knows his doctor as a trusted and respected figure, the person who delivered their babies or cured grandma's cancer. We know our doctors, and in the current debate we can sit down and talk to them and ask them what they thinkand if you do that, you're likely to get an earful. I sat down recently with a local Charlottesville physician, Dr. Gary Helmbrechtwho also happens to be one of my wife's obstetricians. (I had last talked to him when he performed the ultrasound I described in a previous article.) Dr. Helmbrecht confirmed my sense of what the health-care crisis is not. It is not a crisis in the availability or quality of care in this country. The actual experience of patient care, he says, is "exemplary." The process in which a patient notices a problem, goes to a doctor, undergoes medical tests, gets a diagnosis, and receives treatment is well-oiled. He gave an example of a woman he had recently treated, who had reported a problem with her pregnancyand was then able to secure appointments that same day with three different specialists, leaving his office at the end of the day with medications in hand. (See a similar story about Dr. Helmbrecht here.) When a patient has a problem and needs to be treated, "It gets done." But he also pointed out that this is about more than just known treatments for known problems. The current system also allows for a "free entrepreneurial spirit." Dr. Helmbrecht's specialty is prenatal diagnosis, and he and his partner were leaders in the use of nuchal translucency screeninga way of using a certain physical marker in an early ultrasound to assess the risk of Down Syndrome and other chromosomal defects. Many of their customers were other doctors' patients who were referred to them for this special screening. But now, he says, other physicians are catching up, so his practice is trying to stay on the "front end of the curve" by purchasing new ultrasound machines that give them better, clearer pictures and more information. They can do this because there is no big bureaucracy they have to answer to. A big institution would have a "capital equipment committee" to make that kind of decision, but in Dr. Helmbrecht's case, he and his partner can make a major decision just with a conversation in the hallway between appointments. "We are the capital equipment committee." Now compare that to the Medicare story above. That's the direction the "public option" is taking us: greater control of the entire health-care system from Washington, DC, which will seek to control physicians' spending and manipulate their priorities. Consider, for example, the proposals for a government board that would establish "guidelines" about which procedures are "cost-effective" and which are not. That creates a bias in favor of known, established procedures and against any kind of innovation. New treatments, after all, are often more expensive, and precisely because they are new, their benefits are less well-established. So under a government-controlled system, forget about pioneering tests and new ultrasound machines. But the biggest threat is that the whole goal of the current legislation is to control costs by imposing Medicare-like reimbursement rates as standard payment for physicians. The problem? Medicare cuts its costs by reimbursing physicians and hospitals at low-ball rates that are generally unprofitable. The hospitals make up for the shortfall through "cost shifting"charging higher rates to the rest of us to make up for the money they're losing on Medicare patients. But once the whole system is run by government, there will be nowhere left to shift the costs to. Dr. Helmbrecht talked about what that would do to practices like his. At Medicare-level reimbursement rates, "we can't even cover our expenses." The result, he says, would be "catastrophic." Large, state-connected institutions (like the University of Virginia Medical Center) may survive, but community hospitals (like Martha Jefferson Hospital) and a whole constellation of private practices associated with them will be wiped out. And it gets worse. Dr. Helmbrecht pointed to a little-discussed fact. There is already a shortage of doctors, which will only get worse as the baby boomers age. So providing free or subsidized health care to millions of new people would cause a surge of demand for doctors' services, just as unprofitable reimbursement rates are driving them out of business. It is a prescription for immediate shortagesa problem that would then have to be solved through government rationing. Dr. Helmbrecht had much more to say about the problems with the current system and what actually should be done about it. But the overall conclusion I took from our conversation is that the current health-care bill was designed with no consideration for the way an independent private medical practice works, for the economics of how doctors are to make a living and be rewarded for their work. There has been no thought on this subject because the left doesn't care about the rights of the producers of health care. They focus only on the demands of the consumers. Dr. Helmbrecht related a recent case in which he drove down to Charlottesville from a conference in Northern Virginia to perform an emergency procedure to save a woman's pregnancy. He interrupted his trip and got on the road late at night because he is the only doctor in the area who performs that procedure. But you have to ask, he said: "Where's the motivation?" Under the current system, he said, "If you work hard for the patient, the funding follows." But what will happen if that is no longer true? In Ayn Rand's timeless novel Atlas Shrugged, the mysterious hero John Galt is a symbol of the man whose productive energy is withdrawn from the world in protest against living as the despised pawn of the state. But Ayn Rand was aware that the disappearance of the men of talent did not always happen as a deliberate act of protest; it is often just the natural outcome of any system that punishes hard work, ambition, and independent thought, discouraging and demoralizing men with those life-giving qualities. This is what some people have started referring to as "going Galt." If we accept such a system in the medical profession, we could find ourselves paging Dr. Galtand getting no answer. back to top One-Year Subscription $74 Six-Month Subscription $38 Subscribe now! Copyright © 2009 by Tracinski Publishing Company PO Box 8086, Charlottesville, VA 22906 To remove yourself from this mailing list, reply to [email protected] with the subject line "unsubscribe." 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