As I write about the current national debate on health care, I get a sense of what Pope Benedict XVI might have felt at Regensburg. Compelled to speak about Islam and violence, the Holy Father was keenly aware he was walking on thin ice. The Vatican’s track record during the Crusades was not a shining example of Christ’s teaching on peace and justice . Yet, despite the historical baggage, Pope Benedict forged ahead to address the errors of Islamic fundamentalism.
In good company, therefore, I will speak about health care reform. A short essay like this simply cannot cover the health care debate in a fair and comprehensive manner. So, I will address the issue in a series of articles.
At a recent Knights of Columbus convention in Phoenix, a well-educated Filipino, upon learning that I was a surgeon, brought out the topic of health care reform. From his perspective, the solution to providing health care to 40 million people without medical insurance was simply to reduce payments to physicians, hospitals, and drug companies. He must have read the USA Today interview of House Speaker Nancy Pelosi, who assured the nation that securing $1.4 trillion to fund a new government program was easy – the government would simply tax doctors, hospitals, and pharmaceutical companies.
So I asked my brother knight what he thought I would get compensated for if I got out of bed at 2 in the morning, rushed to the ER to examine a patien t, reviewed the blood tests and CT scans, diagnosed appendicitis, then brought the patient to the Operating Suite for emergency surgery. And what if I kept the child or adult in the hospital for several days of intravenous antibiotic treatment, saw him or her every day on rounds, conferred with the nurses and updated the family regarding the patient’s clinical progress, then checked the patient again in the office for the next couple of weeks until he or she could go back to school or work?
My fellow knight promptly mentioned a dollar amount that was easily ten times what I would actually get paid for. Assuming, I did not get an IOU check from Sacramento, as is happening these days under the state budgetary crisis.
And what did he think I would get paid for services rendered after surgery? He guessed wrong again. How about zero dollars, I said. Everything that surgeons do after surgery falls into what is called a postoperative “global period” of 60-90 days when all services provided for the patient are free.
He thought I was joking. “Doc,” he said, “don’t you get paid $500 every time you opened a chart?” This led me to conclude that he (and millions of Americans) must have been listening to the President of the United States who claimed that surgeons got $50,000 for amputating a leg. I wonder on which planet these surgical fees are being disbursed. Overworked physicians can certainly use such generous reimbursements here on earth for the ever increasing malpractice premiums we pay to protect ourselves from lawsuits that have become casino lotteries for patients and malpractice lawyers.
Knowledgeable experts estimate that if tort or much-needed malpractice reforms were instituted, and defensive medicine eliminated, health care expenditure in the United States will immediately be reduced by $200 Billion a year.
Last year, an article entitled “Patient Perception of Medicare Fee Schedule of Laparoscopic Procedures was published in a surgical journal (Surgical Innovation, September 19, 2008). It was a study conducted by a team from the University of Miami School Of Medicine and presented to the Society of American Gastrointestinal Endoscopic Surgeons annual meeting.
Concerned that the public (and congressional representatives) are under the erroneous notion that physicians receive substantial remuneration for surgical procedures, the team surveyed 96 patients. 83% of the patients had been operated on.
The survey revealed the following: Almost all of the patients (98%) thought Medicare should pay more for technically difficult surgical procedures. 32% felt Medicare paid physicians well but 91% thought Medicare should increase fees for doctors.
Interestingly, patients thought that surgeons were paid $14,963 for a gastric bypass operation and that Medicare should increase payment for the laparos copic procedure to $16,877, when, in fact, Medicare pays only $1,504 for such an operation.
For gallbladder surgery, patients thought that surgeons were paid $8,746 and that they deserve to be paid $10,555 for the operation. In actual fact, Medicare pays $620.
Medical students surveyed in a 2007study thought that surgeons got paid $3,000 for gallbladder surgery while most surgeons thought they were getting paid $700. Again, the actual payment was $620 for removal of the gallbladder by laparoscopic surgery. Such compensation also included medical care before and after surgery.
For initial patient visit to the doctor’s office, the survey showed that patients think Medicare pays $144 and that doctors deserve to be paid $181. In fact, Medicare pays surgeons $90.58 for a patient’s visit. Additional visits are paid lower.
The study concluded that “lawmaker perception of Medicare physician reimbursement probably resembles public perception, which may explain the fact of the ever-threatening cuts in Medicare reimbursement to physicians.”
Next year, Medicare plans to cut reimbursements further by another 20%.
Jolted by facts, my friend in Phoenix said that Medicare had trouble containing costs and that Medicare constitutes only a fraction of most medical practices anyway. He was right. Depending on type and location of practice, Medicare makes up 20-40%. However, what he did not know is this: most, if not all insurance companies, now set fee schedules as close to Medicare rates as possible. And Medi-Cal rates are even lower than Medicare.
That is why most physicians, while recognizing the value of universal heal th care, are concerned that the proposed government option plan will be nothing more than a Medicare clone.
I will examine another aspect of health care reform in the next article.
more . . . E-mails from the Desert - Dr. Ed Gamboa
28.AUG.09 Health Care Reform: Getting the Facts Right
08.MAY.09 Yosemite's Half Dome
24.APR.09 Obama, Notre Dame and the Culture of Life
27.MAR.09 A friend goes on vacation
06.MAR.09 The Garden of Eden
06.FEB.09 Double Speak
30.JAN.09 A Cup of Tea, Before Sunrise
16.JAN.09 A different kind of Santa
19.DEC.08 A lonely Christmas...
28.NOV.08 The Perils of Capitalism
21.NOV.08 Sold-out Audience Cheers for Asian Silk Road Concert
31.OCT.08 The Sarah Palin Factor
10.OCT.08 Restore Traditional Marriage - Vote YES on Proposition 8
19.SEP.08 Olympics, Philippine Style
08.AUG.08 Wisdom - where to find it?
25.JUL.08 Moonlit Beach
11.JUL.08 Breast Cancer Treatments
27.JUN.08 Breast Cancer 101
13.JUN.08 PATHWAYS
06.JUN.08 Coming Out Soon! "Virtuous Healers"
30.MAY.08 Filipino Nuncio
23.MAY.08 Pan de Sal Cruise
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