Health Car Reform: Getting the Facts Right

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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Yosemite's Half Dome

Yosemite National Park is one of California’s treasured natural preserves. One of the nation’s first wilderness parks , Yosemite encompasses 761,266 acres or 1189 square miles. The “park” actually spans over three million acres of the Sierra Nevada if adjoining wilderness preserves, as designated by Congress, are included.

Yosemite makes natural wilderness -- rivers and waterfalls, cliffs and meadows – readily accessible every year to three and a half million tourists, campers, and hikers from all corners of the world. For San Diegans, accustomed to long commutes, it is merely 450 miles away or a pleasant 8-hour drive up I-5.

We owe a debt of gratitude to pioneers like Galen Clark, Yosemite’s first official guardian, and naturalist John Muir. Their efforts led to the preservation of this vast wilderness for generations to enjoy. Presidents Roosevelt and Lincoln as well issued presidential directives to protect this environmentally “green” project.

Have you given in to your adventurous side and climbed Yosemite’s El Capitan, or its second great cliff, the 87 million-year-old Half Dome? I have climbed Half Dome twice, and as quickly regretted it. It is a grueling ascent to a height of 8,836 feet above sea level. Hikers gifted with prime cardiovascular reserves and well-oiled limbs can make the extremely strenuous hike in 12 hours or less. For weaker mortals, like myself, the hours can painfully stretch much longer.

We have been trekking to Yosemite for years. The crisp mountain air and starry nights are unfailingly a pleasant way to spend summer days and nights with family and friends. We’ve pitched tents by its streams, gone fishing, built campfires, and slept in campers . We’ve also rented cots at Camp Curry or availed of more comfort at the Lodge, hiked through the meadows, and climbed up to the waterfalls.

In recent years, led by my naturalist brother Robert, we’ve set our sights to climbing the daunting Half Dome cliff. Five years ago, I almost died after a punishing day long hike when my knee gave out four miles into the descent back to the valley. But memory is short, and challenged (taunted, really) by my physically fit progenies a year ago, I climbed it a second time. Which endeavor resulted in blisters, aching limbs, and the loss of at least four toenails.

My consolation was that, as darkness descended on the way back to camp, bears and mountain lions had either had their supper or simply failed to spot me. Hikers of Yosemite have been known to simply disappear during nightfall -- into the bellies of beasts, presumably.

I’m not sure if the privilege of wearing “I climbed Half Dome and made it” is good enough to justify this insanity. But I have to say it is worth doing, at least once in your life -- like skydiving or sailing around the world.

Summer is just around the corner. Put Yosemite in the top of your list. You will not regret it, unless you fall into the temptation of climbing Half Dome, or El Capitan. Just kidding...

more . . . E-mails from the Desert - Dr. Ed Gamboa

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

Obama, Notre Dame, and the Culture of Life

On May 17, 2009, in the campus of the University of Notre Dame, my wife and I will be seated at the Joyce Center among thousands of students, faculty, parents and alumni, listening to the President of the United States address the graduating class of 2009.

Our daughter, Lauren Marie, would have received her diploma by then. However, two decades earlier, if President Obama’s “culture of death” philosophy had won over Notre Dame’s Catholic “culture of life” theology, our daughter would never have graduated. Simply because she would never have been born!

In 1987, we found out that my wife Lucie was pregnant. Previously, she had suffered a few miscarriages. I was a surgical fellow at the University of California San Diego at the time and we sought the help of pediatricians at the university medical center. Well-respected professors in pediatrics and genetics recommended an amniocentesis. They felt that it was important to know if Lucie was carrying a defective embryo, and therefore at risk for yet another miscarriage.

We both were troubled. What if the amniocentesis confirmed the worse – that the fetus was defective? The answer from the experts was straightforward: a therapeutic abortion. Why carry a risky pregnancy to term, which would likely end in spontaneous abortion anyway? And if the fetus survived, did we really want to raise a retarded baby, who would be a burden to carry for the duration of his or her unproductive life?

Our medical colleagues could not even understand why we were reluctant to have Lucie undergo an amniocentesis. What was there to think about?

Lucie as a pediatrician and I as a surgeon were familiar with the medical science on which the experts based their recommendations. We were also practicing Catholics and aware of the traditional teaching of the Catholic Church on abortion and the protection of human life.

If we proceeded with an amniocentesis, there would be the minor risk of an induced abortion. If the study confirmed that the fetus was normal and healthy, that would be great news. However, if the fetus were shown to be defective, would we then have it aborted?

We thought long and hard. We prayed about it. The medical arguments for amniocentesis and potential abortion were compelling. The Catholic and ethical considerations were convincing. Even if the baby turned out to be physically disabled or mentally retarded, we ultimately decided that we would accept God’s gift of life in gratitude, even if the future did not look too bright.

To this day, we are glad we made the decision to “keep the baby”. The pregnancy went smoothly and Lucie delivered a bouncing, robust, and healthy baby girl. We have four children and that baby is our only girl. What a bundle of joy she is!

Lauren Marie graduated in the top of her class in grade school and high school. She has been in the Dean’s List at the University of Notre Dame. Far from being the burden that medical experts had feared, she has been the jewel in our eyes and a delightful gift to our lives.

Yet, had we followed the promptings of the “culture of death” rather than the “culture of life”, we wonder what our lives would have been without her.

It is estimated that over three thousand abortions occur in the United States every day. The majority are not the rape or incest cases that pro-choice or pro-abortion advocates, the liberal media and Planned Parenthood are so concerned about. Most abortions are the result of lack of information regarding viable alternatives to abortion, such as adoption. Many are based on unfounded fears – will the baby be defective? How can I financially support the baby? How much of a burden will the baby be? What will my parents think? What will the future be like?

The controversy surrounding President Obama’s commencement address at Notre Dame, from my viewpoint, is not so much about the university’s traditional invitation to a sitting president, which dates back to President Dwight Eisenhower. Rather, it is about Notre Dame’s awarding the President an honorary doctor of law degree. How in the world can the foremost Catholic University in the world justify conferring such an honor on a politician whose major policies to date have trampled on Catholic ethics and principles?

As an Illinois state legislator, Barack Obama personally worked to block legislation banning the killing of disabled newborns that survived botched abortions. In the US Senate, the senator from Chicago was involved in fundraising to continue the practice of partial-birth abortion (an obstetrical technique to deliver a live infant except for the head which, in utero, is incised and suctioned resulting in death). As a presidential candidate, Obama promised the passage of the Freedom of Choice Act that would eliminate all existing regulations from the practice of abortion.

In the President’s first 100 days, he has issued executive orders facilitating the funding of international abortion agencies and for stem cell research utilizing human embryos. President Barack Obama disregards scientific data that confirm the embryo’s human characteristics or the developing consensus that adult stem cells offer a viable therapeutic and ethical alternative to embryonic stem cells.

At present, President Obama is preparing the federal government to eliminate conscience protections from physicians and from clinics and hospitals morally opposed to carrying out abortions. Furthermore, he has appointed to the White House and key federal agencies bureaucrats and lawyers recommended by extremist abortion advocacy groups.

Freedom of speech is guaranteed by the constitution of the United States and the President should be allowed to speak his piece at Notre Dame. However, his record speaks for itself and should be more than sufficient to persuade the University of Notre Dame not to confer an honorary degree which exemplifies its recipient as the embodiment of the Catholic values of the University of Notre Dame and the ethical and moral aspirations of its students, graduates, and alumni.

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