Monday, October 18, 2004


Kerry's Medical Reform Plan Will Lead to Even Less People Getting Flu Vaccine

Kerry is definitely getting desperate. He and his running mate have repeatedly blamed Bush for the flu vaccine shortage. First of all, this is just pathetic, ridiculous campaign spin. It really doesn't justify a response. There is a deeper issue though. It has to do with Kerry's wanting to "reform" the health care system. And by "reform" Kerry means make it one big government program. Watch out for this because the only thing worse than "managed care" is "government managed care". And this is one of the big reasons why we do not want to put Kerry in office.

In my training and practice I have worked with doctors from Canada, Germany, Ireland, Sweden, Italy, Russia, Israel and France. All of these countries have one form or another of socialized healthcare. The one constant is that the more the government pays for health care, the more rationed it becomes. A close friend who practiced orthopedics in Canada for many years tells of having to wait up to two years before people are able to get a knee replacement. By the time they make it to the operating room, their knees are so bad that the surgery becomes technically more difficult leading to poorer patient functional outcome. In addition, years of taking anti-inflammatories and narcotics for the pain lead to increases in bleeding ulcers and tolerance to the pain medicine we use after surgery. Enough people die in the two year waiting period (attrition), or go south and have the surgery done in the US by paying out of pocket, that the Canadian government saves having to pay for a significant number of surgeries. Additionally, many of these people pass a certain age or develop other medical problems. The government then tells those people that a knee replacement is "not indicated" for them.

The socialization of health care also leads to the use of rigid algorithms which are produced by the government and mandatory for use by the physicians. Medical judgment gets thrown right out the window. Medicines and procedures are rationed to those who will apparently derive the most benefit. Usually this means that as you get older, less and less medical care is available to you. It also means that more tests are done on younger patients without utilizing critical judgment. As an example, a friend of mine who was spending a year teaching English in Germany fell and hurt her knee while playing soccer. She went to the emergency room where she received an MRI! Any credible sports medicine doctor will tell you that with the exception of the professional athlete, no person needs an emergent MRI for a sports injury. I and most thoughtful orthopods treat the injury symptomatically, prescribe therapy when the patient can tolerate, and if symptoms persist and the patient is interested in a possible surgery, we get the MRI. I estimate that we do an MRI for one out of every 100 (or less frequently) knee injuries which come to the emergency room.

Medical liability reform is also so very important to good care. We know W will take on this issue but the Kerry-Edwards duo is never going to bite the hand that feeds them (lawyers groups) or that fed them (juries and unlimited settlements). Two specific examples of how liability issues have lead to less and inefficient heath care. First, as a medical student I met many doctors who volunteered their time by serving on missions to foreign countries. My thoughts were that their service was admirable but that many people here in the United States needed their care. I finally confronted one surgeon about this. His response was surprising and nothing I was ready for. He told me that many doctors who have volunteered in inner cities or free clinics have had their generosity repaid by being sued by their patients. Some have nearly lost their practices. Overseas volunteer work puts the doctor at much less liability risk and is therefore preferred by many. Second, several years ago I was on call for the ER. A patient came in reporting back pain after a fall. He had previously had spine surgery more than ten years earlier and had not had any problems with it until now. The MD in the ER determined that the patient had no fracture, no nerve or spinal cord injury and was not in need of admission to the hospital. The radiologist MD confirmed the ER doctor's finding of no fracture or other problem on the X-ray. So the ER doctor called me down to the ER to consult on this patient. Why? In his words "it's a medico-legal thing." He then explained that all he really wanted was for me to see the patient and agree with his assessment of no neurologic deficit. Sounds nice but the fee for a surgical subspecialty consult is about $1000 - quite an expensive CYA (for the patient, insurance company and YOU).

Finally, in the last debate, Kerry said you could choose to join in his government program or choose your own. This over-simplification of the consequence of having a huge government-run health care system is missing the fact that most people get their health care insurance through work. Most employers today cannot afford to offer more than one or two plans to their employees and even then, the employee generally pays a big share of the premium. Now the government comes along with a super-cheap (but bad) plan. Next year, your employer will jump on the lower cost plan and leave you with little or no choice. As employers drop private plans, the cost of those plans will rise. The gap between private insurance and government insurance will become very wide making private insurance a luxury item. This is the case in several other countries where only the very rich can afford private health care. Government health care also reimburses hospitals, doctors, nursing homes, therapy facilities, laboratories, and radiology facilities poorly. Since these institutions no longer have market forces driving them (no matter what they do they get paid the same amount) quality, service and compassion are lost. Your health care becomes a post-office type disaster of disgruntled employees, long waits, and mediocre service.

We all know John Kerry is the wrong leader abroad and on the war on terror. But his plan for your health care will hit every single American, not just those unfortunate souls who are in the wrong place at the next wrong time. Bush has been clear about medical liability reform. He has been a clear market minded president. The answer to the healthcare problem is not another government plan. The answer is government in a limited role to keep the poorest among us from suffering and to encourage market forces to produce affordable and available healthcare. For those who want healthcare, programs like medical savings accounts, liability reform, tax incentives and corporate accountability will help make healthcare more available. Oh yea, almost forgot the flu vaccine. How many people do you think will get the flu vaccine when the government is rationing it?

NOTE: Just saw the 250 word limit - sorry Hugh.

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