Medical Tuesday Blog
Government Medicine Cannot Avoid Gluttony
Having worked primarily in government hospitals for the first 12 years of my professional life, I knew very little about private health care. Medical school had a university hospital for all our clinical work. There were generally two services: the ones that the resident/intern were primarily responsible for; and another for the professor’s private practice where only the resident was allowed/required to record the history and physical, and to order the laboratory, x-rays and other necessary procedures. Some of the attending staff were volunteers who taught one day a week and represented private practice.
On the colon/rectal service during my senior year, I must have gain the respect or admiration of a colon-rectal surgeon, who invited me to spend an afternoon in his office. Our first patient was an elderly lady with rectal pain and difficulty with having evacuation. Since she was a referral from an Internist he had reviewed the record and found no significant cardio-pulmonary as well as no other medical problems and went directly to a focused rectal/colon history. His nurse then prepared the lady for a digital rectal exam. We then re-entered the examination room where the patient was lying on her left side, her buttocks were neatly position and spread apart by the nurse. He applied K-Y lubricant to his gloved index finger and entered the anus and immediately found a large mass nearly obstructing the anal canal. He invited me to put on a pair of gloves. I applied K-Y Jelly to my index finger and immediately found the large mass, about the size of a lemon, covered by rectal mucosa. The buttocks were then covered by the nurse with a white sheet and the clinical professor addressed the patient and her husband who was at the head of the patient examination table. He discussed the tumor, which he stated was malignant, and needed to be removed. Since it was so close to the anus, she could only be reasonably cured by removing not only the cancer, but the anal sphincter. Thus she required a combined approach through her abdomen and from the anus. This was called an A-P resection and colostomy which would remain permanent. It would also require wearing a colostomy bag which would collect her feces. There then followed a discussion of the cost. The surgeon replied that would vary from $500 to as low as $0 if they had no funds to pay for it.
This was very impressive to a medical student who saw medicine in the raw before the advent of wide spread health insurance. This whole interface was in the world of private medicine, free enterprise, a direct relationship between a purchaser of health care and a provider of healthcare, which produced the lowest possible cost that was favorable to both parties. There could be no Medical Gluttony since no other party was involved to manipulate the system.
The world of health insurance companies’ determining what procedures were covered, by whom, and what the reimbursement would be was still decades away.
When insurance companies started to control prices allegedly to contain health care costs, prices mushroomed and inflation of nearly 100% occurred in the next two to three decades. The major unintended consequences of fee control were poorly understood by organized medicine and doctors in general. As doctors became more open to socialized medicine and as organized medicine openly supported Obamacare, they gradually became members of the TSR (Tax & Spend & Regulate) party. They adopted the fascist concept that we must exert greater control to reign in health care costs. They actually agreed with the socialist that controlling costs was their “sine qua non” and failed to understand how that was the very reason health care costs got out of control. They actually believed that we must “Regulate” and “Control” more firmly. This was epitomized by my successor as editor of Sacramento Medicine, who stated that the only reason socialized medicine hasn’t worked so far, is that people have too much freedom. This has also been echoed by Hillary Clinton when she also stated that Americans have too much Freedom. But isn’t that why our grandparents came to this country in the first place? Why return to Europe, where most of us originated from, when Europe is now in a death spiral?
Many insurance companies are now covering 100% of more and more items. This destroys the very concept that was putting any breaks on health care gluttony–a copayment on every test and procedure.
Medical Gluttony thrives in Government and Health Insurance Programs.
It is controlled with Appropriate Deductibles and Co-payments on Every Service.
Medical Gluttony disappears with a cash co-payment on every test and procedure which controls abuse and misuse.