Diary

Help not wanted: Healthcare Reform will ruin MY life too.

I’m a doctor. Not the fancy kind you see on TV, or even the kind on one of those cool government commissions. Just a pediatrician, with a sideline in healthcare IT and maybe a little more knowledge about how the government works than the average doc.

But I know enough to make a simple request of those people in Washington earnestly working to “reform” health care. So, without further ado, my open plea to the Powers that Be:

Stop. Please. Give up, go away, and please stop trying to make my life worse. There is nothing that you’re talking about that is going to do anything good.

Oh, there are things that would help. If you really wanted to make health care cheaper for all Americans, you could start by funding Medicare and Medicaid at levels that didn’t require me to charge more to every other patient so that I can make ends meet for my government-funded ones. No, wait, that’s not on the agenda. Increasing the number of government-funded patients, yes. Making sure that I don’t take a loss on every one I see, not so much.

Or you could ease up a little on a regulation here or there. Medicine is, you know, the most heavily regulated profession in the country already. Maybe just charge me a little less for my DEA? It’s not terribly expensive, but every few hundred dollars is another expense that my patients get to pay. See, I don’t actually print my own money – the only money I get to spend is money from my patients, or their insurance companies. If you want to pay less for medical care, how about charging me less to provide it?

Actually, why do I need a DEA at all? Could you maybe just stop trying to regulate addicting drugs at a federal level? No, no, I’m not serious. I’m sure it does some good, somewhere. I’d just be interested in a sort of societal ROI on that one. ‘Cause I’m pretty sure it costs a heck of a lot more than it saves.

But back to reality. How about working to streamline the FDA some? The reason that things cost so astonishingly much in medicine is partly because of regulations. The cost of the saline in a pre-packaged IV flush is less than a penny. The cost of the sterile container and transport (not counting the regulations) is probably a few cents. The actual cost to the hospital is about $15.00 (per syringe), and nobody’s making a killing on it. MRI scans? A few cents for electricity, a couple hundred for the radiologist still paying off his student loans, and a couple thousand more because it’s medical, the machine costs a fortune, and you’ve got to make the capital expense work.

I’ve never actually heard about the FDA making a single thing easier or cheaper to do. I’ve actually done medical device development, as well as having a sister in Big Pharma, and neither of us can recall a single time when a regulation or process was challenged, made cheaper, or eliminated as not productive. Nobody is arguing that we don’t want oversight, and I guess the FDA is as good a way as many (although I can think of some private ways that would be better), but is it too much to ask, in 2009, that you stop spending health care dollars as if they were on fire? Or that you remember that every dang regulation you enact produces costs that trickle right back to the bedside?

Now if you REALLY wanted to help, you could maybe put a muzzle on the plaintiff’s bar. Not just the ones who sue doctors (although I do have sort of a grudge against them), but the bottom-feeders advertising for mesothelioma patients, the ones looking for people who have been harmed by various drugs, and so on. There’s a line between appropriate compensation for inflicted economic injury and reckless profiteering on the backs of patients and providers alike, and that line is way the heck back there someplace.

And patients (or insurance) pay for it all. Again, I don’t print money. So my malpractice premiums, those of my colleagues, and the liability insurance for the hospital all come out of the pockets of the people we treat. Actually, those liability costs are built into costs for labs, X-rays, drugs, and everything else in health care. Pretty much everybody gets sued, and in a closed lottery like this one, you can guess who pays. HINT: It’s not the trial lawyers. Now I really don’t expect you to do anything about that, because everybody in Washington, Democrat and Republican alike, has a soft spot for plaintiff’s attorneys, but it would actually help quite a lot. Just saying, is all…

See, we have the best health care system in the world right now. Sure, you can say how awful it is, but how many people really want to go anywhere else? The best physicians are here, the best emergency care (by far) is here, and the serious problems we have with health are all long-term issues caused more by lifestyle (we think) than by failures to take care of people. If you’re ill, the United States is the best place in the world to be. If you’re poor and ill, it’s one of a handful of nations rich enough that you’ve got a good chance to get care without having to pay for it. If you’re poor, ill, and homeless, the United States might be the only place on earth where you’re not going to die of the first major illness you contract. So is it too much to ask that you at least try to preserve that?

Yeah, it probably is. So I’m left hoping for sloth, political infighting, and distractions of a thousand other kinds to get in the way of doing anything. If you can avoid trying to help, we’ve got a chance to keep the system we’ve got, fix some of the things that are wrong with it, and keep improving. The more you “help”, the less bandwidth I and my colleagues have to actually take care of people.

Think I’m kidding? Think again – that lovely HITECH act that you passed as part of the Spendulus has created a land-office bonanza of consultants and vendors trying to sell things to “comply” with the requirements for “meaningful use” of “certified systems”. Only nobody actually defined those terms, so everybody’s guessing. Sometime later this year, we’re going to have a ruling from the Office of the National Coordinator who will put a stake in the shifting sands and say “this is meaningful use”, and then there’ll be about a hundred major fights, a few lawsuits, and a few thousand health systems trying to go after some of the money. But there isn’t that much money, and the result is that we’re already spending a lot of cash that (a) isn’t paying for care, (b) doesn’t have anything to do with doing anything better, (c) doesn’t specify or predict any particular date or time when results are going to improve, and (d) will never be paid back in anything like the quantity in which it’s being spent. The whole thing is a boondoggle, and my system (and a lot of others) are participating mostly because we figure that you are going to drop our (already below-cost) reimbursement to compensate for our “stimulus windfall”, so if we don’t play the game, we get put out of business. With help like this, who needs swine flu?

And that’s just the warm-up. Sometime in the next year, unless you lovely folks manage to find someone else’s house to burn down, you’re going to “reform” my profession and my life. I expect payment “reform” that will make it virtually impossible to stay in business, combined with regulations that will permanently fracture the industry. I expect punitive sanctions for random “crimes”, mostly having to do with “profiteering” and maybe with “inefficient” or “unsanctioned” care. I expect bureaucrats to decide everything from hospital staffing to health plan formularies, and I don’t imagine those individuals will have the knowledge or the direction to make those decisions to improve anything at all. I expect, to be perfectly blunt, that a batallion of chimpanzees with submachine guns will be put in charge of me, my patients, and my profession.

Oh, we’ll keep taking care of people (including you) as best we can. I didn’t get into this profession because I was going to make a fortune, and my early-’90’s Toyota gives a pretty accurate picture of how much of a fortune I didn’t make. I knew when I was getting in that I would have to work around people hostile to everything I do, and I have done so for years. So don’t worry, I’ll still see your kids if I’m reduced to accepting food stamps in the process, and I’ll play whatever games you make me play in the process, but I’d really rather not go there. So again, to all of you in Washington earnestly looking to camp on someone’s lawn and “make a difference”, could I ask once again that you do it somewhere else? I really don’t need the help.

Honest.