Monday, March 22, 2010

Passage of Health-Care Reform Bill

Well, to no one's surprise, the very flawed bill was passed. President Obama did prove he is a strong president, for better or worse. I am convinced that unless there are substantial changes made to this legislation, it will have very negative financial reprecussions, impede access to care and reduce quality of care. More people will have access to insurance but not more access to health-care. Even many democrats agree this is a very imperfect bill. Our strength is in the living, ever-changing democracy that we are proud to call our own. But it does take great strength to shift the direction of this great ship. When we have strong convictions, we must not give up on achieving our goals. We can still, in the end, have a health-care system that provides the highest quality of care at affordable cost to all the citizens of this country. We must remain proud of our health-care sytem, the greatest of all our public services.

Saturday, March 13, 2010

My Poem of the week

Late April Afternoon

The green, green grass
Softens my expanse of yard
And I do see it green, green
Though I’m a color-blind bastard of unwanted birth
At least from my father’s recounting
The setting sun so soft and warm
This late April afternoon
A Brahms piano waltz
Dances me to the precipice of clarity
The residua of a decaying carcass
Barely breaching my olfactory groves
So close to my beloved amygdala
I remember nothing
I recall everything
So green, green, green

Ezriel Kornel
April 28, 2009

Tuesday, March 9, 2010

Are the health insurance companies' profits too high

President Obama is right about one thing in his plan for health-care reform: insurance companies need more controls placed on them. Insurance companies are middle-men. They don't diagnose illness and they don't treat illness. Some offer incentives to stay healthy but mostly they decide how to spend your money. What they prefer to do is not spend it at all and use it to make a profit and distribute your money to the shareholders.They make money when you are healthy and they make money when you are ill by denying services that your doctor requests in order to make you healthy again. Somehow they think they know better than the doctor if a treatment plan may work or not. So why not restrict the profits of insurance companies since they are only "managers" of your money? Why not do what is done with utility companies, allow only limited profits. somewhere in the neighborhood of 1-2%. More money would go to providing health care and less into redistributing the money that you paid to obtain good health-care.

Saturday, March 6, 2010

Tort Reform

I could go on and on about the topic of medical tort reform but in a brief essay I can say what needs to be heard . In New York, all neurosurgeons who have been in practice for more than two years have been sued for malpractice. The average number of suits is just shy of one a year. So a neurosurgeon in private practice for twenty years can expect to be sued almost twenty times. If each suit suggests that bad doctoring has been going on, one must therefore assume that all neurosurgeons in New York are performing substandard care on a regular basis. The only other explanation is that doctors are being sued, not because they are providing substandard care, but because patients think that they should sue when an outcome is not perfect (and believe it or not, some just lie about it.) Who tells them it's appropriate to sue? Why the lawyers, of course. They know that the harassment of a suit pushes many doctors to settle rather than have to spend years worrying about a case and weeks to months in court when they should be taking care of patients. Lawyers are happy when doctors settle because it's far less work for them. Don't forget that in an effort to minimize suits, doctors are told to order countless tests so that no lawyer can say that perhaps "the one test" that wasn't performed may have lead to a different outcome. Even more unsettling, doctors perform invasive procedures and even operations because they fear that if they do not do "everything" some lawyer will say they did not do enough. All doctors know this to be true. No one is of the opinion that patients who are the victims of substandard care should not be compensated. We need a system that accomplishes this goal justly and fairly and appropriately. We can use the money wasted on paying into the legal system and use it instead to provide health-care to more of our citizens.

Thursday, March 4, 2010

Poem of the Day

The Pronouncement

His still, angular form
Lies upon the bed
Clad only in the hospital gown
And his socks

When he pulled them onto
His feet this morning
He could never have conceived
That they would offer
Far more tangible evidence
That he once was
A breathing man

Than that
Still, angular form
Which once
Contained him

Ezriel Kornel

Wednesday, March 3, 2010

Medicare editorial from BackTalkLive

Just as I was preparing my editorial on medicare, CNN asked me for an interview about my perspective on medicare. What did I tell them? It's a SHAM because it doesn't pay doctors who want to practice quality medicine enough to stay in practice. So how can they stay in practice? From the income private insurance pays. This means that medicare is a subsidized insurance program, like a charity. Primary care doctors either have a patient mill with a squad of physician extenders such as nurse practitioners and physician assitants (most are very competent) working for them or they can't make a living. That's why so often you don't even get to see your doctor or if you're lucky, maybe for five minutes and that's after waiting for an appointment for a ridiculous amount of time. I, a surgeon, opted out of medicare because I didn't want to support a sham. It doesn't come close to even covering my costs so I want my patients to know the truth. I ask them if they can pay a reasonable fee, I never want them to go broke but I want to at least cover my expenses. If they can't pay anything and are determined to have me perform their surgery, I will do my best to work something out. Not all doctors are prepared to do this, they just can't carry the losses. If my only reimbursement was medicare based, I would have to perform over 500 operations before I saw a penny of it myself. None-the-less I always give the best of myself no matter whether my over 65 patients can pay or not. Most of my patients do choose to pay because they want to feel good about selecting the doctor of their choice. With medicare further cutting payments, more doctors will be forced to opt out and patients will all have to pay more out of pocket or receive second class medical care.