Some Thoughts About Healthcare Reform
August 26th, 2009 Dr.Terry Hand
After a bit of a hiatus, OK four months, I am back to blogging. Sorry about the stop and start but I realized that I did not just want to blog about current plastic surgery topics and procedures. I wanted to share my opinions as I said I would. Soo ….. forget about the PC safe subjects only, today I have another issue on my mind. I’ve been following closely the national debate over health care reform. As a practicing plastic and reconstructive surgeon, I have been amazed by some of the statements I have heard. A couple of examples: When the insinuation that doctors perform certain medically necessary surgical procedures solely for the purpose of greater financial remuneration was made, I almost jumped out of my seat. When I heard President Obama state that if hospitals sent a patient home and he became ill 2 weeks later, they didn’t do it right and should be penalized financially, again I was livid. The suggestion that maybe the American public would have to get used to the usage of generic instead of brand named medications, only added to the absurdity of the generalized explanation of the problems with health care. I can only speak definitively for my practice and experiences in providing health care, but I know many of my colleagues in most specialties practice the same standard of medicine as I and are hesitant at best to have this group of bureaucrats deciding the future of American health care.
Doctors as a group are a hardworking and ethical group, following a standard practice of conservative care first and surgically intervening only when a non-surgical course does not or cannot solve a problem. Sometimes, a patient is in eminent danger or the problem cannot heal itself without dire consequences. Do I operate on folks that I don’t think need surgery, NO! What great gain is in it for me if I do? When I do a surgery that is insurance related, the visits within the following 90 days after surgery are considered follow-up care, as they should be. There are no additional charges for visits (which can be frequent depending on the surgical issue) , dressing changes, suture removal, etc. I can charge anything I want, but what insurance will pay is the real factor. Most physicians base their charges on standard billing amounts for the appropriate descriptive codes. Medicare sets the trend for physician reimbursements and the health insurance companies follow. How many of you have gotten the note from your insurance company that a bill is “beyond the reasonable and customary amount”? I can’t count the number of patients that are amazed at how little I was paid given the level of time and expertise it took to put them back together.
As for the hospitals, human beings are protoplasm that is constantly changing. Most will leave the hospital and continue to do well, some will become ill again. There are multiple factors in recovery from any illness and some individuals will struggle because of preexisting health issues or chosen behaviors. Think about this example, a 65 year old diabetic smoker with a wound infection. He goes home, does not monitor his blood sugars, has a few drinks and lights up. Oh, and he only takes his antibiotics once a day instead of 2 times. He doesn’t come in to his doctors office for his follow-up appointment. Guess what happens, it is the weekend and he starts running a fever and has a large red area around his wound. He heads off to the emergency rooms to “fix it up again”. Is the hospital at fault? Perhaps the doctor? Maybe the patient? Regardless, if this man has insurance, he is and should be covered for this problem. The slippery slope of 2nd guessing fault instead of accepting responsibility for the delivery of health care to an insured individual, is one that most of us probably do not wish to start down. What happens next? Will it cost more for health insurance to be 10 pounds overweight, to ride a motorcycle or to have a genetic propensity for high cholesterol?
I do believe that presidential speechwriters do alot of research and are masters of wording, but, and it is a big but, they are not physicians and neither is he. There are many times that I believe a generic medication can be used, but often a brand named drug is the most recent addition and the most appropriate. What is the difference? The brand name is “on patent” for 10 years, the generic is no longer on patent. Why does the brand name cost more? Of course, there is profit involved, but also expensive research and development and the process of safety checking and research studies needed to gain approval by the FDA. I and most of my colleagues understand the importance of making prescriptions financially reasonable for our patients. Almost daily, my office deals with an insurance company that will not honor a prescription unless it is changed to a less expensive one on the drug formulary. This is the part of health care that is broken and what does our government do? Agree with the insurance companies! There might be more to worry about in my opinion like the salaries of health care company CEO’s that range from a paltry 3 million to 24 million dollars a year. Maybe if that was regulated too, we could all get the name brand medications!
