What Do You Mean by the Word "The"?

 Clouds Rest - photo by JoAnn Sturman

by Scott Sturman

Last November in Hawaii a Canadian pediatric cardiologist, an attorney practicing in California, and I sat down after dinner to sort out the American health care system.  Presumptuous by all means, but how could we could do a worse job than the politicians who have made a career running the wagon train off the cliff?  All on the panel prefer to simplify problems, so it wasn’t long until we settled on two topics to resuscitate another leadership failure.  Fraud and waste seemed like a good place to start.
 
The FBI estimates health care fraud costs $80 billion per year, while the New York Times put the value at $100 billion for Medicare alone and $250 billion for health care in the aggregate.   The latter value represents nearly 10% of the annual national health care outlay.  For Democrats that translates into a lot of food stamps and delta smelt and for their colleagues on the other side of the aisle plenty of tanks and airplanes.

When a television announcer proclaims, “If you’re on Medicare or Medicaid, this product won’t cost you a dime.  In fact we’ll fill out the paperwork for you, and XXX will be delivered to your door at no cost,” one should envision wheel barrows full of $100 bills leaving the U.S. Treasury and into the pockets of entrepreneurs.  Vendors must feel no small comfort that the odds of a customer examining an invoice with zero balance is virtually zero.

Solution #1: Whether its seeking health services or purchasing medical merchandise, even a modest financial obligation encourages patients to use them sparingly, peruse bills for accuracy, and report fraudulent activity. 

Our committee disagreed on the extent and cost of defensive medicine, but the attorney was out numbered, and victors write history as they see it.  As doctors, it has been our experience that tests and procedures frequently are ordered, which have as much to do with fending off potential lawsuits than being thorough.  What is the scope of these expenses?  Estimates reported in the Wall Street Journal range from $270-650 billion per year with potential savings of $2.6 trillion over the next ten years.   

Did you have sex with Ms. Lewinsky?”  a reporter asked Bill Clinton, while trying to extract information at a press conference about Monica and a cigar.

“What do you mean by the word ‘have’?” Clinton, the Georgetown University and Yale Law School graduate, responded.

At the time Clinton’s retort sounded ludicrous, but he simply reverted to his lawyer mantle, where even the definitions of basic words are contested.  Plaintiff attorneys thrive in this environment, and carefully chosen words translate into cash and a lot of it.  No where are these linguistic skills more lucrative than when used to tie dull jurist’s minds in knots to the point they actually wonder what the word “the” means.

 Last August my wife attended a seminar in Las Vegas on “Malpractice and Fetal Monitoring,” where both defense and personal injury attorneys discussed jury selection.  Suffice to say, each side is in the market for a different product.  A cynic could conclude the facts of the case are secondary, if a juror’s primary attribute is mental malleability.  

By its very name the Affordable Health Care Act purports to place a priority on financial prudence.  It stands to reason if medical malpractice costs and defensive medicine are a major contributors to excessive health care expenditures, then they should bear no less scrutiny than any other component.  That tort reform was deemed off limits by politicians who wrote the law smacks of obscene cronyism which places special interests ahead of the welfare of the country.

Solution #2:  Tort law is a major contributor to the unacceptably high cost of health care.  Loser pays, protection from frivolous law suits, and relying on a panel of experts rather than gullible juries would help rein in the reign of terror being waged by personal injury attorneys against the medical establishment.

It took us a couple of hours to save the country half a trillion dollars a year without reducing patient access to health care.  It is really not all that difficult if the primary motivation is solving the problem rather than trying to get reelected.    

One of Us?

Anchorage to Denali - photo by JoAnn Sturman

by Scott Sturman

As the only conservative in America whose favorite magazine is the New Yorker, I long ago stopped reading the editorial page.  Unlike the op-ed page, which reminds me of a high school valedictorian’s commencement speech proclaiming how their generation will right every wrong in the world, the articles are informative, entertaining, and well written.

Like many in my medical group I share the view there is too much waste in medicine, which is often exacerbated by needless regulations which make our jobs more difficult.  As an example, we are forced to discard perfectly safe and effective drugs which are not only scarce but expensive.  The insanity reminds me of my experience in the Air Force in 1973 when the nation was in the throes of a fuel shortage.  With cars backed up for miles at service stations, we flew so many hours that our butts cried for relief.   Even without a valid mission, Lt. Colonel Michaels ordered his pilots to bore holes in the sky and waste tons of JP4 for fear if not used, the unit would be allocated less flying time the next quarter.

And then in 1998 some articles began appearing in the New Yorker Magazine written by Atul Gawande, a physician who was also a surgical resident.  How did he have time to churn out these in depth, poignant observations, when at the time most surgical residents considered a hundred hour work week to be short?  Essays followed which discussed clinical problems from a unique, but refreshing point of view and exposed inefficiencies within the health care system which were expensive and extraordinarily wasteful.  Here was an eloquent spokesman for the medical profession and one of us.

After the Presidential election of 2008 Dr. Gawande’s writings took on more of a political slant, and although medical problems and waste were frequent topics, his articles were suffused with comments supportive of national health care.  His solutions to the the health care crisis made no mention of market forces, competition, or health savings accounts, but relied on central control, as he extolled the merits of ObamaCare.  If this bright man, whose success as a journalist was based on exposing inadequacies in the system, why did he virtually ignore tort reform and fraud as contributing causes?  He was no longer a colleague but the voice of socialized medicine.

An author’s background offers clues about personal motivations, and a glimpse at Wikipedia was revealing.  Medical students and residents may have political views, but most are not political activists; there is simply not enough time or resources.  This is particularly the case of general surgery residents, who battle fatigue and sleep deprivation, and extra time is spent collapsed in bed.  Dr. Gawande’s history is unusual in this respect.  As a student he volunteered for the Gary Hart Presidential campaign and again for Al Gore in 1988.  He took a hiatus from medical school in 1992 to campaign for Bill Clinton and served as a senior advisor for the Department of Health and Human Service in the Clinton Administration before returning to medical training.  During this time he cultivated contacts within the Democratic Party and main stream media which catapulted his career and gave him access to resources far beyond those of the normal surgical resident or practicing physician.

Dr. Gawande is a gifted writer, and he has used his skills to popularize issues in clinical medicine and to propose sweeping changes to the health care system.  However, when it comes to choosing between national health care or private practice medicine, he is one of them and not one of us.