Newtons First Law of Medicine

I got into a discussion of healthcare policy today while watching football in the OR lounge waiting for the OR to get ready. The discussion was with one of the anesthesia folks who is a bit on the liberal side. Anyway, the discussion came to how much we could save with preventitive care. He thought that with national health insurance, everyone would be able to get the preventitive care and the savings would be huge. I thought it was ironic that we were waiting for the OR to be ready so we could operate on a patient who had Medicaid but did not want to go to the doctor for years and then comes into the ER at deaths door. From my experience, people only want to come to the doctor when they are sick or in pain, otherwise they will blow it off. Likewise, the people who are not motivated to get a job or education will tend to just collect wellfare and will not be the ones who get up and get their screening exams. Oh, for what its worth. If you have you Medicaid appointments before 11:00 am, almost none will show up.

Governmentium

I dont know where this came from, but I salute the author!


New Element Discovered
A major research institution (MRI) has recently announced the discovery of the heaviest chemical element yet known to science. The new element has been tentatively named Governmentium. Governmentium has 1 neutron, 12 assistant neutrons, 75 deputy neutrons, and 224 assistant deputy neutrons, giving it an atomic mass of 312. These 312 particles are held together by forces called morons, which are surrounded by vast quantities of lepton-like particles called peons. Since governmentium has no electrons, it is inert. However, it can be detected as it impedes every reaction with which it comes into contact. A minute amount of governmentium causes one reaction to take over four days to complete when it would normally take less than a second. Governmentium has a normal half-life of three years; it does not decay, but instead undergoes a reorganization in which a portion of the assistant neutrons and deputy neutrons exchange places. In fact, governmentium's mass will actually increase over time, since each reorganization will cause some morons to become neutrons, forming isodopes. This characteristic of moron-promotion leads some scientists to speculate that governmentium is formed whenever morons reach a certain quantity in concentration. This hypothetical quantity is referred to as Critical Morass.

"But, I'm not dead yet!"

I just saw today on World net Daily that one of Obama's Czars, Cass Sunstein, has written that the state controls your organs and should be able to remove them if you are dead or in a hopeless condition. Futher, he wrote that the state can remove your organs without your permission. When I heard this, I thought that someone was pulling my chain, but guess what, it is right there in his book "Nudge: Decisions about Health, Wealth and Happiness".

Where did the president find these guys and how in the world did they get to be in positions to affect policy? My father always told me that you are judged by the friends you keep.

Taking it below the dentate line

In order to help balance the budget, the lawmakers of the State of Pennsylvania have decided to raid the fund MCARE. This is a fund (100 million dollars) that Pennsylvania physicians were forced to pay in addition to their malpractice payments to cover catastrophic losses. In fact the MCARE (Medical Care Availibility and reduction of Error Fund) was just the renamed Medical Professional Liability Catastrophic Fund. Anyway, the State Legislature just decided to take it and use it for other things. I wonder why they dont make the lawyers pay into a fund and then steal it in the middle of the night?

Ginormous Headache

The medical center gets all kinds of complaints and in almost every one the person filling the complaint threatens a lawsuit. The latest was from a patient's attorney that claimed she was discriminated against because of her disabilities and requested a cash settlement to prevent a "large lawsuit from moving forward". When I looked into the case, I found that first she was disabled. She had severe arthritis, backpain, diabetes, could not walk, in fact she could not even care for herself. She was on Medicare, Medicaid and had Social Security Disability. Secondly, I found out she was 780 pounds. I looked into the case further and found two notes from the nurse manager of the floor. The patient had filled a complaint two hours after she was admitted because she was not allowed to smoke. Since she was admitted for a respiratory condition amoung other things, the attending physician said no. She then demanded that she be allowed to smoke anyway in the room. When she was told that she could not smoke in the hospital (which is the law) she demanded to be taken outside to smoke. (It took 9 ems personell to transport her to the hospital, 7 to get her onto the "Big Boy Hospital Bed".) When her nurse said that they could not roll her bed outside for her to smoke she then demanded to be put in a wheelchair. (The max load of the Big Boy wheel chairs is 600). When the nurse said that they didn't have a wheen chair big enough, the patient went off further.

So, the long and short of it, this was an attempt to "extort by attorney" money from the medical center by a patient who is disabled because of obesity who claims she was discriminated against because other patients were allowed to go out and smoke!

Magical Medicaid

I know that many liberals think that the answer to healthcare accesss is government plans. I actually had one in the office on Friday. He was mad that it took so long to get an appointment. As usual I claimed responsibility for the delay, said I was sorry and took care of him. He muttered that he had insurance (Medicaid) so he should have had to wait. This is what I really wanted to tell him.

All of us physicians have templates. These are the schedules that allow us to schedule patients. Right now, if a patient has Blue Cross we get paid three to four times as much as someone who has Medicaid. In fact, a patient who pays $40 out of pocket is paying us twice as much as someone who has Medicaid. If we want to maximise our payments we would see only Blue Cross, if we could not fill our schedule we would see lower reimbursed insured, we would then add self pay, and then if there are any openings left, we would see Medicaid. So, every physician has to decide if they are going to see any Medicaid at all. Since it pays worst of any other insurance if you do take it you put them to the back of the list. I hate to say it but Medicare is just infront of Medicaid. So, if you are going to take government insurance, those patients will be at the back of your waiting list. Our group has decided that it wants to help everyone as best as we can regardless, that being said, we still have to stay in business so we have placed in stone some Medicaid appointments in everyones schedule. I have to admit though, you will wait alot less if you have good insurance.

So, what is going to happen with this government option? It is going to put even more people at the bottom of the list. Face it, if you pay cash, you will get in sooner. This whole thing about preventive care? Medicaid pays $19 dollars for a 30 minute preventative care visit. Blue Cross pays five times that amount. If you are already full, why would you take less money and incur more liability to do preventative visits that aren't worth the money? Of course, there is no medical liability in the healthcare bill either!

Giving them the middle finger of the Upper Hand

The State of Michigan has been running ads trying to get some foolish business to move into the state. The ad campaign has as it slogan, 'Michigan gives you the upper hand". Michigan is in dire straits with its huge entitlements and policy of increasing everything from the sales tax, gas tax and of course the state income tax. In reality it appears that Michigan is just giving its citizens the middle finger of the upper hand. Well, they have now decided to stick it to the physicians that have not left the state by imposing a 4% tax on all physican payments and other medical fees. By doing this they hope to decrease their multibillion dollar deficit. Since Michigan already has made sure that it has the lowest Medicaid payment rates and chased as many businesses out of the state as possible, it seems that the medical business will be the next to leave the state. On the bright side, Michigans Democratic Majority are trying to overturn what little tort reforms they had on top of all this.