Logan's (Obama's) Run

How do you save healthcare dollars? Dont take care of patients. A group from the AMA just met with Zeke Emanual who is Obama's right hand man for healthcare. Zeke started off the conversation that he wants physicians and the AMA to go along with his plan or face a 21% cut in Medicare. Although the "healthcare plan" is still on the drawing board, the Obama administration has focused on cutting healthcare costs by decreasing the end of life costs. In general, about $55,000 dollars are spend on healthcare costs in the last years of life. This is critical care, chemo, surgery etc. that are used to prolong life from cancer and other chronic or severe conditions. They want physicians to "sway" patients and their family away these treatments to save money. They further want to appoint a panel to determine what cases and care that they feel are futile. In a sense, they want what they have in europe where no one gets dialysis after age 65, the elderly with pneumonia are allowed to die and a broken hip is a death sentance.

I am not supprised that the Obama administration wants to be the ones who decide who should live and die after all they are proponents of elective abortion and Obama is on record for saying that a baby that was born during a botched abortion should be allowed to die because of its cost to society.

When I heard all these things that Zeke wants to do, I thought at first he was only saying that Medicare would not pay for these treatments. Unfortuantely, Obama plans this for all healthcare costs as he makes the care priciples universal to all payors. Even when you are spending your own money. I guess he also wants to save Social Security as well by allowing all those old enough to get it to die of treatable things before they have a chance to collect.

I was really glad to hear that a physician told Emanuel that we as physicians work for a patients and not for the government, unfortuanely it seems that he wants to change that as well.

Call Pay

It has been one of those weekends. It seemed that every few moments either the beeper was going off or I had to run to the hospitals. As my beeper was going off yet again in Bible study, one of my class mates made a comment that "at least it was good for the bottom line." It then dawned on me that he had no idea how doctors got paid. In fact, it seemed that most people did not have any idea. So I though I would give some of the answers.

We do not get paid by the hour. We do not get paid to answer pages or phone calls. For example last night I had several calls were people were just hoping that I would call in medications for them even though they had never been seen in the office. We do not get paid to answer calls from the ER. We also dont get paid to see patients in the ER. (If we are lucky and then have insurance we may be able to bill but this weekend I had 14 ER hits and only one had insurance.) That means that the other 13 were for free. In order to have hospital privaleges and to comply with EMTALA and COBRA we have to see anyone whom the ER calls us to see, and we have to see in follow up anyone that the ER sends us. So, as a result all this is usually for free and it costs us our time, staff and supplies. The patients of course then can always sue us! By law, we can not write off on taxes any of the free care that we provide. (Lawyers can) We only get paid when we can bill from insurance or in the rare case that the ER patient actually pays us. For the trauma patients who we don't get paid we also get the joy of having to cut our clinic schedule to be deposed as they try to sue each other and everyone else they can.

We get paid by clinic billing for our insured patients. So, we get paid to treat migraine headaches in clinic, not to take care of the girlfriend of the meth head who stuck her in the head with a steak knife at 3 am. We dont get paid to take care of the drunk who tried to play frogger and run across the interstate during rush hour. We dont get paid to take care of the illegal immigrants who were shot when they tried to invade someones house. We dont get paid when they come in the office and insult our staff, steal our supplies and the demand narcotics.

I though about how to answer my class mates "bottom line" statement, and just said, "it is good for Gods bottom line". Call isn't about the money, its about doing what is right.

Geithner Syndrome

I was wathching Timothy Geithner's interview with Katy Couric and noticed that he always leans forward with his shoulders bent and looking up at who he is talking to. I checked and this is how he was during the Congressional Hearings. Infact, I can not find a single video or picture of him with his head in anatomic position. I have got the feeling that he has a high c-spine abnormality and that he can not extend his neck to neutral. He also aways turns slightly to one side so that he can twist his head when he is talking which to me suggests that this is a fixation problem, most likely at the atlanto-axial level. The other thing that I noticed is that he has very delayed blink reflexes. Even with the hot lights of the interview, he blinked at a rate of 1/3 that of Couric. This is definately suggestive of some major medication or CNS issue. There is a lot more going on with this guy then we are led to believe.

Ozoned!

We had a patient in the ER with SVT that was a bugger to slow down. Apparently he was having an asthma attack and went to use his inhaler. It was of course one of the new $60 inhalers that most of our patients can not afford. He used it but could not feel the spray so he used it about 20 times and managed to get himself a bit toxic. Our great leaders have determined that to save the ozone of the planet it is best to get rid of the CFCs that are used in asthma inhalers. This is all part of the Montreal Agreement and as a result CFC containing inhalers can not be sold as of April 1st. The new inhalers to comply with this are very expensive and as a result many patients can not afford then, nor are they covered by insurance. To add to it, the new inhalers use a propellant that can not be felt when they are used which is very disturbing to those about to suffocate. Somehow, I dont think asthmatics are responsible for ozone depletion.

Aprosody

Boy have I got to stop watching CSPAN! I cant help it though it is so rich in pathology. I was watching Rep. Barney Frank when he was discussing the A.I.G. issue. At first it was hard to get through his aphrasia and his velopharyngeal incompetence but when I closed my eyes it was the aprosody that was so striking! It is just like the responses I get when I catch a prescription drug abusers trying to convince us that they need pain medications in the ER for something that they dont have. Then in between questions he had classic Biot's breathing which makes me think that there may be hydrocephalus or at least something worthy of a mri and tap for opening pressure.

I know that I mentioned this before and I am sure that it is probably why the whole HIPPA law was enacted, but cant we make sure that every elected official has a complete physical and mental health exam before running for or taking office? I mean we can comply with HIPPA and keep all information private except to the election commission who could simply state, "you cant run because you have a brain defect on MRI". Oh, wait a minute, that would be discrimination and they passed laws agaist that as well. How then do you get rid of an elected official who has a major health issue that prevents his or her ability to fill their post? Are there guidelines and then who enforces them? I'll bet money that the amount of Senators with Lewey bodies on MRI would scare the pants off of us. What about the meds that they are on? Would you trust your representative if you found out that they take 1 mg of Xanax tid for anxiety, adderal for ADD and then Effexor for depression and that they have bipolar characteristics? We have already had a president with Addisons disease and associated steroid psychosis and he managed to put nuclear missles in Turkey and take us to DEFCON 4. How do we even know what the blood alcholol level is of our Congressman when they vote on bills? Is there routine drug testing? Do you even notice that Sen. Feinstein has conjunctival irritation and mydriasis? I hope that it is allergies and the result of her medications!

Back to CSPAN, Sen. Dodd is talking, does he have ocular hypertelorism?

Fratricide

(Blue on Blue) It was an amazing meeting for the AMA and rumors were rampant. One was confirmed today by the Amercian Legion. The Obama Administration is planning on changing Veterans Benefits in a significant way. Injuries that are acquired by military service will not be covered and treated through the VA. Instead, it will be out of your own pocket by your own health insurance! That is to say if you can get it! Part of a RPG in your back tends to be a pre-exisisting condition. I can just see it now. IED strike, mulitrauma make it to Balad oh wait, lets see, you are BlueCross PPO, let me see if I can get that pre-certed for you. Oh, this is out of network so it will cost you more unless you want to go to Ramadi! I wonder if the politicians who are thinking of doing this have ever looked at dog-tags. They have your blood type on them, you know, the blood that you are spilling for your country. Oh, wait a minute, they have never served in the military.

Is Healthcare a Right? Or a Left?

I was stuck in an airport and managed to catch a local radio show. I think it was the "Valentine Show". Anyway, I was struck by his statements about "the right to healthcare". It goes something like this. I am paraphrasing as I can not remember it exactly. "If healthcare is a right, and we are going to make the government provide our "rights" then lets look at some other things that also then should be "rights". Lets say, food. You need to eat. Clothing, you need to be warm. For that matter, heat then should be a right. Of course, a place to live should be a right as well. So, if healthcare is a right and we decide that the government is to provide it, then they should also provide food, clothes, and places to live on the taxpayers dime. But then, by forcing one group to pay for anothers healthcare, isn't that violating their rights? I guess for the "Left" a "right" means that it is something that you get for free or at least someone else pays for the bulk of it while a "Right" "Right" is something that you can go out and get on your own and the government should not get in the way.