Dr. J provides a long opinion on healthcare that’s well worth your time. Hence, we’re declassifying it:

Your Notoriousness,

I have read Dr. Scherz’s editorial in the Wall Street Journal and the patient letter on his PAC website Docs4patientcare.org.

I bring the following thoughts to the subject.

I do not need to recapitulate his evisceration of the Obamacare bill. He is comprehensive and to the point. Obamacare, as well documented is neither comprehensive, nor to the point.

Most Americans are unhappy with the Obamacare bill. The reason is that it provides less care to more people at greater cost. They are made further unhappy because of the process involved in passing it. The passage of the bill was made possible by parliamentary tricks and nonsense.

The whole of the pro-life movement has seen it for what it is. Despite all of the talk of ‘helping the poor’ with this bill, that talk is laid to waste with the facilitation of on-demand abortion that it provides. In the eyes of the Catholic Church, for example, the gravity of the sin of abortion is so great that the ‘number of lives saved’ with the bill could never erase the stain created by one abortion funded via this mechanism. ‘Puter can back me up on this one.

Doctors are unhappy about the bill because we understand best the ramifications with regard to the quantity and quality of patient care that we will be able to deliver in a system where resources are made artificially finite. Many of us do not relate to individuals like socialist Donald Berwick, or so-called ethicists like Zeke Emanuel. Their views on life and death decisions are made with spreadsheets, and not behind closed doors with the individual patients and their loved ones, as these issues should be made. As much as individuals complain about insurance companies, their degree of interference and delay of payment are far less than those of CMMS (Centers for Medicare and Medicaid Services). A physician cannot maintain a viable practice via CMMS payments alone.

Obamacare was the next great step in the long range Progressive plan to create a nanny state. The creeping doom began with wage controls during WWII, resulting in the creation of employer based health insurance. This conditioned many individuals to the idea that this was a benefit of being an employee, and over time, it became an expectation. This was followed by Medicare/medicaid which provided another entitlement for the the poor and the elderly further creating reliance on the government of these too populations. Changes in Federal Law in 1973 brought about the HMO act which required employers of 25 or more to offer HMO’s in addition to indemnity insurance. So as a consequence individuals became conditioned to $15 dollar co-pays. This act has resulted in a clear increase in utilization of resources by individuals. Folks who wouldn’t bring their kid to the pediatrician for a ‘cold’ for a $100 office visit would certainly pay $15 to be reassured that it’s just a cold. That coupled with continuous beating of the “Health-care is a right” mantra and whole generations have grown up thinking that they shouldn’t have to pay (much of) anything for health care. After Al Gore lost in 2000, the media ratcheted up the rhetoric, as did the Democrats in the House and Senate attacking, unrelentingly, President Bush, who would do nothing but turn the other cheek. This pillorying had its effect in that the 2004 election was too close, given the opposition, in 2006 the House went the other way (in part because conservative voters rightly believed a ‘A Pox on Both your Houses’ as the Republican majority in the House became too corrupt for its own good, and finally President Obama got elected with 60 in the Senate in 2008. Gerrymandering and intrenched districts on both sides has further caused problems with governance. That is how we ended up where we are today.

It’s proponents will argue that the people voted for President Obama, and for a supermajority of Democratic senators. Thus, what they do, in a Republic is by the consent of the governed. That’s about all that they can legitimately argue. This bill is too long, not economically sound, not medically sound and very likely unconstitutional.

While I haven’t spoken to any of the 52% who voted for Obama to identify those who have buyers remorse, I suspect that at least a good 5-10% of them are in that camp. I suspect that they voted for him for historical reasons (to say they voted for the first African-American President), or because he gave them a thrill up their leg when he spoke, or because they had Bush/War on Terror fatigue, or because they bought the haterade they were saturated with for 8 years since the Bush vs. Gore decision by the Supreme Court. The ones who still support him do so because they are a) elites who are/think they are part of the controlling cabal, b) will get free stuff like Health Care, c) still have Haterade in their system for W., d) have no understanding of economics, civics, and health care due to the fantastic education they received at the hands of the NEA.

I applaud Dr. Schertz’s efforts. I hope that his work will have an impact in November.

Sadly, I feel that this level of energy must persist through 2012 and beyond, for there to be hope of true repeal of this abomination of a law. A conservative President, conservative Republican majority House, and I suspect a super-majority Senate would be required for repeal.

I pray that the Supreme Court finds the individual mandate unconstitutional.

Fortunately, the Gormos pay cash.

Gormo-care, were I to create such a thing, would be market based, and as a consequence, it would put the rationing back into the hand of the consumer, where it belongs. I steal much from Whole Foods CEO John Mackey’s thoughts. (http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html, http://3.14.242.153/2010/07/gadsden-frosting.html)

These would be the basics of my plan:

0) Education – If you can’t educate people that they can’t get something for nothing and that common sense dictates that health insurance and saving money for the future trumps the iPhone 4 and a 55″ LED TV and the coolest new sneakers, they deserve what befalls them as far as I am concerned.

1) Personal savings accounts – Up to $5,000 per year per family member may be set aside pre-tax. Parents, obviously setting aside money for their children since we aren’t allowed to put the little buggers to work. Furthermore allow the money to roll over, rather that allow it to be ‘use it or lose it.’

2) Extend the employer based tax deduction for providing insurance to individuals. This should be self explanatory.

3) De-regulate the insurance business with regard to the types of plans they must offer, and allow interstate competition. Insurance companies have one very simple goal in life. They want to make money on behalf of their shareholders. THERE IS NOTHING WRONG WITH THAT. Obviously the company with the best customer service and the best products will win the day. I personally don’t want to pay $10,000 a year for a plan with $15 co-pays when my out of pocket expenses would be much less just paying cash. Insurance should be there to cover the cost of big ticket items, but not the oil changes. Partner with insurance companies to develop plans that incorporate the aging population rather shunt them to medicare.

4) Facilitate cost transparency to patients. I don’t know how this would be best done, however one example is that Walmart and now other large companies provide very low cost generic drug prescriptions. Over the course of the last few years I have had patients change from asking for the newest most expensive blood pressure and cholesterol medications that they see on TV to now requesting the $4 drugs at Walmart whenever possible. This was a transformative paradigm shift. I think patients having skin in the game via seeing a $15 copay vs. a $4 payment was a rude awakening. This would translate nicely with more expensive testing. Indeed Dr. J. chose a stress echo over a nuclear stress test, not only for the better positive predictive value of the stress echo, the lack of ionizing radiation and the shorter time spent in the doctor’s office, but also, it costs half as much and I do have a deductible.

5) Still have an ‘egg-custard’ safety net for the truly needy because if it were chocolate, or even vanilla, folks would want to stay on it rather than grow away from it.

Warmest Regards,
Dr. J
Royal Surgeon to the Gormogons

Confucius, Œc. Vol.

Don’t ask impertinent questions like that jackass Adept Lu.