The new buzz phrase in health care delivery is paying for performance, which is the method of tying reimbursements to outcomes. What this formula doesn’t adequately take into account are the intangibles: The efforts, skills and devotion of the providers, the unpredictability of the science and the patients’ comfort level during the process.

Provider efforts are influenced by costs, availability of resources, liability concerns and reimbursement levels. Skills are directly tied to differences in the level of training and experience of the providers— physicians, nurse practitioners, chiropractors etc. The most difficult to quantitate is the providers’ devotion to the patients versus devotion to the ‘system.’

In this era where the delivery of health care tends to focus on the bottom line, the fact that medicine is the science of disease is often forgotten. With advances in the science, the unpredictability of outcomes decreases, but it will never drop to zero. More efficient utilization of health care dollars and resources should be a goal, just not the goal.

The comfort level of the patient is elusive and the most difficult to put a dollar figure on. It not only includes physical pain and suffering, but also the ‘peace of mind’ that the patient is not just a number and a sense that their care is not being compromised in order to ‘balance the budget.’

If the goal is the least morbidity at the lowest cost, how is that measured? Readmission rate? Length-of-stay? What other factors could affect these outcomes— genetics, concomitant medical problems, age, patient compliance, resources, etc? There appears to the assumption by many of those who make the rules and pay the bills that expenditures can be reduced until a point is reached that potentially affects outcomes in a negative way. The example being the decreasing reimbursement rates in the Medicaid program that often leads to longer waits for therapy and frequently by less qualified providers. Who suffers? The patients!

It first started with the private insurance companies telling their policy-holders how much they would reimburse a patient for a particular service. Then it graduated to when Medicare and Medicaid first started dictating reimbursement levels to their providers. Then Medicare and the payers under managed care teamed up to create length-of-stay guidelines and ‘bundling’ of charges. Now that the Accountable Care Organizations (ACOs) seem to be the future under the Obamacare model, all the parameters are coming together for a delivery system that is more efficient based on costs balanced against outcomes.

ACOs must be able to alter their providers’ practice patterns to be more cost efficient. This can only be done by linking their reimbursements to established practice guidelines (practice parameters) or incentivizing providers to be more fiscally efficient, as in capitation models. The concerns are two: The threat of liability if these practices violate community standards. Even more important, the loss of the providers’ ability to incorporate their own clinical judgment into the decision making process. Essentially the providers are being ‘disenfranchised’ from their patients.

“The superiority of subjective measures may also explain why private medicine, where peers, patients and professional associations subjectively evaluate a physician’s value-added does a better job of providing quality care than the quality measures adopted in national systems run by governments,” writes Linda Gorman in her blog, What’s Wrong with Pay for Performance?” February 13, 2013.

If the goal is to generate the least costs to make the correct diagnosis and then prescribe the least costly therapies to attain the best medical outcomes, that usually implies reimbursing the providers, hospitals, drug and medical equipment companies at the lowest level possible. Even today, using less qualified providers when ever possible is already becoming the norm.  But who is qualified to make those determinations— the Feds, the payers, the state legislatures?

The answers appear to raise more questions than answers. The group that is the most qualified to deal these difficult decisions is the providers themselves, particularly the physician community. Instead, they are often relegated to the sidelines, only to be called on when their support is needed around election time.

In his blog, Paying for Care, March 11, 2013, John Goodman writes, “The people who are on the supply side of the market have more information and better insight than the people on the buyer’s side. That’s why successful reform needs to start with the people who practice medicine, not with the people who buy their services.”

If paying for performance is to become the benchmark for health care delivery, other questions arise. Does this system allow for further diagnostics and therapeutics that might add value or prolong patients’ lives even though the odds for success are not likely?  Is everything that deals with heath care delivery going to come down to cost/benefit ratio? Are there options to ‘buy one’s way out’ of the delivery system (more tests, more expensive therapies)?

Although the delivery systems in England and Canada base control of total costs by limiting resources and reimbursements to providers, a comparison of their outcomes to this country’s is revealing. A report in Investor’s Business Daily released the following survey results: The per cent of men and women surviving a cancer five years after diagnosis was 65% in the US, versus 46% in England and 42% in Canada. The percentage of patients diagnosed with diabetes who received treatment within 6 months was 93% in the US, 15% in England and 43% in Canada. The percentage of seniors needing hip replacement who received it within 6 months was 90% in the US, 15% in England and 43% in Canada. The percentage of patients referred to a medical specialist who see one within 1 month is 77% in the US, 40% in England and 43% in Canada. Finally, the number of MRI scanners per million people in the US is 71, 14 in England and 18 in Canada. If these findings tell us anything, it is that the delivery system in this country is more convenient (shorter wait times and less morbidity at the least). More important, the current system in the US probably produces better outcomes (performance) if the statistics on cancer survival hold up across the board.

It is sadly ironic that the advances in health care that allow for longer, more productive lives are projected to be limited in the elderly because the resources have a better cost/benefit ratio in the younger population.

Paying for performance might also appear to demonstrate an apparent lack of trust by the regulators and the payers that the medical community will only function efficiently if regulated to do so. This ‘free-rein’ approach is a potential flaw in the fee-for-service system. But does that concern justify attempts to dismantle, what is considered by most as the word’s best health care delivery system?

Is the goal a ‘bare bones’ delivery system that just scrapes by doing the least, caring the least and trusting the least? Or is it the more noble aspiration of the most efficient use of the limited health care funds and resources? Sometimes it seems our elected representatives and the payers get those priorities confused.

Federal entitlement programs dominate the public debate. Social security, Medicare, Medicaid, and the social welfare programs of food stamps, disability and unemployment insurance are the most widely discussed. As a share of the federal budget, entitlement spending accounts for over 60% (up from 25% in 1960). They can be divided into the programs that are targeted for those who are unable to provide for their own needs (Medicaid, disability, etc.) and those that are funded by past contributions (Social Security and Medicare), regardless of financial need. With almost half of this country’s population receiving some form of government subsidy, many are predicting that the United States is becoming a ‘welfare state.’ The results of the last Presidential election within many inner city voting districts, where entitlement income rivals earned income, would tend to substantiate that claim.

With future generations left to clean up a growing national debt that threatens to reduce this country to a third world status, the focus in Washington has turned to ‘fixing’ the entitlement programs as a major part of the solution. Although the Social Security program is an integral part of this fix, it is the ‘tinkering with’ the Medicare and Medicaid programs, under the new Accountable Care Act (Obamacare), that specifically impacts the medical profession. In a thinly veiled attempt to hide the increased tax burden from the electorate, the initial proponents of this legislation, proposed moving $716 billion out of the Medicare program (the elderly) and into an expanded Medicaid program (mostly the younger uninsured which comprise 25% of this group) over the next ten years. It is a shell game of potential catastrophic proportions.

The arguments that make this new legislation more affordable are through several methods: First is rooting out fraud and streamlining health care delivery (specifically in the Medicare and Medicaid population). Next is turning over much of the frontline care to non-physician practitioners. (See my blog, Turf Battles, but on Whose Turf?, April, 2011 @ http://www.robtenerymd.com. Finally, it is by raising taxes on the ‘rich.’

The arguments concerning streamlining (reduced treatment options for the ‘senior’ population) are addressed in my blog, Obamacare Has ‘Thrown Our Seniors Under the Bus, October, 2012. Addressing the issue of increased taxes on the ‘rich’ (restoring the taxes for the wealthy to the Clinton administration levels) seems to be the main hurdle between the President and beleaguered Republican leadership in the House of Representatives. Even now that the President has gotten his way, the revenue that the President’s win will add to the Federal coffers comes nowhere near the added costs of the expanding entitlement programs. Both political parties agree, besides seeking ways to cut government spending, more revenue needs to come into the system from somewhere.

Each year health care providers are facing decreasing reimbursements from their Medicare patients. Each year more providers stop taking new Medicare patients or drop the program altogether. This country is reaching a ‘tipping point’ where the care for our seniors is going to be, not just inconvenienced, but compromised.

With the advances in the science of medicine and a growing population, this country should strive for better care for everyone, not cost shifting from one population to another. Rooting out fraud, decreasing inefficiencies and standardizing certain approaches to care though practice parameters, electronic medical records and telemedicine are definite steps in that direction.  All sides agree on these approaches. Assigning care to alternative providers that are not under physician supervision, just to reduce costs, must be undertaken in such a way as to not jeopardize patient care. It reminds me of the axiom, we may know what we know, but we don’t know what we don’t know.

Where our elected leadership disagrees is how to bring more funding into the system. What is being proposed by the ACA (Obamacare) is increasing taxes on a litany of things such as medical equipment and restoring the taxing structure to the pre-Bush years for the ‘rich.’

Since neither proposal is enough to address the increased financial obligations of the new ACA legislation, another way to bring in monies that are currently sitting in the pockets of the ‘wealthy’ is through a proportional decrease of their Social Security benefits and by making them spend more for their medical costs under Medicare. This is not a new concept. There is already a sliding scale (means testing), based on income, for Medicare taxes.

Adding to the tax burden of the wealthy potentially means that they will horde more, spend less and hire less. More spending equates to more jobs and more commerce. Whereas more taxes often equates to more regulations and more entitlements.

With Social Security, the concepts for savings that are being discussed are raising the age limits for eligibility and tying the cost of living adjustments (COLA) to price fluctuations, rather than changes to the national average wage.

No one program will solve these problems. Health care savings accounts (HSAs) have been very successful and should be made available to a larger part of the population. Their distinct advantages are that they allow the patients some determination (control) of their first dollar coverage and HSAs bring new money into the system. Issuing vouchers, like food stamps, is another proposal. They do allow for some determination of spending by the disadvantaged population, but they don’t bring new monies into the already financially-strapped funding system.

For the Medicare program specifically, new influx of funds could come from balanced billing.  The providers of health care services would be allowed to bill those who could afford the added expenses not covered by the current Medicare allowable charges. This higher fee scale should not exceed the private industry standards and eligibility determined by the means testing methods that is already in place for adjustments in Medicare insurance costs. This idea has been proposed by the medical sector before, but has fallen on deaf ears in the nation’s capitol.

A change that would have an immediate effect would be ‘balance billing’ for those who could afford to pay.  The patients would be responsible for a portion of the costs of their medical care.  The amount for which they are responsible would be determined by their ability to pay.

If patients could not afford to fund a predetermined portion of their costs, the system for them would work as is does now.  For a system such as this to work, a means test would be required— It would make for a more normal patient/doctor relationship by partially removing the government payer as an intermediary.

Congress would benefit by transferring some of the costs to those who use the system, at the same time introducing a cost-containment measure on the utilization of available services.  Patients would think more carefully about seeking care if they were going to pay part of their own costs.

The system must be set up in such a way that these patients would be protected from catastrophic problems that could deplete their resources.

For any healthcare system to be financially viable, there must be a method to limit utilization.  What better way than to put it in the hands of those that both use and can afford to pay for it.

R. Tenery,  American Medical News. April 22/29, 1991

Balanced billing brings more revenue into the delivery system, but maybe even more important, the influx of increased reimbursements encourages more providers to care for more patients who are covered under Medicare. It guarantees many Medicare participants greater access to health care services. It encourages spending instead of hoarding. Finally, by putting the responsibility for first dollar coverage back where it belongs, the patients assume some of the responsibility and control for their own care.

Since the feds are still grappling for solutions, maybe its time this idea is looked at again. It seems the majority in Congress have little trouble supporting raising taxes on the ‘so-called’ wealthy to bring in more money to the federal coffers. But when it comes to bringing in more money to those who actually perform the services (health care providers, hospitals, drug companies, etc), they seem reluctant.

Maybe it’s because they would have to give up some of their control!

Visiting with associates and even a few of my family members, I wonder why we seem to be divided into two almost opposing positions on the critical issues that affect this country. We come from similar backgrounds or have devoted much of our lives to the medical profession and seem to share the same values.

So what makes us look at the way our Federal government operates from almost opposing points-of-view? The results of past national elections have shown us that this country is and has been almost evenly divided along similar lines.

When broken down into the issues of abortion, illegals, gun control, preservation of U.S. interests abroad and the environment, even though we might not agree on some or all of these, I don’t think these are what divide us. I also feel whether we align as a Republican or a Democrat doesn’t divide us either. Although there is a wide divide between the progressive wing of the Democratic Party and the Tea Party of the Republican Party, most of us are somewhere in the middle.

I think what probably divides us, and the political parties that we alien with, are our positions on the entitlement programs— how to make them more financially viable and the ramifications if they are not  ‘fixed.’ Our concerns center around how they affect each of us individually, our children, their children and then society as a whole.

We all generally want what’s coming to us, such as Social Security and Medicare benefits. Is any one reading this blog willing to give back their SS check or crazy enough to head into our later years without some type of heath care coverage? I’m not! I earned those benefits and I’m not willing to give them up without a fight.  It is a familiar refrain recited by almost everyone who receives benefits from one of the numerous federal entitlement programs. We see any candidate or political party that might cut or even revise our entitlements as a threat and we vote accordingly. The 47% remark that probably lost Mitt Romney the election is a prime example. But unless we are able to rise above just being concerned about our own needs and come together on solutions, this country is going to ‘ride the fiscal train over the cliff.’

Where we differ are with the ‘entitlements’ that apply to others (the ones that are not affected by our own bias) and how to continue to fund them. The current administration seems to support raising the debt ceiling, printing more money and higher taxes for the ‘wealthy’ as the solutions. The conservative platform concentrates on growing the business community that encourages commerce to bring in more revenue though taxes. The real solution is the ‘elephant in the room’ that neither side is willing to take on— clean up the entitlement programs by ‘weeding out’ those that don’t belong and build in initiatives that force those that are able to earn their way to do so, regardless as to how they vote in the next election. Once we can clear out the waste, graft and over-utilization, both sides can probably reach a compromise on the funding issues.

It sounds too simple. Unfortunately, Washington and our state capitols exist on a system of pandering to whatever constituency that will keep our elected officials in office. The perks and their loyal constituents that keep them there are their ‘entitlements,’ and, like us, they are not going to give them up without a fight either.

Virtually everyone, who has studied the entitlement programs (Social Security, Medicare, food stamps and a myriad of other federal subsidies) seem to feel that they are not sustainable in their current format. Several of the European countries, such as Spain and Greece, are examples of what this country will face if we don’t address these issues now or in the near future.

Even Paul Krugman, an economist and strong advocate for the Democratic positions, at a recent question and answer event, admitted that the only way to pay for the current entitlement programs in the future was by increasing taxes, such as a value added tax on all goods and services, establish ‘death panels’ for Medicare and Medicaid patients and raise taxes in the middle-class sector. All of which, will put a strong disincentive to economic growth.  Krugman didn’t say when he thought it would be necessary, but intimated sometime after 2024.

Most of us can agree on providing ‘necessary’ benefits to those who can’t help themselves. The problem arises when defining that population and ‘weeding out’ those who could help themselves and become more self-sufficient. Two examples: It has been estimated that there are 10 million people on the food stamp program who don’t qualify for those benefits (individuals who qualified when they were unemployed, but didn’t drop the program when they became employed again). The second example is a mother of five children, whose low-income level qualifies her for welfare benefits and her five dependent children, who qualify for several federal social programs. She has no incentive to find a job, since she receives more income from the federal programs than she could ever hope to make with her poor education. She might just as well have more babies and receive more federal benefits. Additionally, the environment her children are born into almost traps them into a life of poverty and frustration.

Programs like Head Start are where both sides of the aisle should pull together to get these mothers out of this vicious cycle and give her children a real chance of getting out of the ghetto. We must not ‘balance the budget’ on the backs of these disadvantaged families. At the same time, we need to ‘incentivize’ these mothers to pull their ‘fair share,’ even if brings into question to which political party they cast their vote. Political intransigence has ground Washington to a halt, and we should not tolerate it!

Maybe we’re not so far apart after all. We all want what’s best for our families and our country. Maybe its time, instead of ruminating among ourselves, we tell our Congressional representatives what we think. That we are going to hold ‘their feet to the fire.’ That we still want to help the people in this country who really need help, but insure that the beneficiaries of these benefits are, at least, trying to take themselves off the dole. If we are going to add more oversight committees in Washington, maybe instead of adding them to monitor Obamacare compliance, the Feds should create committees to clean up the abuses in the entitlement programs.

We shouldn’t leave our children to solve ‘our’ problems. They deserve better from us!

There was a time when physicians in this country spoke with one voice. Beginning in 1847, the American Medical Association was that voice. No more! In the early 1950s, the American Medical Association’s membership penetration was over 75% of physicians. Since then, the percentage has fallen into the mid-teens for a variety of reasons. Although the rise in the influence of the specialty organizations and physicians who disagree with the AMA’s position on one particular issue or another are contributing factors, the most likely reason for this decreased participation is the apathy of disengagement that is epidemic throughout all strata of society. Look at the loss of membership by many traditional churches, the Boy Scouts and the Masons. (1)

The passage of the current health care law, the Affordable Care Act (ACA), is an example that demonstrates when control is delegated to others by either nonparticipation or proxy; the outcome may not reflect the majority will of those they purport to represent. Even though the leadership of the AMA, the American College of Physicians (ACP) and a scattering of other physicians’ organizations lined up behind President Obama’s proposed legislation, virtually every poll showed that the majority of physicians opposed the bill.

Whose fault is that? Although there are many who would disagree, it’s not the AMA’s or the ACP’s fault. These organizations were just acting on decisions made by a majority vote of their leadership, who were elected by their membership.

The problem is the more individuals within any special interest group abrogate or delegate the authority of representation to others, the less control those individuals, who are not involved, have over their own destiny. The results speak for themselves: not only with the passage of the ACA (Obamacare), but the inability to fix the SGR, the lack of meaningful liability reform in many states, the growing influence of third party payers and the increasing takeover by hospital corporations, just to name the most obvious.

The once strong chorus of the medical profession is now being dispersed into thousands of discordant voices. That is not to say that physicians have lost their direction, only their ability to control the path they will take.

The fate of the future medical profession appears to come down to two choices: Maintain the status quo by allowing others, often outside of the profession, to determine medicine’s destiny, or reunite the muffled interests of this noble profession.

Unionization of physicians, as advocated by the Union of American Physicians and Dentists (UAPD), seems self-serving for a profession that supposedly adheres to a higher calling. But maybe that option should be on the table if physicians ever hope to recapture or maintain what few choices that remain for them. Although the UAPD claims “to putting physicians back where they belong— in control of their practices,” the only methods they offer are lobbying efforts, filing lawsuits and preparing amicus briefs. These appear to be no different from the conventional organizations. (2)

Unfortunately, this may not be enough! Traditionally, unions exert their influence by duress or the threat of duress. In more basic terms, union members withhold services that deny consumers the benefit of their products. Except for rare and the dire circumstances, physicians have not been willing to ‘go to these lengths.’

The IPAs and HMOs have contracting authority. But they have two inherent flaws: First, many of them, especially the HMOs, are, at best, not entirely owned or run by physicians. Second, the number of physicians within these entities are often so small that any forcible changes they try to enact are usually offset by another competing organization.

In 2000, 57% of practicing physicians owned at least a part of their medical practices. That percentage is projected to drop to 36% by 2013. (3) With hospital corporations swallowing up existing practices at an alarming rate and with the future establishment of Accountable Care Organizations, the ability (or even the desire) of physicians to negotiate on issues that affect the profession is evaporating.

How then can physicians protect their own authority and best represent the interests of their patients? An answer may be to form a ‘binding’ organizational model, such as the Screen Actors Guild, that crosses specialty, organizational and geographic boundaries.

In a January 30, 2013 article in the Wall Street Journal article, David J. Leffell, MD, a professor at the Yale School of Medicine, wrote,  “… The Obama Administration, by intent or accident, has effectively driven a major change in the status of physicians… to seek employment with health systems or large physician groups… It becomes clear that when the majority of physicians are no longer self-employed— and barring any legislation to the contrary— their new employed status will provide doctors with the right to collective bargaining… If doctors unionize, that raises an immediate question about their right to strike— the key lever in collective bargaining.”

This move would almost certainly evoke claims of violation of antitrust laws by the Justice Department and the Federal Trade Commission and raise ethical concerns of the ‘do no harm’ pledge that is the underpinning of the medical profession.

United in cause, physicians have proven that they possess the power to bring the system ‘to its knees,’ as seen in the 1975 California liability crisis:

The situation in malpractice liability coverage reached crisis levels in 1975 during the post-oil-shock recession. Commercial insurers left large numbers of physicians without coverage. In California, many physicians were facing doubling and even tripling of their premiums within a year’s time. Many practices closed and often the inflated premiums were passed on to the patients. In an act of desperation, physicians organized a work slow-down, only performing emergent care. Governor Jerry Brown called the legislature into an emergency session. Out of that legislature came The Medical Compensation Reform Act of 1975, known as MICRA…

Following the passage of MICRA, malpractice settlements have been 53% less than the national average in one study, while malpractice premiums have increased only 7% annually versus 17.5% per annum nationally. California internists and general surgeons pay about one-third less in malpractice premiums and obstetricians/gynecologists about one-half compared to their counterparts in New York and Florida. (4)

There are three questions: could, would and should physicians exert this power?

The results that produced the MICRA legislation in 1975 seem to answer the questions of could and would. Although the work slow-down was only by anesthesiologists, who refused to assist with elective surgeries in San Francisco for four weeks, their decision was effective.

It is important to look at why the work slowdown in California took place and who benefitted.  The decisive action occurred because the exorbitant rates for malpractice insurance were closing practices and denying patients access to affordable medical care. The beneficiaries were the physicians that realized decreases in the costs of their premiums, but, more important, the patients benefited even more with increased access to affordable care.

Through political influence in their state legislature and with the support of their Governor, Texas adopted a liability reform package, Proposition 12, in 2003. Since then there has been a 59% growth in the number of newly licensed physicians in the last two years versus the previous two years prior to the adoption of this legislation. In rural areas, the number of practicing obstetricians has increased by 27% post reform and the number of orthopedic surgeons has gone up by 15%. (4)

The current avenues of representation by the conventional organizational models, except for a few exceptions like the example above of malpractice reform in Texas, have only slowed, what appears to be, the inevitable takeover of the medical profession. Would the next step be for physicians to join together in more structured ways in order to protect their own best interests and those of their patients?

What would Hippocrates do? The answer to this hypothetical question might be found in his oath that most physicians recite as they are presented with their medical diploma. Referring to the patients, his pronouncement to keep them from harm and injustice, takes physicians’ responsibility to a higher order— not only to do no harm, but to seek protection from others whose actions might cause them harm. (4)

Physicians, and the organizations that represent them and their patients, historically have pursued tactics that can be generally described as reactive— acting in a response to a situation, rather than controlling it.  If the last 48 years, since the introduction of Medicare, are any indication of what is to come, the only way to reverse this trend is by becoming proactive.

Should today’s almost 700,000 practicing physicians take that next step? It appears from his teachings that Hippocrates might have thought so.

References:

(1) R. Tenery, What If There Were No AMA? Echoes for the Future,@ http://www.robtenerymd.com, January, 2011.

(2) http://www.uapd.com/all-doctors-need-a-union/

(3) Report by the consulting firm Accenture, October 31, 2012.

(4) R. Tenery, In Search of Medicine’s Moral Compass, Brown Books, 2011.

The patient/doctor relationship began as an act of beneficence— the process of sharing one’s knowledge with another in need. There was no formal contract. Instead of a handshake, the offer was a helping hand. The ultimate goal was one of good, and not for any reward that might come out of the encounter.

The relationship was an unwritten covenant between the doctor and the patient. It was based on trust. Trust that the doctor would always put the patient’s best interests first. Trust that the doctor would use his/her skills to apply the best diagnostic and therapeutic options available or refer the patient to where those alternatives would be available. Trust that the doctor would never abandon the patient.

Then things changed. The doctor had to ‘make a living’. What was once a relational union between the doctor and the patient began to slowly evolve into one based on a transaction— an exchange between two consenting parties. Those patients, that couldn’t afford to offer anything in return, still received proper care.  Those, with the means to pay more, did— the exchange of skills and knowledge for whatever the receiving party could afford. In those early days it could have been a bushel of corn or a prized farm animal. Later it was more often currency. In spite of this evolution to a transactional relationship, the covenant between the doctor and the patient still stood firm. That was until the third parties became involved. At first, it was private health insurance (later to become Blue Cross/Blue Shield) and the federal programs (Medicaid and Medicare). Even then, it was not until the federal programs started dictating how much the physicians should be paid was that covenant tested.

The growing threat of repercussions from poor results rather than just negligence put this union to the test. But it was managed care, especially under the rules of capitation that this once-sacred relationship began to falter. Under these restraints, the physicians were now forced to recognize the needs of all patients within a particular funding system. No longer was it just about the one patient. Because of an expanding patient base, coupled with growing funding and resource limitations, physicians they were incentivized to do less, and sometimes penalized for doing more.

Along the way, the tide also changed in physicians’ attitudes. No longer was medicine ‘their life.’ What was once a calling to most who had chosen the medical profession, was becoming their vocation. Not because they were any less dedicated to their patients, but because of the advances in technology not only within the profession, but in the areas of telemedicine, cross-coverage and communication had freed them to devote more of their time to their families and other interests. The very technology that has advanced health care to the highest level in the history of mankind was gradually stripping the emotion out of the relationship.

Instead of a stethoscope, an ophthalmoscope and a reassuring pair of hands to probe for underlying pathology, many physicians of today turn to their monitors for answers. Have these advances raised the level of care? Unequivocally YES! If the question was changed to read the level of caring, the answer would be a resounding NO!

A change in patients’ expectations also has played a part. Increasingly, patients are basing their judgments on outcomes and rather than efforts. Not that the trend is totally wrong, but in a science that is still in its infancy, much is still unpredictable. The patients did not come to feel this way on their own. Marketing of health care services have planted the seeds of unrealistic expectations. The media, in its attempt to inform, has failed to paint the whole picture. Finally, the ravenous, legal community stands by, like vultures, watching for the last breath to scarf up the remains.

Most of the rhetoric espoused during both the political conventions this past summer followed traditional party lines. One thought that went right by me, until it was pointed out by a commentator, was the importance of the family. In his acceptance speech for the nomination for President, Governor Romney said that outside of one’s chosen religious beliefs, the issues affecting the family unit were central to everything. This precept goes back to the basics of problem solving in mathematics— reduce the problem to its lowest common denominator. That similarity to our priorities in health care struck a note! Heath care reform, insurance coverage, pre-existing conditions, liability concerns, fees—- the list goes on and on. With all of them, preserving the sanctity of the doctor/patient relationship must be central to everything debated in Washington, in the corridors of our hospitals and in our offices. It doesn’t matter whether it is the advances in the science, the fear of legal jeopardy, regulatory intervention or who’s paying the bill, that relationship must remain inviolate.

Not only do physicians put themselves in legal jeopardy, they also incur scorn from the medical community when they abandon their patients. Abandonment doesn’t always have to be just physical separation. Frequently overlooked are the deleterious effects when the loss of connection is emotional.

When patients refer to their doctors, but can’t recall their names. When doctors only remember their patients by their diagnoses. These examples may be signs of emotional abandonment by either party. Even more important, the physicians have failed to uphold the covenant our forefathers first made with their patients many years ago.

Sometimes injustices stare us right in the face and we don’t recognize them. The shift of $716 billion out of Medicare barely raises a ripple in the pond of discontent.

The election is over and the voters have spoken. By reelecting President Obama to a second term, any chance of repealing the Affordable Care Act (ACA, Obamacare) is essentially nonexistent. However, even the President and his most ardent supporters have agreed to look at changes that would improve the law as it rolls out over the next five years.

All of the concerns over the ACA seem to have been focused on the constitutionality of the individual mandate, the Accountable Care Organizations, the Independent Payment Advisory Board and the outcome of the Presidential election.

What about the obvious? What about any concerns that a substantial portion of monies will be moved out of Medicare to fund the newly uninsured? What will that due to access for our seniors? What will the loss of funding do to curtailing health care services for a group of individuals who have built and defended this country to make it what it is today?

Why did the authors of this legislation single out the elderly to help pay for these changes? The answer appears to be because the seniors are the least likely to speak up and defend themselves.

Look at the positions taken by the entities that purport to represent the elderly: AARP, the American Medical Association (AMA), the American College of Physicians (ACP) and all the legislators that pleaded for the seniors’ support in previous elections. Where are they when our elderly needs them?

The American Association of Retired Persons (AARP) abandoned seniors when their Board of Directors threw their support and millions of dollars of their constituents’ monies toward gaining passage of the ACA. It seems ironic that AARP’s leadership campaigned for legislation that would make it more difficult for their members to access affordable health care services. For what reason— corporate greed for profits from their Medi-gap insurance coverage?

The largest doctors’ organization, the AMA, seems to be more concerned with a fix in the Sustainable Growth Rate and changing Medicare into a defined contribution plan (both laudable and necessary), than rescuing Medicare recipients from this significant burden. What about any concerns from the ACP, since a large proportion of their members’ patient base are senior citizens?

In the August census report, 47 million people were listed as uninsured. Of that group, over one-fourth were undocumented aliens. 37 million of our citizens were listed as 65 or older.

Why not spread the additional costs of this new legislation over all of the population, not just the seniors? Probably because the administration feared the public would balk at an even larger tax hike in entitlement funding. In some ways, this could be considered a regressive tax on the elderly!

John Goodman, the President of the National Center for Policy Analysis in his November 12, 2012 blog, Did the Election Save ObamaCare?, put it succinctly when he wrote:

“This reduction will primarily consist of lower payments to physicians, hospitals and other providers — reductions that are so severe that they will seriously impair access to care for senior citizens.

Harvard health economist, Joe Neuhouse, envisions that seniors may have to seek care in the same places that now cater to Medicaid beneficiaries: at community health centers and in the emergency rooms of safety net hospitals.

During the election campaign, President Obama claimed that the money would come out of the pockets of doctors, hospitals and insurance companies, with no bad effects on seniors.”

It is naïve, and the reasoning not well-founded, to believe that $716 billion dollars can be diverted out of Medicare by increasing efficiencies and cutting down on unnecessary care, without adverse consequences to those who are covered under this program.

Recently, a patient told me that he and his son were visiting about the growing medical costs for the elderly. His son’s comment stopped me cold: “Maybe, we can’t afford you anymore.”

The Medicare program is already being pummeled by the reimbursement cuts legislated by the dictums of the Balanced Budget Act of 1997. Now coupled with the egregious ‘robbery’ of another $716 billion dollars over next ten years and the so-called ‘fiscal cliff’ that currently holds this country in a death grip, our seniors are ‘on the ropes.’

This issue is much more important than whether the law was initially a Democratic or a Republican initiative. It is ‘our’ issue! And if the leadership in Washington DC, does not come together, ‘our’ seniors will pay the price.

If there is a chance to protect Medicare, it’s time for the seniors and their doctors to speak up, since the doctors’ organizations, AARP and the legislators apparently aren’t doing it for them. Maybe, with a groundswell of support, we can reverse the injustices that are about to be heaped on our senior citizens.

The original title of this new legislation was The Patient Protection and Affordable Care Act (PPACA). Lately, the first two words have been dropped from the title to read the Affordable Care Act. From the seniors’ perspective, it’s easy to see why!

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Reference:

http://healthblog.ncpa.org/did-the-election-save-obamacare/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-27826

I’m white, male and a senior citizen. What does that make me? The answer is just another minority. We had a great run—- almost 250 years. But it’s over. Those that follow politics in this country had projected this day would come. Studies have shown that blacks vote their skin color over ninety percent of the time. Hispanics vote seventy percent to the left. The majority of Jews vote Democratic, even though those in power only give quasi-support to the state of Israel.  In growing numbers, single females, support the Democrats because that party has triumphed abortion rights and birth control issues. Unions vote predominately to the left, even in the face of massive job flight to countries that pay their workers far less than minimum wage. Many younger people backed Congressman Ron Paul, because he supported a foreign policy of virtual isolationism.

This country has changed. The groups mentioned above are now the ‘new’ majority. They will carry the United States into the near future. Even though the margin was only a thin 1%, the electorate has spoken: larger government and less presence on the world stage— no longer striving to be the world’s leader, at least by force.

The original authors of the Declaration of Independence were an independent bunch, believing that ‘life, liberty and the pursuit of happiness’ were paramount and they paid for those freedoms with their lives and sacrifices. What these visionaries possessed was a sense of the greater good, and not just what was ‘in it for me.’ They backed it up with their self-reliance, refusing to accept authoritarian dependency. They made changes happen, rather than just accepting change.

The contrasting terms, ‘handout’ and ‘hand-up,’ put this change succinctly. Handouts serve the immediate needs, but incentivize dependency. Hand-ups create independency. The charitable and the federal programs, such as unemployment insurance, Welfare and Medicaid, have made valiant attempts to serve the needs of those who can’t help themselves. Far too often, these programs fail to incentivize self-reliance.  Thus, any moves that threaten those that depend on the entitlement programs are met with resistance at the ballot box.

Like our European counterparts who rely on ‘cradle to grave’ protection for most of their basic needs, this country is moving from an entrepreneurial to an entitlement society of takers rather than earners. How often does anyone send back their social security check or tear up their food stamps?

This transformation comes with consequences: the ‘rationing’ of health care services seen in England will become the norm under Obamacare. The projected cuts in our military budget decrease this country’s ability to protect our interests in the world community. We have an exploding national debt that will ultimately pull this country over the fiscal cliff, similar to the concerns seen in Greece and Spain. There is no European Union to rescue the United States from this abyss.

There are four areas that the electorate will have to address in future elections: heath care, business, world presence and border issues.

Obamacare is the law. The results of the recent election killed any thoughts of a major reversal. The legislation will allow coverage for more individuals, but at lower individual patient costs. However, access, rapport, private insurance coverage and, despite what the supporters of the legislation claim, cumulative costs will take a hit.

American businesses face close to the highest corporate tax rate in the world. Add to that the now mandated extra costs of health care coverage for their employees under Obamacare. What do these impediments do to the entrepreneurial spirit? How does this affect the already-high unemployment rate? As startup for new businesses decrease and others shut down or move out of the country, the void will be filled with imports or government run replacements.

The role of the United States as the ‘world’s policeman’ seems to have passed with the lessons learned from Vietnam, Afghanistan and Iraq. The proposed drastic cuts in the military budget reveal that President Reagan’s approach to peace through strength seems to have fallen by the way.

Here at home, there are even feelers that the second amendment right to bear arms is being questioned. Additionally, the President is making no secret of his desire to bring this country into closer alignment with the long-term strategies of a ‘world community’ under the United Nations.

Any country that can’t control its borders will lose its culture, bankrupt its monetary system and will be taken over, either from without, or within. In many parts of the country, our population is ‘turning brown.’ The United States was built on migration of new blood and the fresh ideas that immigrants bring.  If left unchecked, the current immigration rules, and the lack of enforcement of them, will transform this country to a second rate power. The matter of undocumented aliens is a political hot potato. The Democrats are afraid to threaten this rapidly expanding population whose relatives vote 70% to the left. In hopes of a better connection within the Hispanic community, the Republicans, even during the Bush #43 administration, avoided confronting the problems head on.

This is not just an issue with Mexico, and it is not just building a fence or shoring up the under-staffed border patrol. It is also about controlling the growing criminal element from across the border, preventing acts of terrorism, ID cards, birthright citizenship, more efficient pathways to citizenship and a reasoned approach to amnesty. It is about making inroads into the communities where our foreign-born citizens have laid down their roots and find common ground.

Both parties were right that the economy was the primary issue in this last election. But the Republicans miscalculated the demographics. The average Joe or Jane doesn’t care whether the job comes from the private sector or the government. They care about their salary, the benefits and the security of their position.

A quote that is attributed to Thomas Jefferson says it best: “The government you elect is the government you deserve.” So, as I wait for an appointment with one of the few doctors who is still willing to treat seniors, why don’t you get in line with me?

The more we learn about the Patient Protection and Affordable Care Act (Obamacare, PPACA, ACA), the more it appears our seniors and the providers of heath care services (physicians, etc.) have become the ‘fall guys’ to pay for it. With the hundreds of billions of dollars that are projected to be diverted out of the Medicare program over the next 10 years, the Centers for Medicare and Medicaid Services (CMS) imposed reimbursement penalties for Medicare and Medicaid patients who are readmitted to the hospital within the first 30 days of a prior admission (1) and proposals to provide only palliative care for some of the most serious maladies after patients reach a certain age as enumerated by Betsy McCaughey PhD, a constitutional scholar from Columbia University (2), it seems the elderly and the physicians who care for them are being asked to take on a disproportionate share of the sacrifices under the dictates of this new and controversial legislation. (3)

Why then have the American Association of Retired Persons (AARP), the American Medical Association (AMA), and the American College of Physicians (ACP) all supported passage and continue to support this potentially harmful legislation to the senior population?

For the Board of Directors of AARP, it has always been about the money. It was a payoff to the President. Through its subsidiary company, AARP was one of the main suppliers of Medi-gap insurance, a privately purchased coverage that picked up where Medicare benefits left off. The George W. Bush administration passed the Medicare Advantage program that was a lower-cost alternative to the Medi-gap coverage. More than 11 million seniors took advantage of the program that significantly cut into the AARP Medi-gap revenues. President Obama eliminated subsidies for the Medicare Advantage program that made the more-expensive Medi-gap coverage more competitive.

Even though over $700 billion flagged for the Medicare program would be shifted out to cover the new enrollees under Obamacare and although seniors would end up paying more money for their coverage, the leadership at AARP threw its support behind proposed legislation. Appearing to be more concerned with corporate revenues than abandoning the seniors who comprised its membership, the leadership of AARP donated millions of dollars toward the advertising campaign and lobbying efforts in support of the proposed legislation. Referred to as ‘corporate cronyism’ much of their membership has openly rebelled against AARP’s leadership. (4)

The leadership of the AMA backed the President’s plan early on when he promised to support a permanent fix to broken Sustainable Growth Rate (SGR). In 1997, Congress passed the Balanced Budget Act (BBA). In an attempt to control the growth rate of expenditures to doctors, the sustainable growth rate (SGR) was established. Using a fee schedule determined by relative value units (RVUs), the intended goal was to limit the total pay for doctors to not exceed the growth rate of the rest of the country. Unfortunately, the formula to calculate the SGR was flawed from the beginning.

When the 1997 law first went into effect in 2002, the SGR formula called for a cut in doctors’ fees of 4.8 percent for over 7000 physician services. Congress overrode the enactment of the BBA, but claimed it was too costly to eliminate the SGR on a permanent basis. Every year since, Congress has blocked the reductions called for under the SGR. They have accomplished this by using two methods: The ‘clawback’ legislation that temporarily prevents the proposed SGR reductions, but allows for this additional funding to be taken out in future years. The other is labeled ‘cliff’ legislation that prevents the scheduled SGR fee reductions, but overrides the law that says that rate reduction cannot be more than seven percent in any year. Although the draconian cuts in reimbursements were put off for another year, President Obama was not able to deliver on his assurances of a permanent fix.

Why then has the AMA leadership continued to support this harmful legislation that will cut reimbursements to many of their membership and most of the elderly patients they claim to support? The same should be asked of the ACP.

One overriding question that seems to be at the heart of any health care delivery system with limited resources is balancing the obligations between helping young people to become older verses helping older people to become older indefinitely. (5)

Prioritization of health care services has been around since the beginning of time. In earlier times, battlefield victims were left to die when their wounds were judged too severe to sustain life. Triaging mass casualties when delivery systems are overwhelmed. Organ transplant allocation that leaves many in need of a second chance at life. Rationing of health care services is a less palatable term but, means the same—- costs, urgency, likelihood of outcome and availability are all a part of making therapeutic decisions.

The federal programs, Medicare and Social Security, are similar to long term care insurance— they are based on a promise. When individuals are younger, part of their wages are set aside or taxed to fund benefits for later in their life. Although all carry obligations to fulfill promises, none can completely insure their participants against less coverage due to inflationary costs and more expensive advances in technology.

A century ago the limiting factors were access to and availability of any needed therapy. Today, it is affordability. Advances in technology have allowed patients to live longer, more productive lives. By necessity, as the costs of care rise, cost/benefit ratios become a delineating factor. Consider the example of contrasting the costs generated by giving an 1800-gram neonate a chance at a long, productive life versus an eighty-five year old senior with multiple system organ failure who is clinging to life in an ICU. Multiply that by a thousand times a day in hospitals across the country. Both have priorities. But what happens when the resources are limited? Which gets cut first? Just as we don’t have the right to take a life, we don’t have the obligation to automatically prolong life.

There are four disadvantaged populations in this country: the extremely young, the extremely old, the uninsured and those that are in this country illegally. Each creates significant costs to our already-strained delivery system. Instead of broad, sweeping dictums that give support to one group over another, maybe the answers lie in the individual encounter—- what is the most humane decision. After all isn’t that the way medicine was practiced until the third parties became involved?

Call it by any name: Obamacare, the Patient Protection and Affordable Care Act (PPACA) or the Affordable Care Act (ACA), they are one and the same. It is interesting that lately this controversial legislation is most often referred to as the Affordable Care Act. We can only presume that once the powers in Washington found out more of what was in the legislation that they voted for without first reading it, the Patient Protection part was left out. At least it would seem that way for the elderly.

The outcome of the election that is almost upon us, possibly the most important this country has faced in recent times, maybe ever. As physicians, citizens, potential patients and, if we are fortunate, seniors, we should cast our vote only after very careful consideration. The future of health care delivery for the elderly depends on it!

REFERENCES:

1. http://www.fiercehealthcare.com/story/cms-start-readmission-penalties/2012-08-13
2. http://defendyourhealthcare.com/about-us/betsy-mccaughey/
3. http://news.investors.com/ibd-editorials-perspective/101012-628841-obamacare-medicare-cuts-danger-to-senior-citizens.htm?p=full
4. President Obama 1, President Clinton 0, Echoes for the Future, July 23, 2012.
5. http://virtualmentor.ama-assn.org/2008/06/oped1-0806.html

Frowning at what looked like a mountain of spinach on the dinner plate before my six-year-old eyes, my mother cajoled me to take a bite. She pushed, “But you haven’t even tried it.” I shook my head. “I’ve already made up my mind,” I answered, remembering what my close friend had told me about spinach. I was not going to like it no matter how it might have tasted.

This is an example of the term mindset— a fixed state of mind. Deciding on something before one has even tried it or listened to the other side.

Being reared in an allopathic, medical family, I thought anybody who had a doctor of Chiropractic medicine after his/her name was a charlatan. A sagely professor of Pathology taught me a valuable lesson during one of his lectures to our sophomore, medical school class. “In every discipline of medicine, there is some truth and some that is not,” he reminded us. What his words of wisdom taught me was to not close my mind to persons or thoughts that were different to my own.

Needing a solution to my chronic back pain of the last several years, I consulted a close friend and orthopedic surgeon who opened my eyes to Chiropractors. “We use them all the time for certain problems like yours.” My friend had found truth in the Chiropractic field and some of his patients were better for it.

Today’s volatile situation in the Middle East is a reflection of the ‘only one way’ mindset of many radical Muslims. The torment suffered by Jesus is probably the most glaring example of the thinking that anything that conflicts with one’s current mindset is wrong or threatening.

Even though the President and both houses of Congress voted for the Patient Protection and Affordable Care Act’s (Obamacare) passage, very few of them had actually read the voluminous bill in its entirety. Speaker of the House of Representatives, Nancy Pelosi, charged her fellow legislators, “We have to pass the bill so you can find out what is in it.” So what did most of them do? They let others make up their minds for them.

Days after both political conventions had drawn to a close, pollsters began dividing up the country into blue states, red states and swing states. So had both candidates for President. The red and blues states (thirty-eight at the most recent count) were now only good for one thing— raising money to support the political campaigns that would be waged in the twelve swing states. A closer look reveals that even in the swing states only about five to ten percent of voters are listed in the ‘undecided’ category. Since our country elects its President by the Electoral College, it only makes sense to concentrate the contributions and energies of the campaigns on that very small group of the ‘undecided’ voters that are most likely to be swayed.

According to the polls, the majority of the voters in the red and blue states have already made up their minds. They are going to vote along party lines or according to their skin color, religion, geography, their pocketbook and in what entity they put their trust (the media, a personal friend or family member). The breakout of a large-scale war in the Middle East, a dramatic drop in the stock market, or possibly, a stellar performance in the Presidential debates could change this dynamic. But barring any of these unlikely events, the outcome of the Presidential election is in the hands of only a small percentage of our population. Because everyone else has already made up their minds!

What does it take to change voters’ minds? A ‘bridging source’ from what or whom they share a commonality. It is similar to my revelation about Chiropractics through a close friend and associate. It was about me. Unfortunately, most of us don’t base our decisions on what is best for the greater good. Our vote boils down to how it affects us, our families and our pocketbooks. The old adage: All politics are local, even with the election for President of the United States.

A large percentage of the electorate base their decision on how to vote by the media from which they get their information. Even then, most support their current position by reading newspapers, listening to radio stations and watching television stations that lean toward their already predetermined point-of-view.

Beginning with the Watergate scandal in 1972, reporting changed. News was no longer just the facts. It was information interpreted and selectively distributed in the viewpoint of whatever particular media outlet was covering the story. The complete story was no longer complete. Throughout the last forty years, the media’s influence on the electorate has grown exponentially. The sophistication of the delivery of their biased message is so shrouded in the facts that only those few who dig deeper will realize that they are being manipulated. (1,2)

Techniques such as where a story is placed in the newspaper or in a broadcast or ignoring the story altogether, using a headline to push the edge of truthfulness and juxtapositioning positive remarks made by one candidate the reporter supports alongside negative comments or images by the opponent are now commonplace. Broadcast media can change voter turnout by announcing national election results in states that close their polls earlier than other states where the polls are still open. Even the pollsters exert their influence by deciding what voting population they will interview and weighting positions that could be taken by any underrepresented segment in their sampling.

The repeating theme: Others making up our minds for us.

This country was founded on the premise of entrepreneurial independence. The entitlement programs encourage others such as the Feds to take over the care of our needs. For many who are not so fortunate, a safety net of subsidies is their only hope. However, for the majority of the population, who could help themselves, the addiction to entitlements only strengthens the government’s ability to make up their minds for them.

Maybe its time we ‘tasted the spinach’ for ourselves!

References:

1. http://www.foxnews.com/opinion/2012/09/29/mainstream-media-threatening-our-country-future/?utm_source=twitterfeed&utm_medium=twitter
2. http://pjmedia.com/rogerlsimon/2012/10/01/media-coup-detat/2/

In the early 1900s, Henry Ford not only revolutionized transportation but all of American industry by developing the assembly line technique for mass production. The process has been labeled modernization. Consumer goods, previously available only to a select few, were now available to the ‘masses’. Later McDonald’s and Wal-Mart can be credited with similar accomplishments— make available more products, while at the same time, producing them more cheaply.

This concept had its origins during the mid-seventeen hundreds in the United Kingdom with the awakening called the Industrial Revolution. More specifically, it was a transition from a manual and draft-animal labor based economy to a machine-based economy. (1) In more encompassing terms, it was a transformation where social changes and economic development were driven by technological innovation. Spurred by income rises, the demands of the working groups (consumers) increased in proportion to the availability. Previously resigned to less, the working class now wanted and could afford more of what they produced.

Although assembly line efficiencies increased the number of goods available, the quality of each individual product did not always keep pace. More did not always equate to better. Just because Henry Ford could put more of his automobiles on the road, did not mean that his Model Ts were better, or even as good as the painstakingly assembled cars of his competition. Putting aside profit motivation, one could assume Henry Ford’s altruistic goals were to raise the standard of living for the masses.  Affordability and availability were Henry Ford’s aspirations. Noble as his premise was, it also introduced the concept of duality— products for the masses and the option of other, often better, products for those who could afford more.

With mass production also came a depersonalization — a distancing of the producer from the consumer, not only because of wider distribution, but emotionally as well.  Since the investment of ‘blood and sweat’ was concentrated on just one small area in a series of steps, the worker had less opportunity to develop a sense of ‘ownership’ in the final product.

That was automobiles. This evolutionary transformation, called modernization, could just as easily apply to other disciplines. Although the practice of medicine is a blend of science and the ministry, with the explosion of technological advances, the delivery of health care services has evolved into an industry. Some would say medicine’s industrial revolution began with Sir Joseph Lister’s introduction of the sterile surgical technique with the use of carbolic acid in 1867. Others might claim the discovery of sulfonamide in 1932 by Gerhard Domagk or in 1928 when bacteriologist Alexander Fleming discovered that a mold, which would later be turned into Penicillin, killed the bacteria Staphylococcus aureus in a Petri dish.

These discoveries, as well as others too numerous to list, were pivotal in moving medical therapy from symptomatic manipulation with potions and poultices into a science that actually struck at the cause of diseases. They literally bought medicine out of the dark ages. At the same time, they set the delivery of health care on a path of predictable evolutionary changes mirrored in the automobile industry with Henry Ford’s introduction of mass production.

Once accepted as ‘the will of God’, the outcomes of certain diseases could now be altered, giving affected individuals a better chance at recovery. In conjunction, there also developed an obligation to make those discoveries available to other individuals who had also been struck down with these diseases. Sharing medical knowledge has always been an act of beneficence. Reliving pain and suffering had now evolved into curing. Distribution of knowledge and therapies to a widening patient base introduced a demand to increase methods of communication and production of instrumentation and therapeutic agents not needed in the past. What was once just a relationship between a doctor and his patient had blossomed into an industry that was necessary to supply multiple patients and their doctors with the latest technological advances.

Automation, or more efficient methods, had to be introduced to increase the growing needs of an expanding patient base. As production of these services increased, competition arose to make these services and technologies more readily available and cost efficient. Commercialization has turned many in the pharmaceutical and delivery side of health care into multi-millionaires.

To the stockholders, members of hospital boards of Trustees and those who are entrusted with the continuing viability of their institutions, their patients are being counted as income generators. To the pharmaceutical and medical equipment companies, they are thought of as customers. To the insurers, they are considered policyholders. Finally, to the elected representatives, who are involving themselves, more and more, in health care delivery, they are voters and potential donors. In this modernization of health care delivery, depersonalization is turning patients into widgets— widgets whose feelings, pains or fears don’t matter; good for one thing— to be counted. The more widgets one has and the more cheaply they can be produced (treated)—- the better. Most important widgets have no say in what happens to them.

Facing the future, these health care widgets (patients) may have only one remaining advocate, other than themselves, against the profit-makers, the payers and the rule-makers — the members of the professional health care community. If one stops to think about it, the reverse is true also. Just as much, doctors need their patients as their advocates. To often, this co-dependency is forgotten.

The industry of health care the delivery is different from the art and science of caring for patients. With the explosion of technology, coupled with an expanding and demanding patient population, modernization is inevitable. The problem is coping with the depersonalization that comes with these changes.

When we hear certain physicians extol about the number of patients they see in a day or the number of surgical procedures they can squeeze into their schedules, they’re no longer talking about their patients, instead they’re talking about their widgets.

References:

1. http://en.wikipedia.org/wik/Industrail_Revolution