Obama and MD

Obama - V - MD
By Zane F Pollard, MD
Below is an opinion of one of Atlanta's most recognized physicians, Dr. Zane F. Pollard, who works in pediatric ophthalmology for Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA



I have been sitting quietly on the sidelines watching all of this national debate on healthcare. It is time for me to bring some clarity to the table by explaining many of the problems from the perspective of a doctor.

First off the government has involved very few of us physicians in the health care debate. While the American Medical Association has come out in favor of the plan, it is vital to remember that the AMA only represents 17% of the American physician workforce.

I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta , Georgia that accepts Medicaid. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.

Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.

Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point -- rationing of care.

Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time.

Again, extreme rationing. Solution: I have a foundation here in Atlanta supported 100% by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrants children for free. Again, waiting for the government would be disastrous.

Last week I had a lady bring her child to me. They are Americans but live in Sweden , as the father has a job with a big corporation. The child had the onset of double vision 3 months ago and has been unable to function normally because of this. They are people of means but are waiting 8 months to see the ophthalmologist in Sweden. Then if the child needed surgery they would be put on a 6 month waiting list. She called me and I saw her that day. It turned out that the child had accommodative esotropia (crossing of the eyes treated with glasses that correct for farsightedness) and responded to glasses within 4 days, so no surgery was needed. Again, rationing of care.

Last month I operated on a 70 year old lady with double vision present for 3 years. She responded quite nicely to her surgery and now is symptom free. I also operated on a 69 year old judge with vertical double vision. His surgery went very well and now he is happy as a lark. I have been told -- but of course there is no healthcare bill that has been passed yet -- that these 2 people because of their age would have been denied surgery and just told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously cheaper than surgery.

I spent two year in the US Navy during the Viet Nam war and was well treated by the military. There was tremendous rationing of care and we were told specificially what things the military personnel and their dependents could have and which things they could not have. While I was in Viet Nam, my wife Nancy got sick and got essentially no care at the Naval Hospital in Oakland, California. She went home and went to her family's private internist in Beverly Hills. While it was expensive, she received an immediate work up. Again rationing of care.

For those of you who are over 65, this bill in its present form might be lethal for you. People in England over 59 cannot receive stents for their coronary arteries. The government wants to mimic the British plan. For those of you younger, it will still mean restriction of the care that you and your children receive.

While 99% of physicians went into medicine because of the love of medicine and the challenge of helping our fellow man, economics are still important. My rent goes up 2% each year and the salaries of my employees go up 2% each year. Twenty years ago, ophthalmologists were paid $1800 for a cataract surgery and today $500. This is a 73% decrease in our fees. I do not know of many jobs in America that have seen this sort of lowering of fees.

But there is more to the story than just the lower fees. When I came to Atlanta , there was a well known ophthalmologist that charged $2500 for a cataract surgery as he felt the was the best. He had a terrific reputation and in fact I had my mother's bilateral cataracts operated on by him with a wonderful result. She is now 94 and has 20/20 vision in both eyes. People would pay his $2500 fee.

However, then the government came in and said that any doctor that does medicare work cannot accept more than the going rate (now $500) or he or she would be severely fined. This put an end to his charging $2500. The government said it was illegal to accept more than the government-allowed rate. What I am driving at is that those of you well off will not be able to go to the head of the line under this new healthcare plan, just because you have money, as no physician will be willing to go against the law to treat you.

I am a pediatric ophthalmologist and trained for 10 years post-college to become a pediatric ophthalmologist (add two years of my service in the Navy and that comes to 12 years). A neurosurgeon spends 14 years post-college, and if he or she has to do the military that would be 16 years. I am not entitled to make what a neurosurgeon makes, but the new plan calls for all physicians to make the same amount of payment. I assure you that medical students will not go into neurosurgery and we will have a tremendous shortage of neurosurgeons. Already, the top neurosurgeon at my hospital who is in good health and only 52 years old has just quit because he can't stand working with the government anymore. Forty-nine percent of children under the age of 16 in the state of Georgia are on Medicaid, so he felt he just could not stand working with the bureaucracy anymore.

We are being lied to about the uninsured. They are getting care. I operate on at least 2 illegal immigrants each month who pay me nothing, and the children's hospital at which I operate charges them nothing also.This is true not only of Atlanta, but of every community in America.

The bottom line is that I urge all of you to contact your congresswomen and congressmen and senators to defeat this bill. I promise you that you will not like rationing of your own health.

Furthermore, how can you trust a physician that works under these conditions knowing that he is controlled by the state. I certainly could not trust any doctor that would work under these draconian conditions.

One last thing: with this new healthcare plan there will be a tremendous shortage of physicians. It has been estimated that approximately 5% of the current physician work force will quit under this new system. Also it is estimated that another 5% shortage will occur because of the decreased number of men and women wanting to go into medicine. At the present time the US government has mandated gender equity in admissions to medical schools.That means that for the past 15 years somewhere between 49 and 51% of each entering class are females. This is true of private schools also, because all private schools receive federal funding.

The average career of a woman in medicine now is only 8-10 years and the average work week for a female in medicine is only 3-4 days. I have now trained 35 fellows in pediatric ophthalmology. Hands down the best was a female that I trained 4 years ago -- she was head and heels above all others I have trained. She now practices only 3 days a week.

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Obama Promised $2,500 in savings?

Where’s the $2,500 Savings Obama Promised?

Throughout his campaign, then-Candidate Obama repeatedly made two promises about health care reform: that if you like your current health plan, you could keep it—and that it would cost about $2,500 per year less. Obama made this pledge on his campaign web site, in the second presidential debate, and in the third debate, :

“If you have health insurance, then you don’t have to do anything. If you’ve got health insurance through your employer, you can keep your health insurance, keep your choice of doctor, keep your plan. … And we estimate we can cut the average family’s premium by about $2,500 per year.”

One continuing theme in the current health care debate has been over whether you will actually be able to keep your plan if any of the current bills in the House or Senate pass.

But what about the $2,500 in savings?

There is nothing in any of the current health care reform proposals that would produce anything like that savings, or even any savings at all.In fact it does just the opposite.

A study by John Shiels and Randy Haught of The Lewin Group estimates that the average private insurance premium—the cost of the health insurance you have right now—will actually go up, not down, costing the average working family $460 a year more. That figure accounts only for cost-shifting that they assume will occur because the new “public plan” will pay doctors and hospitals less than they receive now from private insurers, and in some cases less than the cost of providing health care service. In reality, the cost increase might be much higher, because a new “Health Choices Commissioner” will have the authority to mandate coverage of more services than your current plan – in which case you will not be able to keep your plan, and the plan with that extra coverage will necessarily come with a higher premium.

Doug Mills/The New York Times

The closest the House bill (H.R. 3200) comes is to provide some income-based subsidies to purchase health insurance. These would apply only to those who both don’t have employer-sponsored insurance and who have incomes below four times the federal poverty level. They are designed to limit the percentage of income that an eligible family would spend on the “basic” government health insurance package in the new “public plan,” to 1.5 percent to 11 percent of income, depending on how close the family is to the federal poverty level. But this is not for the insurance you have now, it’s for government-run insurance “standard” insurance package (similar to Medicare only with much higher premiums). And the subsidy is not “savings for the average family,” it is just shifting part of the cost of insurance from some families to other families—the ones who pay the taxes necessary to fund the subsidies.

Health Care And The Federal Budget, US - The Committee for a Responsible Federal Budget

The Committee for a Responsible Federal Budget released "Health Care and the Federal Budget," documenting the alarming state of the U.S. health care system with a special focus on the role of health care in the federal budget.

With national health spending totaling around $2.5 trillion in 2009, and projected to grow to $4.4 trillion by 2018, there is obvious cause for concern that health care spending is out of control. This is especially true given that over a third of health care spending comes from the federal government (outside of the tax system), and these costs are driving the country toward fiscal disaster.

With over fifteen percent of the population uninsured, a major goal of health care reform has been to expand insurance coverage; this could greatly increase government spending on health care. Measures to achieve this must be accompanied by offsetting tax and spending changes as well as credible efforts to control costs.

The federal budget already faces serious structural deficits that stem from government promises outweighing revenues. Adding health care spending into this mix, without a proportional and broad based commitment to pay the taxes necessary to finance new spending, would cause the budget outlook to deteriorate even further.

More importantly, unless key changes are made in health care delivery and payment systems, costs will continue to rise rapidly and quickly reach untenable levels. Absent significant cost controls, Medicare and Medicaid will double as a percent of GDP by 2035, and consume as much as we typically raise in total revenue by 2080. That type of growth will place serious constraints on the economy's ability to meet alternative needs of the population and make it that much more difficult to improve overall standards of living.