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David Fisher, MD, MPH: November 2009

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Thursday, November 26, 2009

Engage with Gravy, then Engage With Grace

I have blogged before about the importance of sharing your end-of-life wishes with someone you trust.  Thanksgiving is the perfect time to have that conversation as you gather with family.  The fine folks at Engage with Grace have put together a slide of 5 questions that will make this process easier.

If you have the gizzards to bring up these questions at the Thanksgiving dinner table, you deserve the Myles Standish Award for Bravery.  Even so, I find that once the ice is broken, these conversations can be quite cathartic, and you and your family will feel like you accomplished something important at Thanksgiving besides overloading on poultry and dozing off into a tryptophan-induced haze.  So, after you engage with gravy, Engage with Grace this holiday.  You can thank me later.

...would love to hear your comments on how it goes...
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Sunday, November 22, 2009

The "Million Med March"

Today I attended the Million Med March held in cities across the US and here in Chicago.  It was sponsored by Docs 4 Patient Care, a grassroots organization of physicians, healthcare professionals, and concerned citizens who want to reform health care while preserving the integrity of the patient-physician relationships we enjoy in this country.  I didn't know much about the group before today.  There weren't exactly 1 million doctors at Chicago's rally today- maybe 200-300.  Even so, there were some important messages.  Here is a summary of what was said, and my reflections on the event.

1. We are blessed to live in a country where the exchange of ideas is protected by law.
It was a privilege to gather with like-minded people today and express my views on an issue that I care about.  Few nations on earth protect, and even encourage, free and peaceful assembly to promote a cause.  The police who were present were not there to break up our meeting, or even monitor what we were saying, but to protect our right to assemble.  I'm not a big "rally" guy, but I appreciated the chance to participate today with no risk to my personal safety, my job security, or my family's well-being. 

2. Doctors are bad protestors/activists.
Today's rally lacked the energy that I have experienced at other public events.  It was not because the doctors present do not believe strongly in sensible health care reform.  I think most physicians, in an effort to provide their patients with the best, evidence-based medical care, get used to just falling in line with the latest recommendations and "standard of care."  Protests do not come naturally.  That, combined with the even-tempered personalities often found in physicians, makes us bad activists.  We are not a "rah-rah" crowd.

Most of the doctors I talk to are not in favor of the current health care bill.  Most of them also feel there is not much they can do to impact the health care reform efforts in Congress.  Part of that is due to the fact that very few doctors were actually invited to participate in the process.  The American Medical Association (AMA) supports the bill, but it represents less than 30% of doctors.  (Many AMA members are newly graduated physicians who have not taken time to cancel the free membership they received as a medical student.)  Another reason doctors don't feel we can have an impact is that, for whatever reason, we tend not to rally together.  Perhaps it is the self-sufficiency we learned in medical school and residency training.  It may be that we are too busy to ask each other to participate in an event seen as an "extra" thing.  The laws prohibiting physicians from forming a union also prevent us from uniting around a cause.  I am proud of those physicians who attended today.  As one physician and speaker put it, "I wasn't going to come today because I have a busy practice, a family, and few minutes to spare, but then I realized, that is why I needed to come today, because health care reform is going to affect all of those things."

3. The introduction of a public option will lead to government-run health care.
Even if this is not the stated intention, offering a government-subsidized health insurance plan to all will eventually destroy private health insurance as we know it.  The argument for the "public option" says that health insurance companies need a competitor to "keep them honest" and the government needs to provide this competition to prevent abuse.  Sounds great, but since when did the US government compete with its own people?  One enters a competition for one reason: to win.  That means that the clandestine goal of the government-run plan is to make private insurance companies into losers.  Since a government plan does not have to remain profitable to stay in existence, it will play by different rules.  Since its inception in the 1960's, Medicare has operated at a $37 trillion loss, yet it is bigger than ever.  No private company can "compete" against a beauracracy that bulletproof.

4. The "opt-out" provision in the Senate bill is a sham.
To create the impression that the public option is not being forced upon us, the Senate included language that will allow individual states to opt out of offering the public option.  What is not publicized is the fact that states who opt out will still pay the same taxes as states who opt in.  They will incur the same costs but no benefits.  It's doubtful that any states will opt out of the plan, since they cannot opt out of the cost.

5. Estimates of the bill's costs are grossly underestimated.
You have probably seen the CBO estimates of a $849 billion price tag for the current health reform bill.  The CBO numbers are based on a ten-year projection.  Since the changes to the health care system are slated to take place in 2013, the estimates only include 6-7 years of costs, but they include 10 years of increased taxes that will start immediately.  In other words, three of those ten years are income-only years for the program, with no costs.  Let's say you move into a house in June and paying six months of mortgage payments of $1000 each.  Would you then assume that, since you paid $6000 for your mortgage this year, that you would pay $6000 again next year, and your payments would only be $500/month?  Of course not, because you failed to take the entire year into account, but that is essentially the way the CBO is projecting the costs of this health care plan.

Plenty more was talked about today, and I encourage you to read as much as you can and get as involved as you can.  To learn more about today's event, visit Docs 4 Patient Care.
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Saturday, November 14, 2009

Nonpartisan Agency says House Bill will reduce Senior Care

In June, I wrote about why the proposed health care reforms will end up reducing benefits for seniors.  This week, a major nonpartisan agency agreed.  Today's Washington Post has a story about the report from the Centers for Medicare and Medicaid Services.  It reads:

"The report... found that Medicare cuts contained in the health package approved by the House on Nov. 7 are likely to prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether."

Read the full article here.

Good intentions do not always equal good results.  Congress needs to consider the unintended consequences of asking our health care system to do more with less.  As the Post article explains, the weakest and most infirm could still end up out in the cold.  We need different solutions to the problems with our health care system than the ones currently being proposed in Congress.  The bill offered by the Republicans, while not perfect, offers more common sense solutions, like giving incentives to individual States for reducing their numbers of uninsured, increasing tax benefits related to Health Savings Accounts, and at least addressing problems with medical liability.  Before the Senate votes on health care reform, let your Senators know that the current proposals are a bad prescription for America.
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Tuesday, November 10, 2009

Dennis and Me

I had the chance to attend a live broadcast of The Dennis Miller Show at Navy Pier.  I took it upon myself to grant him an honorary MD, since laughter heals and he is one of the best.  Listen here.
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