Friday, July 24, 2009

I've been insulted. Grievously. And, yes I take it personally.
Dr. Obama has stated that doctors will take out kids' tonsils just because they get paid better. I've been in medicine for 20 years, and grew up in a medical household. The number of physicians I have met who would do procedures harmful to their patients, just for money, could be counted on one hand. Yes, they exist (unfortunately) but we despise them. They are the marginal in our profession, and are treated as such. Certainly the percentage of greedy physicians is much lower than the percentage of greedy, unscrupulous politicians, by far.
Let me explain how the system should work. Children who are sick with a sore throat, as judged by their parents, come in to see the pediatrician. The pediatrician treats them with antibiotics, or allergy medicine or nothing, as he sees fit. If the child keeps coming in with sore throats, he starts looking for other problems. If he decides the child needs a tonsillectomy, he sends the child to an ENT surgeon. The ENT surgeon then decides whether he agrees that the child needs a tonsillectomy or not and if so, does the surgery. Now, the pediatrician DOES NOT get paid for the surgery. He does not get a percentage; he does not get a kickback. The surgeon gets paid for the surgery, but if he does surgeries that the pediatrician did not think was necessary too often, he gets no more patients from that practice. If the parents disagree with the pediatrician or the surgeon, they are free to find another one. If that happens too often, the pediatrician has no practice. Automatic checks and balances.
Do you see the problem with that system? When anyone other than the parent and the pediatrician have control over the interaction, it fails. So when the government wants to control costs, where's the check and balance on their control?
I had a conversation with a doctor in training the other day. She didn't really pay much attention to health care policy, because she is too busy learning what she needs to know to care for children when she graduates. Lovely person, she'll be a terrific doctor when she's done. We talked about health care reform, and the problems of a nationalized health care system. I said something about the government deciding what procedures would be done for which kids, and her response was, "Well, the first time that happens, Dr. (someone she really admires as a good physician) will quit!" Of course he will. And who will be left to care for our children?