The One Good Thing About ObamaCare

I'm not a fan of the Affordable Care Act for many reasons, not all of them political. Essentially, I don't think politicians and bureaucrats should be making medical decisions. Some day I will write about this in more depth but today I want to let you know about the one thing I do like about ObamaCare.

As the program develops, hospital systems (face it, hospitals as we knew them are dead) will be forced to see more and more patients and get paid less and less to see them. Right now, a hospital system or clinic would be lucky to receive 20 cents on the dollar billed. That is not due to over-billing in the first place but rather to the fact that reimbursements are approved or disapproved by bean counters pouring over charts and converting a human activity, a sacred encounter between doctor and patient, into numbers. A lot is lost in the translation.

Remember these facts and you will begin to understand how health care works in the U. S: it's all about motivation and intention. A physician or nurse is motivated by two factors: the profit motive so that they can feed their families and enjoy a decent quality of life and making people better. Sometimes the two motives pull the same weight within an individual practitioner while in another one or the other motives is more important. Sometimes they change rank depending on the provider's personal and professional circumstances.

A hospital system on the other hand is motivated first by the profit motive (hell, maintaining the CEO's pool is expensive) and secondarily by image. While the first is never mentioned in public, take a look at the ads hospitals pay tremendous fortunes on and see for yourself. "Our hospital performs the most heart surgeries in the state;" "Our hospital has a 5-star rating in ..." and so on. Changes occur when hospital systems feel that their profits or images are at stake.

Lastly, the government-run insurance programs are motivated by two factors: saving as much money as possible and providing members with access to health care that is adequate at worst and exemplary at best. The former explains why we see only twenty cents on the dollar but it will also explain why I think something good is going to come out of ObamaCare. It can be summed up in one phrase: preventive care.

My friend, economist and financial adviser John Mauldin writes with a style and clarity that can only be described as inspiring. I'll give the link to an article that describes how the ACA is going to force hospital systems to change in order to stay in business. I'll let John delve into details. What I find ironic (and sad) is that we have been saying the same thing for the last 23 years. Preventive care saves lives and money in the long run. With very few exceptions (and you know who you are!), I feel like I've been preaching to the wall. But with the weight and influence of large hospital systems, the message will reach the masses.

Briefly, consider the cost of treating a patient with heart disease compared to the cost of teaching people how to eat and exercise in order to prevent heart disease. Again, a large segment of the adult population suffer from Metabolic Syndrome which is earmarked by obesity, hypertension, and insulin resistance. This Syndrome inevitably leads to Diabetes Mellitus II and all of its dangerous complications such as heart disease, circulatory problems, mental health issues, and more. I personally have gotten patients off of cholesterol and diabetes medications through diet and exercise alone. At the front end, this saves money on medications and in the long run, saves money on more intensive interventions such as surgery and expensive drugs.

Someday I'll write about what you can do right now to experience better physical and mental health without resorting to medications and surgeries. On your part, please look at Mauldin's article and understand why I have hope for the future.
Dr. Mike
http://www.mauldineconomics.com/editorial/thoughts-from-the-frontline-the-road-to-a-new-medical-order

HOW TO THINK LIKE A DOCTOR

It's 3 am Thursday morning and I just finished my first book with the above title! Who should buy this book when it is published? Anyone who has ever been a patient. Anyone who has never been a patient. All med students, NP's, PA's, EMT's, Paramedics, and MA students. And those scared of doctors like children and hospital administrators.
Also for anyone who has walked into a clinic, saw the doctor, then walked out thinking "what the hell just happened?
If you think in your own mind that you "know better" than your physician, then read this book and show her the error of her ways.
Read this book then begin to use it like a medical journal of your own health and wellness. Did Dr. Pitel do all the things a good physician does as explored in the book or did he leave something out that Dr. Mangold said should have been done? Or did the medication Dr. Poofandsmoker from Hartford Hospital give you match up with your story and his six minute exam? Did he explain side-effects and med interactions with you or did he punt that off to the pharmacy tech instead?
So please pass on the word. It will only be published as an eBook available at amazon.com for a very reasonable rate. Click on the amazon link to the right to take you there.
Comments and criticisms are welcome but may make me cry.
Thanks all. Get out the word.

PARACHUTING IN CIRCLES

Stream of consciousness tonight. Watched "The Hobbit" with the Young Padawan, the Cowboy, Blair Corbett of Ark of Hope fame, and Gimli, son of Gloin. The Cheshire Cat would pounce in and out of the viewing area while the Cowboy seemed to think that the chair and his bed were interchangeable living arrangements.

Gandalf healed Thorin with prayer. In my practice, that occurred 10% of the time. Can I prove it? No. Prove I'm wrong.

Angie once bragged that her brother was a great photographer because he had a lot of great photography equipment. I still won't let her live that one down. In photography as in medicine, there are paths of knowledge where critical factors overlap. My own father was a professional photographer. One of my best friends was the photographer extraordinaire Dan Harris. They both trained on high-tech equipment (the more they learned, the techier it became. Did I invent another word?).They could also take outdated equipment and playfully create works of art.

Using whatever equipment you have available, and trying to make a diagnosis is similar. It CAN be done with the most expensive toys found in any hospital. Trust me, they won't be in your local clinic. It can also be done through listening to a patient carefully and doing a thorough physical examination. The use of extra tests usually serves to verify a good physician's suspicions. A bad physician will run batteries of tests to arrive at something. Anything. There is an old saying in medicine that if you run enough tests, eventually you will find something abnormal.

Abnormal. What if there was a test that created "abnormals" that were ill-defined and vague. How do you interpret that and how do you treat that? Aurora Health Care in Southeast Wisconsin discovered how to do that AND make money doing it: http://m.jsonline.com/features/health/113541984.html?dc=smart&c=y&ua=blackberry. We heard of these tricks Aurora was pulling when an ostracized cardiologist came to our clinic and repeated to us what he saw with his own eyes. When he complained about it, he was let go unceremoniously and lives with the bitterness of knowing that there is no "Employer Retaliation" protection against whistleblowers in the state of Wisconsin. The state brags there is. Believe me, there isn't.

I will be parachuting for the first time next week. No, I will not have a Golden Parachute like the ex-CEO of Aurora whose termination package amounted to more than $20 million. Ironically, the company stopped construction recently of one facility because they were $20 million behind in projected costs.

So the take home message today is this: hospitals are not the hospitals our grandparents and even parents knew when they were younger. They are hospital systems and their bottom line is profit. Second in line, image. Third, helping people get better. A physician's and nurse's bottom line is making people better. Profit should come second. Sometimes job security or the security of a steady paycheck has more pull than pure profit. Sometimes profit wins but really, it is patient care.

Say a prayer for me on the 23rd when I sky dive for the first time in my life. I hope my knees can take it.