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Patrick D Hahn

Patrick D Hahn
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AUGUST 20, 2009 9:56AM

Letter from physicians to the American people and my reply

Rate: 6 Flag

relax, this won't hurt a bit

Here’s an article in the Baltimore Examiner by Delia Chiaramonte, M.D. According to the article, a web community of physicians, sermo.com, has posted a “Letter from physicians to the American people,” which has been signed by over 4,000 physicians.

You can’t even get on to sermo.com without pretending to be an M.D. or a D.O., which I thought is a bit odd. What’s the point of addressing a letter to the American people that we’re not allowed to read?

Nevertheless, Dr. Chiaramonte was kind enough to reproduce the text of the letter for us. Here’s is what it says, along with my reply:

To the American People,

We, the physicians of this country want to reform healthcare and improve the quality and access to care for our patients while reducing costs. True healthcare reform will only succeed if: 1. Unnecessary tests and procedures are reduced through tort and malpractice reform

And give up just about the only means we have of holding the members of your guild responsible for their actions? No, thank you. If you want to reduce unnecessary tests, why not stop Medicare from reimbursing doctors for referring patients to diagnostic centers owned by the same doctors who made the referral in the first place?

2. Doctors are allowed to spend more time with their patients and less time on paperwork by streamlining billing and making pricing more transparent (create an alternative to CPT codes)

No argument there. That’s an excellent reason to adopt a single-payer system like they have in the UK

3. Medical decisions are made by physicians and their patients, not insurance company administrators

Sounds like you’re asking for a blank check to foist on patients as many interventions as they will stand for. I can’t agree with that. There’s always gonna be a limit to how much we can spend on health care or anything else. Somebody has to say no, whether that somebody is an insurance company administrator or a “government bureaucrat.”

4. Adequate supply of qualified physicians is assured by revising the methods used to calculate reimbursements.

Could this possibly be a more circumspect way of saying, “More money for the members of our guild?” If you really want to make medical interventions more available, we ought to design package as many techniques as possible and design for self-use or administration by family members. Which, according to Ivan Illich, is most of the techniques which actually make a measurable net positive contribution to life expectancy. If I can’t afford your “concierge medicine” fees, the laws ought not to stop me from treating myself.

And yes, I know Ivan Illich was not a member of your guild, but he had one of the most far-ranging minds of the twentieth century, so I wouldn’t dismiss his conclusions out of hand.

We invite policy makers to work directly with the men and women who are on the frontlines of healthcare each and every day caring for the citizens of this country. We pledge to be partners in true healthcare reform, improving the healthcare delivery system in this country while honoring the Hippocratic oath that we all have taken.

Respectfully Yours,

America's Physicians.

No comment.

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Patrick, I agree that the ONE PAYER system would take care of most of this. I disagree with you on tort reform. I think that we should have caps on awards. The interesting thing is that there are more suits, not because of actual malpractice, but because people are unhappy with their care, and physicians are a big target in the lawsuit lottery. They make lots of money, and have lots of insurance. I know a person who goes to different doctors, trying to find something to sue about. And I know a lot of excellent doctors who have been sued without just cause. Tort reform is a small price to pay for health care parity. This little letter is actually not as crazy as some attitudes I've seen. Of course, it doesn't support one payer per say, but that would help a lot.
If we had a single-payer system, people still could sue for damages, but they wouldn't have to sue just to get medical care.

Thanks for your comment.
Oh, how they want that tort reform. Strange indeed, that you must be "in the club" to enter their site. Hope you signed in as "Doctor Schnabel." Excellent piece.
Tort Reform over malpractice is a shadow war between the wealthy. Insurance companies love those big premiums, but lawyers love those big fees. Doctors hate to pay those big premiums and fees because they'd rather be paying for a second vacation home or another Jag instead. Lawmakers are bought and paid by all lobbies involved, but no matter what pansy-ass protections they try to enact, we are the only losers in the equation. With such a corrupt system, I am not surprised that some of us try to jump in and skim some illicit cash. All are punished.
At one of Senator McCaskill's town hall meetings, an audience member asked about tort reform, and the senator replied that Missouri had enacted aggressive tort reform laws in 2005. After the applause died down, she asked how many people in the audience had seen their health care costs reduced since the tort reform - no one answered.
To Rolling:

"Tort" is an old-fashioned word for injury. Tort law is the body of law that allows you to sue if, say, you go into the hospital for surgery and your doctor amputates the wrong leg.

To tary:

Thank you. That says it all.

Thanks to everybody for your comments.
There probably should be some measure of tort reform because there are some wacky situations out there in which juries award ridiculous sums for pain and suffering. Those are few and far between, however, and the bigger problem is the premiums themselves. Why are they so high? Few doctors actually get sued, but the premiums are unnaturally high for the risk level the insurance company is taking.

Sooo, once again it boils down to the insurance companies. The doctors are blaming lawyers, who don't pay their salaries, instead of the insurance companies, who do. Coincidence?

I have to disagree with this, however:
"Sounds like you’re asking for a blank check to foist on patients as many interventions as they will stand for. I can’t agree with that. "

Most doctors don't run unnecessary tests and most doctors just want to help their patients. The ones who do want to take advantage of the system are going to do it anyway. The insurance companies should not be determining care. That's the crux of our problem.
Doctors don't need tort reform, they just need to know what they are doing and pay attention to the needs of the patient.
Too many are sloppy, careless and absent from the bedside.
And way too many rely on what the drug makers tell them and push nothing but pills and more pills instead of actual health care.
What we need is to package and design as many medical techniques as possible for self-use or administration by family members. If I can't afford their goddamn "concierge medicine" fees, then the law ought not to forbid me from treating myself.