Monday, August 31, 2009

The Perfect Storm?

A reader, GBK, was kind enough to comment on my blog about Ezekiel Emanuel, MD, PhD.

Ezekiel Emanuel is the brother of Rahm Emanuel, and in an act of apparent nepotism, has been appointed by Obama as a "health care" adviser. Ezekiel is a big proponent of H.R. 3200, the Obama/Pelosi bill. Betsey McCaughey is a political commentator who wrote an article published in the New York Post about Ezekiel Emanuel. GBK issued--along with disparaging remarks about the New York Post and Betsey McCaughey--the following challenge to me:

Here is a JAMA article cited numerous times in [McCaughey's] piece. It's a whole 3 pages, but I think you can handle it.
The gauntlet having been thus thrown, I took the liberty of reading the JAMA (Journal of the American Medical Association) article, which is co-authored by none other than the archangel Ezekiel Emanuel himself.

Ezekiel attempts to place the blame for the "perfect storm" of American Healthcare on doctors and--get this--patients. Doctors, because they try to do everything they can for their patients, and patients, because they demand the best that hi-tech medical care has to offer. In making the case against our existing system, Ezekiel managed to convince me more than ever that we are better off with what we have than with what the Congress wants us to have. Consider these comments by Ezekiel, which he offers as proof that our system is a failure compared to socialist models:

[Compared with their European Couterparts]
Hospital rooms in the United States offer more privacy,
comfort, and auxiliary services than do hospital rooms
in most other countries. US physicians’ offices are typically
more conveniently located and have parking nearby and more
attractive waiting rooms.

US patients utilize many more “new drugs”—
those on the market 5 years or fewer—than patients in other

This one is my favorite:

Peer recognition goes to the most thorough and aggressive physicians.
The prudent physician is not deemed particularly competent,
but rather inadequate. This culture is further reinforced
by a unique understanding of professional obligations,
specifically, the Hippocratic Oath’s admonition to “use
my power to help the sick to the best of my ability and judgment”
as an imperative
to do everything for the patient regardless
of cost or effect on others.

[emphasis added]

Although most physicians are not income maximizers, they knowthat it is better to be paid to do something, and the higher the payment the better.
[What about members of Congress? Do they know this?]

Then there is the patient side. US patients prefer high technology
over high touch.

In normal markets, demand is modulated by cost. But
third-party payment for patients attenuates this control. Although
patients experience deductibles, co-payments, and
other out-of-pocket expenses, health insurance and gov-
ernment programs significantly shield patients’ decisions from
the true costs of health care.

So, by all means, says Ezekiel, lets expand the insurance system; lets let the government get more and more involved; lets take away financial pressures from patients and doctors entirely and let Congress decide who gets treatment and who does not. That will surely help keep costs under control.

Like I said: I read Ezekiel's own words, and I oppose HR 3200 more than ever.

To see an example of a sensible, understandable plan that the government can undertake to improve health care in this country, see my blog 4 Steps and 3 Sentences to Health Care Reform, 2009 Aug. 23.

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