The Beast Speaks

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The Abuse of Public policy Driven Medical Care.

Technology has provided vastly improved methods for diagnosis, treatment and prevention of disease. Consequently, society has tacitly proclaimed nearly unlimited power over illness, and therefore feels driven to accept nearly unlimited responsibility for health. The injured or ill move from the limiting but intimate unequal physician-patient relationship into the sanguine arena of high tech public policy driven medicine.

This transition is uncomfortable, to say the least, yet is unavoidable. Where public policy and administration of medical care is concerned, what we see now are demands that threaten failure of our traditional  medical system. Whether it is welcome or not, it is unavoidable. It is here.

Recent heated debate about cost-shifting and competition for dollars among providers of medical care, reflect our societal dismay (or dis-ease). To resolve that situation requires open and frank expression of opinion, which can lead to rational decisions despite unprecedented circumstances. The voice of any individual physician, any citizen whatsoever, should be heard in this debate. To reach a rational and acceptable conclusion, I think it essential to be tolerant of views that vary from our own.

I have practiced in California for more than 50 years, the last 25 in emergency medicine, and have witnessed the birth of multiple generations of laws redefining the practice of medicine, as well as the coming of age of technology allowing people great control over their own medical conditions. For me, as a physician, it has been a truly magnificent ride, not that I haven’t made mistakes, but that I have learned to learn. This is a time to speak clearly with one another, and with our fellow Californians, with  humility and respect – to listen tolerantly, unafraid of hearing that which we don’t like. To learn that a once cozy hierarchic profession has expanded exponentially to include  a well intentioned but myopic, bumbling, self interested, and self absorbed  Legislature, creators of the medical legal Frankenstein that now lays waste to medical practice; to understand that a public who  once believed that magic was medicine now believes that medicine is magic.

The common occurrence of multi thousand dollar charges for evaluation and treatment of a minor illness or injury are to the point, defended by those profiting exorbitantly from  fee for service, mandated cost-shifting, or simply fraud. They do so by taking advantage of Robin Hood laws that promote robbery of one group to the benefit of another. Such practices constitute a stealth tax, raising costs for all, and don’t benefit of not the needy, but  medical industry charlatans.

Every day in Sacramento there are egregious abuses of the medical system by hospitals, physicians, drug manufacturers, pharmacies and others.   The real problem is how to change laws that are unfair and unworkable,  like those that force hospital “providers” to charge Mr. A $10.00 and Ms. B $100.00, while a similar procedure in a private office is fraudulent if either A or B is charged more than $10.00.

Res ipsa loquitor. The beast speaks for itself.

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