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Title: Blog by Novelist William S. Frankl, MD

Archive for October, 2009

Malpractice Reform

Wednesday, October 28th, 2009

The Healthcare Bills continue to lurch and stumble through The Senate and House like a stroll through the countyside by Dr. Frankenstein’s monster. The bills are incoherent and, indeed, monstrous. There was a great article about a key forgotten element, malpractice reform, written by a distinguished academic physician, in the Weekly Standard, October 27th issue. Here is an excerpt and I’m providing a link to the full article, THE MALPRACTICE PROBLEM:

There is much that can be done to make our health care system more efficient. Tort reform is a great place to start, says Dr. Stanley Goldfarb, the associate dean of clinical education at the University of Pennsylvania School of Medicine.

In Texas, there’s a law capping payments for pain and suffering to $250,000, which provides some benefit. As reported in the Wall Street Journal, malpractice suits have been dramatically reduced:

–––The year before the caps on pain and suffering payments took effect, there were over 1,100 medical liability suits filed in Dallas, but only 142 cases were filed in 2004.
___Also, there was a surge of physicians coming into Texas to set up practice as malpractice premiums fell by about 50 percent.
___Texas is a state with low health care spending; according to the National Center for Policy Analysis, but is fifth highest in Medicare spending per capita and 43rd in per capita spending for the state’s entire population.

Whether the malpractice caps in Texas account in any way for these data is uncertain, the pattern is encouraging, says Goldfarb.

The problem for physicians is not only about the money expended in malpractice insurance premiums or about excess payouts to plaintiffs. It is also about the time and effort that defending against lawsuits requires. It is also about the potential for a trial and the stress associated with the experience. Avoiding these legal troubles is as much an influence on doctors as the desire to avoid a potential increase in insurance premiums following a malpractice suit, says Goldfarb.

Source: Stanley Goldfarb, Associate Dean of Clinical Education at the University of Pennsylvania. ” The Malpractice Problem,” Weekly Standard, October 27, 2009.

Unconstitutional?

Wednesday, October 14th, 2009

The Baucus Senate bill, for the first time in the history of our country will force us as  constituents to buy a product. We’ve been free to buy or not to buy things, but now for the first time we’re going to have to buy health insurance. And if we don’t buy it, the IRS is going to tax a family of four $1,500 or more.

Whether this provision is unconstitutional, this issue has never been raised before about having to buy something. Some constitutional lawyers are indicating that it is unconstitutional, or at least a violation of the Tenth Amendment.

Stay tuned . Our country is in free fall. Let’s hope we can survive.

A Very Dark Day

Wednesday, October 14th, 2009

It’s difficult to deal with the following thought: Today or tomorrow ––––Harry Reid (with great personal ethical problems in his home state, Nevada), Christopher Dodd (under investigation by the Senate ethics committee for financial misconduct and partly responsible for our present recession due to his involvement with the subprime mortgage pecadillos of Fannie May and Freddie Mac), Max Baucus (a congenital voter for increased taxes and spending), and Obama’s chief of staff, Rahm Emanuel (whose brother, Ezekiel is a major Obama advisor on health care and who believes that the Hippocratic Oath is too widely applied by doctors, especially in the care of the elderly and the disabled)––––are meeting behind closed doors to plan how to push the disastrous Senate Finance Committee Healthcare bill through the full Senate and beyond. Shouldn’t it give us all “the creeps” to realize that these four disreputable characters are deciding what the future health care will be for over 300,000,000 Americans?

Life Saving Medical Care is the Target

Saturday, October 10th, 2009

The Senate Finance Committee Health Care “Reform” bill engineered by Max Baucus is due to come out of committee on October 13th. In it is a carefully hidden provision that will take American medicine down a slippery slope to rationing and utter mediocrity. The bill specifically attacks the fields of cardiology and oncology. Compared to primary care physicians, specialists in these two fields cost more to train, and they use more expensive technology, both of which cost the government more money. Nevertheless, it was the specialists in these fields who over the past six decades improved and extended the lives of millions of American citizens.
Tucked away in the bill is a provision mandating that beginning in 2015, Medicare will rank all doctors against their peers on how much they cost the program and then automatically cut all payments by 5% to any physician who falls into the 90th percentile or above. Therefore, every year one of every ten physicians will be punished if he/she orders too many tests, performs too many procedures, or prescribes too many drugs, whether or not these were required to provide a better outcome for their patients. The 5% fine is enormous given the fact that Medicare’s price controls already pay only 83 cents on the private dollar.
In preparation for 2015, next year the Administration will be instituting Draconian regulations to alter the way physicians are paid. Higher payments in the order of 6-8% will go to primary care physicians and general internists. These increased payments will come at the expense of specialists. There will be an 11%-28% cut in cardiology payments and a 19% cut in radiation oncology payments. These targets are being established in order to cut the costs in Medicare. Yet, almost 70% of morbidity and mortality among Medicare recipients come from heart disease and cancer.
The cuts in cardiology are enormous. Echocardiograms and stress tests along with cardiac catheterizations are being hacked by 42% and 24% respectively. Oncology physicians are hit because, according to the Administration, they order too many MRIs and CT scans. And these changes will be applied not only to these, but to all advanced technologies. The American Society for Radiation Oncology estimates that payments for antitumor radiation therapy will fall by up to 44%, causing a devastating effect on the care of cancer patients. And it must be emphasized that these changes don’t cut spending, but rather just redistribute spending from one group of physicians to another. It is quite likely that many specialists in these fields will retire or severely restrict the number of Medicare patients they see, resulting in unacceptable waiting lists and de facto rationing.
Despite requests by cardiologists and oncologists to be heard and to protest these regulations, no one in the upper echelons of the Administration will talk to them. So the Obama Administration is on a path to undo decades of progress in American Medicine. One can only hope that the American people will learn about these anticipated changes and work hard to express to their senators and representatives that they vigorously oppose them.

An Unexpected Missile Attack

Friday, October 9th, 2009

For years I strongly suspected that the world elites had an enormous distaste for America’s superpower status. That became quite obvious during the George W. Bush era. But I never thought these elites could significantly influence our domestic and foreign policy. I was wrong. This morning I learned that Barack Hussain Obama, president of the USA, was awarded the Nobel Peace Prize. For what did he get it?  OK, you can’t think of anything and that would leave a large empty space on this post. So let’s ask why the otherwise peaceful Nobel committee fired a missile right into our foreign policy and blew it up. Was it to gave the president a logical reason to: accelerate the pullout of all our troops from Iraq; decide against our generals who have asked for 30-60,000 more troops to win the war in Afghanistan; and make certain we placate Iran and allow the mullahs to become the first fundamentalist theocracy in history with nuclear weapons? After all, what else can the 2009 Nobel Peace Prize winner do?(Or perhaps the Prize just helped him do what he was already going to do). Well, Obama will be in good company: Jimmy Carter, Al Gore, and of course, the well known peacemaker, Yasser Arafat.


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