Letter From an MD on Proposed Health Care Reform

Hi folks,

I personally called the number listed in this letter and confirmed that the letter is genuine and that the author is an MD. I commend it to you all.

For my own comments on health care issues, simply click on "health care issues" at the end of Dr. Hess' letter.

Joe

September 23, 2009

Representative Ann Kirkpatrick
1123 Longworth House Office Building
Washington, DC 20515

Dear Congresswoman Kirkpatrick:

Over the past few months I have followed with great interest the debate about health care that has been unfolding in Washington, D.C. My interest led me to read HR 3200 in its entirety. The 1000 plus page House bill is a convoluted legal document that I suspect even my good friends at Arent & Fox LLP on K Street don’t understand.

Being both board certified in Internal Medicine and in Cardiovascular Disease and having practiced in both the academic and private sectors, I feel that I have some knowledge related to the issues that have been debated. In addition, my wife, Pamela Jones, holds a Master Degree in Healthcare Management from Duke University and has over twenty years of healthcare experience, consulting with large hospital systems and physician groups. Our collective observations and opinions are outlined below:

1. "Primum non nocere" – At the time a medical student examines his first patient, he is reminded constantly of the wisdom: “First do no harm”. It is a warning that Congress should itself heed. It is unfathomable to me that those in Congress believe they have the knowledge, experience, and wisdom to completely overhaul the manner in which payment for medical services is provided. This is especially appalling when, in fact, few in Congress have any medical experience what so ever. For instance, Senator Max Baucus of the Senate Finance Committee, is an attorney, with no experience in providing direct medical care or in working in the medical industry (such as a hospital administration, health insurance, pharmaceuticals, etc.) Yet, despite this lack of ‘hands on’ experience, Senator Baucus has just released a healthcare proposal every bit as overreaching as the ones currently in the House. Whenever I am asked what I think of the Congress ‘overhauling’ healthcare, I tell people: “It would be like having a group of cardiologists overhauling the air traffic control system of America. Would you want that to happen?”

Representative Ann Kirkpatrick
September 23, 2009
Page Two

The fact that Congress has undertaken such an endeavor in an expedited manner indicates to me a degree of hubris that is unlike any I have ever witnessed. By proceeding in this fashion Congress will undoubtedly produce an outcome far worse than the original problem itself.

2. Law of Unintended Consequences – Everyone agrees that there are issues related to the affordability, portability, and accessibility of health insurance. But what no one knows or can predict is the consequences of the proposals now before Congress. Why would the members of Congress believe they could create major changes to 17% of the nation’s economy and perfectly predict the outcome one will get – the outcome as to cost of care, quality of care, and accessibility of care?

Just for discussion lets take the issue of accessibility of care. Using the president’s estimates of 30 to 45 million uninsured people, what will happen when they suddenly have access to care? There are not enough doctors, nurses, or allied healthcare personnel to care for a 10 to 15% increase in patient volume. Yet, nowhere in the discussed proposals is this question addressed. It takes ten or more years to change the medical educational system to produce more physicians. Recently, when this ‘manpower shortage’ was questioned in the media, those in favor of a major overhaul have argued that there would be no major increase in utilization because the majority of the uninsured are young and healthy. If that is the case, why is it a crisis to change healthcare in such a rush to insure these healthy youngsters?

We caution you that the proposed changes are draconian and no one can predict the resulting outcome. However, based on prior Congressional programs one can predict that if a program is ‘passed’, it will be more costly and less effective than predicted.


3. American Medicine Exceptionalism – Why care if the proposed programs are not perfect? The answer to that question is hopefully clear to Washington: The United States is universally regarded as having the most advanced medical care in the world. There is a reason that more than 400,000 foreigners travel to the United States each year to undergo treatments and procedures. Radically changing a successful system is risky business, but Congress seems oblivious to the risks involved. America is the incubator from which medical advancements hatch. Just to name a few such ‘breakthroughs’:

Representative Ann Kirkpatrick
September 23, 2009
Page Three

In 1987, Dr. Eddie Joe Reddick, a private practice general surgeon in Nashville Tennessee, performed the first laparoscopic removal of a gallbladder, paving the way for the field of minimally invasive surgery. In 1985, patients undergoing gallbladder surgery were usually hospitalized for 5 to 10 days and were off from work for 4 to 6 weeks. In 2009, the same surgery is performed as an outpatient and most patients are back to work in less than a week. Dr. Reddick’s technique radically changed the way surgeons approached many surgical problems. A new approach that produced improved outcomes and significant cost savings to society. The rest of the world then followed our example.

In 1981, Dr. John Simpson, a private practice cardiologist in California, invented the ‘movable guidewire’ for coronary angioplasty catheters, thus revolutionizing our approach to the treatment of coronary artery disease. Something that once required open-heart surgery, a prolonged hospitalization, and weeks away from work, could suddenly be treated with a simple catheter procedure, a one-day stay in the hospital, and only a few days away from work. A new approach that produced improved outcomes and significant cost savings to society. The rest of the world then followed our example.

Drugs classified as ‘statins’, that lower cholesterol remarkably and have resulted in significantly lower mortality rates from heart disease, were developed in the United States. Americans have better access to these ‘wonder’ drugs than European patients. In the U.S. 56% of patients who would benefit from a statin drug are taking such a drug, whereas only 36% of Dutch, 29% of Swiss, and 23% of Britons are receiving them. Not only did America make this ‘breakthrough’ in heart disease prevention but has also proven more effective in disseminating the treatment to those who will most benefit from it.

American advances in the treatment of heart disease are producing dramatic reductions in mortality. In 1970 the death rate from heart disease in America was 448 per 100,000 population. In 1980 it was 345; in 1990 the rate was 250. By 2006 (the last year data are available) the death rate from heart disease was 135 per 100,000 population. One cannot merely view the increase in healthcare expenditures without evaluating the results produced by that expenditure. In heart disease care alone, there are 400,000 fewer deaths per year than there were in 1970. I would suggest that those saved by these new treatments and procedures would agree that the expenditures were well spent!

Representative Ann Kirkpatrick
September 23, 2009
Page Four

America sets the standard for cancer treatments. Breast cancer mortality is 52% higher in Germany than in the U.S. and 88% higher in Great Britain. The mortality rate for colorectal cancer patients is 40% higher in the United Kingdom than in the U.S. Why would we want to incorporate any aspects of health care from these European countries with inferior treatment outcomes?

During his treatment for malignant brain cancer, Senator Ted Kennedy received proton beam therapy at Massachusetts General Hospital, which spares viable tissue while attacking the cancerous tissue. It is only available to patients in the United States. The reason Senator Kennedy did not seek treatment overseas, is because the most advanced health care in the world is here in the United States.

There is no doubt that the proposals currently being debated in Washington will produce an end to the era of American Exceptionalism in Medicine – ask any doctor. The legacy of the 111th Congress will be the death of American Medical Exceptionalism if it passes any of the current health care proposals.

4. “Show me the Money” – The current proposals in Congress rely on savings generated from eliminating more than $500 billion in ‘fraud and abuse’ from the government’s Medicare and Medicaid programs. Every president and Congress since Nixon have made similar pledges, but you know what – the waste is still there. One does not have to pass a major ‘overhaul’ of health care to solve this problem. The government ‘owns’ Medicare and Medicaid – why not immediately begin to realize these savings if they can be identified and eliminated? If MasterCard and VISA can effectively control ‘fraud and abuse’ in their trillions of dollars in transactions yearly, why can’t the government do the same with a much smaller program? The reason the ‘fraud and abuse’ are still a part of those programs is the government does not have the expertise or technology to identify the ‘waste’.

Confidence in the government’s ability to manage a significant change in healthcare would be much greater if the government could demonstrate that it can fix the problems that currently exist in its present programs. Why not take the next two or three years and concentrate on the fraud and abuse in these government programs and prove to the American people the government can get results, not just make promises?

Representative Ann Kirkpatrick
September 23, 2009
Page Five

5. Inflammatory Rhetoric –The manner in which a proposed program is framed is an excellent indicator of the advocator’s beliefs. As a physician, I am terribly disturbed by the manner in which President Obama has characterized the medical profession. For the purpose of illustration I will give two such instances of this characterization:

• Portsmouth, New Hampshire August 11, 2009: Taken directly from transcripts of President’s Obama’s town hall meeting. President Obama states: “All I'm saying is let's take the example of something like diabetes, one of --- a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed. Well, why not make sure that we're also reimbursing the care that prevents the amputation, right? That will save us money.” (Applause.)

• Press Conference, East Room, White House July 22, 2009: Taken directly from transcripts of President’s Obama’s press conference. President Obama states: “So if they're looking -- and you come in and you've got a bad sore throat, or your child has a bad sore throat or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, you know what, I make a lot more money if I take this kid's tonsils out. Now that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies, maybe they have something else that would make a difference. So part of what we want to do is to free doctors, patients, hospitals to make decisions based on what's best for patient care.”
For expediency I have bolded and highlighted the portions of the president’s speeches to indicate the inflammatory manner in which he has categorized physicians. In the first example he has stated that a surgeon would receive $30,000 to $50,000 for performing an amputation – nothing

Representative Ann Kirkpatrick
September 23, 2009
Page Six

could be further from the truth. The customary surgeon’s reimbursement for such a procedure is from $600 to $800 dollars. Not even the total hospital bill would approach the numbers ‘thrown out’ by the President.
In the second example, the President implies that physicians take into consideration what they will be reimbursed in making clinical decisions and only places like the Mayo Clinic base decisions on “what is best for the patient.” This statement is a vicious attack on the ethical values of physicians and is so egregious it does not even deserve a comment.
The use of rhetoric like this has only one purpose, not to disseminate the facts but to distort them to obtain a goal – in this case the President’s vision of medical care. By demonizing physicians as ‘money grubbing’ individuals, the administration seeks to gather support from the public. My disappointment in the President is only exceeded by my disappointment that no one in Congress stood tall and said – those statements are wrong! Do not think that these statements were overlooked by the medical profession; every physician I have talked with about the healthcare issue spontaneously brings up these two examples.
6. Absolute False Statements: One can intelligently debate issues without purposefully giving false statements to embellish one’s argument. The most glaring example was during President Obama’s speech before Congress on September 9, 2009 when he gave examples of abusive actions by insurers. Mr. Obama referred to a man in Illinois who “lost his coverage in the middle of chemotherapy because his insurer found he hadn’t reported gallstones that he didn’t even know about. They delayed treatment, and he died because of it.”
According to Scott Harrington of the Wall Street Journal: the President’s conclusion is contradicted by the transcript of a June 16 hearing of industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce. The deceased's sister testified that the insurer reinstated her brother's coverage following intervention by the Illinois Attorney General's Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week "window of opportunity" from "one of the most renowned doctors in the whole world on the specific routine," that the procedure "was extremely successful," and that "it extended his life nearly three and a half years."

Representative Ann Kirkpatrick
September 23, 2009
Page Seven

Why would the President use a false statement on a nationally televised speech? Do we have to distort the facts to win our position? Why demonize the insurance industry in a fashion similar to the way he has demonized physicians? One can only conclude that the healthcare debate is really about President Obama delivering on a major social issue and not about what is best for the average American who is quite satisfied with their own personal health insurance situation. Once again Washington is about who wins and who loses – the people have been forgotten.
It is my sincere hope that you will vote against any of the current health care proposals before Congress (or any iteration of the same) and seek a more reasoned, incremental approach to addressing the major issues related to insurance ‘one problem at a time’. In the interim, this Congress and administration can immediately demonstrate its commitment to reform by implementing processes that actual identify and eliminate the ‘fraud and abuse’ in the current government medical programs.
Should you wish to discuss these issues in more depth, I would be happy to discuss them with you by phone, (928) 771-0978 or in person. Thank you for taking the time to read this lengthy letter.
Yours sincerely,


David S. Hess, M.D., F.A.C.C.