The Scalpel that wags the Surgeon

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As the Congress  of the United States in its wisdom has voted to “Kill ObamaCare”, Paul Ryan Speaker of the House States;  During the Jake Tapper CNN Townhall last night said, that the Republicans have Seven Plans to choose from which will simultaneously REPLACE the Affordable Care Act which can be viewed on the Republican RNC Website.  Really?

If we step back to 1992, then Congressman Bill Dannemeyer of Fullerton, California took to Hillary Clinton some basic concepts which would have made Healthcare in America more efficient and competitive with the rest of the world.  There were some pretty good ideas about Healthcare with coverage which you could take across state and regional borders.  There were provisions which suggested that price for procedures be based on Regional Costs and Regional Norms.  There were provisions for limiting the cost of prescription drugs through competitive pricing and restricting non productive marketing by drug companies.  There were provisions for outcome based awards to doctors for doing a good job – the first time and being more thorough in their diagnosis of diseases and ailments in general.

Well, with these basic thoughts in mind…back in 1992 – the blowback to Hillary Clinton, who Bill had assigned to be charged with the duty of achieving Healthcare for all Americans became immense.  Hillary and the Clinton Administration, sat down at the mahogany table with the AMA, the NIH, Big Pharma Representatives, Big Insurance Companies, Medical Equipment Providers, Hospital Associations, University and Independent Health and Research Facilities and about 2000 of their paid lobbyist….and it was WAR!  What resulted from these meetings and mayhem reminds one of all the Arabs meeting with “Lawrence of Arabia” and discussing who was going to get how many horses for what.

The 1994 Resolutions to fixing the rising cost of prescription drugs – was to allow our Drug Companies to manufacturer drugs in Third World Countries for pennies on the dollar and for the Drug Companies to create “Generic Drug Markets” which offered a supposed “cost effective alternative”.  At that point The Generic Drug Market simply removed essential “Buffers and Mitigators” to extremely strong but again supposed effective treatment for ailments and disease.  The Side Effects however or Non Intended Consequences of that of course was that the Drug Companies reduced the strength of each medication and that required more product to heal the ailment.  Instead of taking five pills – one a day for five days:  You would take 10 or 20 pills at a higher dosage over a much longer period of time with more given per day.  The other trick employed was that each Generic Drug has secondary Side Effects because of ingredients added or buffers not added.  This causes the Doctor to proscribe up to three more drugs to mitigate those side effects.  Vicodin was generally used for tooth extractions or root canal work for example.  Reading the small print that these might be “Addictive” was written in very small print and willing Doctors which got “incentives for using a certain companies products” was more than willing to prescribe more if the pain continued passed the three days described by suggested by the AMA or Dental Association.  Product Credits, Kick-backs and Junkets wre some of the incentives.   It is essential that every drug you are proscribed that you check the web for any and all Side Effects!

Meanwhile, Hospitials were given “Carte Blanche” to double, triple or quadruple bill each patient without blowback from Government or the Insurance Companies, because they could simply raise Subscriber Rates each year with impunity and without regulation.  Patients submitted the bills they got from the Hospital and the Insurance Company just paid them.  When you called the Insurance Company to tell them about it, you were met with:  “Yeah, this is how the system works!  They need those payments to make up for all the non insured immigrants that walk in!”  This is where the typical Emergency Room Visited skyrocketed from $78 dollars to over $420 dollars, plus any X-Rays, Testing or Consulting Visits and readings of the info by a Specialists – that might be required.  This was in 1994.  The AMA and smart Doctors and Surgeons around the country figured that they could make a bunch of money – not giving any care:   So they started the HMO Concepts and Specialty Surgical Groups.  Three Orthopedic Surgeons join together, work hard, buy all the latest equipment, do a bunch of surgeries and make plenty enough money to pay the ex-wife, make the payment on the Ferrari and buy the Million Dollar House.  Maybe, enough left over to send the two kids to College and buy the daughter a new car and still go to the Yachit or Country Club three days a week.  Life was good.  Then they retire and bring in some guy from elsewhere, without the same commitment to patients.

Healthcare is a reflection of our society.  Dr. Ben Casey, Dr. Kildare  and visits to your house for little Johnny when he had the croup….were over by 1994.  Open Borders, Free Trade, Global Society, Energy Costs, Privatization,  Robotics, Automation, NAFTA changed all the deck chairs for Healthcare in America.  Millions of immigrants were coming to America with an eye on something called the Dot Com Revolution!  Going from an Analog to Digital world was going to change everything.  The dated too dangerous X-Ray machines of old became the dangerous MRI and CAT SCAN machines of the new age. Old our of calibration Radiation were disfiguring and harming folks too!  Over doing the Chemo was typical.  But with the Digital Age:  Surgeons that spent years of study on how to read X-Rays, now could see the exact size of any tumor or malady – and if patients wanted to know;  They too could see what had to be done!  The veil of Modern Medicine was becoming far more transparent.  Most people just went along with whatever the Doctor said!  After all, the Doctor went to Medical School and signed the Hippocratic Oath – how bad could it be?  In the words of Clemenza in the Godfather when asked what will happen after he takes out Police Chief McClusky and Sollotzzo: “Pretty damn bad…..we will go to the mattresses and you will disappear for a while,   But we need these things every five or 10 years to clear out the bad blood!”

For the next 20 years, a large percentage of America’s Hospitals closed by the shear weight of the Uninsured that needed to be treated in Emergency Rooms, that had babies, gunshot wounds, treating cancer and diabetes, drug addiction, drug overdoses and domestic abuse issues which required more and more psychotropic drugs to mitigate the great pain of living with unaffordable medical and dental insurance.  Those going  to HMO’s experienced long waits, rationing of care or no care at all for pre-existing conditions.  Millions of American became Uninsurable and those that qualified: Unable to pay huge the huge Premiums and rising co-pays for Drugs and Doctor Visits.  PPO Insurance, the so called Cadillac Healthcare Plans, also was hit with higher co-pays, higher deductibles and prices that only the one percent could soon afford.  Another method of Healthcare Rationing.  The folks that needed a knee or hip replacement, those with various surgical issues found the Doctors looking at them as potential “Revision Candidates” the minute they walked in the door.

Finding a great Orthopedic Doctor is challenging enough.  Try one that wants to repeat the same high dollar procedure up to three or four times, because your insurance will pay for it  and then refer you to one of their cronies for collaboration and more “Revision Action”.  All Americans that go to Doctors for Surgeries need to ask the first question:  “How many Revisions have you done in the last three years?” Much like days when Doctor’s “had a calling”, “were much like kind priests”, “gave of their time and caring endlessly” – Medicine is nothing more than big business, dollars and cents, insurance deductibles and a lot of prayer for those that get into the system.  As mom said about many folks:  “They are only in it to make a buck!”  We can be sure that Big Pharma feels that way, because none have spent any out of pocket resources to produce the necessary antibiotics and cures we need for the modern infectious diseases – that are everywhere.

Big Pharma is not restricted to the United States – these are all Global Companies selling the same goods across borders, many with just a change of name and packaging.  We always wondered why the same drug made in India, by a German, Swiss, French, English or US Company sells for one tenth of the price that we pay in the United States.  Why did the Congress last night turn down a provision that would allow US Citizens to purchase their drugs in Canada?  OK, so when will the Chinese start to produce drugs and pharma that works and that can be purchased in the US at an affordable price?  If only they could guarantee Quality Control and maintain safe Quality Assurance procedures!  Drugs in this country, made in India – are all suspect.  No one, including the AMA or NIH has done an assessment of the effectiveness or the quality of the drugs produced for 1 to 2 cents a pill off shore and distributed here in the United States.

OK, the Republican Congress and the President Elect will be Repealing ObamaCare or the Affordable Care Act.  Here are a few things to consider:  In 2018, Nano Tube Memory will replace all chip memory.  All new Medical Devices will have to change over to this new technology:  Welcome to Star Trek technology.  Nano Surgery will replace all known types of surgeries in the next four years.  Most of the Medical Evaluation equipment including Radiation, MRI’s and such will either have to be retrofitted or thrown out and given to the poorest African Nations who cannot pay off the Medical Device Companies with Oil Credit Cards, because the price of oil will fall to just about $10 dollars a barrel.  Any Wars in between now and the next five years will not hold back this technology.  People are living to be over 100 years of age on a regular basis and today AGE is no longer a deterrent to any NON Invasive Surgery.  By the way, no more open surgeries….everything that is laproscopic will become nano-scopic.  The point:  The rules for Healthcare are changing!  We will need less Medical devices, Less Doctors, Less Hospitals, Less Drugs that have to be taken for the rest of your life.  Less – not more!

Big Pharma does not live in a vacuum and this is why, much like the tobacco companies – they want folks hooked!  They want that pay check and they are willing to pay Doctors, Nurses, Hospitals, Insurance Providers, Medical Professional Groups and anyone else they can find that is an elected representative – to keep their paycheck coming!  For years Big Pharma has held up the Digital Revolution in Medicine because it would be too easy to track Drug use and sales by Doctors and many patients that are nothing more than secondary market distributors.

So Congress of the United States – let’s bite the bullet:  Open enrollment of Medicare to any and all.  You don’t want ObamaCare?  Great offer an affordable alternative.  Open enrollment to all non-citizens to sign up for State supported Medicade, which is Federally Backed and Funded for this specific group…..as it should have been for the last 30 years.  Require that all Medical procedures and tests be done Digitally and Centrally Gathered for easy access.  You already have the Patriotic Act – how bad could this be?  Everyone needs to be covered regardless of age of previous pre-existing conditions.  All premature births – no matter what the complications – Covered!  Require that the life of the mother be a pre-eminent priority!  Obama Care has brought either 11 or 22 million people into healthcare coverage…but that is not enough.  Fixing the reimbursements to Doctors and Hospitals and HMO’s, Walk-In Clinics or even the Red Cross should be a major priority.  You want Regional Pricing and Grouping?    Great make it sectional like the NCAA does with different college football teams and do a total of SIX.  Some areas that open their plans to other regions should be allowed to, but guarantee continued coverage for five years once someone moves into their region.  Many Insurance Providers will not open their borders….but that it up to them.  The facts are:  This will take another two year program of discussions and Summits with input across the board….not just the usual paid lobbyist.  They need to open up the box of worms and start taking each one out….one at a time!  Or…we could just fix it overnight!

The Scalple that Wags the Surgeon!  The time has come to finally put away childish things!  Let’s be grown ups for once!  Fix it!