Placebo Journal - Medical Humor With A Purpose

The results of the much awaited Medicare P4P pilot project are in. Yeah! This huge study that every administrator has been waiting for found that hospitals that received bonuses and incentives to follow certain treatment guidelines didn’t significantly improve more than those hospitals that didn’t get those financial benefits. This proves once again that there is no evidence that P4P works! Yet, somehow it is used by everyone as the biggest way to fix our healthcare system. The article in the WSJ was even more interesting in that it quoted Steven Nissen, a cardiologist from the Cleveland Clinic. This is what he said:

The funny thing is that it was Nissen who started all this Avandia paranoia! Maybe he should have slowed down before scaring the crap out of everyone with his meta-analysis study. But I digress.

No one has figured out why P4P hasn’t worked but they will continue trying. Trust me. They will figure a way to force this square peg into a round hole under the guise of “paying a bonus” when in reality it will be a way to threaten and manipulate physicians. Let me once more say that P4P is NOT good medicine.

The typical household pays about $250 a year just for fees and taxes for phone and cable TV services. This was found by a study form The Heartland Institute. This was just taxes and fees. By my estimate, if you add total cost of phone, cable, cell phone and internet together the price has got to be over $3000 a year. Aren’t people entitled to those things? But I guess they are entitled to all the free health care they want? Kind of like a free buffet. Wait a minute, buffets cost money too. I have an idea, let’s have EVERYONE give up the expensive phone plan, the cable, the cell phone and the internet and put that into the Universal Healthcare system. That would fix the issue right there.

If you haven’t received your June issue of the Placebo Journal, you will shortly. Right now I am starting issue #36. This will be the last issue before we make a slight increase in our rates. In almost 7 seven years we have kept our rates flat. Unfortunately, our friends at the United States Postal Office have not. Therefore, if you want to get in on our lower rates, subscribe below. And hurry!

As a physician, I must admit I am the first to complain about our collapsing health care system. I complain to my colleagues, my patients and my wife. And yet as physicians who are on the front lines of this negotiating jihad we call health care, we rarely offer up any solutions or suggestions. We typically leave that to our elected officials and then complain bitterly about the fiscal impact on our medical practices.

So I am proposing a solution, one that combines the risks of our medical interests with that of

America

’s fastest growing risk industry: the future of medicine lies within the institution of gambling. Yes, you heard me right. It is one of the most profitable businesses this country has ever known. Casinos always make a ton of money, and because of this they continue to pop up all over the place (usually on a Native American reservation).

The way to fix the healthcare system is to combine casinos with medical clinics.

Sounds crazy? It isn’t. Casinos are filled with the same patients who fill my office anyway. Just double the size of our waiting rooms and fill them with slot machines. The rest is magic. The same people who complain that they have no money for medication will now be smoking and joking as they gamble away right in front of your receptionist. We can charge them nothing because we’ll get it back tenfold from their gambling outcomes. You heard me right: free medical care!

I see a time where “casino care” will be the most popular medical practice in the area. I’ll hire some of those Vegas-type waitresses to hand out Viagra, Aricept or Celebrex samples. I guarantee the pharmaceutical companies will be sponsors and my patients will love it.

The slots will be just the beginning. I predict that as “casino care” grows in popularity (join our open-enrollment lottery contest), I can add hotel suites; we’ll call them Soylent Green Rooms. Better yet, we can add nursing homes with names like Anoxic Gardens or Crepitus Creek Condominiums. We may want to start a program where patients cash in their social security checks for chips or just have them mailed right to our practices.

What about health insurance? Who needs it? My casino will accept exactly what every other casino takes – cold, hard cash (or credit cards). Sick people from all over the country will fly in to gamble and get their arteries opened up with an angioplasty. Colonoscopy suites will allow our patients to play poker while we prod them with our scopes. Think of the medical innovation that would occur. Each slot machine could have an ultrasound connected to the foot pedals to give our little old ladies an idea of their bone densities while they drop more coins in the till. The possibilities are endless!

So, let’s summarize. I’ll charge nothing for your care because I’ll make it up in slots (and every other game). All of the profit is cash. Health insurance companies, Medicare and Medicaid will no longer be needed. The healthcare crisis is solved. I know what you’re asking, “What about the taxes?” The answer is simple. There must be someone I know (preferably a medical subspecialist) who has some Native American blood in them? I’ll get them in as part owner. By getting Chief Resident Long Finger as my partner, taxes will be cut to nothing.

Let me end this by saying that gambling is fun. Fun for all my patients who are doing it already, fun my accountant who gets to count cash, and fun for my community that will now get a new baseball field from our charity donations. And if organized crime comes around to take their percentage, I would give it. In the long run, their extortion at least offers some protection, verses the strong-arm tactics of HMOs.

Oh, and the name of my casino? That’s easy. I would call it Seizure’s Palace.

As you may know, the Democrats failed in getting the government to allow Medicare to negotiate prescription drug prices under Medicare D. It seems the lobbyists won again. I would love to see how many democratic congressmen had to be paid off to get this bill to fail. It’s funny, but I have read some editorials how this really wouldn’t have saved that much money. According to the Institute for American Research, we would have saved $30 billion. Sure some choice of medications would have been limited. Such is life when you get basically a free ride. Would it have made a dent in their morbidity and mortality if senior citizens had to use VA-like formularies? Probably not. I bet PhRMA is laughing all the way to the bank. Literally.

6. Heart Disease Facts

You can convince me that our healthcare system is too costly but you still can’t convince me it does a bad job. Sorry Michael Moore. Physicians, nurses and even hospitals do a fantastic job. In fact, a recent study showed that the rate of death from heart disease fell in half over the past 20 years. Most of that improvement came from medical measures (medications, doctors, etc.). Lifestyle improvements such as smoking cessation, healthier diets and exercise did help as well but unfortunately this was offset by the fact that are getting fatter and fatter.

A psychiatrist was doing his normal morning rounds when he entered a patient's room.

He found Patient #1 sitting on the floor, pretending to saw a piece of wood in half.

Patient #2 was hanging from the ceiling, by his feet.

The doctor asked patient number 1 what he was doing.

The patient replied, "Can't you see I'm sawing this piece of wood in half?"

The doctor inquired of Patient #1 what Patient #2 was doing.

Patient #1 replied, "Oh. He's my friend, but he's a little crazy. He thinks he's a light bulb."

The doctor looks up and notices Patient #2's face is going all red.

The doctor asks Patient #1, "If he's your friend, you should get him down from there before he hurts himself"

Patient #1 replies, "What? And work in the dark?"

What has changed since the days of the $7.00 office visit? (That is mentioned only to show you how old I am). There have been numerous explanations by the economists, drug manufacturers, politicians, physicians, as well as tirades from numerous governmental organizations. Arguments over the contribution of these costs by various groups have been presented and for a considerable period of time the blame was placed on the physicians. Unfortunately for the physician, each increase in medical care costs has resulted in further contraction of his or her income. What are the real factors that have caused this phenomenal growth in the cost of medical care and the paradoxical decrease in available medical care for the patient?

Like in the fairy tales, “once upon a time” a patient’s contact with his physician was a simple process. The relationship was one to one. The patient made payment to the physician. There was no large sieve in the middle siphoning a large share to this impediment to patient care.

Being simple minded I thought that even though I no longer participate in this process I could try to find some simple answers.

At the store while shopping I bought some medication the cost was $8.50 for fifty pills. On the next shelf the generic version of this same medication was 500 pills for $3.98. In the evening while listening to the television there are always numerous commercials advertising various medications. The emphasis by the pharmaceutical companies is to push medications that can be prescribed for the rest of the patient’s life. Medications that can be taken for only a short period of time are not “pushed” as hard and spending research money on short-term drugs does not pay good dividends. The motto seems to be invest in drugs that profit the company, if they happen to help the public that’s fine also. The cost added by pharmaceutical companies is considerable and the amount paid for television ads and lobbyists also contributes to the “cost of Medical Care”.

While driving on Highway US 50 a few weeks ago I noticed many large office buildings that are owned and operated by HMO’s and Health Care Insurance Companies. The parking lots outside these buildings bulge with hundreds of cars. I couldn’t help thinking about what did all of these thousands of employees do before health insurance and health management groups gave them employment at salary levels that made parking lots filled with new cars possible and permitted them to find housing in the Sacramento area where houses are not cheap. Since these are all multimillion-dollar businesses the CEO’s have commensurate salaries.

The medical clinics and offices we had many years ago were relatively shabby and most of us were very careful to keep expenses to a minimum. Today the offices run by corporations are lavishly furnished. There are numerous clerical and nursing personnel. Computers are plentiful and large office staffs are necessary to keep all of the records straight. Procedures once done in the office have in many instances been transferred to the hospital. In some instances this is to increase the charges that can be collected from Medicare as well as Insurance companies.

Last week while visiting a friend (not a physician) who lives in a rather expensive neighborhood I asked him who can afford to buy these one million dollar plus houses at this time. One of the ones he pointed out was bought in the past month by someone who works in the medical insurance industry.

Hospitals all plead poverty and are always ready with an outstretched hand to accept your tax-deductible contribution. The economics involved in operating hospitals is complex and lined with many sinkholes. Frequently mentioned costs involved in the treatment and care of the non-insured patient are stressed. There are of course some hospitals where this is a real problem but many hospitals in wealthier communities inflate their involvement in the care of the indigent to a larger extent than is real.

Doctors working hours and schedules permit little flexibility so that the patient with an acute problem cannot be seen on short notice. If care is needed sooner the emergency room must be utilized. Emergency rooms are compensated considerably better than physician’s offices by private patients as well as Medicare and other insurance companies. The emergency room physicians, unfamiliar with the patient and having no history, order laboratory and radiological examinations that would probably not be needed by the patient’s primary care physician. Evaluation and treatment in the emergency room is a revenue enhancement process that is quite effective but not for the unfortunate patient.

Unfortunately correcting many of the ills affecting medical care costs might well affect the economic well being of thousands of individuals who are responsible for the increased cost but provide no professional care to the patient. On the other hand the economic stagnation that has discouraged physicians would probably improve to a considerable extent and might even increase their pride in their profession.

10. I’ve Been Tubed

You can now see another piece of a lecture I did a little while ago on You Tube. I try to do keynote speaking when the right opportunity reveals itself. My current favorite topic is “Seven Essentials To Becoming a Happy Physician”. Check it out at:

Don’t be afraid to give me a ranking, either. Everyone’s ego needs a boost now and then, even those with a distorted sense of self-importance.

It was about a year ago that I had my own TB “incident” as described in one of my columns for the Placebo Gazette. I had sent a patient to the local TB clinic. When I called about myself, a resident doc, and my staff who were potentially exposed, I was initially told this would "violate HIPAA." Puh-lease. After persisting, I got the information. We were all relieved that he was not infectious.

Recently, this gentleman has got everyone scared by flying across the world with a highly infectious and resistant form of TB. Will others get the same HIPAA crap? There is a cost to all this HIPAA ....and it isn't just the paperwork. It can truly be dangerous. Why does someone else’s right to "privacy" override the publics right to be free of preventable health hazards? We love our freedom and privacy but sometimes I think common sense has been thrown out the window.

I saw this curious piece in Medical Economics. The title was Docs beat the Blues. It went on to say that an estimated 900,000 physicians nationwide will share $128 million in compensation in a settlement with the Blue Cross and Blue Shield Association (as well as 23 of their plans). The suit was filed in 2003 because the doctors were underpaid on insurance claims. The interesting thing to me was how the magazine portrayed this as some big windfall. When you do the math each doctor will end up receiving $133 a piece. Impressive. I wonder how much the lawyer firm will receive?

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