Irony in Health Care Debate

The Obama Administration is investigating the large premium hikes instituted by Blue Cross here in California. The insurance company is raising premiums on its individual policy holders an average of 39%. Now everybody is now up in arms.

Of course the irony of this situation is that the health care reform bill being pushed by Congressional Democrats and the President requires that everybody in the country buy health insurance from one of these private insurance companies. When insurance companies are not allowed to raise premiums on the sick or deny coverage for those with preexisting conditions, you better believe everybody's premiums will rise. And there is no insurance regulation in the bill that would limit the amount of price inflation the companies can institute. No one envisions regulating insurance companies like electric utilities.

Ultimately the government will wind up paying so much money to subsidize the American public to help them buy insurance that the whole enterprise will collapse. Then people will realize that the single payer system is the only alternative to a for-profit insurance industry. The insurance companies will then be reduced to selling supplemental insurance policies, like they already do for Medicare recipients, which they do quite profitably.

He's Back

Conrad Murray, Michael Jackson's personal physician and alleged murderer, was charged with manslaughter today. Manslaughter, the unlawful killing of a fellow human being without malice or intent, carries at most a four year prison sentence. The doctor pleaded not guilty. It is widely reported that the Jackson family is outraged at this light charge.

The LA Times has a nice background on Dr. Murray. He was born in Grenada and his Caribbean accident enchanted MJ. He was in financial difficulties when he was hired by Mr. Jackson. Dr. Murray is supposedly supporting six children, two of which are with his wife. The youngest of his illegitimate children was born just last March in Santa Monica. He owed $1.7 million on his country club house that is now assessed at $1.08 million. He also was in debt of $435,000 to his creditors and student loans.

He is praised by his patients for excellent bedside manners. He blames his financial predicament on treating poor patients in Houston two days a month. He reportedly asked Michael for $5 million to be his personal physician during the "This Is It" concert tour. Michael insisted on having Dr. Murray accompany him to London despite urging by the tour company to use local doctors. The agreed salary was $150,000 a month. Michael had the last laugh though. He never signed Dr. Murray's employment contract. Now he is s*** up the creek and he didn't get a single dime out of this whole fiasco.

That's what happens when you use a doctor who is not invested in your health but in his own wallet.

News From The ASA

I noticed a couple of interesting items in the current issue of the ASA Newsletter. One, the tenth anniversary of MOCA is upon us. The year 2000 was the first year the ASA started granting time limited board certification. All the anesthesiologists who finished their residencies before then can coast to their retirement without taking another freaking exam. But the rest of us have board certificates that expire every ten years. This being the tenth year, all those anesthesiologists are required to pass their recertification before January 2011. The ASA lets you take the recert exam starting in year 7, assuming you've accumulated enough CME credits. This gives the anesthesiologist at least three chances to pass the test.

According to the ASA statistic, only 60% of the class of 2000 have passed the exam so far. The other 40% have only one opportunity left this year to take it. Hmm, I think we have a huge class of procrastinators out there. Luckily the pass rate so far has been greater than 90%.

The other article that caught my eye was a letter from a group of anesthesiologists in Boston. They advocate using a transparent ether screen (blood-brain barrier) in the operating room. They say the ability of for the surgeon to see the anesthesiologist working diligently in the OR promotes safety and cooperation with the OR staff.

I don't know about this suggestion. It's bad enough when surgeons peer over the screen to tell me how to conduct my anesthetic. I couldn't imagine how intrusive the surgeons will be if they can see into my workspace. Plus, when will I have a chance to eat my bologne sandwich in the middle of an eight hour case if they are always watching my every move?

Beware Naked Man With Marijuana

A U.S.Airways flight from Philadelphia to Los Angeles was diverted to Pittsburgh when a passenger became unruly after taking too much medical marijuana. Kinman Chan went into the plane's restroom after takeoff and started screaming. If that wasn't concerning enough, he emerged with his pants down and shirt untucked. When told to sit down he became combative and had to be subdued with a choke hold.

Mr. Chan's excuse was that he took double his usual dose of medical marijuana cookies he had with him. The U.S. attorney's office in Pittsburgh examined his medical marijuana prescription and agreed he had a "legitimate" health issue for taking the drug.

This raises some interesting questions. If Mr. Chan took double the normal dose, does that imply there is a standard dose of marijuana? Is a medical marijuana prescription written in a state that allows the stuff (California) legally recognized in other states that don't (most of the U.S.)? Even though the the DEA has never recognized the legitimacy of medical marijuana, which it still considers an illegal substance, can the U.S. attorney claim a person has a legitimate health reason for taking it? If marijuana is legalized in more states, will we have an epidemic of naked men, or women, running amok in society? Where's President Obama's wisdom when we need it the most?

When Less Is More and More Is More

Will people really take better care of themselves if they were forced to pay more out of pocket health expenses? That has been the knock against insurance policies that shield people from the actual cost of their health care. In an article published in the New England Journal of Medicine, researchers have refuted that notion.

In the research that looked at Medicare recipients, they studied the effects of increasing copays on patients and their well being. They discovered that patients who had higher copays wound up using fewer outpatient services, had more hospital admissions, and longer hospital stays. They conclude that patients refuse to pay more for their care therefore they bypass routine health maintenance and wind up being hospitalized more frequently.

So this raises a perplexing problem. Trying to lower the cost of health insurance by making everybody pay higher out of pocket expenses winds up costing more money in the long run with increased hospitalizations. But if you lower the cost of health insurance to, let's say free, you also make the system more expensive as more people will abuse the system.

I'm just a poor anesthesiologist. I have no idea how we are going to get ourselves out of this conundrum. If you have any brilliant insights, I hear they need a few in Washington.

Why We Need Anesthesiologists

I'm scheduled to give anesthesia for a PEG. The patient has been having recurrent aspiration. In preop the patient was breathing about 40 times per minute. Room air O2 sat was 89%. "This doesn't look optimal for a MAC anesthesia," I thought. I start looking through her chart.

In the H+P in the very first paragraph the physician had dictated that the patient had a complete esophagectomy last year. Huh? WTF. She's scheduled for a PEG? Her GI doctor walks in. "Are we ready to get the patient into the room?" he inquires. "Uh, Dr. GI, did you know she had a total esophagectomy last year? Does she have a colon interposition or gastric pull up?" I asked. "Really, she had an esophagectomy? I didn't even know that," he replies stunned.

There is no mention of the type of esophagectomy in the H+P so we look at her CT scan. "Esophagectomy with gastric pull up" is what the radiologist dictated. "So Dr. GI, do you plan on putting the PEG through the patient's left ventricle?" Clearly embarrassed Dr. GI replies, "God I feel like such a bonehead. I'm going to schedule her with interventional radiology to get her feeding tube in. Thank you for looking out for my patient."

"Just doing my job Dr. GI." And that's why we need anesthesiologists.

Osama Bin Laden, The New Al Gore

Osama Bin Laden has now become an environmentalist. No, this is not a headline from Jon Stewart. In a statement released yesterday Bin Laden wants the whole world to abandon trade with the U.S. and stop the use of the dollar as a global currency because he accuses this country of causing global warming. Says Bin Laden, "Talk about climate change is not an ideological luxury but a reality. All of the industrialized countries, especially the big ones, bear responsibility for the global warming crisis."

Is he getting desperate because his jihadist messages are no longer resonating with his fellow Muslims? Does anybody think the Palestinians, the ones he claims to be fighting jihad for, care a rat's a** about global warming? I think Bin Laden is taking a page from Al Gore and trying to court the elite Hollywood crowd. He may even get an Oscar or a Nobel Peace Prize if he continues this new anti-Western message. Knowing the candidates the Nobel Peace Prize committee have rewarded, they may just give one to him.