- Del Meyer, MD - https://delmeyer.net -

On World Ratings, the Future, Social Justice

WHO, CMA, Los Angeles County Medical Association and Sonoma County Medical Society.

The World Health Organization has listed the best healthcare systems in the world. The USA ranks 37th out of 191 and France heads the list.

I recall the time I was leaving Paris and a gentlemen with a bandaged eye lay on a stretcher in front of me. He was risking an emergency flight home to repair a detached retina, rather than the increased risk, according to his wife, of interfacing with French medicine. Why would someone want to flee the world’s best healthcare system for one 37 down the list?

Anthony Daniels, a British physician, responds in the WSJ to the WHO report stating that we rank just below Costa Rica, just above Slovenia and 15 places below Colombia. On his visit to Colombia he saw many advertisements concerning healthcare facilities in the US. He was unable to find advertisements in American periodicals concerning healthcare facilities in Colombia. He felt it curious that people are prepared to travel long distances and spend large sums to be treated by a worse healthcare system than the one they have at home.

He suggests that we imagine two societies, both with 20,000 people who will die without a heart operation. In one society no such operations are done; in the second, 10,000 are performed on the half who are most able to afford them. From a fairness point of view, the former system, in which everyone died prematurely, is clearly superior. But it would surely be an odd person who preferred a system in which everyone died. He feels fairness is not an important feature of a healthcare system, and should not be used to make comparisons between them.

He also points out that it is unfortunate that these lists, once distributed and memorized along with the periodic table of elements by school children, have essentially no useful meaning. However, it will be almost impossible to liberate minds from the prejudice that these must mean something.

Meanwhile our California Medical Association has a Re-Engineering Task Force precipitated in part by a decline in CMA membership below 50% of practicing physicians in California. A broad survey found that a majority of respondents indicated that the CMA of the future should be a more effective and efficient professional organization focused on legal, legislative and economic advocacy. Reasons for failure of prior efforts included insufficient grassroots involvement and the conservative nature of the CMA leadership. The top three recommendations included that the CMA implement a program for introducing and advancing economic advocacy legislation throughout the legislative session to improve physician reimbursement, establish an Economic Advocacy Task Force to serve as a think tank to improve economic advocacy for physicians, and establish a “quick response” Economic Advocacy SWAT Team to take immediate and direct economic advocacy action when necessary.

With the AMA stating that the average physician income is equal to that of the President & Commander-in-Chief of the worlds most powerful country, the proposals concerning inadequate compensation and reimbursement of physicians could have an even greater negative effect on our professional status. If we’re speaking of the financial consequences of MICRA, HCFA, CMB, or protection from attorneys in general, we should be more specific.

Sharon A Ferrell, president of the California Medical Billing Association has an article titled Code Blue! in LACMA Physician. She points out that there are hundreds of intermediaries, commercial carriers, trade unions, HMOs, PPOs, and IPAs, each with its own reimbursement regulations, making up their own codes; changing rules; losing your claims, delaying, denying, reducing payments; and disputing your appeals. This causes physicians to unnecessarily write off billions of dollars annually.

She cautions that any billing error may be considered fraud and abuse, thereby subjecting physicians to fines, penalties, and sanctions by federal and state authorities. Billing for a test that may not be medically justified may be deemed fraud. She lists over a dozen areas that could end our medical careers.

In The Future of Medicine, an editorial in the Sonoma County Physician, Heather Furnas, MD, points out advances made during the 20th century, when life expectancy increased from 47 to 76 years and may go to 100 years in this century. Cloning could allow for the birth of a thousand Hitlers and genetic engineering could produce an exclusively Aryan world.

Technical advances have allowed us to increase the exactitude of our diagnosis with increasing patient safety so that we could return to the practice of diagnosing without touching the patient.

However, she feels that if bureaucrats continue to bleed the lifeblood from the health care system, we may return to diagnoses made solely by palpation, percussion, and auscultation.

Marcy Zwelling-Aamot, MD, Los Angeles County Medical Association (LACMA) Treasurer, discusses Laurie Zoloth’s book, Health Care and the Ethics of Encounter: A Jewish Discussion of Social Justice, in the current issue of L. A. Physician. She was elated to be given the task of reviewing the book and then discovered the contents were more like oatmeal turned to cement and proceeds to dispute Zoloth’s premises one by one.

She disputes Zoloth’s premises, starting with the first one – that health care is a scarce resource and thereby a rationed good. Zwelling-Aamot feels the scarcity of health care results, in part, from the marketplace that has left those involved in “the encounter” in the dust.

Zoloth fails to see the role of government or business in the health care encounter as a negative force. In fact, Zoloth states the simplest act of “caring for the vulnerable ill person is a social encounter” and “the provision of healthcare is a necessarily social good; it cannot be otherwise.” Zwelling-Aamot agrees that the Talmud is a wonderful demonstration of Jewish discourse and does provide insight into Jewish social justice, but it doesn’t describe health care as a social right . . . The story of Ruth . . . does not apply to issues of diabetes or hypertension.

Zwelling-Aamot concludes that there was no discussion of . . . a true medical encounter: that between a patient and a physician. The encounter remains a private moment. . . It is not about justice or social obligation.. . . If God wanted healthcare to be a social issue, He/She would have made it one of the 10 Commandments: “Thou shalt have a Pap smear and spread thy shanks for the world to pass judgment” or “Thou shalt share thy hemorrhoids with thy neighbor.”