I get to spend a lot of time at sports events, being the father of 5 athletes. So last year I found myself at a baseball game with my 10 year old son. His coaches have the team warm up about one hour prior to the game. So while I was detachedly watching our team warm up, I noticed the other team was warming up as well. I began to "eye the competition". They looked okay, but not nearly as good as our team. It looked like a good day for a win. I noticed the coach, Mr O'Dell. I knew him, he has been a good coach, and he is on the baseball league board. We had talked a few times about the baseball league. He was a really likable guy. He is pationate about youth baseball. Most of the parents liked him and his team seemed to respond well to his coaching. The more I watched, I noticed that he had a few good players, but a lot of rookies. I was beginning to think that we would not have much trouble winning this game. I just hoped it would not be a blow out. However, I had heard that this team had 12 wins and no losses. They sure did not look that good.

My phone rang, disturbing my musing. I was on call. As I answered my cell phone, I walked away forgetting about the teams that were warming up. The call from my answereing service was not a very intense medical need, but seemed to take forever to get sorted out. It was the kind of free care that I provided every day. By the time I finished the phone call the game had started. I wandered over the the stands. Our team was up to bat, in the first inning. I noticed that there was only one umpire. Usually there was two; one in the field and one behind the plate. Today, there was just one behind the plate. I had missed our first batter. He had struck out already. Our second batter was in trouble. The pitch was way wide, but the umpire called it a strike. Not a good call ... but as I always teach my kids, nobody is perfect. You will get a few bad calls. Some of the parents on my side started to grumble. Our next batter came up. Three pitches were thrown and three strikes were called. There was more grumbling from the stands. I could not make out who the umpire was, with his face guard on. I knew most of the umpires because I had watched what seemed like a thousand baseball games. This one seemed new to me.

During the next half of the inning we had more poor umpire calls. Consistently when it was a close call the umpires called it for the other side. The grumbling from our parents got louder each time.
"Didn't I tell you he would call it for his team.", said one father.
"Yeah, but our kids get to play the game and he doesn't cost much." said one of the mothers.
Just then I turned to look at the field. The umpire took off his mask. It was the other teams Coach, Mr O'Dell!
"What is going on?" I asked.
"Talk to O'Dell." came the chorus of replies from my stands.

The games continued, dismally, we lost 10 to nothing. The calls always going against our boys. Throughout the game, Mr O'Dell always remaind kind and cheerful. Each time a harsh comment came from the crowd he woud respond with a genuine smile and never fired back. You just felt like liking this guy. He was personable and ...well ... just likable. A guy you wanted to be around. I cornered him after the game and gently ask why he was both a league board member, a coach and an umpire. He explained that there had been a few complaints about a few of the hired umpires. The board, at his suggestion, had decided that it cost too much to pay the umpires. This way the board members could coach for less cost to everyone and provide a higher quality of umpiring. In fact, the board was considering lowering the enrollment fees.

"Don't you think its unfair for the game and the boys,that the people who make the rules also call the game?" , I asked.
"In fact," he replied, "we think it makes the game better. It adds competition for the umpires. It keeps them honest. It improves the competition and makes the boys work harder to win. We believe in our decision, whole heartedly. Its what this league has needed for a long time. And we had the votes to make it happen."

His response caught me off guard. He was so nice and seemed to know what he was talking about. I did not even know how to respond. I just walked away, shaking my head. It made no sense to me. How do you improve competition by rigging the system. If you are the one who makes the rules and enforces the rules, what makes that good.

The next day I called another board member, Mrs Pellagrino. I told her about my conversation with Mr O'Dell and asked her opinion.
"I am excited about this new system!", she replied, "In fact I just got off the phone with a baseball league organizer in Nevada. They are hoping to change their system to be like ours! It provides great quality control when you can make good rules, have coaches you trust teaching the rules and be sure the game gets umpired by those who care about the rules."
"How do you think it will affect the boys?" I asked.
Mrs Pelligrino went on, "They will love it once the novelty wears off. We just need to give them some time to get used to it. We have worked hard on this change. We studied it and talked it to death. I hope you can see that this change is for everyone's best."

She was not as kind and likeable as Mr O'Dell, but seemed like a reasonable lady. I wondered if maybe I had gotten it wrong. What was I missing? Was this really a good thing? It did not make sense, but the board was convinced. I decided to let it drop. Maybe it was not worth the effort to argue against this. I had other things to do. Other more pressing responsibilities.

A year passed and last month we were deciding whether or not to sign our now 11 year old son up for this year's baseball. When we called around to the various leagues we discovered that all the leagues were now using the same system. All the leagues board members were coaching teams and they were using only board members for umpires. We also discovered, without surprise, that no parents were willing to coach the teams. The only teams that had formed were coached by board members. We decided that our son would not play baseball this year. We will find another game to play.

Many of you reading this have already guessed that it is a fictional story. It would be absurd for a league to take over baseball like I described. No one would play the game. The parents would not allow it. The board members would be thrown out or the parents would start new leagues.

Yet, this is what our current federal government and its willing accomplices in the legislature wants to do to our economy. With the bailout of our economy, they now make the rules (via legislation), coach the team (by owning car companies) and umpire (by enforcing their regulations via "Czars"). The game is rigged and our freedom to compete is being stripped from us. They want to take over the game. Yet this game is not baseball, its our financial well being.

The President and the Legislature now wants to do the same with your healthcare. Our President wants to "improve" the system by adding "competition" for the insurance companies. But how can an industry compete with a government system that is regulated by the same people who make the rules. I am not a fan of the Health Insurance industry, and it is a big part of the problem. However, just look at Medicare, Medicaid, The VA, and Tricare. These are Government run systems and they are very badly run. These programs are a large part of the poor quality that we are getting in our current system. Why do you want to give more power to the same people who have messed up Medicare. The proposals that are currently before congress are a death to our health in this country. Please contact your federal representatives and ask them to vote "NO" to the current proposals. I will write more in my blog, in the future, about what kinds of fixes might be better for our healthcare.

Sometimes you scratch your head and do not know what to say. The thinking of the federal agency that administers Medicare is profoundly perplexing. During a meeting today, I found out that Medicare will not pay for the cost of an injection performed in my office. In other words I can give an injection of antibiotic, but medicare considers my cost of ordering, buying and dispensing the injection a normal part of an office visit. So when a patient comes with a skin infection, requiring an antibiotic injection. I can give an antibiotic injection ( but will not be paid for the cost of that injection) or I can send them on to the emergency room where they can get an injection. In their infinate wisdom, Medicare will pay the hospital for the cost of the antibiotic injection (when given in the Emergency Room). The cost of an Emergency Room visit to Medicare is around $300 and my visit costs Medicare around $50. Why spend $50 when you can spend $300. The fortunate Medicare patient can spend less than an hour in my office and spend half a day in the Emergency Room. Lets see, what would I chose. You might begin to understand my concern about a federally mandated health insurance system. Our president and congress was elected to bring Change. It is change, but does it make sense?

In the era of discussing Healthcare Reform, we should consider patient rights and responsibilities in an attempt to define the problems and suggest fixes. I found a pretty good list at About.com (The Wise Patient's Guide to Rights and Responsibilities
By Trisha Torrey, About.com Updated: February 19, 2009. ) Trisha's lists are, I think, a good starting point for most discussions. Hre is the basic list:

" Consider these Patients' Rights
•The Right to Be Treated with Respect
•The Right to Make a Treatment Choice
•The Right to Refuse Treatment
•The Right to Obtain Your Medical Records
•The Right to Privacy of Your Medical Records
•The Right to Informed Consent
•The Right to Make Decisions About End-of-Life Care

The entitlement of patients' rights for Americans is accompanied by patients' responsibilities, too. In order to get the best care, and find our most successful medical outcomes, we must adhere to these responsibilities.

Consider these Patients' Responsibilities
•Maintaining Healthy Habits
•Being Respectful to Providers
•Being Honest With Providers
•Complying with Treatment Plans
•Preparing for Emergencies
•Reading Behind the Headlines
•Making Decisions Responsibly
•Understanding Prescription Drugs and Their Possible Effects
•Meeting Financial Obligations
•Reporting Fraud and Wrongdoing
•Avoiding Putting Others at Risk"

I recommend thinking about each of these points. Discuss them with the people around you. Both lists are critical in order to consider various fixes to hour system.

Today, back to trying to define the problem. Last time, I looked at whether the quality of care was substandard. I think we have good quality of care. Please do not mis-understand, there are always problems, however, the quality of care is not the "crisis" in health in this country. The cost of care is a problem. Everything associated with medical care is too expensive. The cost to the patient is too high. Medical supplies are too expensive. Medical training is too expensive. Litigation adds a layer of cost to the system. Insurance adds a layer of cost to the system.

Today, I would like to touch on Insurance and managed care. Prior to the 1970's there was not "Managed Care". The patient used to manage their own care. They made decisions about how their money should be spent. After the federal "Health Maintenance Organization Act of 1973", the decision making and the power in medical care has shifted further and further away from the patient. In both subtle and overt ways, the payor (Insurance or the Government), determines what is available as options and when those options may be used.

A pretty good starting point is the following article by "Blarney in Politics". " What's really wrong with the United States medical system? "


So when considering other legislative options, please advocate solutions that give more control over to the patient. This will result in better care and lower cost.

In my next blog, I will try to discuss the need for meaningful Tort (suit) reform as a cost reduction.

The Federal Government is talking alot about "Health Care Reform". As a Physician who is committed to providing great care for my patients, I do have an opinion.

First we have to ask:

1) "What needs reformed?"

The objective and honest answer to this question will determine all the suggested fixes. We get to hear a lot from the politicians about "fixing" the system. But they are short on objective and accurate information. Individuals who are interested in a government based program will quote statistics that we have a lower life expectancy then all of Europe and Canada. However, they fail to mention that when you remove deaths due to violence (murders, largely). Our life expectancy is higher than most of the world. So, if you are in favor of a system that increases our life expectancy, you should not change Medical Delivery, but should work on the social and moral climate that contributes to a high murder rate in our society.

When you consider the delivery of health care, lets consider the effects of cancer care. The United States leads the world in survival from cancer. Review the following articles: "Nationalized Health Care and Breast Cancer Are a Deadly Mix" and " Cancer Survival Rates Improving Across Europe, But Still Lagging Behind United States" From these reviews, it seems we are at least doing cancer treatment better than the socialized systems in Europe.


I will continue to post on this as I have thoughts.