This Really Shouldn’t Be A Surprise

A few years ago, I moved from Massachusetts to North Carolina. There was some culture shock. One part of that shock was the gun culture of some of the South. I grew up in a house where no one hunted, so the whole gun thing was very foreign to me. One of the first things I did was to take a gun safety course to education myself. I learned a lot and began to understand why the Second Amendment is so important to our freedom. Unfortunately the leaders in the Commonwealth of Massachusetts have not yet gotten that message.

Yesterday The Gateway Pundit posted the following headline, “Boston Mayor’s Office to Force Doctors to Identify and Document Patients Who Own Guns.” Wow. What is the Mayor’s office doing collecting information from doctors?

The article reports:

Here are three of the top goals for health care legislation outlined by his office:

Involving doctors in gun safety: This act would require medical professionals to ask patients about guns in the home, and bring up the topics of gun safety. The goal, Boston Police Commissioner William Gross said, is to identify those at risk for domestic violence, suicide or child access to guns in order to guide people to mental health counseling, resources or other help. “We’re just asking them to help identify ways to save lives,” Gross said.

The fact that a patient owns guns would not be put in their medical record, and is not intended to have physicians help solve crimes.

Chief of Health and Human Services Marty Martinez said that while the program is already common practice at many of the city’s community health centers, legislation would broaden the program statewide.

Does anyone actually believe that gun ownership would not be made part of a patient’s medical record? If the measure is supposed to save lives, what action are the doctors supposed to take after they have determined that a person has guns in the house?

I may be paranoid, but this seems like a back door approach to finding out who has guns so that the guns might be taken away later.

Those Nasty Unintended Consequences

On Monday, Investor’s Business Daily posted an editorial detailing the impact of ObamaCare on doctors.

The editorial reports:

A year before ObamaCare became law, an IBD/TIPP Poll warned that it would lead to doctor shortages because many would quit or retire early. New evidence shows that our warnings were dead on.

A recent report from the Association of Medical Colleges projects doctor shortages of up to 121,300 within the next 12 years. That’s a 16% increase from their forecast just last year.

Not only are medical schools having trouble attracting doctors (New York University plans to offer free tuition to its med students), but current physicians are cutting back on patient visits, retiring early or switching careers.

An article in a recent issue of the Mayo Clinic Proceedings says that nearly one in five doctors plan to switch to part-time clinical hours, 27% plan to leave their current practice, and 9% plan to get an administrative job or switch careers entirely.

The editorial cites one possible reason for the declining number of doctors:

One of the big drivers of doctor exits, by the way, is the Obama administration’s “electronic health records” mandate, which was supposed to vastly improve the quality and efficiency of care.

It’s had the opposite effect. A Mayo Clinic survey found that the EHR mandate is reducing efficiency, increasing costs and paperwork hassles, and pushing more doctors to quit or retire early.

A Harris Poll found that 59% of doctors say the current EHR system foisted on them by the Obama administration needs “a complete overhaul,” and 40% say it imposes more challenges than benefits.

ObamaCare continued what had been a long and sorry trend in health care. Government-imposed rules designed to fix some problem in the system instead generated mountains of new administrative work.

The result has been that while the number of physicians in the country has climbed modestly over the past three decades, the number of health care administrators exploded.

This is an illustration of the consequences of government interference in the free market. The free market isn’t perfect, but it is the best way to keep prices down, innovation up, and industries (and professions) moving forward.

As Our Population Ages, This Is Important

 The Wall Street Journal posted an opinion piece this morning about the impact of doctor-assisted suicide on the practice of medicine. The author of the piece is Dr. William L. Toffler, national director of Physicians for Compassionate Care.

The article points out that in recent years, there have been about two dozen suicide bills introduced in legislatures in America. Dr. Toffler suggests that before we support these measures, we examine what has happened to the practice of medicine in Oregon, where assisted suicide was introduced 20 years ago.

The article details some of the impact of assisted-suicide laws:

In one case a patient with bladder cancer contacted me. She was concerned that an oncologist treating her might be one of the “death doctors,” and she questioned his motives. This was particularly worrying to her after she obtained a second opinion from another oncologist who was more positive about her prognosis and treatment options. Whichever of the consultants was correct, such fears were never an issue before.

Under Oregon’s law, a patient can request lethal drugs only if he has a terminal illness and less than six months to live. However, it is nearly impossible to predict the course of an illness six months out, and many patients given such prognoses live full, rewarding lives long past six months.

There is also the question as to whether cost enters into assisted-suicide decisions:

Also concerning are the regular notices I receive indicating that many important services and drugs for my patients—even some pain medications—will not be covered by the Oregon Health Plan, the state’s Medicaid program. Yet physician-assisted suicide is covered by the state and our collective tax dollars. Supporters claim physician-assisted suicide gives patients choice, but what sort of a choice is it when life is expensive but death is free?

It also appears that the statistics on physician-assisted suicide are being hidden:

A shroud of secrecy envelops the practice of assisted suicide. Doctors engaging in it do not accurately report the actual manner of death. Instead they are required by state law to fabricate the death certificate, stating that the cause is “natural” rather than suicide. In late 1997, right before assisted suicide was about to begin, the state legislature implemented a system of two different death certificates—one that is public and includes no medical information and another that is kept private by the state. As a result, no one outside of the Oregon Health Division knows precisely how many assisted suicides have taken place, because accurately tracking them has been made impossible.

Dr. Toffler shared his own experience with a patient afflicted with MS:

One inquiry came from a patient with a progressive form of multiple sclerosis. He was in a wheelchair yet lived an active life as a general contractor. I asked him how the disease affected his life. He acknowledged that MS was a major challenge and told me that if he got too much worse, he might want to “just end it.”

I told him I could understand his fear and frustration and even his belief that assisted suicide might be a good option. I also told him that should he become sicker or weaker, I would work to provide him the best care and support available. No matter how debilitated he might become, his life was, and would always be, inherently valuable. As such, I said that would I not recommend nor would I participate in his suicide. He simply replied: “Thank you.”

As our population ages, there will be an increase in the number of terminally ill patients. Most of us have watched a loved one struggle with terminal illness and wondered what in the world was being accomplished by their suffering. I suspect we will never know the answer to that question. However, we need to look at the impact of doctor-assisted suicide on the practice of medicine.

When researching this article, I discovered the following at Wikipedia:

It is a popular misconception that the phrase “First do no harm” (Latin: Primum non nocere) is a part of the Hippocratic oath. Strictly speaking, the phrase does not appear in the oath, though an equivalent phrase is found in Epidemics, Book I, of the Hippocratic school: “Practice two things in your dealings with disease: either help or do not harm the patient”.  The exact phrase is believed to have originated with the 19th-century surgeon Thomas Inman.

It seems to me that even if “First do no harm” does not appear in the Hippocratic oath, it is a really good idea. I have no answers as to why some people suffer through terminal illness, but I also do not feel that as mere human beings we have the right to decide when a person dies. I truly think that decision is above all of our pay grades.

Just as an aside, I recently attended my 50th High School Reunion. The person I sat next to at the reunion was told years ago that he would only live a few months (he had cancer). He was sitting next to me, cancer free, and fully alive. It would have been a shame if someone had wanted to ‘end his suffering,’ which I am sure he went through in fighting the disease.

The Impact Of Obamacare On Your Doctor

On Thursday, the Wall Street Journal posted an article by Scott Gottlieb discussing the impact of Obamacare on doctors. The article points out that the regulations in Obamacare will move doctors toward being 40-hour week employees rather than being in charge of their own offices.

The article reports:

…Because when doctors practice in small offices, it is hard for Washington to regulate what they do. There are too many of them, and the government is too remote. It is far easier for federal agencies to regulate physicians if they work for big hospitals. So ObamaCare shifts money to favor the delivery of outpatient care through hospital-owned networks.

The irony is that in the name of lowering costs, ObamaCare will almost certainly make the practice of medicine more expensive. It turns out that when doctors become salaried hospital employees, their overall productivity falls.

This is another result of government by special interest groups. In this particular case, the special interest group is the unions.

The article explains:

All of this reduced productivity translates into the loss of what should be a critical factor in the effort to offer more health care while containing costs. Yet hospitals aren’t buying doctors’ practices because they want to reform the delivery of medical care. They are making these purchases to gain local market share and develop monopolies. They are also exploiting an arbitrage opportunity presented by Medicare‘s billing schemes, which pay more for many services when they are delivered at a hospital instead of an outpatient doctor’s office.

This billing structure exists because hospitals are politically favored in Washington. Their mostly unionized workforces give them political power, as does their status as big employers in congressional districts.

This is another example of a law regulating health care that was written without concern for the impact it would have on medical care for individuals in this country. The law was written with special interest groups and government control in mind. It needs to be repealed and rewritten with the needs of American citizens in mind.

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