Thursday, July 23, 2009

Tonsillectomies of Greed

I didn't watch President Obama's health care-heavy news conference last night. As I mentioned in an earlier post, yesterday was my fourth wedding anniversary, and I had a feeling that if I spent 60 minutes watching President Morpheus and the White House Press Corps, I would be in too foul a mood to celebrate four years of marriage the way it should be celebrated.

This morning, I read the transcript of that news conference, and I realized the wisdom of that decision.

As always, the President said a lot of things I take issue with. And as always, one comment in particular jumped out and really made me shake my head:

Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there. So if they're looking and you come in and you've got a bad sore throat or your child has a bad sore throat or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, "You know what? I make a lot more money if I take this kid's tonsils out."
I grew up in a medical family. I've worked in the business side of a medical practice. And I've edited medical journals and textbooks for closing in on 20 years now. I've literally lost track of how many specialists, general practitioners, registered nurses, licensed practical nurses, medical assistants, and even medical billing clerks I've had conversations and dealings with over my life. And not once have I ever heard of a doctor ordering a unnecessary surgical procedure on a child simply because he thought he could "make a lot more money" that way.

Not once.

That's just my own experience, of course. So if you have an actual example, Mr. President, please share it with us. Because I'd like to have that doctor reported to his or her state medical licensing board.

I do, unfortunately, know of some possibly unnecessary tonsillectomies that have been performed, but not because of the chance to "make a lot more money," as President Obama suggests. These were performed as protection against potential malpractice lawsuits, in case at some point down the line the decision not to perform the procedure turned out to be the wrong one. These were performed for the same reason a lot of potentially unnecessary tests and procedures are -- as defensive medicine. But to acknowledge that fact of our current health care system would mean dealing with medical malpractice premiums, lawsuits, and jury awards. And how many Democrats currently involved with health care reform are highlighting medical malpractice reform as a priority in this debate?

Besides, greedy doctors cutting open children for higher profits is much easier for President Obama to argue against than, say, trial lawyers like Democratic icon John Edwards, who once famously channeled the words and thoughts of an unborn fetus before a jury to help secure a $6.5 million judgment. But then maybe doctors have been performing a lot more cesarean sections in recent years simply because they can "make a lot more money" from those procedures compared with natural childbirth, and not because of previous jury awards (one of which reached $112 million) in malpractice suits when not performing a cesarean at the first hint of trouble turned out to have been the wrong call.

Or maybe it's all some lesser kind of greed. After all, if performing unnecessary procedures protects you against future malpractice lawsuits and allows you to stay in practice, you can "make a lot more money" over your career than you will if you try to avoid those procedures and eventually make the wrong call.

Now, in the interests of full disclosure, I actually do know of a medical practice (no longer practicing) that did perform unnecessary procedures simply for the money. Primarily made up of Medicare patients, that practice would routinely obtain an electrocardiogram on those patients, whether or not an electrocardiogram was actually needed. And the practice did this for the money. Not to pad their profits, mind you, but to help minimize, given the Medicare reimbursement schedule, the financial losses that practice incurred when providing necessary procedures for those patients.

It was a futile attempt in the end, but it did help them to continue providing necessary care for long-time patients, at least for a few years. The fee schedule drove that practice to do this, yes, but greed had nothing to do with it.

I'll be the first to say the American health care system needs reform. I don't know of anyone, Democrat or Republican or Independent, who thinks the status quo should be kept unchanged. But if a person's underlying assumption is that greedy doctors performing, say, unnecessary tonsillectomies to pad their bank accounts are what's driving the explosion in health care costs, then no wonder that same person can believe that "two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs."

Two-thirds of a trillion or more dollars, just by reallocating waste.

God help us all.

UPDATE: Welcome, Instapundit readers!

UPDATE II: My use of the phrase "possibly unnecessary tonsillectomies" is intentional. I'm not a physician, and I don't claim to be. These are three cases I've been told about over the years, in each case by one of the professionals involved, in which fear of a future lawsuit was given as the deciding factor. I can't judge the medical merits of those cases myself, obviously, but I've had no reason to doubt their word.