Medicine Globally by Dr. Rene Menguy

By Dr. René Menguy

Our country is embroiled in a raging debate about an overhaul of our health care system, which many consider the worlds best. The debate focuses on a cost of care that, last year, increased at twice the inflation rate. Unfortunately, few understand the forces behind the growth of a burden that, if unchecked, promises to reach $4.3 trillion by 2017. The Administration naively takes the Willy Sutton approach and blames the insurance industry, “because that’s where the money is”. In a previous commentary, I suggested that instead of blaming the Insurers, we should blame the providers who, forever striving to improve health care, have trained more doctors and specialists than society needs.

The responsibility for directing money flow, within groups as small as the nuclear family and as large as General Motors, falls to certain people. In the Medical Industry, it is the doctor who initiates and often demands additions to a hospital’s, budget: more patient beds, more operating rooms, enlarge the emergency room and so on and so on. “Are you telling me that I can’t get my duodenal ulcer patient in before next Monday. Do you know who I am?” I was dumb enough pull that stunt once. An hour later, the head of psychiatry called. “Hey Rene, I’m worried, Admitting tells me you don’t remember who you are.” In medical schools, department heads lobby for larger classes and more trainees for their respective specialties. The stature of a professor, be it surgery or cardiology, is measured by the number and achievements of his trainees.

Or, it may involve equipment. For example, take a Metropolitan area with a population of one million, a medical school, a university hospital and three affiliated teaching hospitals. One of the latter, a not-for-profit institution, tried to recruit a renowned radiation therapist who made his acceptance conditional upon the hospital’s purchase of a cobalt bomb, an expensive piece of equipment that uses radiation from cobalt-60 to treat cancer. An appropriate ratio would be one such machine per one million people. The purchase price, however huge, was only one budget line. The hospital had to build a special facility to house the machine, hire the technicians to run it and a Ph.D. physicist to perform dosage computations. So, what’s the problem? The problem was that the community, already boasting of two similar machines at the other hospitals, did not need it. The hospital’s purpose in bringing that doctor and his expensive equipment on board was to fill more beds. Of course, its debt increased. Not to worry! The CFO factored the radiation therapy expenses along with a lot of other stuff into the room rate and, in due course, the local HMOs approved a new and higher hospital room rate. What else could they do? Imagine similar scenarios replicated thousands of times all over our country and you’ll understand why hospital room rates have become absurdly high. Oh, I almost forgot. After two years, the renowned radiation therapist went back to England. As for the hospital, it discovered twenty years later that leverage has its limits, succumbed to its huge load, went bankrupt and, a hospital dating back to the 19th century, closed its doors forever.

We Americans, Conservative or Liberal, must understand that a health care system that has slowly evolved to its present state, warts and all, only needs correction, not overhauling. It has already tried hard to self-correct. The insurers have used many methods to reduce spending by providers. For example, inter alia, during the nineties, before I could admit a patient through the ER at any hour of the day, I had to contact the patient’s HMO and request approval for the admission (without which the patient’s hospitalization would not be covered). I really doubt more could be done through a “public option”.

Cognizant of the huge increase in the hourly cost for the use of a conventional hospital operating room, surgeons have taken to perform their less complicated procedures in surgicenters. By devising methods of feeding patients intravenously with calories or antibiotics almost indefinitely, physicians, with the aid of a cadre of dedicated, competent and compassionate Nurses, have eliminated the weeks and months of in-hospital convalescence, once the norm. We now have all over the country, and in Naples in particular, a home care and a hospice network that will help us “go gentle into that good night”.

Let’s be civil. Strident discourse only generates heat. No one’s going to throw grandma under the bus, and a Nazi, he’s not. Believe me, I know. Those kinds of arguments only hurt our conservative cause.

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