July 27, 2009

"We await the President’s evidence that the nation's pediatricians are striking it rich with unnecessary tonsillectomies."

"'You come in and you’ve got a bad sore throat, or your child has a bad sore throat or has repeated sore throats,' President Obama explained at Wednesday’s press conference. '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.' If that’s what he really thinks is wrong with U.S. health care — and with the medical profession — then ObamaCare is going to be even worse than we thought."

***

Is the government's approach to medical care going to be more solidly based on science and less focused on dollar amounts than the system we have now? Or is it the other way around? Obama impugns doctors, because, supposedly they care about money more than science, but, without evidence — and considering the rarity of tonsillectomies — he doesn't seem too well grounded in science.

And he's been presenting his program mainly as a way to save money, so he's openly admitting he's about the money, in which case, why bash doctors for being about the money (if that's what they are)? Obama talks as though he'll only deny us expensive treatments that are less effective than cheaper ones, but I'm trusting that far less than I trust my doctor.

IN THE COMMENTS: Bissage writes:
At this very moment, presidential aides are lining up pediatricians to invite to the White House for a beer.
Donald's Designated Driver says:
Personally, I'm glad that our President has the balls to take on Big Tonsil.

71 comments:

Fred4Pres said...

When you get your medical data from watching old Brady Bunch episodes, this is what you get.

But don't worry, the government will give us all ice cream if we are good.

AllenS said...

Obama needs to go after hospitals that employed people like his wife, Michelle, and rid those hospitals of unnecessary workers, that do nothing but suck the profit out of the business. Healthcare would immediately become less expensive.

traditionalguy said...

It is just more Hoodoo economics from the Harvard educated Half-African wing of the New World Order. The American public has suddenly tired of playing Three card Monte with these frauds. We want all three shells removed, and we will pick our own future, thank you very much.

Ben (The Tiger in DC) said...

What should we call the president's position? "Tonsil-truthism"?

MadisonMan said...

I would say that the President's comment is pretty insulting to many many pediatricians -- like my kids' doctor (Hi Dr. B!) -- who are dedicated to the extreme.

My son's doc hobbled up to my son's hospital room just after he (the doc) had knee surgery -- the drainage bag was fascinating to see -- right after my son's birth (Son was under the lights for severe jaundice).

Bissage said...

At this very moment, presidential aides are lining up pediatricians to invite to the White House for a beer.

Big Mike said...

Even David Broder is having second thoughts about Obamacare.

The sad reality is that the Obama administration is actually more scientifically illiterate than the preceding administration.

Mortimer Brezny said...

As someone who has worked on health care fraud cases, let me just say, doctors do abuse the system for kickbacks and it is widespread.

Quayle said...

Obama talks like his programs will (1) deliver medical care of the highest quality of results, (2) be much cheaper, and (3) be readily available.

Anyone that has ever had a real job in the market knows that, at best, you can only have two of the above.

But Obama keeps talking like we can have all three, and in this he reveals his stupidity.

The Drill SGT said...

We have a couple of MD's around here to check my work however it seems to me the Obama doesn't know what he is talking about.

Aren't most kids seen by GP's or Pediatrians?

So the assertion is that these GP's would rather not have the income stream from regular appointments for sore throats, but instead would operate?

The flaw is that the GP doesn't do that procedure. It's done by an Ear, Nose and Throat surgeon (Otolaryngology)

So what he postulates is a wide spread series of criminal conspiracies to defraud insurers.

Bring in the FBI :)

Mortimer Brezny said...

Quayle:

You can develop a system that constantly rebalances the three in realtime, producing better outcomes than just leaving things be.

Lem said...

At this very moment, presidential aides are lining up pediatricians to invite to the White House for a beer.

Funny you should mention that ;)

An urine test is $1,465.00.

According to supply and demand the price would go up with more DWI convictions.
More DWI’s presumably means more carnage, more carnage... Its one ugly business.

traditionalguy said...

The current administration reminds me most of the guys on the street selling "Stolen Rolex" watches for $100 trying to get your greed instinct goingand make you overlook the fact that the watch is only a cheap phoney worth nothing. A hustle with "Science" is still a hustle.

MadisonMan said...

If Doctors abuse the system, the doctors should be prosecuted. The system shouldn't be changed predicated on the notion that all doctors are abusing the system.

Quayle said...

Mortimer says: You can develop a system that constantly rebalances the three in realtime, producing better outcomes than just leaving things be.

Oh, I think you are right.

And the best one ever invented is called the free market system.

If you disagree, and feel that the government should take over, I would ask you what Milton Friedman has asked: why do you believe that political self interest is more noble than economic self interest?

Freeman Hunt said...

You can develop a system that constantly rebalances the three in realtime, producing better outcomes than just leaving things be.

You don't even have to develop it. It's called the free market.

jayne_cobb said...

As someone who has worked on health care fraud cases, let me just say, doctors do abuse the system for kickbacks and it is widespread.


Well I'm glad there are no such problems with government officials.

William said...

Some time back there was a study that showed that male gynecologists ordered and performed hysterectomies seven times more often than female gynecologists. Why do I bring this up? In the new health care bill there is a provision that Hillary had insisted on insterting to increase the number the female urologists. There is a shocking lack of female urologists. A willingness to perform radical surgery will cut the astronomical expenses associated with BPH, and only women are at sufficient remove to make this tough decision.

Bart Hall (Kansas, USA) said...

he doesn't seem too well grounded in science.

My dear ... Mr. Obama isn't grounded in much of anything, apart from Chicago-style politics and early '80s university rhetoric.

Some of us tried to help you understand that before you voted.

AJ Lynch said...

In my work experience with healthcare business owners, 95% of are squeaky clean and scared to death to even come close to crossing the line. 2-3% are careless and or uninformed about regulations. 1-2% are scumbags robbing the insurance system.

So yes there is fraud and abuse but not enough to pay for universal healthcare.

Robert Cook said...

Of course Doctors are abusing the system...it's human nature that any system designed to allocate money will find people trying to get some of those dollars allocated to themselves. However, not ALL doctors are abusing the system, and probably not most of them. Obama's a dope, because the real problem with our health care system is not corrupt doctors but for-profit insurance companies. Of course, Obama's plan, whatever it will be, will leave the insurance companies in place, so he must blame the high cost of medical care on corrupt doctors, because if he acknowledged the real problems with our grossly overexpensive system he could not justify leaving the insurance companies with any participation in the delivery of health care at all.

Anything less than single payer will be a disaster.

DADvocate said...

Is the government's approach to medical care going to be more solidly based on science and less focused on dollar amounts than the system we have now?

Of course! Liberals don't have any problem with people making money and getting rich. They'd never try to cap someone's income. All their motives are altruistic.

Who in their right mind go through all the education and training necessary to be a doctor if they couldn't make a good living? A few, I'm sure but not many. Not many good ones, they'd go into another, more lucrative field.

BTW - My youngest son had his adenoids and tonsils removed about ten years ago after chronic sinus and throat infections. He's never had a problem since. Healthy as a horse.

AJ Lynch said...

The next big question the MSM needs to ask about Obama is "Can he learn on the job? Can he get better?"

His handlers will put some duct tape around his mouth for the next month or so. I guarantee it.

Patrick said...

The one-second rule for whether or not to take health care cost-cutting initiatives seriously:

Do they mention litigation costs?

If the answer is 'No', you can go back to doubting every self-serving hypocritical word.

Roost on the Moon said...

The Cost Conundrum by Atul Gawande.

There is a real problem with the way doctors' incentives work.

Let me throw in my anecdote. (Stick around: it's about sleazy trial lawyers.)

Man gets hurt at work, repetitive stress injury to his back. Hires lawyer. Lawyer (inderectly) suggests a doctor he knows. The company is going to be on the hook for at least this guy's medical expenses, and if he can't work, loss of future income, and some pain and suffering.

I've seen this happen scores of times. Every single back injury gets a spinal fusion. All of them. Full-blown invasive surgery. Hugely expensive. Minor discomfort or major pain, every time without fail.

Now, I doubt this doctor thinks of himself as a bad guy. (In fact, I know he thinks of himself as Jesus.) He has himself convinced that every single one of those guys needed that procedure, which just so happens to be the most expensive thing on the menu.

Fat check for the doctor, fat settlement for the lawyer, and an early retirement for the worker.

Doctors are people, and people can convince themselves of just about anything, especially if believing it results in a multimillion-dollar income and messianic social status.

Roost on the Moon said...

You may think that Obama doesn't have the answer. But then argue that! Don't poison the well by pretending that everything works fine.

knox said...

Who knew the whole problem with our health system is greedy, corrupt docs. They all just need to be monitored, regulated and sued within an inch of their lives and then everything will be OK! Oh, and let's drastically reduce their income while we're at it. Makes sense.

Sloanasaurus said...

They used to take out tonsils all the time. Today its much less common. Since Obama has used it as an issue, I would like to see some real facts on it.

Lem said...

Isn’t medicine a practice more than a science?

My impression is that (as it is with law) prices are set arbitrarily high because nobody really knows what the hell is going on.

Shanna said...

Every time Obama speaks about healthcare he demonstrates his ignorance and he wants us to give control of our healthcare to people who obviously have no clue what they’re talking about.

I get more worried every time they mention this subject.

knox said...

Obama has done a great job over the last week or so randomly insulting various people. Cops and Doctors--no lower forms of life!

Maguro said...

Of course there are doctors out there that perform unnecessary operations, but that is not a major reason why healthcare is expensive and it's either naive or dishonest for Obama to pretend otherwise.

This is reminiscent of of his stupid comment about how we could save so much energy by inflating our tires back in the campaign, though at least he didn't insult anyone back then.

As an aside, promoting socialized medicine as a cost-saving measure is tactically stupid because cost-cutting claims are so easily disproved.

Quayle said...

But then argue that! Don't poison the well by pretending that everything works fine.

OK, here are two solutions that Obama hasn't mentioned once, that I can tell.

1. Stop all perscription drug advertisements.

2. Either bar all tort suits on drugs that have been approved by the FDA, or get rid of the FDA. But to force a drug company to go through onerous testing and approval, and still be subject to tort suits is pure waist.

How hard was that for a lay-businessman to come up with.

The real problem is that the politicians are so in the pocket of their funders that they can't move.

All they can do is pretent that they are helping the public - that can't really do anything that goes against their funders.

Shanna said...

I’m just waiting for him to say that people should stop getting unnecessary vaccines to prevent autism.

Roger J. said...

William--I have no problem with increasing the number of female urologists--but arent gynecologists the ones that perform hysterectomies?

AJ Lynch said...

Yeah the inflate your tires idiocy was priceless. Almost as priceless as watching the MSM try and defend his idiocy.

bagoh20 said...

traditionalguy: "We want all three shells removed, and we will pick our own future, thank you very much."

I like that. It's just how it feels regardless of which party is moving the shells.

I think this is the internal driving force behind the Tea Party Movement.

AJ Lynch said...

AllenS said:

"Obama needs to go after hospitals that employed people like his wife, Michelle, and rid those hospitals of unnecessary workers, that do nothing but suck the profit out of the business. Healthcare would immediately become less expensive."

Are you suggesting Obama should cut some fat out of the healthcare system?

NKVD said...

Cookie is back, spreading his particular brand of bullshit, while ignoring the tort system that gave us such junk-science millionaires as our former senator and current Maury show baby daddy John "Silky Pony How Does My Hair Look" Edwards.

Nice try, Cookie, but get off your hammer and sickle encrusted commie bandwagon and come back when you have some sense.

Roger J. said...

Its all well and good to talk about basing a program on science, but epidemiological data is not always that clear cut and decisive. Here's a good example about cancer survivability rates--You can find it in the CONCORD Study in the Lancet Oncology, August 2008. The Cliff note version is here:http://www.webmd.com/cancer/news/20080716/cancer-survival-rates-vary-by-country

The important thing about the article is to read the caveats; We epidemiologists (including me) can generate statistics for the population as a whole, but those statistics tell you very little about the individual's chances. The practice of medicine is directed at the individual; the practice of epidemiology is directed at populations. Statistics, as always, should be used carefully.

As to medical practice? Most physicians use the guidelines established by their respective colleges (not the academic institutions). Those practices in general reflect the current science; as science changes, practices change (eg treatment of stomach ulcers). To use practices that were in vogue 20 years ago to support one's arguments probably isnt wise.

KLDAVIS said...

DADvocate said...
"Who in their right mind go through all the education and training necessary to be a doctor if they couldn't make a good living? A few, I'm sure but not many. Not many good ones, they'd go into another, more lucrative field."


Oh, give them time. They'll make all of those jobs equally unattractive.

Donald's Designated Driver said...

Personally, I'm glad that our President has the balls to take on Big Tonsil.

AJ Lynch said...

Kldavis said:

"Oh, give them time. They'll make all of those jobs equally unattractive."

That is Obama's goal IMO.

Bob From Ohio said...

Roost said: "Man gets hurt at work, repetitive stress injury to his back."

That is worker compensation which is a government mandatory insurance program.

Not a great argument for single payer as cutting costs.

DADvocate said...

KLDAVIS - too true, unfortunately. But, then some smart people, doctors, etc, will move to other countries where the financial rewards are greater. My doctor, and his wife also an MD, came to the U.S. from another country about 15 years ago because they could enjoy a higher income/standard of living. And, if some other country is smart enough, they'll create a welcoming climate for doctors and other needed professions.

Roost on the Moon said...

Not a great argument for single payer as cutting costs.

And not intended as such. I don't know how to fix healthcare. But I do know that ridiculing Obama for identifying a real and major problem exposes bad faith on the part of the WSJ.

chuck b. said...

The doctor recommended a tonsillectomy for my partner's sleep apnea but said it would be "incredibly painful". We haven't decided.

ironrailsironweights said...

The one-second rule for whether or not to take health care cost-cutting initiatives seriously:

Do they mention litigation costs?

If the answer is 'No', you can go back to doubting every self-serving hypocritical word.


The one-half second rule for whether or not to take health care cost-cutting initiatives seriously:

Do they mention outcome-based rationing?

If the answer is 'No', you can go back to doubting every self-serving hypocritical word.

Sorry folks, but spending enormous amounts of money on heroic treatments to extend the lives of dying people a few weeks or even days (e.g. heart surgery on a senile 95-year-old with multiple organ failure), when the quality of life and chances of long-term survival are both zero, is absurd and barbaric.

Peter

Chris said...

"Personally, I'm glad that our President has the balls to take on Big Tonsil."

Isn't he standing up against the mercenaries who would remove them unnecessarily? Seems he's in bed with them, not taking them on.

Pogo said...

Here are some salient Friedman comments from the YouTube video above:

FRIEDMAN: "What is greed? Of course none of us are greedy; it's only the other fellow who's greedy. The world runs on individuals pursuing their separate interests. … In the only cases in which the masses have escaped from the kind of grinding poverty you're talking about … they have had capitalism and largely free trade. … So that the record of history is absolutely crystal clear: that there is no alternative way so far discovered of improving the lot of the ordinary people that can hold a candle to the productive activities that are unleashed by a free enterprise system."

When Phil Donahue bemoaned that capitalism does not seem to reward virtue, Friedman responded:
"Is it really true that political self-interest is nobler somehow than economic self-interest? … Just tell me where in the world you're going to find these angels who are going to organize society for us? I don't even trust you to do that!"

AJ Lynch said...

I bet you could count on one hand the number of times open-heart surgery was done on a 95 year-old senile patient with multiple organ failure.

AJ Lynch said...

Yeah Friedman killed Phil Donahue on that video.

But you know what? Donahue did not learn a thing from it.

save_the_rustbelt said...

Actually, there are some physicians who do way too many tonsilectomies.

(Actually, they are usually ENTs or general surgeons)

Many of them are minority physicians serving urban, heavily Medicaid minority populations.

I doubt Obama would talk about that.

Paul Zrimsek said...

When the House finally has a bill ready to go they should name it the Gulf of Tonsil Resolution.

AlgonquinS said...

"You'll take my tonsils when you pry them from my cold dead throat!"

Famous speech from the
National Tonsil Association.

Kirby Olson said...

Now that he's alienated all the police unions, he's going to alienate all the physicians.

Who's next?

Truck drivers? Longshoremen? Secretaries?

He has a lot of very bizarre prejudices. He hates hunters, and religious people, and the mentally retarded. Add to that the police and now, physicians.

Who doesn't he hate and suspect of fraudulent behavior?

AllenS said...

"Who doesn't he hate and suspect of fraudulent behavior?"

Skippy Gates.

tim maguire said...

By selling his health care bill as a budget cutter, he's not being all about the money, he's indicating he thinks we're all about the money (that it is the aspect we will find most persuasive). The tonsil story lets us know what he thinks of people who are about the money, indirectly letting us know what he thinks of us.

Jason (the commenter) said...

For me, this was one of the best press conferences I have seen in a long time. I think the President did an excellent job and every Conservative should be applauding him.

His dissaproval rating went up 5%, people stopped talking about health care, and if the health care plan now fails, no one will be able to blame the Republicans.

I may put an Obama sticker on my car.

More press conferences please!

Bob From Ohio said...

"And not intended as such."

Then what is the point?

It is not a health insurance corruption example at all. It is an example of a corrupt government program that only in part involves a doctor.

Just Lurking said...

"He has a lot of very bizarre prejudices."

Twenty or so years of listening to a nutjob like "crazy uncle" Rev. Wright, just might do that to a person.

BJM said...

Obviously Michelle handles the medical care for their daughters as Obama hasn't a fucking clue.

Bruce Hayden said...

Here are a couple of comments about tonsils: Instapundit, and Jennifer Rubin at Commentary. Both make the point that too many tonsillectomies may have been a problem a generation or so ago, now the problem is probably just the opposite, too few.

Rubin ends with the observation: "So we shouldn’t personalize the criticism of Obama’s medical illiteracy. It is not any failing of his. It is simply impossible for all medical knowledge and the needed wisdom and flexibility to treat 300 million people to be dispensed from Washington. That’s why we shouldn’t try. And that’s as good a reason as any to junk ObamaCare and start over."

avwh said...

"For me, this was one of the best press conferences I have seen in a long time. I think the President did an excellent job and every Conservative should be applauding him.

His dissaproval rating went up 5%, people stopped talking about health care, and if the health care plan now fails, no one will be able to blame the Republicans.

I may put an Obama sticker on my car.

More press conferences please!"


Post of the day, Jason (the commenter)!

Bruce Hayden said...

Yes, there is some amount of actual medical fraud. And some of it is probably in response to some doctors believing they are getting screwed by the current system. Medicare right now expects a lot of GPs to work essentially below cost on Medicare patients. Add in all the extra paper work that they need to have filed, and it looks a bit grim from the point of view of a lot of physicians, and esp. GPs.

And, yes, there are greedy docs. Back 40 years when I was in college, the only place where our honor code really broke down was with the pre-meds. And some of those pre-meds later became doctors, and did it for the money.

But there are plenty of easier ways for the best and brightest to make a good, if not great, living these days. One way to maybe better use that pre-med major is to go to law school, and then sue those poor suckers who did go on graduate from med school for malpractice. In many states, that is much more lucrative.

holdfast said...

Take my tonsils, please!

Seriously, despite repeated bouts of severe tonsillitis as a kid, I was not sick quite frequently enough for the overlords of Canadian healthcare, and so these stupid things are still causing me all kinds of trouble. I need to find one of Obama's greedy doctors to get them out before he bans the procedure entirely - do you think he has a list I could borrow?

Pogo said...

Yesterday I successfully persuaded another smart young man away from going to medical school. Once he understood the economics of paying back $150K-$200K in student loans while taking no income for four years, and then limited income for 3 to 10 years of additional training, and facing massive Medicare cuts with reduced payments for the commercially insured, he saw that he'd be better off playing video games all day.

He would have made a good doctor, perhaps. But score one for socialism.

Pogo said...

I have made it my own little mission to dissuade as many people as possible from going into medicine.

Unless they're already rich, then sure, donate your services.

BJM said...

Just heard an ABC news item that the obese are pushing up health care costs at an alarming rate.

Thus far Obama has insulted doctors and frightened seniors trying to sell Obamacare. Fat people are today's target health care cost demographic.

It's going to pretty crowded out there on the ice floes.

btw-One cannot help but wonder if Obamacare/IMAC cost-bending exclusions will inadvertently create a higher percentage of untreated Americans than under the current system.

LarsPorsena said...

Cook:

"..because the real problem with our health care system is not corrupt doctors but for-profit insurance companies..."

Yep!, like for-profit life insurance companies , the for-profit car insurance companies, the for-profit
home insurance companies, the for-profit business insurance companies, etc., etc. etc.

Damn those for-profit companies. If it wasn't for them the millenium would have arrived by now.

blake said...

As someone who has worked on health care fraud cases, let me just say, doctors do abuse the system for kickbacks and it is widespread.

As it will be (and is) in a government-run system.

You can develop a system that constantly rebalances the three in realtime, producing better outcomes than just leaving things be.

Others have pointed out the free-market is such a thing, but I know you meant a system within an organization. If you such a system is possible and you could convince an HMO of that, you would be a very person indeed.

You may think that Obama doesn't have the answer. But then argue that! Don't poison the well by pretending that everything works fine.

The problem with that logic is that it basically gives the government carte blanche to control anything, on the basis that "everything isn't fine".

There is no human endeavor of any scale where "everything works fine". And the problem ain't the system.