I am convinced that President Obama is ignorant–not generally, but about how medicine is actually practiced. Recall when he defamed pediatricians by claiming that some perform unnecessary tonsillectomies for the money, apparently unaware that a child’s primary care doc would not be the actual surgeon in such cases. Then, there was the “red pill versus blue pill” nonsense.
Well, now he’s done it again. The other day, the president issued a rambling 17 minute non answer to a woman in a crowd questioning the wisdom of Obamacare and claiming that we are over taxed. That would usually be beyond our scope here. But part of his answer reveals that he still doesn’t know how medicine is practiced in the real world. From the transcript:
And it turns out that a lot of times, you know, if you go to the doctor, you get one test, then you go referred to a specialist, you get another test. Then maybe you go to a third person, the surgeon, you get a third test. It’s all the same test, but you’re paying three times. So what we’re trying to say is, we’ll pay you for the first test, and then e-mail the test to everybody.(LAUGHTER)(APPLAUSE)Right? Or…(APPLAUSE)… or have all three doctors in the room when the test is being taken. But — but that’s an example of the kinds of things that save money and will start reducing costs over the long term. So what we’ve done is we’ve embedded in how Medicare reimburses, how Medicaid reimburses — all these ideas to actually reduce the costs of care.
What? Doctors routinely share test information today. And even if the same test was performed repeatedly, POTUS’s hypothetical scenario would not necessarily be useless redundancy–which would not be paid for by health insurance in any event–but would take place over weeks or months to ensure that each doctor in the chain of diagnosis and treatment has up-to-date information to best care for the patient. Moreover, follow up tests are often not be the same, but may be increasingly sophisticated to better identify the problem. And why would you want all three doctors in the same room for the test, particularly if the first test was what identified the need for further inquiry? Does he think doctors are clairvoyant and know that a test will be required by three physicians practicing different specialties?
Utterly nonsensical. President Obama still doesn’t know what he is talking about when it comes to actual medical practice.
April 6th, 2010 | 1:13 pm
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April 6th, 2010 | 2:13 pm
We shouldn’t be surprised. I don’t know if you caught this one, Wesley, but POTUS also _still_ (at his age, and as one of the most powerful men in the world) appears not to know the difference between minimal auto insurance to cover other drivers, required by most states, and comprehensive auto insurance. He literally told a story, still indicating a sense of grievance after all these years, about how in college his car was damaged in an accident and his insurance would not cover it. He discovered that he had had only the state minimum coverage. Yet instead of realizing that this meant that, as a young man, he hadn’t informed himself about his policy and thought he was entitled to more coverage than he had purchased, he concluded that the insurance company was somehow deceptive or sneaky, and he *still talks like this today*. It was embarrassing. It is embarrassing, like so many of these crazy comments about health care. He is just uninformed about these practical matters, more uninformed even than most ordinary people who have used the services he considers himself qualified to hyper-regulate. It’s frightening.
April 6th, 2010 | 2:34 pm
Of the many ways that people try to attack Obama, the worst way is to try matching wits with him. As always he is absolutely right. Administrative costs of health care increased by 30% during the lost years of Bush! Medical records management in the US is hopeless, and worse outsourcing of Medicare records management to mercenaries – oops! I mean contractors – has made matters worse.
But this is definitely interesting. For the first time a POTUS has owned up what a whole bunch of denialists haven’t. The US has ht eworst healthcare system among developed countries. Administrative inefficiency is why it is so expensive.
April 6th, 2010 | 2:49 pm
I agree with you, Mr. Smith, completely. Obama rarely listens, and if one is to have a dialogue, one must start to listen first. I hope this is not too presumptuous of me but let me share a short essay I wrote about exactly that (Obama and dialogue) a few months ago. You may peruse it if you’d like to: http://ethicsaesthetics.blogspot.com/2010/02/is-anybody-listening.html
Thanks!
April 6th, 2010 | 3:12 pm
Wes: “What? Doctors routinely share test information today. ”
I wish that were true. But lack of a homogenized medical database means that transfers are awkward. I personally have had to walk x-rays and MRI’s from one provider to another. On one occasion I had to REPEAT an x-ray because they couldn’t exchange info.
I also had to teach one provider a computer trick so that his system would show the tests I had done on another provider’s system, even though they were already linked up.
BTW, the systems these providers use are considered state-of-the-art today.
HIPAA has inadvertently made this worse, since medical administrators are scared to death they’ll reveal something they shouldn’t and they’ll get whacked. Ever try to get an administrator to take a risk?
One of Obama’s goals is to get medical records standardized, and if he succeeds I guarantee you it will save lives.
April 6th, 2010 | 4:16 pm
Obama displaying ignorance. Wow, talk about the pot calling the kettle black.
Obama is correct. Many in the practice of medicine have seen repeated tests (sometimes necessary, sometimes not) as well as over zealous docs referring unnecessary procedures to their buddy docs so both can get their hands in the vault (anyone been reading what’s going on medicine in Texas?). I’m skeptical that it’s very common as a percentage (except in Texas), but it occurs – happened to a patient I know just this very week.
We’re fortunate to have a rather bright and intelligent individual as our president.
This post reveals the extreme intellectual poverty that has befallen the foes of health care improvement through reform. (many of whom were already swimming in the shallow end of the thinking pool) At this point, they are grasping at any tenuous straw they can find or invent and speculating to support their foregone conclusions. This is a rather weak complaint against a lengthy answer. It guess it’s just getting that much harder for the muckrackers to do their job; or they are just that bad at doing their simple job.
A rambling, non-answer?
Obama’s answer was complete, logically sound, and appropriate.
If one doesn’t understand it because it’s not spoon-fed, lacks elementary catch-phrases, references to guns, lower taxes, guvment, god, bible verses, or patriotism, that’s their problem. Complex issues require complex thinking and even more complex answers.
Accept reality and deal with it.
April 6th, 2010 | 4:50 pm
one: tests get lost.
It might be quicker to repeat than to wait for the secretary to find it (we might send the xray report, but the specialist needs the x ray itself).
two: the test might change in the weeks waiting for a specialist.
three: privacy act regulations. if you don’t have the form correct, you could be sued for releasing the data.
and email is not acceptable: No privacy.
Four: Paper work gets lost.
I used to write letters so the doc would know what was going on, but this took time. Even then, it doesn’t mean his secetary put it in the patient’s chart…I had a bad lupus case diagnosed as osteoarthritis/hysteria because he didn’t read my letter that I had started her on methotrexate and prednisone, and put her in remission because it took six months to get a rheumatology referral with a specialist who accepted our IHS/federal system’s low reimbursement.
April 6th, 2010 | 5:39 pm
Five: Sometimes tests need to be repeated because the first test yields questionable results. If you’re going to diagnose a disease and start treatment, you’d better make damn sure the first test wasn’t a fluke.
Example: when my son was having frequent nosebleeds, his pediatrician tested him “just in case” for a kind of hemophilia that runs in my family. Results came back positive and he was referred to a hematologist.
This particular test is tricky and requires careful handling in the lab. So the hematologist repeated the test in an in-house advanced lab, just to make sure. Results? Negative. That second test saved a heap of money in unnecessary health care.
April 7th, 2010 | 3:19 pm
I got tested for Lyme disease three times. the first two were borderline negative.
April 8th, 2010 | 7:56 am
“Utterly nonsensical. President Obama still doesn’t know what he is talking about when it comes to actual medical practice.”
But Wesley DOES?
April 8th, 2010 | 8:58 am
With all the medical info available to the government, it will make it easier for the cost/benefit panel to structure your health care. With the increasing federal debt. I’m sure the panel will decide on the patient’s benifit, yaaahhhh suure.
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