I have been sitting quietly on the sidelines watching all of this
national debate on healthcare. It is time for me to bring some clarity to
the table and as your friend by explaining many of the problems from the
aspect of a doctor.
First off the government has involved very few of us physicians
in the healthcare debate.While the American Medical Association has come
out in favor of the plan, it is vital to remember that the AMA only
represents 17% of the American physician workforce.
I have taken care of Medicaid patients for 35 years while representing
the only pediatric ophthalmology group left in Atlanta , Georgia that accepts
Medicaid.Why is this. For example, in the past 6 months I have cared for
three young children on Medicaid who had corneal ulcers. This is a
potentially blinding situation because if the cornea perforates from the
infection, almost surely blindness will occur. In all three cases the
antibiotic needed for the eradication of the infection was not on the
approved Medicaid list. Each time I was told to fax Medicaid for the
approval forms which I did. Within 48 hours the form came back tome which
was mailed in immediately via fax and I was told that I would have my
answer in 10 days. Of course by then each child would have been blind in
the eye. Each time the request came back denied. All three times I
personally provided the antibiotic for each patient which was not on the
Medicaid approved list. Get the point-rationing of care.
Over the past 35 years I have cared for over 1000 children born with
congenital cataracts. In older children and 20 in adults the &nbs p;vision is
rehabilitated with an intraocular lens. In newborns we use contact lenses
which are very expensive. It takes Medicaid over one year to approve a
contact lens post cataract surgery. By that time a successful anatomical
operation is wasted as the child will be close to blind from a lack of
focusing for so long a period of time. Again extreme rationing. Solution- I
have a foundation here in Atlanta supported 100% by private funds which
supplies all of these contact lenses for my Medicaid and illegal
immigrants children for free. Again waiting for the government would be
Last week I had a lady bring her child to me.They are Americans but
live in Sweden as the father has a job with a big corporation. The child
had the on set of double vision 3 months ago and has been unable to
function normally because of this. They are people of means but are
waiting 8 months to see the ophthalmologist in Sweden . Then if the child
needed surgery they would be put on a 6 month waiting list. She called me
and I saw her that day. It turned out that the child had accommodative
esotropia (crossing of the eyes treated with glasses that correct for
farsightedness) and responded to glasses within 4 days , no surgery was
needed. Again rationing of care.
Last month I operated on a 70 year old lady with double vision
present for 3 years. She responded quite nicely to her surgery and now is
symptom free. I also operated on a 69 year old judge with vertical
double vision. His surgery went very well and now he is happy as a lark. I
have been told- but of course there is no healthcare bill that has been
passed yet that these 2 people because of their age would have been
denied surgery and just told to wear a patch over one eye to alleviate the
symptoms of double vision. Obviously cheaper than surgery.
I spent two year in the US Navy during the Viet Nam war and was
well treated by the military.There was tremendous rationing of care and we
were told specificially what things the military personnel and their
dependents could have and which things they could not have. While in Viet
Nam , my wife Nancy got sick and got essentially no care at the Naval
Hospital in Oakland , California . She went home and went to her family's
private internist in Beverly Hills . While it was expensive, she received an
immediate work up. Again rationing of care.
For those of you who are over 65, this bill in its present form might
be lethal for you. People in England over 59 cannot receive stents for
their coronary arteries. The government wants to mimic the British plan.
For those of you younger, it will still mean restriction of the care that
you and your children receive.
While 99% of physicians went into medicine because of the love of
medicine and the challenge of helping our fellow man, economics are still
important. My rent goes up 2% each year and the salaries of my employees
goes up 2% each year. Twenty years ago ophthalmologists were paid $1800
for a cataract surgery and today $500. This is a 73% decrease in our
fees. I do not know of many jobs in America that have seen this lowering
of fees. But there is more to the story that just the lower fees. When I came to
Atlanta there was a well known ophthalmologist that charged $2500 for a
cataract surgery as he felt the was the best. He had a terrific reputation
and in fact I had my mother's bilateral cataracts operated on by him with
a wonderful result. She is now 94 and has 20/20 vision in both eyes.
People would pay his $2500 fee. However20 then the government came in and
said that any doctor that does medicare work can not accept more than
the going rate ( now $500) or he or she would be severely fined. This
put an end to his charging $2500. The government said it was illegal to
accept more than the government allowed rate. What I am driving at is
that those of you well off will not be able to go to the head of the line
under this new healthcare plan just because you have money as no physician
will be willing to go against the law to treat you.
I am a pediatric ophthalmologist and trained for 10 years post
college to become a pediatric ophthalmologist ( add two years of my
service in the Navy and that comes to 12 years).A neurosurgeon spends 14
years post college and if he or she has to do the military that would be
16 years. I am not entitled to make what a neurosurgeon makes but the new
plan calls for all physicians to make the same amount of payment. I assure
you that medical students will not go into neurosurgery and we will have a
tremendous shortage of neurosurgeons. Already the top neurosurgeon at my
hospital who is in good health and only 52 years old has just quit because
he can't stand working with the government anymore. Forty-nine percent ;of
children under the age of 16 in the state of Georgia are on medicaid so he
felt he just could not stand working with the beaurocracy anymore.
We are being lied to about the uninsured.They are getting care. I
operate at least 2 illegal immigrants each month who pay me nothing and
the children's hospital at which I operate charges them nothing also.This is
true not only on Atlanta , but of every community in America .
The bottom line is that I urge all of you to contact your congresswomen
and congressmen and senators to defeat this bill. I promise you that you
will not like rationing of your own health.
Furthermore, how can you trust a physician that works under these
conditions knowing that he is controlled by the state. I certainly could not
trust any doctor that would work under these draconian conditions.
One last thing, with this new healthcare plan there will be a
tremendous shortage of physicians. It has been estimated that
approximately 5% of the current physician work force will quit under this
new system. Also it is estimated that another 5% shortage will occur
because of decreased men and women wanting to go into medicine. At the
present time the US government has mandated gender equity in admissions to
medical schools .That means that for the past 15 years that &nb sp;somewhere
between 49 and 51% of each entering class are females. This is true of
private schools also because all private schools receive federal fundings.
The average career of a woman in medicne now is only 8-10 years and the
average work week for a female in medicine is only 3-4 days. I have now
trained 35 fellows in pediatric ophthalmology. Hands down the best was a
female that I trained 4 yea rs ago- she was head and heels above all
others I have trained.She now practices only 3 days a week.
Zane Pollard , MD