Meandering Out Loud

Don Thorp’s Musing, Muttering, and Mischief Along a Random Path

Politicians, Manipulation, and the Healthcare Problem

In general, I’m not a big fan of politicians. I know they’re a necessary evil but I am troubled when they step over the line and over simplify and possibly just misstate facts just enough to inflame support for their position, whether their position is right/wrong, good/bad is immaterial.

What I’m not trying to do with this post is bash Obama, it is just an example of the type of speech that bothers me. Take a look at the two paragraphs below. This link was brought to my attention by @repeatnone. I have included the link to the original letter, so please read it.

Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.

Three weeks ago, the President suggested that a surgeon’s decision to remove a child’s tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what’s right for the patient.
- Excerpted from http://www.facs.org/news/obama081209.html

Let’s examine the statement in the first paragraph. Anyone who has looked at an EOB (Estimate of Benefits, if you have insurance) knows that $50,000 does not go to one individual doctor and the amount that insurance reimburses the doctor is typically nowhere near the initial invoice amount. A portion goes to the hospital, the anesthesiologist, re-sterilizing instruments and the operating room, etc. It’s an over generalization that might lead someone not inclined to question blanket statements to take it as fact and spread the wrong message.

I have not read or seen the entire town hall transcript so I am definitely NOT trying to say it was deliberate. It could have been over simplified by an aide or later explained in full. I’m just trying to point out the danger in that type of statement. Although it’s for a smaller amount of money, the doctor asking to be paid amount X but agreeing to accept amount Y is no different than a grocery store asking you to pay X for canned goods, but will accept Y if you have a coupon. That part of the statement refers to a simple business transaction that many of use are very familiar with. It seems worse because the quoted invoice amount in absolute terms is so much more than a can of beans that it immediately invokes anger at the greed of the “doctor” to bill that amount.

Which brings us to paragraph two. Assigning intent to a group of people which implies that all members of that group have that exact motivation and can have no other motivation for the given statement. There are many ways this type of statement can be expressed. We all know that very few things in life have only two possible outcomes commonly described as black and white. Most everything in we actually deal with in life is probabilistic or shades of gray. Sometimes we only have horrible choices where we try and select the least horrible choice when we have to make a choice on the issue.

One of my favorite examples is when someone says “You always” or “You never”. Firstly, how many times is that ever true of anyone or any situation. Even trained dogs don’t always do the same thing. This statement usually appears during an argument when you want to inflict emotional damage to make a point. It’s hardly ever constructive.

To make a blanket statement that ascribes greed as the only motivation for a doctor to remove a child’s tonsils is no better than saying every American is just like George Bush, Bill Clinton, or insert any other person in the country here. We all know there are extremes where some members of a population may have that characteristic and we will probably admit, if we’re not being lazy, that there are many other people in that population that don’t exhibit that characteristic, in fact it’s probably a large portion of the population in question.

Finding a solution for healthcare in this country is a complex problem that by its very nature cannot be simplified to single one size fits all solution. I’m going to make some statements about why I believe this is true and I hope you’ll put together your own list and or help me extend or reduce mine.

1) As a nation we do not have unlimited resources to throw at this problem. We already have more programs than we can fund and we do not seem to have the collective will to cut any existing programs.

2) Doctors on average come out of school $100,000 in debt (http://www.studentdoc.com/medical-school-loans.html). I did not look up the statistics for other healthcare providers, but I’m assuming that it’s non-zero. Do we really expect healthcare professionals to not be responsible and not pay off the debt or strive to achieve the American dream?

If you want best in the world medical care the people in that profession must have the ability to compete and gain personally from their efforts. How many of you would honestly say you’d be willing to have your pay capped indefinitely regardless of your expenses, abilities, and effort you put towards the task.

3) People expect doctors to be perfect in a profession that is not always predictable. Part of the existing problems we face is due to the litigious environment we have created. If any person is truly negligent or willfully deceives others then the full weight of the legal system should be brought against them. Another part of the problem can be ascribed to the medical profession, because they do not actively remove members that have demonstrated that they are incompetent. Another issue is the number of people who sue because they didn’t get the outcome they wanted. Things go wrong in biological systems that sometimes can’t be anticipated or corrected no matter the skill of the professional.

4) Many people don’t want to change their lifestyles to reduce their total medical burden. Many of the diseases that we currently face in this country can be attributed to lifestyle. People expect to be able to be sedentary, eat whatever they want, smoke, drink in excess and then have the best medical care in the world fix them when something in their body goes wrong due to that lifestyle. I believe deeply that people have the right to live how they want, but I also strongly believe that actions can have consequences and we can’t always be absolved from them at any price.

In closing, because I’ve expanding this post enough already. This problem is not going to be fixed by political grandstanding, fear mongering, and taking sides as if it were a sporting event. I think the number of people in this country that do not want to see everyone have access to quality health care is small and maybe even non existent. And if asked do you want your friends to have access to quality care and then extend that answer to those friends, pretty soon you’ll have covered everyone in the nation.

Take a stand against speech that tries to polarize or over simplify the problem into a sound byte. Act locally so it can spread nationally. Acknowledge it for the complex problem that it is and then roll-up your sleeves and to try and help foster an environment where we can constructively build a system that we as a nation will be proud of that meets the needs of all of it’s citizens, including your elected officials.

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Date
August 15th, 2009

Author
Don Thorp

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5 Responses to “Politicians, Manipulation, and the Healthcare Problem”


  1. Richard says:

    Don,

    Good points all, but you’re swimming against a strong tide here. What politicians and media want to do is exactly that: reduce large, complex problems to sound bites. And, by and large, that’s what people want these days. Give me a 2 sentence summary of both sides and I’ll choose the side that hits me the best. Interesting new book you may enjoy if this phenomenon is of general interest to you: “Empire of Illusion: The End of Literacy and The Triumph of Spectacle” by Chris Hedges. Short (approx 200 pages), to the point and so brimming with truth I’m on my 2nd reading.

    Richard B.

    • Don Thorp says:

      Thanks for the book pointer. I’m adding it to my reading list. I realize most folks want sound bites, but I felt like I had to at least shout into the wind and not just stay quiet.

  2. Ryan says:

    I agree and get extremely frustrated when I hear over simplified and what appears to be intentionally misleading statements like that. What makes it worse is knowing that a vast majority immediately interpret those statements as truth and that’s where their interest on the topic stops.

    I think on the healthcare debate though no one side is free from those politically motivated statements yet my unfactual and far from scientic tally defintly has Obamas opponets leading the incorrect and misleading statment race by a landslide.



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