Hope and Fail

More lying in Portsmouth: Greedy doctors now want your limbs

Three weeks ago, President Obama accused the nation’s doctors of performing unnecessary tonsillectomies in order to pad their pockets. During his town hall meeting yesterday, the president continued the accusation, except now accusing doctors of going after our legs.

From the White House transcript:

All I’m saying is let’s take the example of something like diabetes, one of — a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family — if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 — immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. (Applause.)

This morning, the American College of Surgeons once again took the president to task:

The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight.

* 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.

We agree with the President that the best thing for patients with diabetes is to manage the disease proactively to avoid the bad consequences that can occur, including blindness, stroke, and amputation. But as is the case for a person who has been treated for cancer and still needs to have a tumor removed, or a person who is in a terrible car crash and needs access to a trauma surgeon, there are times when even a perfectly managed diabetic patient needs a surgeon. The President’s remarks are truly alarming and run the risk of damaging the all-important trust between surgeons and their patients.

Also, this afternoon, the American Medical Association, which has endorsed the health reform bill in the House and was pretty mum about the tonsil comments, piled on:

The AMA contacted White House staff last night to again express strong concerns with some recent medical treatment examples used by President Obama. We’ve made it clear that physicians are extremely dedicated and focused—first, foremost and always—on providing care that best serves their patients.

We agree with President Obama on the importance of prevention. However, a recent example used to illustrate his important point was misleading. Surgeons are not paid $30,000 to $50,000 to amputate a diabetic’s foot. Medicare pays a surgeon, on average, from $541.72 to $708.71 for one of two procedures involving a foot amputation. It is possible that the total bill, hospital stay, rehabilitation, prosthesis, etc. may approach the larger amount mentioned.

In the case of tonsillectomies, a patient is referred to a surgeon after medication therapy has proven to be ineffective. Actually, the medical profession itself recognized questions about utilization and appropriateness of tonsillectomies and took action by developing clinical guidelines, which has resulted in a sharp decline in the rate of tonsillectomies.

These types of examples create the impression that physicians are motivated by payment levels rather than what is best for patients. The AMA will continue to stress to our elected leaders that physicians are dedicated to putting patients first and optimizing health care quality.

Can someone explain how attacking — inaccurately — health care professionals gets the country any closer to health care reform?

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