Doctors warn of trouble

In the nation’s capitol for what was billed by Las Vegas obstetrician-gynecologist Dr. Richard Chudacoff as the Million Med March, the group was a long way from a million: an estimated 200 showed up at a small park named for the first chief justice of the United States, John Marshall.

But like Chudacoff, whose angry June letter to a medical Web site became the catalyzing manifesto for this event, they believe interference in health care by government and insurance companies has all but destroyed the physician-patient relationship.

"We’ve been dealing with no-good fascists for 40 years," said Dr. Raveendra Suryadevara, a Las Vegas psychiatrist. "That’s why we can’t blame how we feel on President (Barack) Obama."

The doctors promise, however, far more troubling days are to come in health care should the reform legislation now being considered in Congress get passed.

Doctors wearing lab coats at the two-hour event gave speeches, handed out petitions and distributed information to take to their representatives in Congress. Some patients even made cross-country treks to show their support.

"Massive new government intervention, billions of dollars of new government spending and regulation" aren’t the answer, said Michigan surgeon Dr. Richard Armstrong. "The problems will only be multiplied, and it will be more difficult for physicians and patients to navigate an already overly cumbersome system."

Up to $400 billion a year, they said, can be saved by implementing malpractice reform. They argued that doctors currently request test after unneeded test to protect themselves from lawsuits.

What can work better for both physicians and patients, they said, are portable health care savings accounts, an alternative to comprehensive health insurance that provides people a different way to pay for their health care that doesn’t tie them to a job or an area of the country.

This fee-for-service model places the responsibility of medical costs initially with patients, up to a certain limit, with the government offering a high-deductible insurance plan to cover any catastrophe.

Critics of the accounts, first established under President George W. Bush, have said in the past that, because of the out-of-pocket expenses, the accounts favored those with higher incomes and healthy lifestyles.

Armstrong said that the government could provide funds for such accounts for those of limited means.

"We need to move to a model where each patient owns their insurance," Armstrong said. "So that it’s always with them when they move or change jobs."

No longer, the physicians said, should insurance companies enjoy monopolistic control in states.

To bring about better patient care, Congress should be working to see that patients aren’t stopped from seeing their doctors of choice because of a change in health plans, Chudacoff said in a speech.

And he said Congress should eliminate pre-authorization for treatments and limits on total patient visits or follow up visits.

"Why should I be debating a bureaucrat about health care?" he said. "If we deem it necessary that a test has to be given, we shouldn’t have to fight for it. We do it because it is right."

Health care attorney Jacob Hafter, a key figure in the current medical assistant battle going on in Nevada, said in his speech that physicians have brought some of their problems upon themselves.

Going back decades, he said, some physicians charged insurance companies too much for care. And so President Richard Nixon came up with Health Maintenance Organizations to counter the increasing costs.

Had physicians done the self regulation that was necessary, then there wouldn’t be so much government intrusion today. Hafter said physicians had a chance to stop the HMOs, but they didn’t want to get involved.

Dr. Alexander Sapega of New Jersey worried that a lack of involvement was still present.

"I wish we had more people here," he said. "This is so important."

But Chudacoff was upbeat after the event. "We’ll be heard where it counts," he said.

"It’s hard to believe everything got so out of hand," said Dr. Patrick Abuzeni, a Florida surgeon. "But maybe we started doing this in time so things wouldn’t get worse. If we have to jump through more hoops to do the right thing for patients, I don’t think I could take it."

Dr. Mark Berg, a 51-year-old physician from Virginia, literally couldn’t take it. He said he quit his practice last year.

"I was tired of being second guessed by someone in insurance companies who knows nothing about medicine," he said.

Rep. Tom Price, R-Ga., promised in his speech that his bill, the Republican answer to the Democratic bill now moving through Congress, would address most of the concerns of the physicians who showed up to protest.

After the speeches Thursday, many of the doctors went to see congressional representatives from their respective states.

Chudacoff had taken that step a day earlier, visiting Reps. Shelley Berkley and Dina Titus, both D-Nev.

It didn’t take him long to realize that Berkley is up on the subject.

"You can imagine what going to the dinner table is like now when you have a doctor for a husband and a doctor for a stepdaughter," she said as she welcomed Chudacoff to her office. "I almost loathe going to dinner."

Berkley’s husband, Dr. Lawrence Lehrner, is a kidney specialist in Las Vegas while her stepdaughter, Dr. Stephanie Lehrner, is in a Southern Nevada family practice.

Chudacoff, generally one of the most vocal critics of politicians, spent much of his time in Berkley’s office nodding in agreement.

"I know that we have to do something about the reimbursements doctors are getting from Medicare and insurance companies for their work," she said.

Later, sitting in Titus’ office, Chudacoff said that physicians have largely been left out of the health care reform debate.

Titus noted that the American Medical Association has been supportive of much of the publicized reform efforts.

"The AMA doesn’t really represent doctors," Chudacoff said.

An AMA spokeswoman said 250,000 of the nation’s 940,000 doctors are AMA members.

"Well, what would you like to see?" Titus asked.

Chudacoff brought up the fee-for-service model.

"When people are more responsible for their health care, they take better care of themselves," he said.

Many doctors, Chudacoff said, will leave the profession if more government intervention in health care becomes the norm.

As it is now, he said, insurance companies will authorize procedures, but often the same companies later determine the procedures were not covered and do not reimburse physicians for their work

"It’s only going to get worse with more bureaucracy," he said, adding that he might quit the profession.

"I hope not," Titus said.

"Doctors are smart enough to do other jobs," Chudacoff said. "Some of us could even be a congressman."

Contact Review-Journal writer Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.

 

 

PHYSICIANS SPEAK OUT

 

"The whole profession is now in the hands of bureaucratic bastards. We can no longer give the treatment we want. We have to ask some bureaucratic bastard if it’s OK. It’s insane."

DR. RAVEENDRA SURYADEVARA

psychiatrist, Las Vegas

 

"If your child’s life depended on an emerging technology … should they die if that new treatment hadn’t yet made it into the policy and procedures manual? Doctors are experienced and capable of making these difficult decisions. Bureaucrats and bookkeepers are not."

DR. BLAKE MOORE

general surgeon, Columbia, S.C.

 

"We now have one insurance administrator per two physicians" in the United States.

DR. PATRICK ABUZENI

physician, Coral Gables, Fla.

 

"We need to move to a model where each patient owns their insurance, so that it’s always with them when they move or change jobs."

DR. RICHARD ARMSTRONG

general surgeon, Newberry, Mich.