Politics goes at a pace that seems ever accelerating. I lost track of the fact that the former governor of Alaska Sarah Palin had originally coined the term. That term has become a political football as of late as the liberals and the conservatives play that big game to secure popular opinion and more importantly control of our country.

Recently I called Larry Elder’s show in Los Angeles as the subject was being discussed. Surprisingly I got on. To many of us in medicine, the concept of “death panels” is a stretch but not that much of a stretch. Obama Care puts some 30 million Americans who were not insured into the freebie health care the government provides…meaning YOU provide with your tax dollars to someone else. The philosophy behind this rubs many of us the wrong way. How such a move can make medicine less expensive seems like fuzzy math. This President with the popular media in his corner doesn’t often get called on such illogical statements however. Lucky him.

Americans already provide free health care to many who do not visibly pay into the system by way of the disability, MediCal and other such systems. The health care system is already too expensive partially due to over regulation and government control. Adding 30 million new freebie members will make it even more expensive. This is not good for the President who was less than 100% truthful when he stated his system would be less expensive than the one in place currently. The numbers are coming back and it will cost us more. Big surprise.

My point to Mr Elder was that the current health care system already has incentives for lack of care. They are “utilization bonuses” paid by HMOs to primary care doctors for not referring to specialists. As a plastic surgeon, my friends in primary care joke that they get paid to not send patients to surgeons for unnecessary hernia repairs and the like. That is great unless you have that hernia of course. It is not too much of a stretch for a new health care system that plans on adding 30 million non-payers to the mix to try to cut one of the highest costs in the system at present; that of end of life care. Encouraging doctors to “discuss” not choosing to engage in expensive end of life care such as dialysis, artificial ventilation, and chemotherapy was an expected move by many of us in heath care. How far the concept will go is another thing.

On my “call in,” Larry pointed out that HMOs are not the government. That distinction has been blurred however by the link Medicare has allowed to HMOs. Medicare patients are allowed, even financially encouraged, to assign their benefits to HMOs like Scan and Secure Horizons (called Scam and Insecure Horizons by myself and other cynics.) When they do so they get lower premiums at the cost of the loss of choice and ultimately rationed care.

The loss of choice and rationed care are very likely the common denominators in Obama’s fuzzy math. This is how he plans on making health care cheaper. You get less care. Get it?

Best Regards,

John Di Saia MD