The issue of MJ’s death bothers me not because I was a huge fan. No! I loved his earlier work but I recently realized I don’t have any of his albums! ….and believe me, I collect! It bothers me because it shows physicians behaving badly.

This guy was one using several aliases to get narcotics and propofol, and no one noticed or tried an intervention! My only explanation is that the money all the physicians were getting bought their silence and compliance! How sad!
Another issue that bothers me is the fact that MJ was using propofol like water! But then there are lots of non-anesthesiologists who demand to use the drug and will probably not appreciate it’s effects.
The practice of anesthesia is a not something one dabbles in. There are peoples’ lives at stake. I know there is a perception out there that “we just put the patient to sleep”! Well, someone just put MJ to sleep, this time eternally!
We as a profession may also have contributed to this perception. True, there is a lot of downtime during certain cases but the probability for loss of life is ever present. Less if you are dealing with healthy, young adults having elective surgery but much higher with the old and very sick.

So we as a profession always stay vigilant. We understand the medications we use, know their effects and appreciate the possible complications. We get to know our patients as well as a physician should and tailor the anesthetic to their needs, the surgical procedure and their general health status. Most important of all, we try TO DO NO HARM! We will not provide an anesthetic for a patient if the anesthetic will endanger his life and the surgery is not life-saving. We will not provide anesthesia at places where we feel the we will not be able to support the patient’s if he needs cardiopulmonary resuscitation.
Of course there are exceptions. If one works in developing countries, one makes do with what they have in equipment and supplies. Then also, there are anesthesia providers who may not be conscientious, but that is the minority.

So it bothers me to see how easily our practice was mimicked to someone’s detriment. We don’t know the details yet but a non-anesthesia provider thought administering propofol in someone’s home without the necessary support and know-how was a piece of cake.
Whoever you are I have news for you – IT AIN’T EASY!

I am a staunch believer in establishing health savings accounts (HSA) as the way of financing healthcare.

How will it work?

Each person gets an account very much like a retirement account. Pretax deductions – paid by employer and employee are paid into this acount. The only thing the money in this account can be used for is buy health insurance, pay medical bills and/or the costs of preventive services like gym fees. Like social security, everyone would be mandated to have one over a certain age.

With this account, one would either decide to pay fee-for-service and/or buy insurance to cover certain needs or for all health needs..

For example, a healthy 28-year-old man may decide to forgo any kind of insurance and pay as needed since he has no demanding health needs or he may buy insurance to cover emergency surgery. A 28-year-old woman may decide to buy insurance to cover OB/GYN needs if she desires to have kids. An older patient may have other healthcare needs. What this does is, it allows people to spemd their healthcare dollars based on their needs while saving if they basically are healthy. The money that is not used rolls over year after year and can be invested.

The health insurance marketplace would have several levels of insurance. From insurance for preventive care to insurance for major surgery and chemotherapy. Hospitals and physicians would have to affordable fees for their services, allowing patients to shop around for elective services.

What happens to the unemployed as well as in cases where care exceeds the amount saved?

That is where the government comes in. Even in those cases, they do not provide the care – the government subsidizes the care of these patients. They pay a percentage. Instead of a blanket insurance for all, the government is able to selectively help those who need it.

As I wrote in 2007, such a system

• forces the population to take better care of itself,
• makes the patient directly responsible for health-care decisions,
• induces a market-style competition between health-care providers which will ultimately lead to pay-for-performance and lower prices and
• saves for the latter years when the majority of healthcare dollars are used.

Now I  am sure those opposed to this idea will pick this apart. Well let’s have a discussion.

The country is in the grip of a healthcare debate that is split unfortunately along party lines. No matter what changes are made, there are certain attitudinal changes that the population has to make or we’ll be worse off than before.

Before all that, there is one question for which I cannot find a good answer.

Is healthcare a privilege or a right?

There is nothing in the constitution about that. Now in the Declaration of Independence, we read: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” That is the closest we come to healthcare being a right. Now prisoners have it good because they receive free healthcare because it is seen as an obligation of the state to them!

If the constitution does not guarantee it, then any argument for or against is just that – an argument!

Congress must then decide whether to pass this as a law or not. If healthcare is a right, all efforts must be made by the government and businesses to ensure that all have adequate access to healthcare. If it is a privilege, that totally changes the stakes. Then, anything the government or businesses want to do is subject to good will and policy.

My feeling is whereas a majority of liberals see healthcare as a right, many conservatives and libertarians see it as a privilege!

As I said earlier, regardless of what happens, the population needs a huge attitudinal change to make any form of healthcare policy work.

1. Prevention is better than cure.

This is an old saying and it has stood the test of time. Yearly checkups, mammograms, staying active, eating healthy are little things that go a long way to keep one healthy and prevent that severe illness and fat bill from the surgeon! It seems to be an anathema these days. It’s get sick, then rush to the ER! Even people with good health insurance are guilty of this. Whatever type of policy is decided on, it should mandate yearly visits to a physician and quarterly visits to a dentist! Europeans tend to be healthier for several reasons – one is the fact that they have very good preventive healthcare.

2. Each is responsible for his/her health

Just as I am responsible for my car’s upkeep, so am I responsible for my body, mind and soul. If my car’s engine burns out  because I forgot to fill it with oil, I cannot blame my mechanic if he can’t fix it. The repair is usually so expensive, most people don’t consider replacing the engine. On the other hand, if one eats uncontrollably, drinks and smokes and ends up in the hospital with heart failure, the expectation is that the doctors should fix him to be as good as new! Consider a scenario where each citizen controlled his/her own healthcare dollars. You paid for every procedure, visit, test etc or you bought the insurance to pay for these services. It would make people  more cognizant of the cost of not taking good care of themselves. I believe there should be an added cost for being obese, for smoking  and/or drinking and for not getting yearly checkups. If a young man decides to go riding his motorcycle even though his blood alcohol level is in the stratosphere, any care he subsequently receives after he wrecks his bike should come out of his pocket. In short, be responsible for your health.

3. Don’t forget the baseline

We live in the age of Viagra, where sex is possible for the older generation. Age does not seem to be much of a hindrance anymore. In 2007 a 60-year-old woman delivered twins in New Jersey. Last year, a 59-year-old delivered triplets in France! We keep pushing the limit. It is no surprise that patients expect nothing short of miracles when they show up in the hospital. Expectations are so high that, it is not uncommon that both doctors and patients seem to forget the baseline. A diabetic who has  uncontrolled blood glucose for years is not going escape unscathed. If he/she shows up with a gangrenous foot, that limb has to be amputated and their mobility is going to be compromised. This reduces physical activity and increases the already high chances for morbidity. Don’t forget the baseline!  It is sad to loose patients to cancer but terminal cancer is in most cases, well, terminal. Heroics just lead to even greater disappointment and pain. Don’t forget the baseline!

4. Let there be Dignity in Death

Maybe it’s cultural, maybe it’s the wish not to loose a loved one but millions of dollars are spent every year in the care of patients who should have been left alone to die in dignity. It may be that the patient is too old and frail to survive a surgical procedure or that a particular test won’t add anything to the attempts to save a loved one. Time and time again, family members insist on having everything done. They are not alone in this. Physicians are apt to give them false hope. There is the need among some doctors,  to look like the knight in shinning armor who swooped in and saved the day. Then is the small matter of litigation attorneys who circle like buzzards. It is much more dignified to let a death occur with family members (after the requisite goodbyes) than alone in some hospital room with the body flayed open and expectations crushed! I agree, death can strike anytime but if one has the chance to prepare for it, isn’t that a bonus for the family and loved ones? Lets accept death when it’s inevitable  – we’ll afford family members and patients dying in dignity and save countless healthcare dollars.

Healthcare resources are not infinite. Lets use what we have wisely!

In yesterday’s edition of the WSJ, Jonathan Kellerman, a noted author and clinical psychologist wrote an opinion piece entitled the “Health Insurance Mafia.”

I thought this article was somewhat simplistic but all the same interesting because it shows a way out of the Healthcare mess. It points to the fact that the route out of all this might be through Health Savings Accounts.

Please click here to read this article.

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