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1. Dear Candidates;
   Iam forwarding a copy of my letter in response to yet another irresponsible poorly balanced newpaper article regarding American healthcare. This one appeared in the NY Times last week and suggested that quality of surgical care would be improved by a kind of free ticket flat rate fee for 90 days of post op care. This is a ridiculous premise for many reasons. Please read my repsonse. I would like a deatailed answer from each of the Democratic candidates regarding this critical national issue in order to make my own voting choices. Most practicing physicians have a wealth of experience regarding the deficiencies in healthcare and would freely offer information and ideas if asked. Yet actively practicing physicians do not seem to be included in most healthcare policy planning. This is a grave mistake; one which the current blizzard of forms, checklists and computerization will never fix. In fact further deterioration is continuing at an alarming rate. Our legislators need to summon the courage to regulate the abuses of the insurance industry before we will see any true change.
   From: Deborah Fein, M.D.
   Date: May 18, 2007 12:33:57 PM EDT
   To: publisher@nytimes.com
   Subject: Surgery With a Warranty
   This is one of several letters I have written regarding your unbalanced reporting of medical issues. I have yet to recieve a reply or acknowledgment to any of my opinions. As physicians no longer seem to have a voice in any societal front, why should The NY Times be any different?
   Your recent article on “surgery with a warranty” is a major additional insult to physicians and our society as a whole.This article reflects many of the malignant healthcare issues driving the most caring physicians to early retirement. Medicine in the US is the most expensive and among the worst in the western world. The free-fall descent of healthcare began when physicians were re- named “providers” (ie equated with PA’s, nurse practitioners, chiropracters and holistic practitioners) and HMO’s came into existence, cramming medicine into a business model. As we all agree, medicine has never been the same since.
   In my opinion, one of the major defects in US healthcare is the funneling of enourmous quantities of healthcare dollars away from healthcare and into insurance CEO’s and investors pockets. Yet these corporate monstrosities, run by executives who belong in jail, are entirely above the law, practice medicine by denial of care and cannot be sued for the fraud that has become acceptable. They promise insurance and deny recommended coverage because they can get away with this theft of service. We are being sold a “Hollywood front” rather than real coverage.
   Have you not noticed the unlimited rise in premiums, associated with continued sharp restrictions in “covered expenses” provided by most if not all insurers? Furthermore have you ever read your Insurance contract which guarantees nothing except the insurers right to deny care. There is no real mechanism for greivance mediation between individual patients involved in disputes with their insurers.
   Mergers such as that between Oxford and UHC on the east coast should be prohibited by law. Such mergers result in stronger monopoly control of these health care giants, who are guilty of repeatedly reducing coverage, fixing prices, and blatantly attempting to drive those labs which will not comply with their price fixing, out of bussiness. In addition they have repeatedly with-held payment to physicians and attempted illegal penalties for physicians referring to labs other than their “preferred providers”. They are now “in bed” with our legislators, judges and attorneys fortified by well paid lobbyists and protected by large donations to re-election campaign committees of our congressmen and women. Thus there are enourmous mountains to climb to promote legislation which will truly improve healthcare quality.
   A recent article in the Times compares patients to “washing machines” and I suppose physicians are the “technicians” charged with the “servicing” of human machines. We” technicians” are however educated at huge personal expense for 7-10 years, are expected to work 24/7 at the beck and call of patients still used to the “Marcus Welby “model of care, yet unwilling to pay for our indispensible services. Show me the mechanic who guarantees his work and delivers without payment for services rendered. My goodness, our society cares more for our hairsalon professionals, our plastic surgeons, our right to sue, and our possessions than for our essential health.
   Those shortsighted journalists, their readers, and legislators who think medicine is a pure science which comes with a manual are deluded or demented. Let me remind all of the most glaring recent error based on “evidence based medicine”– that of the hormone replacement fiasco. Five years ago, evidence supported the major benefits of hormones for post menopausal women. This year that “evidence ” has been entirely refuted, and in fact hormones seem to increase the incidence of breast cancer and do nothing to decrease coronary deaths.
   If your paper honestly thinks that medicine can be practiced in cookbook fashion by clerks and administrators, then why would physicians require 7 or more years of intensive expensive training? Why then can everyone not practice medicine and surgery with advice from the internet? BECAUSE MEDICINE IS AS MUCH AN ART AS IT IS A SCIENCE.The reason physicians WERE so carefully trained is because the guidelines based on scientific evidence are only that–“GUIDELINES” to treatment. Patients often have a complicated array of medical issues, a growing number of environmental exposures and psychiatric ailments so that unique critical treatment decisions do not come in a universal formula.
   Just remember, medical textbooks never change in size, only content. Thus evidence based formulas must be individualized.
   Everyday, I could relay countless medical errors driven by the new wave of quality report formulas and internet grading services which serve to bully physicians into thoughtless formula based protocols. Some of these “quality “ratings are based on the time it takes to treat pneumonia in ER’s. This has lead to a dramatic increase in rapid, often inaccurate diagnoses, and inapprpriate courses of antibiotics for viral diseases that require none.
   To this day, apparently most Americans are ignorant to the fact that the overuse of antibiotics for every cold, as well as the popular demand for prophylactic antibiotics pre surgery has lead to an epidemic of antibiotic induced diarrhea. If any of your journalists cared to research the realities of medical care, they would know that prophylaxis with antibiotics has not been firmly proved helpful in most cases. But because the press and their readers seems to think they are better informed than their physicians, and usually have a lawyer on hand to support any contention they wish to claim, terrible poorly informed healthcare is the result. Physicians are generally held to “standards” devised by medically ignorant self proclaimed experts. Our society needs to understand what physicians already know; medicine is neither a business nor a science.
   The insurance and pharmaceutical industries as well as the legal profession, are sorely in need of serious regulation, and the country in need of major campaign finance reform before healthcare can begin to repair itself. These are very complex issues which will not be fixed with all the computers and warranties in the world. Until physicians are fairly reimbursed for their time and intellectual efforts rather than procedures and rapid discharge of patients, medicine will continue to deteriorate. The most talented physicians I know are leaving the profession and doing all they can to discourage their children from entering it. Let’s hope those warranties and computers can carry on alone.
   These quick fix formulas for healthcare entirely ignore the ART of medicine which takes time, ingenuity and training to maintain. If individualized compassionate care which all patients deserve is to be maintained, it needs to be supported with respect and appropriate reimbursement. It is instead devalued in every concievable way.
   It is no accident that this warranty plan has arisen in the state of Pennsylvania which has suffered among the most catastrophic damage from unregulated malpractice issues of any in the union. The absence of adequate numbers of neurosurgeons able and willing to practice in PA has resulted in the export of neurosurgical patients to NJ for adequate surgical treatment. I would venture to guess that those surgeons involved in the current Geisinger plan described in this article are salaried by the hospitals involved, and will never see the errors this system has created because of the fragmentation of healthcare in this country. When problems arise the patients will return to their primary care physicians for care. Such a plan will certainly require rejection of the most seriously ill. Complex patients who require the most care will become medical”pariahs” or the “hot potatoes” in a perverse game of healthcare delivery. Those hospitals and surgeons involved in warranties will never agree to treat these high risk patients for fear of driving their institutions into bankrupcy.On the other hand, insurers and non-professional rating systems of quality will result in continued closing of facilities and hospitals deemed “poor quality.” No accident that there is a preponderance of such facilities in urban poor underserviced areas.
   It is moronic to think that warranties will result in anything but further deterioration and denial of care for the seriously ill and the uninsured. These citizens and illegal immigrants will become the migrants of the healthcare system unable to obtain adequate care. This is already a mounting problem as hospitals are driven into bankrupcy and physicians denied affordable insurance, being sued into oblivien. Our citizens would rather preserve their right to sue than the right to excellent healthcare for all.
   Before any immigration laws can be adequately drafted, you must factor in the growing need for professionals from other nations. American training programs are failing to fill openings for high risk specialties. Importation of nurses and physicians from foreign countries is unethical and immoral, depriving underserved countries of their best and brightest professionals. America should be ashamed of itself. Due to mismanaged care, and lack of governmental intervention, physicians and nurses are declining in number. Unfortunately, medicine has become a thankless, low paying job, unattractive to most of our best educated students. It is time to attempt real change. Hopefully some of our candidates will recognize the critical nature of this problem before it is too late. You must include practicing physicians in the planning of healthcare reform.

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