Thursday, July 23, 2009

Who Is Responsible For All Those Unnecessary Operations?

Last night during his national press conference, President Barack Obama maligned doctors as doing unnecessary operations based on greed, not the best interest of the patient. He said:

“Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that’s out there. … The doctor may look at the reimbursement system and say to himself, ‘You know what? I make a lot more money if I take this kid’s tonsils out,’” Obama told a prime-time news conference.

The president added: “Now, that may be the right thing to do, but I’d rather have that doctor making those decisions just based on whether you really need your kid’s tonsils out or whether it might make more sense just to change — maybe they have allergies. Maybe they have something else that would make a difference.”

It’s interesting that President Obama discusses unnecessary operations as one of the causes of high health care costs. Do you know what the most often performed operation is in the United States? With heart disease being the number one killer in America, you might think it would be related to that, perhaps bypass surgery or angioplasty.

You might think tonsillectomies are responsible for a huge number of unnecessary surgeries, since the windbag in chief brought it up. You'd be wrong.

It’s cesarean section. In 1965, only 4.5 percent of children were delivered via c-section. Today, 31 percent are. That’s a huge increase for a procedure that was once reserved to emergency situations. And as the Los Angeles Times notes, it has resulted in “an explosion in medical bills, an increase in complications — and a reconsideration of the cesarean as a sometimes unnecessary risk.”

What is the reason for the increase? Is it greedy doctors looking for a new summer home? No, it’s something far worse.

John Edwards.

The now disgraced former Senator from North Carolina made his name, and his money, as a trial lawyer. In a 1985 case, he convinced a jury that a doctor’s negligence was responsible for a child’s cerebral palsy. He argued that had the doctor performed a c-section earlier, the girl would not have been disabled. He went so far as to channel the girl in court for the jury:

“I have to tell you right now — I didn’t plan to talk about this — right now I feel her, I feel her presence,” he said in his record-setting 1985 lawsuit on behalf of Jennifer Campbell, born brain-damaged after being deprived of oxygen during labor. “She’s inside me and she’s talking to you. . . . And this is what she says to you. She says, `I don’t ask for your pity. What I ask for is your strength. And I don’t ask for your sympathy, but I do ask for your courage.’ “

The jury awarded the plaintiff $6.5 million. The New York Times reports this verdict led to more lawsuits:

In the decade that followed, Mr. Edwards filed at least 20 similar lawsuits against doctors and hospitals in deliveries gone wrong, winning verdicts and settlements of more than $60 million, typically keeping about a third. As a politician he has spoken of these lawsuits with pride.

“I was more than just their lawyer,” Mr. Edwards said of his clients in a recent essay in Newsweek. “I cared about them. Their cause was my cause.”

The effect of his work has reached beyond those cases, and beyond his own income. Other lawyers have filed countless similar cases; just this week, a jury on Long Island returned a $112 million award. And doctors have responded by changing the way they deliver babies, often seeing a relatively minor anomaly on a fetal heart monitor as justification for an immediate Caesarean.

So what has been the result of the increase in Caesarean section births? Occurrences of cerebral palsy have “remained fairly stable” at about “1.5/1000 births.”

In fact, the incidence of CP seems to be increasing slightly with the increased survival rates of infants born before thirty-two weeks gestation.

Whether or not fetal heart rate monitoring during labor has led to a reduction in cerebral palsy has been researched extensively. The conclusion established by multiple scientific evidence is: Fetal heart rate monitoring during labor does not reduce rates of cerebral palsy, although it does increase the rate of cesarean section.

As the L.A. Times notes, they also lead to unnecessary costs:

As the No. 1 cause of hospital admissions, childbirth is a huge part of the nation’s $2.4-trillion annual healthcare expenditure, accounting in hospital charges alone for more than $79 billion.

Because the average uncomplicated cesarean runs about $4,500, nearly twice as much as a comparable vaginal birth, cesareans account for a disproportionate amount (45%) of delivery costs. Among privately insured patients, uncomplicated cesareans run about $13,000.


The problem, experts say, is that the cesarean — delivery via uterine incision — exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans also have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.

If the president is really interested in reducing the occurrences of unnecessary operations, he doesn’t need to create the boogey-man of “greedy doctors.” Greedy doctors don’t remove body parts like tonsils. They implant body parts, like silicone breats. The real culprit here is the trial lawyer, who has helped create a medical world choosing procedures based on the CYA diagnosis method. However, the president’s speech last night was not critical of this, and didn’t emphasize tort reform.

A 2001 article from National Review explains why the president doesn’t see a need for tort reform:

An estimated 50 cents of every dollar awarded to tort plaintiffs gets eaten up by lawyers and courts-and a great deal of that money ends up benefiting Democratic candidates. Over the last decade, the legal profession has led all other groups in campaign contributions-giving a total of $357 million to federal candidates-and 70 percent of its cash goes to Democrats. The 56,000-member Association of Trial Lawyers of America (ATLA) was the top PAC contributor to Democratic federal candidates in the last election cycle; the organization spent $2.6 million, 86 percent of which went to Democrats.

If he were serious about lower costs, this would be the cornerstone of his movement. Instead, he maligns “greedy doctors,” many of whom work 16 hours or more a day trying to help people, and lets the “greedy trial lawyers” off the hook. Remember that next time he accuses the Republicans of bowing down to special interests.


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This blog is about my opinions and world view.  I am a conservative, evangelical Christian.  Generally speaking, if you post a comment, I'll allow you to express your view.  However, if you say something hateful, untruthful, or just generally something I don't like, I may remove it.

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