Health Care For America Now

A public health insurance option is mandatory. No other way will incorporate the 46,000,000 uninsured without tremendous impedence. No bickering is needed. Just do it!

This is not about the uninsured.
Everyone knows that the social security system and the Medicare system are going to break this country with 54 trillion dollars of debt. We need a system to terminate the elderly baby boomers fast. Finding a way to limit care will help them with there end of life decisions. Hopefully they will take the needle and release us from the burden. I just hope the government puts the right people in place that can make the hard decisions on what they can and can’t have. They had their day so why should we pay a high tax burden to keep non productive citizens alive and healthy. It was their generation that got us to this point any way and they should bear the brunt of the fallout of the failed system they created. Way to go Mr. President on getting the aarp to sell out.

We do need affordable health care for everyone - now.

I think the new health care reform idea is a great one. However, there's still much needed work to be done! According to the HC reform bill, anesthesiologists (who go through medical and a rigorous residency) would only get reimbursed by Medicare 33% of what private insurers pay. When was the last time you went to a gas station and only had to pay 33% of the total of your gasoline bill? This is a horrible option/addition to the bill for anesthesiologists. For the amount of training and schooling we go through to care for patients (assuming one's care at the most vulnerable stage in health care management - unconsciousness), anesthesiologists around the country are in disagreement with the Medicare rates suggested in the HC reform bill.

For more information:
http://www.asahq.org/news/asanews072409.htm
http://www.asahq.org/news/2009-07-24ECletter-HR3200.pdf

The rush to implement the present healthcare reform includes hidden effects that lead to dire consequences. Anesthesiologists, the professionals who keep you from harm in the operating room and labor suite would be devastated and patient safety suffer.

Anesthesiology is a difficult specialty for which to create quality practitioners. Merely having someone dedicated to caring about people is not enough. They also must be physically dexterous and mentally very quick. We use our experience as physicians to plot a course that minimizes risk and discomfort for each patient's medical condition. Our time frame for anticipating, preventing, recognizing and acting upon problems is in seconds. Even worse, critical situations occur suddenly out of nowhere. We work long hours at a task which requires continual diligence even if things seem routine. A mediocre practitioner is fine when nothing is happening, but you cannot predict that things will remain routine. Judgement, skill and experience take a long time to develop. I would estimate it takes five or more years AFTER residency for a new anesthesiologist to see enough critical events to build a seasoned repertoire of responses. Before that, you're relying on training combined with the person being much brighter than average to keep you out of trouble. You cannot replace good anesthesiologists quickly and you cannot get good ones unless they are adequately paid relative to other specialities and professions.

It wasn't long ago that anesthesiology was an undesirable "back water" specialty. It paid poorly and that meant you didn't attract the most capable graduates into the speciality. Medical students choose a specialty that matches their personality and provides a good quality of life for their work. When incomes improved, there was an influx of the higher quality trainees. Those are the practitioners you enjoy today.

The proposed degree of income reduction, perhaps 60%, would be devastating. Those talented individuals who invested an entire life of superlative educational effort and professional training would be asked to lose their homes, drastically curtail their children's education, and work harder for less pay. We derive satisfaction for relieving pain, but in terms of return for effort we're essentially piece workers. Yes, we usually get paid by the case. How many people who are talented and bright would keep on delivering a superlative effort in a specialty that saw such an income cut, demanded more work, and further diminished social standing?

A medical student will give up 12 years of their life in preparing to become a novice physician. It isn't enough to just feel a "calling." There has to be sufficient recompense to make so onerous an initiation and life remain worthwhile to tomorrow's care givers. From the outside it may seem a "cushy" life, but it is not. Anesthesiologists face extreme stress every day. We work long hours. We work 24 hour shifts. We do it under the never ending pressure that it has to be perfect each and every time. There are no second chances. You'd be a complete fool to do it for just money. You'd burn out very quickly. A strong degree of dedication to excellence and patient care is also needed to sustain one through the anesthesiology career path.

Cut reimbursements by 60% and most of your anesthesiologists, THE person dedicated to watching over you in the operating room, will lose their homes, be unable to send their kids through higher education, and have their life calling of helping others become a bitter lot in life. The best won't enter the field and you'll lose many already in it. In short, you shift the balance towards mediocrity and patients deserved better than just barely good enough care. We saw this happen ten years ago, but this time around, the effects will be far worse.

Retirement of some of our most experienced anesthesiologists would be but an early effect. Those in the middle of their careers will lose their homes and look hard at what other options they have. They are bright people and no degree of personal "calling" assuages a capriciously legislated inability to pay the mortgage and bills. Yes, anesthesiologists are better paid than the average person, but they work in a field that requires superlative personnel each and every time. Do YOU really want the cheapest person possible to keep you alive and whole?

This is a terrible situation being brewed. Anesthesiology is a tiny specialty. It does not have enough numbers to wield the political clout to avoid being incidentally destroyed. We're silently falling off a precipice that will hurt you the patient, demoralize today's practitioners, and cut off tomorrow's generation of anesthetic excellence. We need all the help we can get to prevent this disaster. Do HC reform right — not with the rushed through bludgeon now before congress.

Guy Kuo, MD