Lincoln * Institute

Ralph R. Reiland

Ralph R. Reiland

The B. Kenneth Simon Professor of Free Enterprise at Robert Morris University

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Reflections

Surgeons Cut Into Obamacare

by Ralph R. Reiland
 

President Obama's flip comments about surgeons maximizing their incomes through

unnecessary foot amputations and needless tonsillectomies have produced a biting response from the American College of Surgeons, the largest organization of surgeons in the world.

Obama explained how we can walk into a money-grubbing doctor's office with a sore throat and end up with no tonsils instead of a cough drop: "So if you come in and you've got a bad sore throat, or if your child has a bad sore throat, or has repeated sore throats, 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.'"

It's the same with the doctor down the hall treating patients with diabetes. The doctor, asserted Obama, faces the choice of getting "reimbursed a pittance" if he works with patients "to help them lose weight" or getting a non-pittance jackpot of "$30,000, $40,000, $50,000" if that "same diabetic ends up getting their foot amputated."

At the high end, that's $100,000 for both feet, halfway to the price of a new

Bentley convertible, so why talk about donuts and exercise?

Next thing we know, those insatiable surgeons will be trying to get a house in the Hamptons by cutting off our heads and attaching them to chimpanzee bodies.

Responding, the American College of Surgeons stated that it is "deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States." Further, by making comments that are "incorrect or not based in fact," Obama is doing "a disservice to the American people at a time when they want clear, understandable facts about health care reform."

The physicians' organization provided an example of Obama's misstatements:

"Yesterday during a town hall meeting, President Obama got his facts completely

wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in

fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation.

This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service."

Explaining that "there are times when even a perfectly managed diabetic patient

needs a surgeon," the American College of Surgeons charged that Obama's remarks were "truly alarming and run the risk of damaging the all-important trust between surgeons and their patients."

Equally "ill-formed and dangerous" was Obama's assertion that decisions on

tonsillectomies were based on the desire to make a lot of money rather than on

what's right for patients.

Concluding its statement, the surgeons made the following questionable assumption: "We assume that the president made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care."

Rather than getting his facts wrong "unintentionally," it seems more likely that Obama was trying to demonize physicians in order to get us to believe that we'll be safer and things will be cheaper if we just let the government seize control of the nation's health care sector.

What Obama doesn't mention regarding unnecessary medical procedures is the role of lawyers, a key source of campaign funds for Democrats, and the directly associated cost of defensive medicine. The Center for Responsive Politics reports that 76 percent of the $234 million donated by lawyers and law firms to political campaigns in 2008 went to Democrats.

The accounting firm PricewaterhouseCoopers reports that approximately 10 percent of the total cost of medical services in the U.S. stems from medical malpractice lawsuits --- 2 percent in the direct cost of the lawsuits and the balance due to expenses run up by defensive medicine.

With some $2.38 trillion spent last year in the U.S. on health care, that's $238 billion that the health sector is paying for lawsuits or ringing up in defensive procedures to protect itself from litigation. All that is off the table in Obama's calculations on how to save money. Instead, he wants us to believe that the real problem is doctors who are unnecessarily removing our body parts for profit.

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Ralph R. Reiland is an associate professor of economics at Robert Morris University in Pittsburgh.