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Wednesday, September 12, 2007



The Problem

Please stop blaming the government for the lack of affordable health care in the US today. It is not the government’s fault. Here in Panama individuals can go to a good clinic see a physician for less than $7.00, get laboratory tests, and afford prescriptions given to them. I visited a clinic, was examined by a doctor, had two x-rays, and got several laboratory tests – all for $45.00. The same in the US would have cost me over $600.00. My co-pays alone for the physician, X-rays, and laboratory tests in the US would have been $45-60, equal to or more than I paid for the entire visit in Panama. Insurance would have paid the balance. But remember I have to pay the premiums which is an additional cost to me, the patient.

Do not think for a moment that the quality of medical care in Panama is inferior to the US for it is not. They perform complicated cardiac operations in the top-grade hospitals just as in the US. In fact, in Panama City there is a branch of the John’s Hopkins Hospital.

What is the difference? Besides for the US doctors being so greedy for a high life style, it is the trial lawyers who cause medical care to be so expensive in the US. If fact, there are too many lawyers influencing medical care. Have you ever wondered why the US government is so screwed up? It is also because there are too many lawyers in the congress. As an aside, we should make a vow not to vote into public office anyone who has a law degree. One should automatically be ineligible and excluded. I know this will never happen, but I can dream, can’t I? Maybe our government might turn around yet.

Malpractice Insurance and the Trial Lawyers

Look at the unfortunate obstetrician. His malpractice fees are so high that many are giving up delivering babies. In my home town in Maryland, I personally know some who do not deliver babies any more because they cannot literally afford malpractice insurance. In medicine as in nature things go wrong and babies are born with complications not because the doctor did anything wrong. But, most doctors involved with a bad outcome get sued. Although many of the law suits are frivolous and the ones suing lose, sad to say many win. But whether they win or lose the cost of this legal battles are tremendous to the insurance companies. Someone has to pay and ultimately it is the patient.

Doctors and the Business of Medicine

Another situation increasing the cost of medical care is that doctors are creating their own laboratories to perform tests. In Maryland, it is against the law for doctors to have large pieces of medical equipment, such as CAT Scan machines, for the government knows that, if doctors have such machines, they would tend to order more tests. But many doctors continue to have such machines, but they are not owned by the practice. They are owned by an LLC and so technically the machine, although within the office complex, is not owned by the practice. Hey, who’s kidding who? There is that old saying: “There are more ways to skin a cat!.” Only here the patient is being skinned. Meow!!

The following story I will write in the third person so as not to bring my home town upon me. I will explain what personally happened to a very close friend of mine. His cardiologist insisted he have a radioactive thallium heart scan. This is the same chemical that was used to poison that Russian agent in Great Britain several years ago. His cardiologist informed him that this was the ultimate test to do and insisted that because of his age he should have it done. He had the test and passed with flying colors.

His doctor then suggested he undergo an Echo cardiogram. My friend said to his doctor: “If the Thallium test was the ultimate and I passed with flying colors, why would I need an Echo, which I am assuming would be the sub ultimate?” The doctor insisted that it was important to have it done. He did and passed that with flying colors. He then told my friend that he needed to have the Holter Monitor test. He asked the same question that he did after the first test. But he was strapped with the Holter Monitor and was told to return it in, I think it was 48 hours, or he would be charged for the extra time. Imagine my friend who was a close friend of the doctor was going to charged if he kept it longer than he should have!

To complete the story, the insurance was charged for all three procedures. Let us face it, folks, each of these procedures represents a “profit center” within this doctor’s office, and good profit centers because the insurance companies pay. They had several Holter Monitors which are in constant use, and the first thallium test is run every day to the tune of better than $1,000.00 per pop $5,000/week, $260,000/year – not bad! While my friend was in my doctor’s office another friend dropped by. While he was there, the doctor’s wife called whereupon the doctor informed her that their good friend was in the office to schedule a thallium test. The wife’s comment was: “Good we could use the money!” I hope I do not get in trouble for telling this story. But, folks, I now live in Panama, and I am almost untouchable, except for the voodoo doll the doctor might have of me. I hope he doesn’t stick a pin into the doll’s heart! That would really be ironic, wouldn’t you think?

But I am too old and the other day someone said: “irascible,” but I don’t think I am irascible. I just think that I am free to say whatever is on my mind. Is this not what “free speech” is all about?

Is There a Solution?

I admit I do not have an easy solution to this serious problem of the soaring cost of medical care in the US, and I believe it will get much worse before it gets better. If it makes you happy, blame the government. There are some people who want to blame the government for everything. How can the government cause so many problems when they cannot get their own business done correctly? Essentially, the government is not causing the problem of soaring medical care costs, and they surely cannot solve it.

Michael Moore, the ignorant charlatan but sharp antagonist of the government, has it all wrong. After all I have said, the US has the best medical care in the world and is the reason why important people from all over the world come to the US for their care. Cuba cannot shine the US shoes. Castro knew where to go to get good medical care. He had to get specialists from Spain.

We can go a long way to solving the problem by passing laws of no-fault except in serious instances of gross malpractice. Awards should be tapped. Individuals who are unable to buy a million life insurance policy can easily win an award of millions and millions of dollars as a result of a medical lawsuit. Trial lawyers who get rich from such lawsuits should not be entitled to 30 or more percent of awards. Additionally, cases of potential malpractice should be resolved by special arbitration boards consisting of individuals trained to evaluate such problems. Get the bleeding judges and incompetent and ignorant and unknowledgeable juries out of the way.

Concerning doctors running their own laboratories, pass laws backed by the meat of enforcement to prevent such cottage industries.

But in the US expect to pay for top medical care because it is not cheap.

From Panama, this is my cheerful comment for the day.

nicola michael c. Tauraso, M.D.
Director, Tauraso Medical Clinic


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