Yes, the Academy of Family Physicians has been hijacked by the Democratic party to push their health care bill.

My latest email tells me:

We are closer than ever to achieving significant health care reform in America. Unfortunately, propaganda and misunderstanding about pending legislation threaten to derail its success.

“We” are closer? That implies that all Family physicians are Democrats who unlike Physicians of other specialties, who were found to be 70% against the bill, presumably Family physicians will line up blindly and follow their “leadership” in becoming activists to pass a flawed health care bill that no one has read.

Join your peers one week from today in one of two Telephone Town Hall meetings to learn about health care reform and the Academy’s position on pending legislation. The toll-free calls are limited to the first 1,000 participants.

So, there are 94,000 members of the Academy, and the “TownHall” meeting by telephone is limited to the first 1000 who call.

Arm yourself with the facts so you can be a “health care reform first responder” when patients, colleagues, and friends ask your opinion.

Thank you in advance for your interest and commitment.

Ah, but what about those of us who don’t feel a commitment to let a government takeover, because we have actually worked for the Federal government, and know how “Budgetary restraints” harm our patients?

Well, at least the California AAFP admits there are a few of us around.

Not all family physicians support current reform efforts, and all are entitled to their opinions, of course.

Well, thank you. We can have our opinions, but you run the show, is that it?

But the CAFP and the AAFP, after careful consideration and review of pending legislation, have determined the majority of the principles for health care reform supported by each organization have been met by the provisions of HR3200.

If you want to know the problem with all of this, you have to be a doctor, who is constantly being told that your eleven or twelve years of training in the art of medicine doesn’t count as much as memorizing check lists and CPT codes.

The problem is that the “business” model of medicine is transforming medicine into a cold and heartless profession, where there is no “efficient” way to take time for the human touch.

And time and energy learning complicated “practice management” issues means that much less time and energy learning about diseases.

At the same time, the latest fad is a “medical home” paradigm for patients. Your doc will know all about you, and will decide if you need treatment, and has lots of teachers to help you stay healthy.

Ah, but what if the patient just wants penicillin for a strep throat and not a “home” to lecture him about his smoking, obesity, or if he locks up his hunting rifles?

No wonder chiropractors and Naturopaths are seeing so many of our patients. They still are allowed to practice old fashioned “hands on” caring, not cost effective “one size fits all” treatment that some bureaucracy will decide they need.

This article in the Atlantic suggests some of the real problems behind the discussion that aren’t even part of the discussion.

The article starts with infection control. The author sees regulations as the answer.

But a lot of the infection control problems were caused by “safety” regulations that make hand-washing inconvenient, eliminating those old fashioned basins of soap and water in the hallways that we used in the good old days as a “safety hazard”. As a result, to wash one’s hands, it meant finding a distant sink, and often discovering the soap dispenser was empty or clogged, and that we had to dry our hands with rough paper towels (lower priced towels were bought by a bureaucrat who didn’t check why some towels cost more) …what really “fixed” this problem was not “regulations” as much as the discovery of easily carried alcohol based cleanser to clean our hands.

But the article goes on to note a lot of excess billing is caused by a lot of questionable and elective procedures that don’t work well, but are driven by the idea that something is wrong and has to be fixed. (and paid for, of course, by “insurance”).

So he proposes that mandatory, single payer, catastrophic health care insurance should be seen as the answer. Anything under a certain amount of money (say $2000) would be paid for by cash. Or, rather, health care savings accounts, or loans similar to car loans.

So the consumer would be able to decide if he wants to take out a loan to pay for his third arthroscopic surgery on his knee so he can jog, or just switch to power walking.

He suggests routine checkups be paid for by vouchers, but there are already a lot of free clinics and outreach programs that do preventive medicine (Planned Parenthood does pap smears; Mammogram vans that do free mammograms; health fairs that check your blood sugar and cholesterol) and of course, it might result in the old second class charity clinics and hospitals being reopened. There already is a system for community health clinics; this could be expanded, and staffing could be encouraged by expanding the loan payback program. Many young docs have $100 thousand dollar loans for their medical school tuition to pay back, and expanding the federal loan payback program would encourage more young graduates to staff these clinics. Another idea would be to mandate a two year commitment by all graduates to work in physician poor areas. This was how the Indian Health Care Clinics were run by draftees in the past.

I doubt all of the proposals in the Atlantic article would work–there is just too much money involved to imagine that the “health care industry” to cooperate, and of course those advocating a utopian socialized health care see their own version as the only answer.

But it does show that there are a lot more ways to view medicine than a “nanny program” of “medical homes” to care for and tell people how to live, a “business/QALY” paradigm that sees the old and handicapped as less deserving of care, or the present day system that combines the worst of both worlds.

So yes, I am happy that my “Academy” is busy promoting health care.

But to pretend that by politicizing our academy to order their members to become “Health care bill first responders” and fight the evildoers who say wait a second is not a good sign.

Indeed, without a real discussion with docs who are on the front line of treating patients, their political advocacy not only eliminates a real discussion of how to care for the sick, but they risk a massive loss of members if the hard working family docs start realizing how their dues are being hijacked to support a program many of them do not support.

As for myself: Until I am sure that the present bill does not fund abortions, I will not back it.

As for “rationing”: Until I know who Obama will pick for his “Bioethics panel”, I worry that indeed we will soon see the US equivalent of NICE in the UK telling our elderly and handicapped that they don’t qualify for treatment. But that is not the President’s fault: This type of thinking has alas been the trend in academic bioethics for thirty years, and despite warnings from Cassandras like John Paul II, Wesley Smith, or Nat Hentoff, little publicity has been given about their ultimate agendas.

Nancy Reyes is a retired physician living in the Philippines. She writes about health care at HeyDoc Xanga Blog.

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