About Healthcare In America

I am being inundated by questions from very concerned patients as regards healthcare reform. I am unable to take good care of people because they are using their office visit to express their concerns and to ask my advice. My most frequent question is no longer a urologic one. It is "what can I do about healthcare in America?"

The real answer is "I DON'T KNOW." I am not a politician, I am not an economist, and I am not a public health expert. I am a healer and a well trained surgeon. But, I have my "opinions". Since everyone coming in my office seems to want to know what they are, I will espouse them here. But, be forewarned, I could be wrong. These are only my "opinions".

One.

I have worked in three "government run" healthcare systems. I worked at six different VA hospitals in four different states. I worked all over the state of Louisiana in the Charity system. I worked in California in the children's indigent, government run healthcare system. I took care of Medicare, Medicaid and VA patients for 15 years.

In my experience, government run health care runs about as good as the IRS, the postal service and the FDA. And to me, that was not very well. The patients were not happy and the doctors were not happy and all of these systems were a big giant bureaucracy where it was very difficult to get anything done.

So, unless we are going to "DO" government run healthcare differently than it has ever been done before, I AM AGAINST IT.

In the last week, I have spoken to two Urologists in Canada and in France. They think that "National healthcare is hideous". The waiting list for routine procedures in Canada is two years!!! Canada has turned being a doctor into such an unattractive job that they cannot attract doctors and have a terrible shortage. France does not have the waiting lists that Canada has, but MANY things are simply NOT covered.

Two.

Right now, in my office in a major metropolitan city, it costs me $350 an hour to keep the office open. Medicare is paying me about $50 for an office visit. So, if I saw only government healthcare patients, which is what Medicare is, I would have to see about 7 people an hour. I am unable to deliver good care to an elderly person in less than 15 minutes. Do the math; I would have to close my office. I have a 1500 square foot office that is very basic.

Both of the doctors with whom I spoke, sees about 60 patients per day. I am absolutely unwilling to see a person and try to care for them in six minutes. I would "quit" first. It is not what I am trained to do.

So, with the current government plans to cut Medicare benefits, where are the Medicare patients going to go??? And, who can care for them with a six minute visit??? The "math" does not add up.

Three.

I am a big student of History. The first National Health Service was in Germany, under Bismarck in the late 1800's. He created a "welfare state" in order to secure his power base and to unify Germany. If you want to read some fascinating history, look at how governments throughout the last 200 years have used a "national health service" to gain and keep political power.

I am most certainly NOT saying that is what is happening in America. But, the idea is food for thought. Is the current "push" for healthcare reform all about getting the best healthcare for the American people, or is it about gaining political power??? I don't know. But, I encourage you to study history. There are some interesting "parallels' to be found.

Four.

Who are these uninsured folks that they are talking about??? I don't really know. Everywhere I have ever worked, I saw many people for free. Right now, at my current hospital, we are required, as staff members, to cover the uninsured exactly as we do the insured. We divide up the month and every doctor has a day that he/she is the doctor to cover whom ever comes in and we are mandated to take care of them, just as we do our paying customers! I see, operate on, and care for the uninsured for 48 hours every month. I never get paid a penny for that work and I am "OK" with that.

If you come to our hospital to have your baby, you get the same team whether you are insured or not.

I have five friends who have NO insurance. They tell me that there are well run, easy to access, "free" clinics, all over our city.

So, I don't have any direct knowledge of the uninsured and their plight.

I certainly feel that everyone should have access to basic medical care. I am just not, at all, sure that the government is the agency to manage this effort.

Five.

I feel that we definitely "under utilize "two fabulous resources. A. Home health nursing and B. Hospice.

There are many folks who do not benefit from being in the hospital. I would like to see our culture become much more comfortable with end of life issues and dealing with death. Many people who are in the hospital, in my opinion, do not need to be there. As a culture, we need to answer the question, how far do we go at the end of life?? I see elderly patients brought to the hospital every day for care that they would never choose, if they had their minds or if their families were more involved. A stronger network of good nurses to be the advocates for the elderly would be a huge improvement in our current situation. And, healthcare dollars could be saved. And, many patients would be "happier".

Six.

SOMETHING has to be done about the legal system and the way that it interfaces with the doctors and patients.

Instead of the docs spending $30 billion dollars in malpractice premiums every year and about half of that money going to the legal folks, I'd like to see a big fund set up to pay the patients who are harmed by the medical profession. I'd like to see the patient paid directly.

Doctors and nurses are humans and we will make errors. The people who are truly harmed should have a much simpler route to get compensation, than the legal system.

Take half of those premiums and put them on care for the uninsured. Take the other half and put it in a fund where a patient can present their medical records for consideration and get an award, as is appropriate. Cut out the middle guy and give more of the money to the person who deserves it. Give them the money in the same year that the problem occurred. Forget Torte Reform, let's go straight to mediation!

Seven.

Reform the FDA. It should not cost twice as much to bring a drug to market In America, as it does in the rest of the world. The FDA is a behemoth and is a perfect example of why government should NOT be running the whole show.

Eight.

Make the pharma people lower their charges for drugs. Get their folks at the table and cut out the fat. Should pharma be allowed to advertize as they do? I don't know.

Nine.

Same thing with the insurance companies. Their profits don't need to be through the roof for them to be successful. They need to stop insuring only the folks who don't need insurance. Make them share more of the risk.

Ten.

The doctors: Figure out what a doctor is truly worth and pay them that. An education that cost $350,000 and took 18 years after high school is worth what??? Most docs have experienced a decrease in income over the last ten years. Mine has gone down by 25%.We have bought a cheaper home, a cheaper car and take fewer vacations. We shop at Publix and not Wholefoods, more often.

But, what am I worth to my patients??? Our society has to decide that.

If the salaries go as low as they are in other countries, you must make our education cheaper and you must reform the legal system, or NOBODY will want to do this for a career.

If the salaries really go down, you may get doctors who are much more "altruistic". Or you may get the class "dummy". And who wants him/her for their doc????

When I got my medical school seat, there were five kids trying to get that seat. It was quite competitive. My med school took 300 kids and we had a "cut" to 150 kids after the second year. They only took the "best of the best" and then, "weeded them out" even further.

You don't need to be a genius to be a good doc, but there is an awful lot to learn and the average person is truly NOT capable of doing what I did. What is that worth in salary??

Everyone will have to think about that.

Everyone should be trying to save healthcare dollars, wherever possible.

Personally, I try to exercise at five a.m., four times a week. I try to avoid large portions of food…I meditate, most days.

I don't drink or smoke and I try to avoid sugar and high fat foods.

I ballroom dance, once a week.

I take my vitamins and I try to eat really healthy food. I go to my doctors once a year for routine preventative care.

What do we do in our office to save healthcare dollars?

1. After our patients are fully evaluated, we will refill most of their medications for an entire year without their having to return to the office. There are a few medicines that require a return visit, if we have to monitor their effect on your liver or kidneys. But, most of the time, we can save you from missing work and can save your health insurance from having to pay for visits for refills.
2. We have expensive equipment in our office to do many procedures. This saves you and your insurance company lots of money because you don't have to go to the hospital for these procedures. The hospital is the most expensive place to have any test or procedure done. Over the course of the year, our practice can save our patients and your insurance company $500,000.00!!!!
3. We do not do invasive procedures unless necessary. Even though I am a surgeon, we offer many noninvasive ideas before doing surgery. This effort is best for the patient and decreases healthcare costs.
4. We have the smallest office possible to serve our patients. We "shop the market" for all office and medical supplies every six months. We keep costs down at every turn.
5. We prescribe the lowest cost medications whenever we can. There are times when a generic is not as good as a brand name drug. But, whenever we can we give our patients the cheapest, most cost effective drug.
6. We give our patients who have NO health insurance the absolute cheapest rate that we can afford to give. We try very hard to give "free samples" to our patients with no coverage. We "shop the market" for the cheapest place for our patients to get x-rays, blood work and surgical procedures.
   Everyone should be "cost conscious" when it comes to healthcare. ALL of us should look for ways to save.

Eleven.

All of the studies that talk about our medical system being "36th or 37th" in the world, do not look at the entire picture.

The things that make us so far down the list are:

1. Our violent crime. We are a violent country.
2. Our Obesity. We are fat and we have many, many, health problems just because we are fat.
3. We have widespread drug and alcohol problems. That is not the case in France and Japan. (Two countries who consistently score well)
4. We don't walk everywhere like most countries do.

So, when you read those statistics, remember that our culture is partly to blame, not just our medical community.

So, what can YOU do??

Our elected officials won't do anything if they think it will keep them from getting re-elected. VOICE YOUR OPINION.

• Call your congressman, your senator, the speakers, and the folks in charge of the committees.
• It is very easy to get their numbers off the internet.
• Tell them what you want.
• For me, I do not want Medicare benefits cut. If they cut them anymore, I won't be able to afford to see the patients. I adore my older patients!
• For me, I don't want the government to take over healthcare. I have seen the government run facilities and it is not what I want for me.
• For me, I don't want the insurance industry taxed $380 billion dollars. They are, for sure, going to take that money out in my premiums. I can't afford higher premiums.

For me, I want them to quit trying to "ram" something through and start looking at the multifaceted parts of this issues and make everyone "give" a little to meet in the middle………everyone should "hurt" a little………the doctors, the lawyers, the hospitals, the insurance companies, the pharmaceutical companies, the government, the wealthy, and the folks who don't take care of themselves. And the "pain" that is made in dollars should go to making sure that Americans can see a good doctor, if need be.

No one group should "shoulder" this alone. We are America. We are smart and we are resourceful, we can figure this out!

Thanks,
Dr. Boone

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