Wednesday, August 12, 2009

Not dissing surgeons

OBAMA: So we are going to be taking steps as part of reform to deal with expanding primary care physicians and our nursing corps. On the doctors front, one of the things we could do is to reimburse doctors who are providing preventive care and not just surgeon who provides care after somebody is sick. Nothing against surgeons. I want surgeons. I don't want to be getting a bunch of letters from surgeons now. I'm not dissing surgeons here.

All I'm saying is: Let's take the example of something like diabetes, a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now, if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they are taking their medications in a timely fashion, they might get reimbursed a pittance.

But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000, immediately, the surgeon is reimbursed. So why not make sure that we are also reimbursing the care that prevents the amputation? Right? That will save us money.

I heard the President say that at the town hall meeting in Portsmouth, NH, yesterday, and I'm still trying to wrap my mind around it. Does Obama think we should be reimbursing doctors $30,000 a pop for providing nutritional advice and monitoring medications? Is he trying to equate the level of time, skill and expertise necessary to provide those services with that necessary to successfully amputate a limb? Clearly, he fails to realize that the number of diabetics who require amputation are only a tiny fraction of those who require nutritional advice and medication monitoring (less than 0.4%) and that increasing reimbursement for the latter to even remotely approach appropriate reimbursement for the former would not save money but would vastly increase spending for medical care.

Oh, and, by the way, while I'm a huge advocate of preventive care from a wellness perspective (something that HMOs used to promote in the good old days), Obama's cost-savings-of-preventive-care meme has already been thoroughly debunked. (via Hot Air)