Surgery Center of Oklahoma Blog

July 12, 2011

Right to Health Care

Filed under: Uncategorized — surgerycenterok @ 9:35 pm

This is an easy one.  You don’t have a right to health care.  Maybe I should end the blog right now.

Oh well, I’ll see if I can explain it for those who aren’t laughing out loud right now.  You see, it all depends on how you define “right.”  If by exercising a “right” you violate the “rights” of another….well….then you don’t have the original “right” you thought you had.

If you think you have a “right” to a hernia repair and it ought to be “free”(whatever that means?!) you have neglected to consider the robbery (taxation) of the folks down the street needed to fund the manufacturers of the materials and supplies needed to complete your surgery (kind of a demented version of Bastiat’s “what is not seen!).  Or how about the people providing the service?  Does an obligation exist for them to provide you this service just by virtue of their having the skill to get it done?  Someone’s property rights had to be violated for you to exercise your “right.”  With me so far?

How about this one?  If the surgeon is performing this surgery (with no benefit to himself) with a gun to his head, do you think he really wants to be there?  Do you think he cares about you?  Might this possibly affect the care that you receive?  DUH!!  Trust me….you want your surgeon to care about you!

You don’t violate anyone’s rights when you breathe air.  You are not denying anyone’s access to air if you breathe.  You don’t violate anyone’s rights when you speak in a public square about poetry.  But when you make me provide your anesthetic on terms that I deem not mutually beneficial, you have violated my rights.

We have an obligation to help our fellow man as we can.  This is the almost forgotten concept of charity, taxation having almost entirely taken its place due to limited (not infinite) resources.  The recipient of our charity doesn’t have a right to our goods or services, but we are all free to bestow whatever gifts we have on the needy and we should.  I believe there is a difference, however, between charity and theft.  Do you see this distinction?

G. Keith Smith, M.D.

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Medicare and Fever

Filed under: Medicare — surgerycenterok @ 9:08 pm

A friend of mine told me that his mother called him the other day and told him that she wasn’t feeling well, had a 100.2 fever and was going to the emergency room.  He asked, “what kind of symptoms are you having, mom?”  She said she was just feeling kind of under the weather and had this fever.  He said,”don’t go to the emergency room.  Wait until Monday and go see your doctor or go to one of the AM/PM clinics.”

What was it about the emergency room that made this son caution his mother about a visit there?  He was afraid that it would cost a fortune.  Why did the mother want to go there (by the way, she did go to the emergency room)?  The real question is,”why not?”  Her out-of-pocket exposure is virtually zero so it is human nature to match the demand with the perceived price.

This is the nature of entitlement.   Something  perceived as “free” makes folks demand things they don’t even need.  Ever been to a store that had some items for 80% off?  Ever thought, “I’ve got to get me one of those…I don’t need it but boy if I ever did I’ll sure be glad I got it now.”

“I was feeling ok but just thought I’d come in for a check-up all the same.”  ”Why did you come in to see me?”  ”Because Medicare will pay for so many visits a year.” Physicians see this type of behavior all the time.  I think things would be very different if people had to pay for their own care themselves.  I think there would be fewer emergency room visits if people had to pay for this service themselves.  I think that without major changes that make individuals more responsible for their health/actions this bankrupting behavior will continue and worsen.

Phil Gramm, the former senator from Texas once said,” ..our safety net has become a hammock.”  This, as the above illustration shows, has proven true.

G. Keith Smith, M.D.

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July 11, 2011

Fear and Entitlement

Filed under: Medicare — surgerycenterok @ 3:30 am

Imagine for a moment  that you are poor…really poor.  You read in the paper that the gang in Washington is going to cut Medicare benefits and make you pay more…money you don’t have.  What is your reaction?  Fear would be understandable.  Possibly even anger.

Imagine for a moment that you live in the most affluent neighborhood in Oklahoma City.  You are really rich.  Seriously rich.  You read in the paper that the gang in Washington is going to cut Medicare  benefits and make you pay more….money you have.  What is your reaction?  It might surprise you to know that the anger from the wealthy Medicare beneficiary would dwarf the fear of the poor person in the first example.

One of the most disgusting things I have ever experienced in my 20 years of anesthesia practice is the intense entitlement attitude…..of the ultra-rich.  The entitlement mentality is bad enough.  But when someone whose net worth is 10,000 times what  I could earn in a lifetime and they demand that I provide them free medical care (Medicare) I must admit to shock.

I hope that there are enough elderly folks who want an alternative to Medicare.  I am afraid though that the elderly will dig in and lobby hard  so that “no one touches my Medicare!”  All that the elderly will understand, I’m afraid, is rationing and denial of care….only then will they demand an alternative.

Time for the elderly to let their children and grandchildren off the hook.  Time for the elderly Medicare beneficiary to let these spineless politicians off the hook and demand an end to this  and other Ponzi schemes from which they benefit.

I’m not holding my breath.

G. Keith Smith, M.D.

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Facelifts and Medicaid

Filed under: Uncategorized — surgerycenterok @ 3:02 am

Should Medicaid (welfare) pay for facelifts?  Should Medicaid pay for cosmetic breast augmentation?  Most of you reading this would answer, “no…are you kidding?!”  Well, you’ll be glad to know that currently Medicaid doesn’t pay for these procedures.  But there are some medical procedures they do pay for that cost the taxpayers of the state a lot of money and are…well….unnecessary.

How about epidural anesthesia so the birth of the Medicaid patient’s baby is wonderfully painless?  Should Medicaid be paying for this?  I think about the days when I did OB anesthesia and saw the 19 year old unmarried girl having their third child insisting on a labor epidural so that the experience would be painless (not tolerable, but painless).

Why not have these patients pay for this out of their own pocket (if they can’t afford it, their family can pool their funds for this luxury)?  This would save the state a lot of money and the anesthesiologists in the state would be wildly in favor of this.  Whenever I hear that it is difficult to come up with ideas for budget cuts here in the state I wonder just how much thought is given to the extent to which money is wasted on things like this.

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Unnecessary Surgery

Filed under: Uncategorized — surgerycenterok @ 2:49 am

I recently had a friend scheduled for an unnecessary surgery here in town.  The surgeon is known for his lack of judgement and marginal-absent skills.  Widely known.  Fortunately for my friend I found out what was going on and intervened.  She saw a competent surgeon and was diagnosed and treated in his office.  At what physician-owned surgery center does this buffoon work?  Ready?   He doesn’t work at one.  What?  ”I thought all you doctors were interested in was money?  Why wouldn’t you want someone like this working in your facility making lots of money,” you say?

Because he is trash.  What he is doing is unethical and it makes everyone he is associated with look like trash including the doctor (a hospital employee)  that referred my friend to him and the large hospital that continues to renew his privileges.

But there is more.  This surgeon scheduled another unnecessary surgery last week.  There is just one problem.  The patient is the son of a prominent physician here in town.  The patient’s father is not one to take this lying down.  This situation could be lethal to the career of the idiot surgeon.  This situation will be embarrassing to the hospital that continues to renew the privileges of this guy.   Wouldn’t surprise me if this winds up before the licensure board.

If you need surgery, ask the surgeon what physician-owned surgery center he works at.  If he says he doesn’t work at one……I suggest you run.

G. Keith Smith, M.D.

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July 6, 2011

National Education Association

Filed under: Uncategorized — surgerycenterok @ 8:10 pm

The NEA has just endorsed the current occupent of the White House for president in 2012.  I suggest that the teachers that are members of this organization should try out Obamacare first and let the rest of  us know how it goes.

G. Keith Smith, M.D.

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July 5, 2011

Hugo Chavez: Medical Tourist

Filed under: Medical Tourism — surgerycenterok @ 10:52 pm

Hugo Chavez, the socialist dictator of Venezuela, went to Cuba to have his cancer operation recently.  I figure this makes him a medical tourist.  His trip to Cuba for medical treatment raises many questions, too.

First, why not have his treatment/surgery in his own country?  Maybe because the care there is…well…awful.  Yes, I said it.  Check out this article on health care in Venezuela.  “But the health care in Venezuela is free,” you say.  Of course, nothing is free.  And apparently what care you can receive there is of such poor quality that this man opted to become a medical tourist.  He’s not the only government thug who has done this.  Check out this article on one of the Canadian bureaucrats, Danny Williams.

Second, why Cuba, of all places?  This is perhaps the most interesting part.  Apparently his surgery was done in Havana, but there is no listing of the hospital or facility.  Cuba has a large medical tourist business but none of these facilities are available, of course, to the locals, since their health care is…well….you know, free.  Or, was Chavez simply afraid that a Venezuelan anesthesiologist might not wake him up?

Third, who paid for his care?  Whoa, wait a minute.  His treatment in Venezuela would have been “free.”  It is illegal (just as it is in Canada) to pay out of pocket for care outside of “the system.”  Do you think he paid for this care himself?  Right!  I guarantee you the Venezuelan government (Venezuelan slaves)  paid for his care, just as the Canadian government pays for their bureaucrat’s care when they come to the U.S.  Wait, you don’t think that the Cuban facility did this operation for nothing do you?  Hah!

Fourth, doesn’t he know that he could have received free (I mean absolutely free) care from any number of medical tourist destinations that would love to have held their facility up as the preferred medical destination of the world’s richest and most powerful?  I think that some of the international medical tourist destinations might have even paid him to have his procedure at their facility just for the bragging rights!  But then, he’s a socialist and probably didn’t think about that.

If the purveyors of Obamacare all have their way, they may get to be medical tourists, too.

G. Keith Smith, M.D.

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Medical Research

Filed under: Uncategorized — surgerycenterok @ 1:50 pm

Should taxpayers be forced to fund medical research?  Should taxpayers be forced to fund any research at all?  The academic researcher would say (and has said), “if government doesn’t fund this who will?”  As more and more people are “looking behind the curtain” and finding that national bankruptcy is actually possible and budget cuts are unavoidable, brace yourself for the whining and gnashing of teeth from those who have been gorging themselves at the medical research trough.  See my 1995 letter here.  This comes up from time to time because honest physicians periodically scratch their heads after reading an article in a medical journal and wonder,”So? So What? What relevance does that piece of research (funded by a government grant) have to my practice….or to anything for that matter?”  It seems that lately, the shame associated with frivolous research done as a manifestation of expert grant-writing with little or no purpose at all, is gone.  Academic research departments have expensive labs and staffs and increasingly their eyes are on the next government grant, not on any particularly useful discovery.  Currently, some research department revenues support the academic clinical practice (taking care of patients) while in the past it was the other way around.  Common sense, huh?  If the government pays more for research than for taking care of patients, well, you get more research, right?  I guess my point here is that without the market driving research we are more likely to get research for the sake of research rather than research geared toward results.  I include private charitable foundations in the term “market” because the funds are not confiscated from taxpayers and thus are not politicized.

The politicization of research, an unavoidable result of government funding, has consequences.  Lobby’s and lobbyists spring up with pressure groups.  Politicians are painted as demons unless they “care” enough about this or that disease to “fund” research.  Diseases without lobbies go to the bottom of the list.  The search for a cure for this or that disease is a long process, but almost guaranteed to last forever if discovery of a cure ends your federal funding!

Here is one way  it might go:  a drug company makes large donations to the political campaign of one of the derelicts in Washington.  He leans on members of a committee in charge of funding some government grant-giver to award a lab (at an academic institution also benefitting from the largesse of this same drug company).  That academic lab does a study (and is paid nicely for this) that determines that this or that new drug (made by the above drug company) is indeed safe and effective.  What?  You think that this doesn’t happen?

How much more research money would the global warming guys get if they determined that the data showed that the earth’s temperature hadn’t significantly changed?  Maybe that’s why researchers at the East Anglia Climate Research Unit withheld data that led to this very conclusion.  See here.

Taking the market out of the research process has consequences just like taking the market out of anything.  There are mal-investments and distortions.  Research is done in one area that could (or should) have been done in another.  Failure to make discoveries is often rewarded with even larger grants.  I am anxious for this distortion to end and await the end-of-the-world arguments and whining from those cut off from this funding when it does end.

G. Keith Smith, M.D.

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Whole Foods and Certificate of Need

Filed under: Uncategorized — surgerycenterok @ 3:43 am

Several years in a row, the big hospitals got together and pushed legislation at the state level to require “certificates of need” for any surgery center or hospital that applied for a license.  The idea was that a “need in the community” for the new facility had to be shown in order for the health department to issue a license.

If you are thinking that this was simply their way of limiting their competition go to the head of the class.  Most recently at the national level, the national hospital association greased enough palms in Washington to place a moratorium on specialty hospitals and even on plans for expansion in existing hospitals.  If you think that the hospital association simply purchased protection from their competitors….well…come on this is so obvious I’m not giving out any more credit for this conclusion!  I’ve always wondered why “certificates of need” weren’t used more commonly.  Take grocery stores, for instance.  Whole foods is coming to Oklahoma City.  This is great news for grocery shoppers.  This is terrible news for the other grocery stores.  The current stores are going to have to sharpen their game and maintain competitive pricing and quality or…well..they go out of business.  Shouldn’t Whole Foods be required to show that the community needs another grocery store?  What if they are so good that some of the current stores go out of business?  Couldn’t that jeopardize the food supply?

This is the type of logic employed by the arrogant fools trying to manage our lives for us.  Apparently enough money is passed out to the Washington thugs to make this a reality for specialty hospitals.

G. Keith Smith, M.D.

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July 4, 2011

Independence Day

Filed under: Uncategorized — surgerycenterok @ 9:19 pm

What does this day mean? From what or whom did the founders declare their independence?  From a tyrannical government, that’s who.  The British tyranny of King George paled in significance to what we are seeing now, however, from Washington.  Increasingly, it seems, states are declaring their independence from Washington, D.C. I’ve noticed that this declaration is taking the form of nullification of federal laws.  States are simply ignoring federal laws or even more shocking thumbing their nose at the federal laws…. from refusal to register guns with the ATF to legalizing marijuana to the Obamacare resistance movement.

Happy 4th of July.  May the spirit of independence reign!

G. Keith Smith, M.D.

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