"WHO WILL TAKE CARE OF MY DOGS?"
 
An article by Robert L. Weinmann, M. D., President; Union of American
Physicians and Dentists; Oakland, California; which appeared in the
January, 1995, issue of THE UAPD REPORT, a Newsletter for the Union
membership
 
 
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At eighty-one years old, the gentlelady believed
that her medical condition would be cared for by her
country's government supported managed care medical
system. She was wrong.
 
Denmark has one of the most progressive welfare
systems in the world. Social services for the elderly
are second to none. "Everyone resident in Denmark is
entitled to the benefits of health insurance,"
according to The Danish Counties, published by
the Association of County Councils in Denmark.
While "medical care for all" is proclaimed, the fact
is not everybody benefits equally. One of the
unlucky ones was the elderly mother of Hanne Kirkby, M.D.,
herself a specialist in geriatric medicine in Copenhagen.
 
Doctor Kirkby's 81 year old mother developed what
was first thought to be senile dementia in 1991.
When the symptoms began, the elderly lady noticed
her own lapses of memory. Her memory failed
progressively. She would park her car and then be unable
to find it. Her chief worry became who would feed her two dogs
once she had completely lost her memory. Initial medical
opinion was that the old lady had suffered small strokes
and that aggressive intervention would be useless. Medical
evaluation was sought. However, the aggressive evaluation
upon which possible treatment might be prescribed was initially
discouraged by the establishment in charge of administering the health
care system. Under the 1991 system, stroke patients over
the age of 70 were not to get intensive treatment
and were instead simply to be sent home. Some might say to die.
 
Doctor Kirkby intervened for her mother. A CT scan of the brain
was done. A subdural hematoma was found. An operation to
resect the offending blood clot was successful with total resolution
of the so-called senile dementia. This story has a happy ending:
the 81 year old woman is now 84 years old.  She lives in her own
apartment in Copenhagen. Her two dogs are doing well, too.
 
 
Managed health care in Denmark, like any other
place where managed care is practiced, may be
used to force the elderly into accepting
substandard medical care. The name of the
game is "Move over and die. Make room for
somebody else who is younger and more productive".
Rescinding the 70 year cut-off point for intensive
treatment solved only the problem of arbitrary age
limits. The reason for imposing
this age limit remains. At Frederiksberg
Hospital in Copenhagen where this issue was
addressed, fewer beds were available for
intensive care than heretofore. A triage
decision was made to accommodate the
shortage of intensive care beds. Behind this
triage decision, however, lurks the financial
administration of the health care system: only as
much money as is allocated to health care can
be spent. Some medical care would have to be
denied. "Medical care for all" is a myth not
only in the United States and Canada, but also
in Denmark.
 
 
 
Myth Becomes Slogan
 
 
While "medical care for all" may be a myth, it
remains a powerful slogan. In the United
States, we watch with dismay as senior citizens
give up individuaIized Medicare benefits to sign
on with managed care companies who take over
their Medicare benefits and then deny them
access to specialized care. These companies
profit from denying medical care because
money collected as a premium and not spent on
the Medicare recipient's personal health care
becomes corporate profit. In the case of the
government, the less that is spent, the more
there is for other purposes. In health care under
managed care, the slogan should be "more is
less -- more money for corporate owners, less medical care for
subscribers.
 
 
Profit, Profit, Everywhere,
And Not A Dollar To Spend
 
 
At least not on health care! Where have the
dollars flown now that the doctors are being
squeezed out of the picture?
 
In 1993, total compensation for Sanford Weill,
CEO at Travelers, including salary, bonuses,
and stock options was $52.800,000. U.S.
Healthcare's CEO, Leonard Abramson, pulled
down $9,820,254. Ronald Compton, CEO of
Aetna Life and Casualty, made $2,340,000.
Over at Prudential, CEO Robert Winters raked
in $2,299,255. Metropolitan Life's Harry
Kamen received $1,161,667. Between the
bunch of them, not even one appendectomy was
done. The lesson to be learned from these facts
is that managed care will result in increasingly
expensive insurance premiums for health care
while simultaneously decreasing the doctors'
ability to provide it.
 
 
American physicians know that hospital beds
are being phased out. There is a financial
incentive involved: the more the so-called
"hospital pool" (money set aside every fiscal
year to pay for in-patient hospital care) is
conserved (not spent on patient care), the more
there is left over at the end of the fiscal year to
divide up as profit. A similar pulse runs
through government welfare programs.
Downsizing is the name of the game. Ole
Rosbo, Director of Frederiksberg Hospital,
points out that his hospital recently downsized
from 1,500 beds to about 600. Besides
reduction in beds. Director Rosbo also had to
supervise reductions in length of stay and
intensive care. Per Hubbe, M.D., summed the
situation up when he said that his hospital just
didn't have enough room for everybody. While
the 70 year old age limit was recognized as
imperfect, this age restriction cut costs by reducing
bed utilization.
 
 
(Reprinted with permission from the Union of American
Physicians and Dentists, Oakland, California)
 
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Robert A. Fink, M. D., F.A.C.S.   Phone: 510-849-2555
Neurological Surgery              FAX:  510-849-2557
2500 Milvia Street  Suite 222
Berkeley, California 94704-2636
USA
 
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