"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 ==================================================================== 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) -- ******************************************************** 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 E-Mail: [log in to unmask] CompuServe: 72303,3442 America Online: BobFink "Ex Tristitia Virtus" ********************************************************