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The article below, "Who Will Take Care of My Dogs", was posted yesterday with the final two paragraphs missing (faulty OCR). Here it is re-posted in its entirety. Sorry for the error! --------------------------------------------------------------------- "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. Medical Arms Race? In the United States, hospitals and doctors have been accused of engaging in an arms race. The assertion is made that too much available technology increases access and utilization. But not at fiscally starved hospitals -- Frederiksberg Hospital did not get its own MRI scanner until last year. It was purchased by a wealthy businessman and donated to the hospital. The government and the health care community had to rely on a private handout from a generous industrialist for equipment. There's not enough money to pay CEOs, shareholders, doctors, nurses, and to buy equipment. The United States and countries that have become welfare states are becoming less well staffed and less well equipped in their health care systems than many third-world countries which are driving hard to assume leadership roles. On the other hand, the United States is ahead in one area -- our health care CEOs have become the latest cadre of multimillionaires. UAPD IPA Response The UAPD formed the UAPD IPA as a non-profit riposte to the managed care buccaneers. We are currently negotiating several contracts. One has been signed; however, access to patients has still not been granted because the State of California has not yet signed off on the contract. We are in final negotiations for some other contracts as of this writing. Progress, while satisfactory, has been slow. One obstacle is how one actually negotiates contracts. Some payer companies knowingly submit bids with low payments and onerous conditions. We do not accept these contracts. However, once the payer companies find out that we know what we are talking about and can tell the difference between reasonable and not-so-reasonable contracts, the payers get serious and submit better bids. Then the real negotiations begin. The name of the game according to one CEO with whose company we have concluded a contract is "patience". I keep having to explain to these CEOs that our members spell the word differently, "patients!" So far the outlook is favorable in that the contracts we're negotiating are ones that treat doctors and their patients best. Rest assured, once contracts are signed, and as soon as patients begin seeing our doctors, you will hear about it from us! (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" ********************************************************