Dr. Thompson's Blog

The Problems with Medicare for All

I very much believe in health care for everyone, but do not believe that Medicare for All would work. There will be terrible lobbying by the drug and medical device companies, as well as the health insurance companies. I agree with Representative Seth Moulton that keeping and expanding  the Affordable Health Care Act, allowing a choice of good insurance plans, as was in the Public Option, and allowing a buy-in for Medicare is the way to go. Medicare for all would greatly reduce the money paid to hospitals and doctors and I don't see the U.S. bureaucracy being able to administer a health care plan for all, as is done in other countries. 

One thing that can be done right away to reduce health care costs is for Medicare to be able to negotiate drug prices, as the VA does. The drug companies are making obscene amounts of money. Last year they made 69 BILLION dollars. Yet one in five individuals in the U.S. cannot afford their medications. Our mental health care in the U.S. is very bad.  Rep. Moulton, an Iraq war veteran, says that 50 % of veterans  have PTSD, as he did, and yet  most do not get mental health help. My brother was one of those after the Second World War. It changed his life. Rep. Moulton says that two weeks after discharge a veteran should  have a mental health check-up and then annually. He also suggests this as part of yearly physicals for kids, but because  pediatric care in many places has become so inadequate, I don't see this as happening. We have get resources in this country, and some excellent doctors, but money seems to the real problem now with our medical system, as well as lots of greed.

The Consequences of the Alabama Abortion Ban

I shudder when I think of pregnant teenagers, the women too poor to  have another child and a woman who has been raped and become pregnant. To me children are very special, but to think of any child being raised in a foster home, being unwanted or abused makes my blood curl. The pro-life people think they are doing something wonderful to be sure a child will be born. But what about a child who is unwanted, the child of a teenage single  girl who has no maturity or ability to care for a child? I have seen patients like all of these. The pregnant teenage girls I cared for when I was in private pediatric practice where not even grown up themselves. Their parents would have kicked them out if they had known they were pregnant. What would  the girls have done then? Would they have become homeless, become prostitutes, or married a rich older man and been miserable.  It is fine for the pro-life people to stand on their principles. No one loves children more than I do. But these pro-life people don't seem to know or understand the consequences of a child who is unwanted, the mother who can't support another child or a woman who  has been raped and unable to  care for a baby. I wish the pro-life people could talk with some of these individuals.

As Trump is determined to get rid of the Affordable Health Care Act, reduce  funding for Medicaid, food stamps, and every other form of social support, these woman and teenagers  will have an even harder time if they are forced to have a baby they cannot care for. 

Tragic Problems with Some Medical Devices

An article in the New York Times on 5/5/19 was frightening. The title was " 80,000 Deaths. 2 Million Injuries. It's Time for Reckoning on Medical Devices." There have been multiple lawsuits, particularly about pelvic mesh. It said that "most of these medical devices were approved for market with nearly no clinical data." It also said that "most medical devices are poorly vetted before their release into the marketplace and poorly monitored after the fact." I guess the medical devices lobbyists  have been very busy and successful! Fortunately, the F.D.A pulled the vaginal mesh products from the market last month. The article went on to say that some metal hips, defibrillators and artificial heart valves have caused problems. Other pieces of equipment used in operating rooms  have also caused problems. It makes you  want to stay far away from doctors and hospitals. Money has become so important in the U.S.and morals seem to be lacking more and more. That leaves all of us as patients at risk. I think you have to careful research physicians and hospitals. There are still some wonderful doctors, but having had a recent experience with a doctor I would call a technician and not a doctor, I have become even more cautious. Fortunately, I survived his atrocious surgical care and will ever see him again. Sadly, good doctors often recommend a  colleague or partner and have no idea how he or she practices. 

Despite all the lawsuits against them, the medical device industry  earns about 400 billion dollars annually. I find that amazing and tragic. They seem to care more about making money than saving lives and helping patients. 

The Greedy Drug Companies

When Trump became president, one of the false promises he made was to lower drug prices. Instead, they seem to go up almost monthly. I heard an appalling statistic yesterday. It was that the drug companies last year spent 30  BILLION dollars on lobbying. When we have thousands of hungry children in this country, people working two jobs to try and survive, and a tax law that gave major tax breaks to corporations and the super rich, it is embarrassing.

I had an opportunity last week to speak with a couple from Norway and one from the Netherlands.  Neither couple could understand what has happened in the U.S. with the Trump group and the mess they have created.  There is excellent, free medical care in both countries and both couples said they always thought America was a world leader. We   have lost that status. There are now more lobbyists in Washington D.C. than there are members of Congress. 

As parents and grandparents and every day citizens, we certainly need to let our voices be hard. Drug prices must come down. There is no reason that the government cannot  negotiate with the drug companies and also pass laws that don't allow such greed.

Many people do not fill the prescriptions they need because of the cost. It is either that or they skip meals in order to pay for the drugs and yet we are the richest country in the world. How can we allow such a terrible problem to continue?

Many Medical Schools are Graduating Technicians, not Physicians

My favorite professor when I was a Stanford medical student said " I can train almost anyone to be a technician, but I cannot train just anyone to be a physician." He taught us a physician should have concern for his or her patients, get to know them, and truly care about them. He was a wonderful neurosurgeon.  I am seeing more and more medical students who know what to do on a computer, but many seem to have little or no compassion or concern for patients.  An outstanding older surgical nurse told me today she is seeing the  same thing in many young nurses. She said for them it is all about earning a big salary. If caring for patients is not why someone goes to nursing or medical school, our country is in big trouble. I loved the British nurses when I worked at Hammersmith Hospital in London. Several told me they wanted to take care of patients, not be administrators or head nurses. 

A Kaiser administrator I recently met in an airport asked me what I thought about Kaiser starting their own medical school. I said I had no problem with that as long as they had doctors teaching the art of medicine, as well as good clinical care. If all they do, as sadly I am seeing in many medical schools, is to  just teach the mechanics of medicine and not art and caring then I hope it is not built. Patients also need to be taught how to find the best medical care and not accept poor care from either doctors or nurses. We have some wonderful doctors and nurses in the U.S., but many are dropping out and giving up because  medicine has become a business, not a caring profession. For many it is about money and prestige.

The Border Problems and Family and Pediatric Doctors

It is so hard to hear and see all the misery and terrible care that children and people are receiving at the border. Some children and adults have died. Now that Trump has decided to get even tougher  on immigrants, as physicians I think we all need to speak up. I realize it is hard to be a practicing physician, who is trying to earn a living  to also have to worry about the people at the border. I can remember how tired I would get when I saw patients all day and often into the night and then went to Mexico on weekends to see children.  I  went several time with the Flying Samaritans to a clinic in  Mexico where long lines of people would be waiting overnight to be seen. We worked on cold pavement floors and I always wore a warm jacket to try and keep from shivering. The patients were very grateful for our help and I think we did some good. The best thing I felt I accomplished was to  have some polio vaccine donated and also to refer several cases to orthopedists and other specialists for care in San Diego. 

Now however the problem is  much worse as Trump says "The country is full" and he wants to reinstate his family separation policy. I don't know if some of the family doctors and pediatricians are being forceful about complaining and helping.  I hope so. I also hope the members of their National Boards  of  Directors are complaining to Trump and to Congress. The children in cages are going to suffer long-term effects. We are creating a terrible problem, made even worse because Trump has  taken away the money we formerly gave to these impoverished countries south of the Border.

Good and Bad Health Insurance

The Trump administration is doing their best to destroy everything that President Obama accomplished with his health plan. Now they are allowing junk health insurance to again be  available. In addition, they are doing their best to get rid of the Affordable Health Care Act.  If they do twenty plus million people will lose their health insurance.  Those with pre-existing conditions will be in deep trouble. Also, those with large medical or hospital bills will find that the new junk insurance will not cover their bills. Also, the junk insurance companies can take away insurance from an individual if their medical or  hospital bills get too large. Because Trump has had millions of dollars available to him, even as a child, he has no concept of what not being able to pay your medical bills is all about. The Republicans have no back-up plan if they destroy Obamacare. This is unAmerican and wrong. 

In my book, 101 Ways To The Best Medical Care, I have a large Appendix with many websites that could be helpful if you lose your insurance. A good one that gives a comparison of different insurances is: www.ehealthinsurance.com. There is also a list of state departments of insurance and health that could be helpful. Many people end up signing up for HMOs because they are cheaper. Unfortunately, you usually do get what you pay for and there are lots of problems with HMOs. In my book, I describe these and also what you should check in before you sign up with an HMO. One of my biggest worries about HMOs is that they allow nurse practitioners to see patients without the supervision of physicians. I have seen some tragic results because of this policy. We have to fight the  Trump administration to ensure every American gets the best medical care possible. I spend a lot of time helping parents and others find ways to get good medical care for their children and themselves.

Is Medicare for All a Good Idea?

I believe every person deserves the best possible medical care. As medical care in the U.S. has gradually declined in the last several years, I am not sure Medicare for All  is the answer. The powerful and greedy drug companies, the health insurance industry, and far too many greedy doctors will fight any comprehensive plan. The billionaires who surround Trump and his many supporters will also fight. Why should they worry about others when they can afford the very best health care?

Another problem I see is that Medicare for  All will mostly function the same as the worst HMOs. A patient will have to get permission to see a specialist, and to have any test done. Many of these decisions will be made by nurses or non-medical personnel. Nurse practitioners will have an even more important role, as can be seen in the Kaiser health system. A good nurse is worth his or her weight in gold, but physicians should be the  ones to oversee a patient's care. 

In a recent article in the New York Times by Paul Krugman, he discusses  different plans found in other nations. One is Medicare for America. In this plan patients could keep their own health insurance if they like it, but "they or they employers would also have the option of buying into an enhanced version of Medicare, with substantial subsidies for lower and middle-income families." The U.S. comes last in any survey about healthcare in countries

We need to expand the coverage of the Affordable Healthcare Act and have good regulation of drug and health insurance companies. I don't see  any of this as happening. I am just very glad I practiced pediatrics in the glory days of medicine. It was not about making a lot of money but enjoying our patients, making house calls, meeting patients in the  ER and caring for our patients in the hospital.  The Netherlands and France are still  rated as having the best healthcare. We certainly don't.

How Hospitalists have Changed Patient Hospital Care.

I suspect that few people who have to go into a hospital for medical problems or surgery have no idea about what a hospitalist does. It can change your care greatly. I had my first exposure to a hospitalist when I flew to Las Vegas to see my elderly brother in what was supposed to be the best hospital there. I was appalled at the care I saw from the hospitalist. He wandered in  mid-morning, briefly spoke to my brother and then left soon after that. My brother's private physician said she did not go to the hospital but worked from 9 to 5! I was appallled The hospitalist did not review my brother's past medical records, did not speak to his private physician, or to me. Even the nurses and social workers were appalled at his care. Subsequently, I have had other reports about these physicians. One doctor friend, who had to hospitalize her daughter at our local medical school hospital, finally transferred the young woman to another hospital. She said the hospitalist there was not quite as bad!

I have a friend  who is presently having  surgery by an orthopedist who essentially leaves all  her patient care to the hospitalist. I  have urged my friend not to go back to the surgeon but she liked the results of her first hip surgery, despite the awful care from the hospitalist. I ended up doing a lot of her care with several phone calls a day. The orthopedist is what my favorite medical school professor would call a technician, not a doctor. The orthopedist saw my friend twice and basically stood at the door and said "hello".  She did not examine my friend or really ask her  how things were going. I am afraid we are training more doctors like that. I worry greatly about medical care in the years ahead. It often is all about money. Hospitalists are usually trained in internal medicine and then have some additional training. They make very large salaries and concern about their patients does not seem to be high on the list of the several with whom I have had contact. I am glad I practiced in the "glory days" of medicine.

Health Care for All

I believe every human being deserves the best health care possible. Sadly, in the U.S. with all the lobbyists for the drug and insurance companies, Trump and his group are trying to get rid of much health care as possible. Of course, he and his billionaire pals can pay for the best health care. The members of Congress also get excellent, free health care. 

Many of the Democratic candidates are pushing for Medicare for all. Medicare is a great program, but I don't understand how these candidates plan to fight the insurance and drug companies to get Medicare for all and pay for it. Instead, I think they need too look to other countries to see how they pay for the excellent health care that their citizens get. A single-payer plan, such as Canada has, would be a fight to put in place in the U.S. Another country's health system might be the one to check. This was well put by the journalist, Jamie Daw, in an editorial in the New York Times. The author of the article stated that all German citizens  are required to have health insurance. However, they are given a choice of "More than 100 private, nonprofit insurers. Workers and employers share the cost of insurance through payroll taxes. The government finances coverage for children and the unemployed." The cost of health care in Germany and other European countries is far less than in the U.S. We could make a big start in the U.S. if Congress had the courage to  fight  and place controls on drug and health insurance companies, as well as medical device companies. I read a statistic some place that said there are more health insurance and drug company lobbyists than there are members of Congress. I hope when we  have a Congress, not controlled by billionaires, that some real changes will be made.