Ask Dr. Ira Williams

Praise it or scorn it, Michael Moore’s film, Sicko, presents some very harsh truths regarding healthcare in America, raising the heat on an already hot topic. Exposing severe faults in our current healthcare system is, unfortunately, so easy a cave man can do it. In the best case scenario, Sicko can be used as a catalyst for debate on healthcare change. At its worst, it could be a bludgeon that would widen the divide between positive change and political quick fixes.

Positive healthcare change should never become a partisan political issue. Despite Michael Moore’s world view, Democrats don’t wear white hats and Republicans don’t wear black hats. Any politician who tries to make it so should be shunned, though our current political reality makes this very unlikely.

We should not assume that any president, past or present, understands the cause or the cure for our healthcare woes. The nation dodged a bullet when Bill & Hillary’s attempt at healthcare change became a lead balloon. Why did they fail? Two terms in the White House and over one term in the Senate have yielded zero meaningful healthcare proposals from either source.

The truth between the opposing factions is that, far too many people receive far too little quality healthcare within a system with the potential to be the best in the world – but one that continues to fall far short of its potential. The reason for that failure is a lack of understanding the fundamentals of our existing healthcare system and of how it evolved into its present state.

Few people realize the enormous amount of time money and effort directed toward the “improvement of healthcare” that has taken place over the past three decades. Congressional committees, federal and state agencies, public and private foundations, organizations, think tanks, and other researchers have created mountains of literature. Then Michael Moore and his film crew came along and easily exposed the inept results.

That glaring fact should suggest that no one, including the large group of presidential hopefuls, should attempt to change healthcare before they really understand it. Yet every current presidential candidate has, or soon will have, their personal “list” of healthcare changes that would appear soon after their inauguration. Medicare, Medicaid, HMOs, and the secrecy of medical peer review, is a congressional track record of bureaucratic management that speaks for itself.

Michael Moore and every other “expert” in the quest of healthcare change never speak in specifics regarding the medical profession, that pool of individual doctors so vital to the healthcare system. No magic wand is available to suddenly transform our healthcare system into a mirror image of Canada, England, France, or Cuba. That does not mean that positive change can’t or should not occur.

A perfect starting point for positive healthcare change should be an understanding of Organized Medicine and the regulation, or lack there of, of the practice of medicine.
Why is the practice of medicine so sacrosanct that even Michael Moore couldn’t find specific questions for Organized Medicine?

NO ONE is talking about the fundamentals of our existing healthcare system AND how that system evolved to its present state.

Right or wrong, the majority of our current healthcare system was created on a capitalistic model, making it a consumer product, much like a loaf of bread, a car, or a house. How much of each can you afford?

Sicko documents the need for positive healthcare change.
No Harm Advocate.com provides the “how” for positive change – NOW!

Three events, two very tragic, which could have occurred anywhere in America, occurred in or near my community, at different times, in recent months. These events reveal a little known fact about our current healthcare system.

First event: A construction worker is accidentally killed at the work site. OSHA investigators were at the scene within hours.

Second event: A single-engine airplane crashed on take-off. Both occupants walked away with only slight injuries. FAA investigators were at the site within hours.

Third event: A 27 year old, slender, healthy, wife and mother entered the hospital for minor knee surgery under local anesthesia. She was injected once in the upper thigh area on the front and once in the buttocks in the operating room. Within minutes, she suffered a catastrophic systems collapse and within a few additional minutes she was clinically dead.

NO investigators from ANY regulatory body ever appeared at the site of that accidental death. The hospital administration and medical staff were left to investigate themselves. Not surprisingly, the widowed husband was forced to sue the doctors in order to try to find out what happened.

On the third anniversary of her death a lay jury returned a verdict of no negligence. The doctors had won another court case.

Two very significant facts must be understood from that tragic story.

First, hospitals are probably the only site in America where an accidental death can occur and receive NO regulatory, in-depth investigation – HOW FRIGHTENING!

Second, the practice of medicine is the least regulated economic activity in America.

Events one and two above instantly made the newspapers and other media outlets. However, that young wife and mother’s accidental death wasn’t covered. The hospital risk management staff circled the wagons and it is assumed that the medical staff investigated themselves.

The only way I found out about this was when I was told by a friend that a lawyer he knew had won a big malpractice case. I then went to the library and found a small newspaper article that covered the jury verdict that was handed down…three years later!

Whatever “facts” that presumed medical staff investigation produced, they were never provided to the widowed husband. He was left at the mercy of a jury - twelve, mostly high-school educated, fellow citizens with a collective medical I.Q. of near zero.

Similar accidental events can and do occur in many other parts of our nation, and similar responses repeat themselves. OSHA or FAA investigators will be at the scene of accidental events within their purview.

Newspapers and TV stations have hot lines set up to receive calls for instant notification of tragedies such as the construction worker’s death or events such as the airplane crash.

Who calls about accidental deaths in a hospital and who would they call?

Why is the practice of medicine so insulated?

Perhaps a better question would be, why is the practice of medicine so unregulated?

Does anyone care?

Ask people who they hold responsible for the medical malpractice crisis and attorneys will be somewhere in the answer.

Organized Medicine should get a public relations award for creative obfuscation. Like a parlor magician who diverts attention with one hand and performs the trick with the other, Organized Medicine has diverted most public scrutiny from themselves to a very accessible target – attorneys.

There are 3 things readers should know about this issue:
1. Attorneys are NOT the cause of the medical malpractice crisis.
2. Attorneys can never contribute to the solution of that crisis.
3. I am neither a paid or unpaid advocate for the ATAA.

A solution for a social problem must begin with identifying the root cause of that problem. Just because the AMA says attorneys are the primary cause of the medical malpractice crisis does NOT make it true.

Doctors are the cause of the medical malpractice crisis – and – doctors are the only cure for that crisis.

One of the greatest impediments to solving the medical malpractice crisis is that doctors have been convinced they are not the primary cause of that social reality. Most doctors know far too little of the history of their own profession, particularly that history pertaining to the era of “Modern Medicine.”

A “walk down memory lane” through the Journal of the American Medical Association (JAMA) should disabuse them of the notion that anyone else is the cause of their problem. Read the JAMA, as I have done, from 1949 – 2003. The stark contrast between AMA pronouncements in the early decades of that period and current declarations are illuminating.

AMA proclamations in those early years of post WWII Modern Medicine were those of a true profession:
“Doctors are the best judge of other doctors.”
“We owe it to the public to judge ourselves.”
“If we don’t do it, someone else will.”
“The most logical place to apprehend the incompetent physician is in the hospital.”
And the best one is:
“The only act in medical practice which may properly be termed “malpractice” is
negligence in the care of a patient.”

Idealistic rhetoric rears its ugly head. Literature regarding medical malpractice over the last forty years has a vast quantity of generalities and platitudes, with negligible specifics to find a tangible solution.

“Doctors are the best judge of other doctors” is a truism.
“Doctors do not know how to judge other doctors” is a reality.

Society has been left with that sad reality, but it is not recognized in medical literature. What’s more, there is no authority or media watch-dog to question it.

Everyone wants healthcare change, so what can you do?
First, you must understand where to look for that change.
Let’s “do the math.”

America has two healthcare systems, so each has two different paths that lead to possible change.

Federal healthcare is legislated by Congress and regulated by the Department of Defense (DOD) and the Veterans Administration (VA). They’ve made sweeping changes quickly before so there is NO doubt that they are capable of doing it again…if they want to.

The Department of Defense zipped far past the private practice of medicine in the way they credentialed doctors in the mid-1980s. The VA improved their entire medical and patient care structure in the 1990s.

So they can change. But not without a will to change and a means to do it.

Federal “will to act” on major issues must come from YOU.

Private healthcare is regulated by each state. Private practice of medicine is the least regulated economic activity in America. There is NO person in any state who can prove that statement to be incorrect. There is also NO state which can provide evidence of effective healthcare change during the past two decades of a growing, clearly evident need. They just don’t get it.

State legislatures could create the most effective healthcare change but they are the least likely to do so. If you think Congress functions poorly, spend a few days observing your state legislature in action. Be prepared to come away in tears. It will not be a pretty sight.

Healthcare change can occur through other means.

Harvard Medical School Department of Anesthesia demonstrated in the mid-1980s that institutions can make major changes when they are pressed to do it. Medical schools, teaching hospitals and large medical clinics have the power too, but have never demonstrated the will.

Two additional, potential agencies for healthcare change should also be considered.

Organized Medicine makes state legislatures look better and more competent than they really are, history proves it.

John D. Clough, MD, Editor-in-Chief, Cleveland Clinic Journal of Medicine had this to say in 1997, “In the past, the state and county medical societies played a reactionary role in virtually every political debate affecting health care, and to some extent they continue on this path. They have acquired the reputation of opposing whatever the current reform proposal was, while rarely offering a reasonable alternative (or even directly addressing problems everyone inside and outside the health care system knew existed). The societies protected the interests of physicians, but were often blind to the needs of society and even to the needs of the patients they served. They were almost never seen as a part of the solution, and gradually they came to be viewed as part of the problem.”

So much for expectations of positive healthcare change originating from Organized Medicine.

Let’s also look at the cottage industry of healthcare. Governmental and non-governmental agencies, universities, foundations and think-tanks play a major role in every consideration for healthcare change. They each create volumes of articles and books. Is there any evidence of a viable solution within those works? The end result is that after over two decades of recognized need for change, positive healthcare change remains an illusion.

What can you do? Hammer them. And continue to hammer them. But know who you are applying pressure to and exactly where they can best participate in future, positive healthcare change.

Congress, state legislators, medical educators, and anyone who contributes to the written or spoken word regarding healthcare change must be held accountable.

Congress should NOT attempt to regulate private medicine. State legislatures make a poor enough effort without Congress’ help. Each should stick to their respective area of healthcare influence, but each must be held accountable for what they do, or more likely, don’t do.

You are the best source of power to initiate any future healthcare change. They have proven at every possible level that they are unable to do what needs to be done on their own.

You can continue to be part of the problem by doing nothing, or you can become part of the solution by pushing them to make changes.