I once had a 34-year-old businessman come to my office with trigeminal neuralgia, a horrible pain on one side of the face that develops when a blood vessel irritates a nerve as it leaves the brain stem. There are several options for treating this pain, and I had recommended to the patient that he have surgery to move the blood vessel away from the nerve, which treats the underlying problem and leaves the patient and the nerve normal. His insurance company denied it, recommending instead a surgery to insert a needle into the nerve and burn it. This procedure could be done as an outpatient and for half the price, but left the patient with a numb face. The other left the patient and his nerve normal. This is an example of what problems patients can expect from a small panel of unelected bureaucrats, which does not have to answer to the public, when cost cutting rather than quality of life is paramount. Although most Americans will never see a neurosurgeon in their lifetime, won't you want one available to you—and all the treatment options at his or her disposal—if you do ever need one, such as when surgery is necessary to relieve debilitating back pain?
Fortunately, some in Congress recognize the danger of this approach to Medicare cost-cutting. In April, Rep. Phil Roe (R-Tenn.) introduced a bill in the House, the Medicare Decisions Accountability Act of 2010 (H.R. 4985), to repeal the IPAB. Additionally, in July, Sen. John Cornyn (R-Texas), introduced a similar bill, called the Health Care Bureaucrats Elimination Act (S. 3653). I urge you to support these efforts.
As a surgeon, I'm also very concerned about an issue that was not addressed in the health reform bill and cannot be ignored if we are serious about improving the well-being of our patients—fixing our broken medical litigation system. We learn as part of our training that the average neurosurgeon in the U.S. gets sued every other year. Being sued, we are told by the attorneys, is just the cost of doing business, and we should get used to it. As a consequence, we learn to order extra CT scans, MRIs and other tests in an attempt to protect ourselves. The health reform law turns its back on this crisis of “defensive medicine.” Despite the findings by the Congressional Budget Office that comprehensive medical liability reforms, such as those in place in California and Texas, would save the federal government billions of dollars, Congress did not include any proven medical liability reforms in the health reform law. Consequently, the costs of defensive medicine continue to be shifted to the patients. The ultimate cost is not only financial but also human. Congress must once and for all get serious about fixing this problem or our health system will continue to be dysfunctional.
Although we all agree that affordable healthcare for everyone is necessary, the current healthcare reform proposal contains a number of provisions that worry those of us who spend our days in the hospital, trying to provide the best care we know how to for sick people. To think that someone sitting on a panel or in front of a computer, who may not even have medical training, can determine what is best for our patients without speaking to a doctor is frightening, dangerous and irresponsible. This really is brain surgery, and we need to get it right. Please listen to our concerns and take action by conveying your concerns to your legislators.
Rick Boop, a practicing neurosurgeon in Memphis, Tenn., is a member of the Washington committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.