List Archives

Sat Jul 25 17:29:00 BST 2009

To the international trauma/critical care/acute care surgery persons of all 
 disciplines on this list server,  I do NOT apologize for the recent  
discussion regarding the political and economic debates occurring recently on  
this list server, particularly from Dr. McSwain, Dr. Krin,   and  myself. 

I remind you it was just this week that we congratulated Dr. Karim for  
finally achieving a trauma system for London.   Every one of our  countries, 
and every one of our cities, and every one of our hospitals are going  through 
the same debates about money, economics, power, control,  etc.   The power 
and control has to do with which suture you use,  which imaging device is 
purchased, which mesh is used, which drug is purchased,  and the 
qualifications of the housekeeping, dietary, pharmacy, nursing, and  physician contract 
persons for those that control the  money.   

Let there be no mistake, the system of nationalized care put into place in  
the mid 1960s has run its course and major MAJOR changes are needed, and I  
totally agree with that.    We do NOT however need to infuse huge  amounts 
of new money.   There is more than sufficient money right now  in the system 
(we spend more than 2.3 Trillion dollars a year in REAL money and  give 
away enough pro bona work to bring this current figure up to $3  Trillion/year 
in the USA alone, with more than 50% of that going to overhead,  
administration, hassle factor, paper work, and medical legal  costs.   Huge amounts 
more go (off the top) for profits to  insurance companies and management 
systems.    Huge percentages  (50%-75%) pay for futility and end of life care 
during the last 6 months of  life,  which often is known to not increase any 
quality of life, but does  contribute to increased misery and pain and 
suffering.   I am not  saying do not be humane and focused, but apply your 
professional judgement  to what is best for the patient, not what is best for the  
economy.    Yes, we do need a change.   

The legislative and political and economic and procedural, and yes, even  
regulation, safety, QA and some internal reviews are being done, not for  the 
patient's best interest, but to address the issue, "how do we control  the 
doctors and their influence over patients?"   That too must change  in our 
"Health Management Reforms."  

The reason I am writing here is that I firmly believe that the only broad  
systems of care around the world are those in place and developing for 
Trauma /  Critical Care / Acute Care Surgery / and yes Medical Aspects of  
Disaster.   Many of the leaders in these fantastic models and examples  are on 
this list server and have already had significant input to your own  local, 
state, and national governments.   Please keep it  up.    Your current and 
future patients need  it.     

k

In a message dated 7/25/2009 10:32:42 A.M. Central Standard Time,  
nmcswai at tulane.edu writes:

just  another view of him and his medical insight

The number of uninsured is  not reduced significantly. In a few years all 
the folks will give up their  private insurance so the government will pay 
for it and then the medical czar  controls those gets what and when. But as 
the president said this week when  asked if he would like to be under the new 
system?. "It does not affect me. I  have a physician to follow him around 
all time." 
It is all about the shift  in power from private enterprise to the 
government. It does away with the  capitalism and shifts to socialism.

Norman

Norman McSwain  MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane  University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu  <mailto:norman.mcswain at tulane.edu>  

________________________________

From:  trauma-list-bounces at trauma.org on behalf of kmattox at aol.com
Sent: Sat  7/25/2009 10:22 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: BRAVO to  the ACS

Dr. Krin:   I was in the room when the AMA  house of DelegAtes Boo ed Mr. 
Obama when he stated that there would be NO caps  on non economic damages in 
Med Mal law suits.   

K

------Original Message------
From:  Krin135 at aol.com
Sender: trauma-list-bounces at trauma.org
To:  trauma-list at trauma.org
ReplyTo: Trauma-List [TRAUMA.ORG]
Sent: Jul 25,  2009 10:15 AM
Subject: Re: BRAVO to the ACS

There is one point where  Louisiana does lead the nation in a good way. I've
previously mentioned the  Patient Compensation Fund and the tort reform 
that accompanied the  formation of the fund. I was quite disappointed  that 
Mr.
Obama's plan  did NOT include a reasonable form of tort reform.

Yes, we need to  police ourselves better, BUT there needs to be some 
mechanism to protect  otherwise good doctors from 'acts of God' and  the 
Murphy
factors of  our patients. How many of us know of an OB  doc who manages  a
complicated delivery in an emergency coverage situation, doing   everything 
humanly
possible to save both the mom and the baby, only to be  sued  for problems
which were present *before* the OB doc laid hands  on the mom?

With the pervasive 'victim' and 'lottery winner'  mentalities here in  the
US in regards to medical and other  malpractice, it's not surprising that 
percentage lawyers abound, and have  contributed heavily to both sides of 
the 
political  system.

ck
Charles S. Krin, DO

In a message dated  7/25/2009 08:25:58 Central Standard Time, 
nmcswai at tulane.edu  writes:

I can  say that from experience. I come from the only  state in the Union
with  universal health care. In fact, we have had  such a system since the
1930's.  Gov. Huey P. Long created a medical  care system  that "no citizen 
is
more  than a day's horse back  ride away from a hospital'. Every Louisiana
citizen is  guaranteed  health care Our system cost almost more per capita 
than
any state  in  the union and our health care is very close to the bottom. I 
b
elieve we  are  4th from the top in cost and 4th from the bottom in   
outcome.

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