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Mon Jul 27 10:34:19 BST 2009

Rob,
I just got out of the OR having explored the abdomen of a 21 yo man with a couple of GSW's; he was minding his business and ambling down the street with some dude.  Probably has no insurance, 'cause he doesn't have a job anymore, but got the care he needed.  Much as you and Rocky would do, we "just did it" and took care of the kid, 'cause its what we do.
I am too tired to thump my chest, and even more so to read the Rolling Stone or "hook up" with a male prostitute (or a female one, for that matter.......).  I am not too tired to say again what I said earlier - you and the majority on this list do what ewe do 'cause it is the right thing to do.  And no, I do NOT trust government, the large hospital corporations or the insurance companies to run medicine any more than I ever trusted the likes of the Wall Street and Detroit executives.  The problem is that the government is already running medicine - its called Medicare, Medicaid, and all of the state-run health care plans - and it is running medicine into the ground with the outrageous costs associated with an UNREGULATED "industry".  
As I see it, there is a vast difference between regulation and management, and we must not loose site of that difference.  Presently there is supposedly regulation, but it is garbage as it stands now.  And all of that translates into insurance companies refusing care that is recommended - no, demanded - by physicians, and the docs are too busy trying to care for as many patients as they can so that they can keep the practice going to spend the hours on the phone that would force the insurance company to do the right thing and provide the coverage that their contracts promise.
I agree that we desperately need change.  We need regulation of medicine - and I mean the ENTIRE shooting match - but we do not need government management, 'casue that will put us (docs and patients) so far behind the eight ball that we'll never ever see a pocket.
So, please don't stroke, 'cause the citizens of Chicago need you to keep seeing all of the patients that you know damn well the other hospitals will not benevolently see if y'all ever closed your doors.   You, my friend, and your better half need to keep doing a decent day's work for the decent day's pay the city isn't gonna pay you!!  
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert Smith
Sent: Monday, July 27, 2009 2:49 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Centrist vs Local Social Systems

For all the chest thumping capitalists, I strongly urge you to educate  
yourselves by reading Matt Taibbi's article on the history of Goldman  
Sachs in the current issue of Rolling Stone. For those who would  
rather be caught dead with a male prostitute then be seen buying this  
publication, I can send it to you on line. Talk about being well  
rewarded for doing a job better than anyone else.....!! Oh, and how  
did the economy of our country reach it's current state?

It's important to have different views on issues and there is not just  
one way to accomplish important goals. When so many people on the list  
that I respect and trust voice deep concerns over the government  
managing a healthcare system (never mind that it already does) I have  
to give that serious consideration. I get that you don't trust the  
government. But are you really saying that you trust the health  
insurance companies, the giant healthcare corporations and the  
pharmaceutical corporations to make decisions about what treatment  
your loved one will get MORE?? The insurance companies have a direct  
financial incentive to avoid providing care. Talk about the elephant  
in the room!

I wonder how many of you have had the unfortunate experience of really  
stressing your insurance to provide something that was medically  
indicated but which they wanted to avoid? If you're not another doctor  
willing to do whatever it takes, good luck trying to get the care your  
loved one needs. Don't any of you have patients who's insurance  
companies refused to pay for services you provided or wanted to?  
Routine follow up for TRAUMA care all over the city is to be sent to  
County Hospital. I don't think that's because the doctors don't want  
to treat them. My wife and I have spent over a half century caring for  
large numbers of people with no ability to pay. I'm not entirely  
confident that should our hospital cease to exist the other hospitals  
would benevolently pick up the slack.

I have to stop now before I have a stroke.

Rob

On Jul 26, 2009, at 6:44 PM, Gross, Ronald wrote:

> " Whether you're "productive" or not, whatever that may mean, has  
> had nothing to do with getting paid"
>
> C'mon, Rob!  That is the crux of the matter!  What ever happened to  
> the concept of an honest day's work begets an honest day's pay?  As  
> to productivity whatever that means, well I suggest that it means  
> whatever the boss says it means.  In our case - and in the case of  
> most professions - we should (and should is the operative word here)  
> be our own hardest bosses aka task masters.  Knowing you and guys  
> like McSwain, Mattox and the vast majority on this list, that is a  
> given, and we would work as hard as we could because we love what we  
> do - and we have the moral integrity to make sure that we have  
> earned every penny we didn't get paid.
>
> Now, look at the rest of the labor force - yeah, the very same folks  
> that we provide health care to - and tell me how many of those that  
> demand and expect health care as a God given right have earned their  
> paychecks, and have earned the right to the same quality care that  
> you and I pay for.  Sorry to sound so damn cynical, but therein lay  
> the basic problem that has rotted the infrastructure of our society  
> as we know it today.  I am tired of looking at the elephant in the  
> room and calling it a God-Damned mouse!
>
> OK - fire away.
>
> Ron
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org 
> ] On Behalf Of Robert Smith
> Sent: Sunday, July 26, 2009 6:09 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: Centrist vs Local Social Systems
>
> Puhleeeeze. I've worked my entire career at a public hospital, as I
> assume Dr. McSwain has. I've been paid a salary. Some people there
> could just show up and some people tried to be excellent every day.
> Whether you're "productive" or not, whatever that may mean, has had
> nothing to do with getting paid.
>
> I believe the people on this list that everyone respects would work as
> hard as they possibly could whether they were getting paid a lot or
> not so much for the privilege of being able to do what they do.
>
> Rob Smith
>
>
> On Jul 26, 2009, at 5:56 PM, Gross, Ronald wrote:
>
>> "who believes in being required to be productive in order to get  
>> paid"
>>
>> WOW!!!  What a concept!!  I wonder if it will ever catch on in the
>> US.....................again.
>>
>> Things that make you go Hmmmmmmmmmm......
>> ________________________________
>> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org
>> ] On Behalf Of McSwain, Norman E Jr.
>> Sent: Sunday, July 26, 2009 5:36 PM
>> To: Trauma-List [TRAUMA.ORG]
>> Subject: RE: Centrist vs Local Social Systems
>>
>> Sorry to disagree but I think it is the system that has failed or
>> has allowed the entity to fail. There are many other well known
>> similar systems that failed when they have become 'federalized' .
>> One of these is well known medical system and the other one is a
>> travel agency. Both of these systems started off with very good
>> intentions until the members lost the incentive to be productive and
>> were just looking for a place to remain protected and get their
>> paycheck. More interested in the paycheck than the service that they
>> were supposed to provide to the public. But of course that is a
>> person opinion from one who is capitalist who believes in being
>> required to be productive in order to get paid.
>>
>> 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 Doc Holiday
>> Sent: Sun 7/26/2009 2:24 PM
>> To: .Trauma List
>> Subject: RE: Centrist vs Local Social Systems
>>
>>
>> From: nmcswai at tulane.edu
>>
>>
>>> left out the other 'wonderful' social system...US postal service...
>>
>> ==> When it comes to nationally sponsored bodies he may have also
>> left out the US Military and the judicial system, not only the
>> USPS... There are success stories and failures, be they among
>> capitalist entities or "socialised" ones or "federalised" ones;
>> likely therefore that it is the entities which are at fault, not the
>> sysem within which they live. The UK postal office is not held up as
>> an example of success either.
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