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Tue Jul 28 12:12:00 BST 2009

Pret,

I will pass on commenting on the bulk of your e-mail for fear of boring all with the same old thing in a different wrapper.  Rather, I will agree to disagree, as our positions will never change as a result of our own inherent and very differing perspectives on life, liberty and the pursuit of happiness....and healthcare funding.  Government was designed to lead a nation/state/city/town, NOT define the marketplace, care for patients, or determine standards of care.

What I must comment on is your comment:  "Now consider how providing global basic health insurance would decompress our ED's and free them for their intended purpose."  You are too smart to be serious, or to really believe what you just wrote.  The use of the ED by those who choose to use it as their form of primary care is a habit that will never be broken by giving everyone health insurance because there will never be a satisfactory time frame in which these folks will get to see their PCP.  Even imposition of a huge co-pay will fail.  That is my prediction, based on my observations over the last 33 years of practice.

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Monday, July 27, 2009 4:54 PM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: [MailServer Notification]Content Filtering Notification

Basic healthcare cannot be sustained in a for-profit model.  Neither
can/should basic education, or basic law enforcement.  Selectively
underserving any class or individual is socially, politically,
economically, and ethically untenable.  It's a wonder to me that
Americans have taken so long to admit as much.  

Wait.  We still HAVEN'T.

Of course, emergency care must also be provided without regard to
ability to pay; but that's established in statute already.  (Recall that
there were circumstances within our lifetimes when these patients could
be denied access to certain hospitals.  Be proud of the solution.)  

Now consider how providing global basic health insurance would
decompress our ED's and free them for their intended purpose.  

And how much less expensive and more effective it is to treat most
common ailments when the patient has a regular doctor and doesn't have
to tolerate early symptoms for fear of the cost.  

And how much more compliant patients will be when the pharmacy bill
doesn't get deferred in favor of rent or groceries.

Funny: the Trauma-List is a richly international venue; yet I've not
seen a single message from Canada or Great Britain or Spain or France to
the effect of "NO!  Don't do it!  Keep your system the way it is!
Public health insurance doesn't work.  We wish our system was more like
YOURS."

Or maybe I've missed it.

Regards,

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald
Sent: Monday, July 27, 2009 3:20 PM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: RE: [MailServer Notification]Content Filtering Notification

"Let's instead imply that people who can't afford or qualify for
insurance are inherently undeserving and/or insufferable whiners."

I don't believe I (or anyone else on this site) ever said that.  But
just for laughs and giggle, lets imply that - now what?  We still
haven't come to the essential of the question - just exactly what is
this "miracle cure" that Mr. Obama has proposed and that you and others
are supporting sight unseen.  What are the details?  What are the
numbers? Who are the players?  And exactly how will this new gift from
Obama get all of my inherently undeserving and/or insufferable whiners
covered so that they can get anything they want, supposedly just like
you and Rob and I could get today?

Sorry, but if it seems too good to be true, it probably is.

And Pret, you are so right......this is indeed tiresome and
unsatisfactory.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Monday, July 27, 2009 3:05 PM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: [MailServer Notification]Content Filtering Notification

I haven't been able to keep up.

Okay.  I haven't really tried.  It's tiresome and unsatisfying.  (Sorry,
it is.)

But this one caught in my throat.

I'm used to the cynicism (and generally encourage it, if only for the
entertainment value); but I'm shocked at how NARROW the assertion seems.
Do you really believe that healthcare is nothing more or less than a
commodity?

I suppose it shouldn't be surprising that this mindset would come from a
trauma care provider.  Your customers (and mine, and those of the
hundreds of nurses and paramedics and surgeons EM physicians on the
List) float in a flood-stage risk pool that has been long abandoned by
the commercial insurance industry.  (See also MEDICARE and MEDICAID.)
Thus they are disproportionately more expensive to treat and less likely
to pay.  

The commercial insurance industry is not beholden to society, but to
executives and investors who measure success not by excellent
evidence-based services -- much less the enhanced health of the customer
-- but by financial profit.  The commercial interests have already
signed up all the responsible citizens who are aware of their morbidity
and protective of their fortunes (provided they could afford the
premiums).  

And with the focus off actual disease control (which would regrettably
run counter to marketing), then the quickest way to amplify the
quarterly net revenue is sadly predictable: by denying the illness or
delaying its treatment.  Every month a policy goes unclaimed is another
incremental accrual of capital.

These guys've got a business to run, after all.

But that's America, ain't it?  God forbid we should criticize
capitalism.  Let's instead imply that people who can't afford or qualify
for insurance are inherently undeserving and/or insufferable whiners.

Sigh.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald
Sent: Sunday, July 26, 2009 6:59 PM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: FW: [MailServer Notification]Content Filtering Notification

...

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 G*$-D@*$#!' mouse!

OK - fire away.

Ron

Ronald I. Gross, MD, FACS
Chief of Trauma & Emergency Surgery Services
Baystate Medical Center
Assistant Professor of Surgery
Tufts University School of Medicine
759 Chestnut Street
Springfield, MA  01199
413-794-4022  phone
413-794-0142  fax
ronald.gross at baystatehealth.org

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