Saturday, August 15, 2009

Obama Hates Greedy Surgeons

At a recent town hall, Obama responded to a woman's question about healthcare by explaining how his plan will help keep costs down, partly by paying more to primary care physicians in order to make more drastic options unnecessary. And while this seems obvious to me, someone with the American College of Surgeons attempted to correct a claim he hadn't made.

And in making their "correction," they didn't bother quoting his actual words; which is generally a sign that perhaps the words are being misrepresented. And in my attempt to locate his actual words, I read lots of conservatives who repeated the statement, without quoting his words or providing any context.

I wonder why that was...

The Claim

Here's what they said:
Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation.
The Truth

Here's Obama's words:

On the doctors front, one of the things we could do is to reimburse doctors who are providing preventive care and not just surgeon who provides care after somebody is sick. Nothing against surgeons. I want surgeons. I don't want to be getting a bunch of letters from surgeons now.

I'm not dissing surgeons here. All I'm saying is, let's take the example of something like diabetes, a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be.

Right now, if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they are taking their medications in a timely fashion, they might get reimbursed a pittance. But, if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000, immediately, the surgeon is reimbursed.

Well, ,why not make sure that we are also reimbursing the care that prevents the amputation? Right? That will save us money.
And the point here is clear: Obama is saying that we'll save money by paying primary care physicians to prevent diabetes rather than amputate people's feet after it's too late. And that's simply undeniable. Not that cost savings is the only reason we should avoid foot amputations, but in the context of defending the costs of his health plan, this makes perfect sense.

And he wasn't saying that surgeons get paid $50k for the amputation. That wouldn't make any sense, because he's trying to explain how expensive amputation is. And if Obama thought surgeons received $50k for amputation, then his full figure for amputation would have been much higher and he would have gone with the bigger number. And while I understand how his meaning may have been misconstrued, it's obvious from context what his intent was. Again, the point was the expense of amputations; not the fee collected by the surgeon.

And in case you were wondering, this study claims "nontraumatic lower extremity amputation" cost between $40k-$75k in 2003; per the VA's numbers, which sometimes includes both feet. And so yeah, the numbers Obama quoted are in line with how much amputations cost, so I'd say that this is what he was referring to. (And yes, I wanted a better number here, but was having trouble finding one.)

Conservatives Got it Wrong

And in NO CASE was he smearing surgeons as greedy or suggesting that they opposed preventive care in order to pad their bank accounts. He explicitly said he wasn't trying to "diss" surgeons. The point was merely about how expensive amputations are, not complaining about how much surgeons make or besmirching their ethical standards.

While the surgeons group said they were merely trying to set the record straight, conservatives hopped right on the Slam Obama train, insisting that he was smearing surgeons while either lying or making shit up. But what else was to be expected when they didn't even bother reading his words? And so this attack on Obama's claim was entirely wrong. Yet all the same, conservatives were quite happy to repeat it, without bothering to check it out for themselves.

And why not? After all, Obama's a commie socialist, so of course he'd attack surgeons for being greedy. It's true because they want it to be true. And I've found this to be all too typical of what's coming from the right. They're so eager to finally find something wrong with Obama that they'll leap onto anything they can get their hands on; reality be damned.


Anonymous said...

regardless of his intent, he did say that "if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000, immediately, the surgeon is reimbursed." Either he is a sloppy speaker who doesn't choose his words carefully or he's a liar who intentionally misstated the truth.
a surgeon

Doctor Biobrain said...

Yes, anonymous, he said that. And he was referring to the cost of the amputation, not the surgeon's fee. As I pointed out, the amount he gave IS how much an amputation costs.

DrWes said...

Dr. B-

While I appreciate your comments and attempts to state what Mr. Obama actally said, let's be clear about some of his other statements, shall we?

Like the statements he made claiming that "two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs" - two thirds of a trillion dollars. Do we honestly believe the governent will find this much waste fraud and abuse to fund their monumentally-expensive proposed new entitlement? Who is he kidding? Further, the suggestion that "prevention" will obviate the need for surgical skills to debride or amputate an extremity ignores the basic pathophysiology of diabetic vascular disease. Certainly, careful diabetic control can delay the onset of vasculopathy, but stop it entirely and save money? Where are the data? Surgeons performing amputations that are clinically indicated might even save health care dollars by avoiding recurrent hospitalizations and prolonged courses of antibiotics in some cases. To demonize surgeons as greedy and as one cause of elevated health care costs totally misses the boat and exposes his lack of understanding of the complicated issues inherent to the health care reform debate.

Anonymous said...

Regardless of his intent, or his initial disclaimer, he was careless with his rhetoric. He specifically stated that the 'surgeon is reimbursed...' . He was wrong. At times of such a high intensity debate, I think he should be more cautious of perpetuating misperceptions.

Doctor Biobrain said...

To demonize surgeons as greedy and as one cause of elevated health care costs totally misses the boat and exposes his lack of understanding of the complicated issues inherent to the health care reform debate.

Wes - While much of what you wrote is debatable, there is absolutely NOTHING in what he said that demonized surgeons as greedy. Where are the data, indeed?

I mean, your argument would only make sense if the surgeons were also the primary care physicians, and he was claiming that they preferred to wait until amputation was the only option. And that's obviously not the case. He wasn't accusing surgeons of preferring amputation. He was merely explaining that we'd save money if we treated diabetes before it got to that point, by having primary care physicians educate their patients on how to control their diabetes. And that's a common sense thing I've heard from doctors for years.

And are you seriously suggesting that it might be cheaper to amputate a diabetic patient's foot than to tell patients how to control their diabetes? Really?? If that's the case, perhaps we should amputate ALL of their feet and be done with it. Why bother with insulin when we can just cripple them? I'm sure that's not what you're saying, but if not, I fail to see where you're going with this. Obama was absolutely right and it is better for us to get people proper treatment before it gets to the point of more drastic measures.

And I'll admit that I'm no doctor when it comes to this stuff, so I'll ask: Is diabetic vascular disease not preventable? I did a quickie search and read that it WAS preventable, yet you seem to be suggesting it's not. But I suspect you're only referring to patients who already HAVE these more serious vascular problems, while Obama was referring to having doctors help patients avoid them.

So is there something these websites are lying to me about, or are you perhaps misunderstanding what Obama was talking about? I've known many people with diabetes, yet I've never known one who lost a foot.

ER Tech said...

The problem is "the surgeon is reimbursed". Not "the hospital is reimbursed". He created a parallel between the primary care physician getting reimbursed a "pittance". I know he knows that is not true, but I'm not believing that he misspoke that parallel on accident.

Doctor Biobrain said...

Yes, ER Tech, he made a parallel between the surgeon and the primary care physician. But how does that mean that he's saying the surgeon receives all that money? His point was how expensive the surgery was, and the amount he gave is right for that surgery.

And why exactly do you imagine he'd be purposefully demonizing surgeons? How would that help him?