I received an email from a family member today that contained a "letter" (actually an article from American Thinker) from a Dr. Zane F. Pollard on his thoughts and opinions about a proposed nationalized health care system for the United States (or, as he calls it, ObamaCare). "Letters" like this annoy me. Not because I disagree with his premise (that nationalized health care is bad), but because it wasn't intended to be informative or as a starting point for reasonable debate. The letter is full of logical fallacies, intentionally misleading information (lies), and wording/terminology intended to provoke emotion.
I'm going to weigh in on this on a point-by-point basis interspersed with the original "letter", but I'll be supplying supporting evidence and citing my sources as I go. I'm going to attempt to stay neutral on the topic and just point out the problems with the email, but I'll probably fail.
This letter is from Dr. Zane Pollard. He is operates at Children's Health Care of Atlanta. Google him
I'm playing a little loose with this, but this is a type of logical fallacy called "argument from authority" (argumentum ad verecundiam). It can be summarized as "using the words of an 'expert' or authority as the bases of the argument instead of using the logic or evidence that supports an argument." Basically, "this guy has credentials out the wazoo... you should accept what he says".
Friends:
I have been sitting quietly on the sidelines watching all of this national debate on health care. It is time for me to bring some clarity to the table and as your friend by explaining many of the problems from the aspect of a doctor.
First off the government has involved very few of us physicians in the health care debate. While the American Medical Association has come out in favor of the plan, it is vital to remember that the AMA only represents 17% of the American physician workforce.
Simply because many people may believe, or not, in something (in this case the efficacy of a nationalized health program) says nothing about the merits of that something. This is a type of logical fallacy called the "bandwagon fallacy". For the sake of argument, I'll forgive it (and use it to illustrate the counter point)...
I've been having trouble figuring out the actual number of physicians who are members of the AMA (ranges anywhere from the stated 17% up to about 30%), but the AMA is not the only medical association in the United States to have recommended a national plan. For instance, the American College of Physicians (membership over 126,000, largest medical-specialty organization and second-largest physician group in the United States) recently joined with over two-dozen other national institutions to "correct the record against myths and falsehoods" with regard to nationalized health care.
I can't find any data as to how many physicians have been consulted for their opinions, but I have been able to find several physicians groups set up for the sole purpose of pushing FOR nationalized health care (eg National Physicians Alliance, Physicians for a National Health Program, et al). I tried searching for physicians groups opposing a national health plan, but was unable to find any (with Google).
I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. Why is this. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list. Each time I was told to fax Medicaid for the approval forms which I did. Within 48 hours the form came back to me which, was mailed in immediately via fax and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.. Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point-rationing of care.
Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time. Again extreme rationing.
This whole section isn't even remotely relevant to the discussion at hand. Medicaid is only partially funded by the federal government and is wholly administered by the states (according to Wikipedia). The worst his comments on Medicaid suggest is that Georgia is incapable of properly managing health care for their state's poor. This does not, in any way, reflect on the nation as a whole.
Solution- I have a foundation here in Atlanta supported 100% by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrant’s children for free. Again waiting for the government would be disastrous.
Correct me if I'm wrong, but is this suggesting that the "solution" to the un/under-insured problem is to rely on the generosity of others?
Also, again, his problems extend from Georgia's poor management of Medicaid, not any national system.
Last week I had a lady bring her child to me. They are Americans but live in Sweden as the father has a job with a big corporation. The child had the onset of double vision 3 months ago and has been unable to function normally because of this. They are people of means but are waiting 8 months to see the ophthalmologist in Sweden. Then if the child needed surgery they would be put on a 6 month waiting list. She called me and I saw her that day. It turned out that the child had accommodative esotropia (crossing of the eyes treated with glasses that correct for farsightedness) and responded to glasses within 4 days, no surgery was needed. Again rationing of care.
Who is he suggesting was rationing the care in this example? The Swedes who will still provide (if slowly) health care to uncovered foreigners?
This seems, to me, to be a observational selection fallacy. Choosing an outlying example (foreigners uncovered by a health system) to show that rationing may take place while ignoring the 9 million Swedes who receive timely medical services. According to the British, Sweden has one of the best health care systems in the world and their National Guarantee of Care states that "a patient should be able to get an appointment with a primary care physician within 3 days of contacting the clinic. If referred to a specialist by the GP, they should get an appointment within 14 days, and if treatment is deemed necessary by the specialist, it should be given within 30 days." I couldn't find any data on their policies regarding foreigners, so I can't claim that his statements (or those of his patients) are an outright lie, but they were certainly designed to be misleading.
Last month I operated on a 70 year old lady with double vision present for 3 years. She responded quite nicely to her surgery and now is symptom free. I also operated on a 69 year old judge with vertical double vision. His surgery went very well and now he is happy as a lark. I have been told- but of course there is no health care bill that has been passed yet that these 2 people because of their age would have been denied surgery and just told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously cheaper than surgery.
I had to read this section several times to piece together the intent due to terrible punctuation (I hate to go there, but it's true), but I think I understand his point. If I understand correctly he is suggesting that there were these two older people who needed surgery and he was told that if we had nationalized health care then they would have been denied coverage for the surgeries. There are several problems with this.
The first problem is that he doesn't give enough enough information on the cases for anyone to be able to assess the situation. All he told us was that the surgeries happened. Both of these people were old enough to be covered by Medicare... would they cover it? Did/would private insurers? For the sake of an argument on nationalized health care it isn't important whether it would cover hypothetical case X, it's important whether quality of care would increase or decrease. If these people had to pay out of pocket for their treatments how would anything change?
The second problem is that he doesn't cite any sources for saying that the two patients wouldn't be covered. In politics it is a common practice to make a statement to illicit the effect you want, but distance yourself from the it by saying that you "were told" or that "you heard". To give an example of how effective this can be: I heard that Dr. Zane Pollard makes the illegal immigrants he takes as patients work off their debt to him by selling drugs to children. You see, I can say anything I want (in this case indicating that Pollard is a drug lord), whether true or not, by just attributing it to someone else and STILL make you hear what I want. I'm not saying that he didn't, in fact, "hear" this somewhere, just that he's provided no evidence for it and his tactics for delivering the information are dubious.
The last problem I have with this section is, again, in the last two sentences. There's a fallacy called "argumentum ad baculum" which is basically an appeal to fear or threat.
I spent two year in the US Navy during the Viet Nam war and was well treated by the military. There was tremendous rationing of care and we were told specifically what things the military personnel and their dependents could have and which things they could not have. While in Viet Nam, my wife Nancy got sick and got essentially no care at the Naval Hospital in Oakland, California. She went home and went to her family's private internist in Beverly Hills. While it was expensive, she received an immediate work up. Again rationing of care.Comparing the medical services offered by the Navy to their personnel and their dependents and that of a potential nationalized health plan is a weak analogy, at best. No one is suggesting that a nationalized health plan be structured like that of the Navy's and no one is suggesting that the Navy's plan be extended to the general populace. Further discussion of a poor experience with an unrelated entity is superfluous.
For those of you who are over 65, this bill in its present form might be lethal for you. People in England over 59 cannot receive stents for their coronary arteries. The government wants to mimic the British plan.
This is a outright fabrication (read: blatant lie), at least according to The Guardian. Also, if the government intends to mimic the British plan then why did Pollard spend a whole paragraph discussing Sweden's system above?
For those of you younger, it will still mean restriction of the care that you and your children receive.
Restricted as in how? There are no claims here of any substance to verify/refute.
While 99% of physicians went into medicine because of the love of medicine and the challenge of helping our fellow man, economics are still important. My rent goes up 2% each year and the salaries of my employees go up 2% each year. Twenty years ago ophthalmologists were paid $1800 for a cataract surgery and today $500. This is a 73% decrease in our fees. I do not know of many jobs in America that have seen this lowering of fees. But there is more to the story that just the lower fees. When I came to Atlanta there was a well known ophthalmologist that charged $2500 for a cataract surgery as he was the best. He had a terrific reputation and in fact I had my mother's bilateral cataracts operated on by him with a wonderful result. She is now 94 and has 20/20 vision in both eyes. People would pay his $2500 fee. However then the government came in and said that any doctor that does Medicare work can not accept more than the going rate (now $500) or he or she would be severely fined.
This put an end to his charging $2500. The government said it was illegal to accept more than the government allowed rate. What I am driving at is that those of you well off will not be able to go to the head of the line under this new health care plan just because you have money as no physician will be willing to go against the law to treat you.
I haven't done any research on this, so I'll just take what Dr. Pollard says above at face value. This still isn't a reason against nationalized health care. The government didn't, as Dr. Pollard suggests, make it illegal for his colleague to charge whatever he wanted for a surgery... they simply said that if he wanted to work for them then he could only charge their rate. He had the choice to run a completely private practice or to run a government subsidized one and he chose the government subsidies. In effect, if he wanted to compete then he'd have to compete. This is no different than what the current health care insurance industry does. They basically tell the doctors what they'll pay and the doctors almost always accept (they loosely call this "negotiating").
I am a pediatric ophthalmologist and trained for 10 years post college to become a pediatric ophthalmologist (add two years of my service in the Navy and that comes to 12 years). A neurosurgeon spends 14 years post college and if he or she has to do the military that would be 16 years. I am not entitled to make what a neurosurgeon makes but the new plan calls for all physicians to make the same amount of payment. I assure you that medical students will not go into neurosurgery and we will have a tremendous shortage of neurosurgeons. Already the top neurosurgeon at my hospital that is in good health and only 52 years old has just quit because he can't stand working with the government anymore. Forty-nine percent of children under the age of 16 in the state of Georgia are on Medicaid so he felt he just could not stand working with the bureaucracy anymore.
I've been able to find no evidence that any of the current plans support paying physicians from differing fields equally. I also find it highly suspect that "medical students will not go into neurosurgery" if this turned out to be the case. People have differing interests and many will persue those for reasons other than money. There are many examples in many fields of people choosing what interests them and not just what has the highest paycheck. He, again, gave a single example of something (a neurosurgeon at his hospital who has quit) as if it proved his point (see: observational selection fallacy).
He's also again attacking Medicaid as if it were relevant to nationalized health care, see above.
We are being lied to about the uninsured. They are getting care. I operate at least 2 illegal immigrants each month who pay me nothing and the children's hospital at which I operate charges them nothing also. This is true not only on Atlanta, but of every community in America.
There are roughly 800,000 physicians in the United States. If we assume that each of these physicians can offer the same services (not true, many are specialists) and each of them provide services for two people a month free (also not true) then that means that 19,200,000 people could be seen per year. That is less than half of the number of uninsured people in the US (more than 47 million). This is a generous estimate and this is assuming one treatment per person. Where is the health care for the other 28 million coming from?
There's also evidence that those uninsured who do receive care get a lower quality of service. To quote the Institute of Medicine, "Those lacking insurance received only 50%–60% of the services offered to insured patients, both in terms of ambulatory visits and within hospitals." This suggests to me that either the uninsured are not getting the care that they need or that the insured are receiving care that they do not need. I think it's likely that, between those choices, it is the uninsured who are receiving suboptimal care.
Also, again, as a "solution" this is relying on the generosity of others to provide health care to the un/under-insured. I think this is unfair for all involved.
The bottom line is that I urge all of you to contact your congresswomen and congressmen and senators to defeat this bill. I promise you that you will not like rationing of your own health.
Contacting representatives to make them aware of your thoughts and feelings is not a bad idea. I, however, urge you to make sure they actually are YOUR thoughts. Do research, educate yourself, then contact your representative. Just make sure you have something of value to contribute... be prepared to explain why you think nationalized health care is a bane or a boon.
Furthermore, how can you trust a physician that works under these conditions knowing that he is controlled by the state. I certainly could not trust any doctor that would work under these draconian conditions.
Argumentum ad baculum again. This is appealing to fear without offering any evidence or facts.
One last thing, with this new health care plan there will be a tremendous shortage of physicians. It has been estimated that approximately 5% of the current physician work force will quit under this new system. Also it is estimated that another 5% shortage will occur because of decreased men and women wanting to go into medicine. At the present time the US government has mandated gender equity in admissions to medical schools .That means that for the past 15 years that somewhere between 49 and 51% of each entering class are females. This is true of private schools also because all private schools receive federal funding.
The average career of a woman in medicine now is only 8-10 years and the average work week for a female in medicine is only 3-4 days. I have now trained 35 fellows in pediatric ophthalmology. Hands down the best was a female that I trained 4 years ago- she was head and heels above all others I have trained. She now practices only 3 days a week.
The only evidence I've been able to find that a significant number of physicians are planning to quit over the national health care issue are from personal blogs that don't cite any sources (just like this "letter" didn't cite any). Also, according to the American Academy of Family Physicians "2008 Medical School Enrollment Hits All-time High". Because of lack of real sources, it's hard to know if 5% of physicians are actually planning to quit over this issue, but if they are then current enrollment numbers suggest that it'll only take about 2.5 years to replace them.
I'm not really sure what specifying women's roles in this is supposed to accomplish. Is he trying to suggest that women, on average, work fewer days than men? If so I find this highly dubious and would call out for him to cite sources for this data. He, again, gave a single example of something as if it proved his point (see: observational selection fallacy).
Zane Pollard, MD Dean Booth Miller & Martin PLLC Suite 800
1170 Peachtree Street, N.E.