Donald R. May
Donald R. May MD, FACS is a retina surgeon residing in Lubbock Texas. In 2003, he ran for the United States House of Representatives. He has served on the faculties of the University of Illinois, the University of Texas, the University of California, Tulane University, and Texas Tech Health Sciences University. He has lectured and taught ocular surgery and medical economics throughout the United States and abroad.
Dr. May served for twelve years on the Health Organization Management MBA faculty, a joint project of the Texas Tech School of Medicine and College of Business Administration.
Thursday, July 10, 2008Patient Ownership of Health is the American WayBy Donald R. MayOur nation champions free enterprise and personal freedoms. We have fought wars to end socialist tyranny, and we stand firm against North Korea, Cuba, and other communist dictatorships. How is it that we are on a path to socialized medicine when Canada, Britain, and even Russia and China are seeking free market economic solutions to their socialized health care problems?Money has always been provided for health care and other necessities of life for the poor and disabled. The poor are used as political human shields to provide cover for the push toward universal government-provided health care. In fully socialized health care systems such as exists in Canada, it is the poor who usually receive the minimal level of health care. The solutions for health care financing are quite simple. Health care needs to be returned to the basic economic principles that govern the sale of the other necessities of life, including food and housing. Free markets work and bureaucracy and socialism do not. Personal responsibility is essential to saving health care and to an ownership society. Medical savings accounts for health care and personal investment accounts for Social Security are major reform steps on the road to an ownership society. As most people do not understand economics and fear change, any reasonable solutions will be difficult to implement. Our elected officials must find the courage to return health care, retirement, and other personal decisions to the people as the people can best make their own decisions. The ownership of health care and retirement funds are essential steps in the return to a free and economically successful society.
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Wednesday, July 9, 2008Medicaid, Medicare: Rationing Through a Thousand CutsBy Donald R. MayCategories: Medicaid, TexasIf you doubt that government-run health plans lead to rationing, consider Medicaid and especially Medicare.As Medicare prepares to cut physician reimbursement by 10.6% on 15 July, physicians nationwide are preparing to no longer care for Medicare patients. It was reported last week that 42% of Texas physicians have already opted out of Medicare. Many more will surely follow if Congress does not block this major reimbursement cut. Lowering the Medicare reimbursement of physicians so low that they cannot afford to care for Medicare patients has decreased the ability of many patients to access medical care. This is a very clever move by politicians and bureaucrats as it successfully creates another highly effective rationing tool: It prevents many elderly and disabled from even getting in line for care. (As discussed on this blog previously, Medicaid patients have had similar problems.) Rationing heath care is first achieved by progressively cutting the money paid to the principal providers of the health care, especially the physicians. We have seen this happen with both Medicaid and Medicare. With each cut, some physicians will elect to opt out of the health care plan, as they can no longer afford to provide the services needed by the patients in the plan, pay their employees, and keep their doors open for business.
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Friday, May 30, 2008Fishing Expeditions and MalpracticeBy Donald R. MayCategories: TexasOne of the most feared occurrences in the life of a medical doctor is the arrival of a legal case that has been filed against him or her. Being accused of malpractice is what nightmares are made of for those of us who have practiced medicine. Perhaps the only worse event in the life of a physician is the notification of the sudden and unexpected death or illness of a close family member, a friend, or a patient.The accusatory legal document begins with several remarks defaming the skills, education, ability, integrity, and honesty of the physician being charged. Most of these comments are exaggerations designed to attract the interest of the court, to influence future jurors, and to intimidate and dispirit the physician being sued. Any other physicians unfortunate enough to also be so accused are addressed with the same or similar intimidating and belittling remarks. The defamed physician has essentially no recourse against these written remarks, and the law has been thus far on the side of the accusers. Suddenly the lives of the physician and the physician’s family become a living hell. Sleep is disrupted, family fun and outings are cancelled, the joy is stripped from family life, and the joy of caring for patients is greatly diminished. Some resort to drugs, alcohol, and even suicide. This often happens to those who are excellent physicians and who have done no wrong. Over the past three decades, I have reviewed the evidence in many malpractice cases on behalf of the defense of accused surgeons. I have watched the agonizing effects on the physicians and their families. Even if the case is dismissed, the dismissal will usually occur several months, or even years later. Even if the case is dismissed, the scars remain for the rest of the lives of those affected. I personally know very few physicians who have encouraged their children to choose medicine as a career. A mark of quality service often is noted in family members who persist in a vocation or career that has been in their family for several generations. This includes plumbers, electricians, chefs, lawyers, morticians, farmers, and all other fields of endeavor. This has changed in medicine to the detriment of all, since each of us is or will be a patient. Most of the best and brightest students no longer compete for admission to medical schools. Many physicians and surgeons live in fear of malpractice claims against them. To protect themselves, some have backed away from care that has a higher level of malpractice claims. Neurological surgery and obstetrics services have greatly decreased in many poor and rural areas, as the surgeons often did not have adequate backup from colleagues. The perceived risk of delivering care in those areas was simply too great. Trial lawyers have long claimed that bogus legal claims are relatively harmless. These claims are made to fish for possible fault and a chance to earn large fees. The cost to defend a bogus claim averaged about $70,000 in 2003. The cost has gone up since then. We look forward to additional legal reform in Texas. Our economy is solid, physicians are coming to Texas in great numbers, and common sense and old-fashioned American ingenuity often prevails. I hope what has been done in Texas with tort reform will significantly influence the legislators of other states to do the same.
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Friday, May 30, 2008Saving Medical Care with Tort ReformBy Donald R. MayCategories: TexasWhile most politicians are busying themselves with band-aid fixes for the health care and trial lawyer problems they and their predecessors created, Texas has been fixing the problems. Self-sufficient Texans have looked squarely at the issues and enacted significant tort reform.This tort reform has lessened the financial burdens on physicians, many companies, and the insurance industry. This has been an excellent move in the right direction. A column that recently appeared in The Wall Street Journal, "Why Doctors Are Heading for Texas," (subscriber link) is worth reading. The author, Joseph Nixon, championed the tort reforms as a member of the Texas House of Representatives. As a result of recent reforms in the state, the economy of Texas has been doing remarkably well. Physicians are coming to Texas in record numbers, malpractice and personal injury cases are way down, insurance savings have been very significant, and the greedy trial lawyers will hopefully shy away. These changes in the Texas civil justice system have slowed legal abuses and protected physicians and hospitals. Other tort reform has successfully eliminated more than 99% of the asbestos and silicosis litigation by requiring reasonable burdens of proof before litigation can proceed.
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Tuesday, May 20, 2008We Should Not Kill CanadiansBy Donald R. MayCategories: Single-Payer FolliesThat’s right! If we allow our remaining private health care to be replaced with socialized health care, our Canadian neighbors will lose their access to the high quality medical services presently still available in the United States. Many will unnecessarily suffer and some will prematurely die. Of course, our own health and lives will also be at much greater risk if politicians and bureaucrats have increased access to the control of our health care.There are extensive waiting times in Canada’s socialized health care system for diagnostic procedures, hospital admissions, and surgical procedures. These have resulted in Canadian provinces sending many of their patients each year to the United States for medical care that cannot be provided to them in a timely matter. Canadian bureaucratic planning problems have resulted in shortages of neurosurgical, cardiovascular, and complex obstetric care. Ontario has been particularly heavily hit and has sent hundreds of patients to the United States for medical care it cannot provide. British Columbia and other provinces have also sent patients. These are the fortunate patients as they receive timely quality care and their government pays the bills. Thousands of other Canadians simply come to the United States at their own expense each year for medical care they cannot receive in Canada. Often they have serious medical or surgical conditions such as cancer or cardiovascular disease. They travel to the United States and willingly pay for their own medical care. With waiting times for medical care in Canada of often many months, the decision to seek care in the United States is life saving for many Canadians. Patients also come to the United States from Britain and many other socialized health care countries seeking high quality care they cannot receive in their own countries. These patients travel to the United States and personally pay for care they cannot even purchase at home. Many such patients are evaluated and treated at the Mayo Clinic and at other medical facilities in Houston, Miami, Los Angeles, Seattle, and many other cities. These health care tourists add billions of dollars each year to our economy by purchasing medical, surgical, and other health care services. While they are in the United States, they and those who accompany them spend money at hotels and restaurants. They shop and purchase other goods and services. In Britain, patients are being left waiting in ambulances for hours at a time. These seriously ill patients are kept out of the hospital emergency rooms so as not to produce adverse statistics showing long waiting times for emergency room care. Such deception seeks to hide the inefficiency of the vastly overcrowded and understaffed British emergency rooms. The ambulances become the temporary waiting rooms keeping them out of service and unable to respond to other emergency calls. Such is some of the insanity created by the bureaucracy of socialized single-payer health care systems.
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Friday, April 18, 2008The Many Faces of RationingBy Donald R. MayRationing heath care is first achieved by progressively cutting the money paid to the principal providers of the health care, especially the physicians. We have seen this happen with both Medicaid and Medicare. With each cut, some physicians will elect to opt out of the health care plan, as they can no longer afford to provide the services needed by the patients in the plan, pay their employees, and keep their doors open for business. The decreasing numbers of physicians participating in the health care plan makes it more difficult for the patients in the plan to make appointments with physicians. In many towns and small cities there are currently no physicians who will accept appointments with Medicaid or Medicare patients. Malpractice litigation is another effective way of rationing care. Unwarranted malpractice cases have driven many physicians, especially obstetricians, from their small rural practices. Many women must travel far for obstetrical care and the delivery of their babies. The poor, elderly, racial minorities, rural residents, and veterans are the first to experience the full brunt of the rationing. They can often not afford to seek other sources of health care. Rationing is increased to allow the diversion of more funds to the bureaucrats administering the plan. The bureaucrats use the money intended for health care to expand their own ranks and to increase their importance in their health care plan. Managers and bureaucrats soon outnumber the health care providers. Management and bureaucracy usurp an ever-increasing proportion of health care funds. The medical bureaucracy of the health care plan creates extremely complex problems. These problems require more bureaucrats and ever increasing numbers of regulations. This is the secret of socialism. It is a self-perpetuating process. Regulations replace the free market. Physicians and other health care providers are buried under paperwork, red tape, and bureaucratic regulation. The next time you are in a hospital, notice how nursing personnel spend almost all of their time at the nursing station documenting patient care in charts and almost no time delivering care and comfort to the patients. The bureaucracy judges nursing care by the records the nurses keep. Individuals with far less training deliver most of the direct patient care. I am of the opinion that this is the source of many health care problems. This is a major change in the delivery of nursing care from the time I was in medical school. The demand for health care from the plan always exceeds the projected costs. Patients demand more care when they perceive that the price of the health care is low. There are no human limits to health care “need.” With increasing demand, the rationing of health care services becomes the primary goal of the health care bureaucracy. A government-run health care plan increases health care costs, reduces health care quality, and rations health care services. Monetary and criminal penalties are added to insure compliance with the plan and the expansion of the rationing. The bureaucratic solution for physicians not participating in the plan is universal health care coverage, which will force all patients and physicians to participate in the plan. As little is effectively being done to halt the progression of socialized medicine, its eventual implementation is all but assured. Medicare Part D, pushed into place by otherwise conservative capitalistic Republicans, added the largest socialist medical plan ever. By the time patients and physicians both began to experience progressively decreasing levels of satisfaction with socialized medicine, it was already too late. The social health care plan and bureaucratic job security are what really matters, and both are already firmly in place. There has been little courage on the part of physicians or politicians to reverse the process. As long as voters do not understand that government is the problem and not the solution, health care quality will continue to deteriorate and costs will continue to rise.
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Wednesday, April 2, 2008The PlanBy Donald R. MayIn a bureaucracy, people do not matter. What matters are the elite administrators and their social plan. The plan is the intent. It does not matter how the plan is implemented. Lying, deception, suffering, and death are all permissible in a bureaucratic health care plan as long as the goals of the plan are achieved. In a government health care plan the people are promised that the plan will provide them with great “free” health care. They, the governed, are highly taxed to pay for the plan. They, the people, end up waiting in line. Many patients and physicians will embrace the plan, as they believe the plan will take care of them and remove the bureaucratic hassle of the current health care system. By the time they realize the solution is far worse than the current system, the plan is fixed in place and the managers and bureaucrats are in firm and unrelenting control. Most patients like the plan as their minor health care problems are quickly addressed. This keeps 96% of the patients happy. When one falls into the 4% of the patients who need serious specialized care, the reality of the plan first hits home. The delays and denials of care can be overwhelming. Those who do not survive the delays and rationing will no longer drain money from the plan. "I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them." Thomas Jefferson
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Thursday, March 20, 2008Grandmother Paid Her Own BillsBy Donald R. MayCategories: PharmaceuticalsIn the three decades I have been involved with surgical education, dramatic changes have occurred. These changes significantly impacted me and my ability to care for patients. Virtually all of the adverse changes have been due to the intrusion of government into the delivery of health care and the provision of welfare financing. My formative years were as the son of a poor tenant farmer in Illinois. My generation was the first to make it beyond the 8th grade. We had no health insurance, and neither did anyone else we knew. No one in our immediate family had ever asked for public assistance. Long hours of hard work provided money for savings, which provided money for health care. We looked at health care as a service and a provider of pharmaceuticals. My paternal grandfather was hospitalized for several months as he was dying of cancer. My grandmother paid the bills from their savings. No one ever suggested someone else should pay the medical bills. The welfare system at that time was at the county and state levels and worked well with limited bureaucracy. On a train trip to Chicago in the early 1950s, I recall meeting a mother and her young daughter. The daughter had webbed fingers on both of her hands. She was going to be admitted for surgery at the University of Illinois Hospital. The mother joyfully explained that her county health care physician had referred her daughter for specialized hand surgery. There would be no cost to her as it was a state-financed teaching hospital. Twelve years later I started medical school and saw teaching patients at that same hospital. By then, welfare was rapidly changing because the involvement of our federal government. During my medical student obstetrics rotation in 1970, the most common age of the mother having a baby I delivered was 13 years of age. Aid to Dependent Children was already having a major adverse social impact. During my graduate medical training in the 1970s, an orthopedic resident told of the difficulty of keeping casts on the broken arms of children. Many children would return weekly for the replacement of broken or wet casts at no cost to the patient. To remedy this problem, a small fee of about $2 or less was charged for the cast. When the children came back to have their casts removed, the casts were generally in like-new condition. The children said their parent or grandparent threatened severe consequences if the cast were damaged and they had to pay again for another cast. Any damage to their personal finances was an important issue. This program of charging the patient a nominal fee for casting was quickly stopped by social workers citing apparent violations of various laws. The casts were again replaced every week or so. So much has changed with health care delivery over the past four decades. While it is true that technological advances and some new medications have improved medical care, much that was good has been diminished. Quality has been replaced with expediency. There is a progressive increasing lack of interest in the patient. The focus of medical care has shifted from the provision of all necessary care to the rationing of all possible medical services. Documentation and adherence to laws, rules, regulations, and red tape have displaced patient care. The most significant change I have noted is the small amount of time spent talking with the patient and learning from the patient what problems the health care providers might need to address. Laboratory, radiological, and other testing have replaced the detailed medical history. At one time, the medical history and the problems stated by the patient drove the examination. Some physicians still do this. Many years ago, nurses were found spending most of their time in the hospital rooms of patients delivering care and compassion. Now, hospital employees with far less training deliver much of the nursing care. We find the nurses congregated at the nursing station working on patient chart documentation. The quality of the documentation is how nurses are now primarily evaluated. Overshadowing health care is the fear of litigation. This, and bureaucratic regulation, are primary in escalating health care costs and in decreasing health care quality. Physicians and surgeons may order excessive testing in order to show a reasonable standard of patient care. They may defensively perform caesarian deliveries out of fear of being sued. The human lifespan has almost doubled over the past century. Much of this has been because of pharmaceutical companies and the innovative medications they have developed and produced. A century ago infections were the primary killers. Antibiotics and vaccines have significantly reduced the deaths. We are encountering bacteria that are now resistant to all available antibiotics. This is not a problem of antibiotic overuse producing the resistant bacteria strains. It is primarily a problem of an insufficient number and variety of new antibiotics being produced. Attacking pharmaceutical companies is a lot like killing the fabled goose that laid the golden eggs. Government regulations, red tape, and litigation slow, and often eliminate, the development of new drugs. Trial lawyers have made drug companies a target to enrich themselves. Drug reactions can be damaging and even fatal. Such is the chance a patient should assume in taking a medication. It should be a patient who has been thoroughly informed by his or her physician who decides whether the known and unknown potential risks of a medication are a reasonable risk for them to assume. I am honored to join the StateHouseCall.org Blog. I will draw heavily upon my experiences as I address the above and other current issues. In this blog I will discuss current health care issues from the perspective of a Conservative. My desire is to appeal to both the Right and Left of the political spectrum by making the issues relevant to their lives and to their families. My goal is to help others to better understand the powers and issues that are shaping the 21st Century. My comments will be based on existing facts. I will refer you to original sources and to the best available current facts and opinions. I will challenge opinions and information both from the Left and the Right. I will defend the Constitutional right of others to have opinions different from mine while I try to cure their misconceptions.
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