In 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 8^th 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 21^st Century.