Wednesday, March 24, 2010

Gerald O'Malley, DO: Legislative tyranny

I wanted to write an essay this week about the residency match and the excitement (and disappointment) that happens this time every year along with St. Patrick’s Day in the ER. We celebrated in the hospital by sharing several big pots of traditional Irish stew (my dad’s recipe) and my wife’s soda bread and tea brack with the Pogues and Clancy brothers on the CD player. I started to write that essay, but the words just wouldn’t come.

The congressional approval of the healthcare takeover bill is so profoundly unjust I can’t not write about it. So much has been written and said about the legislation that the House approved late Sunday night – what more is there to say?

From an emergency medicine perspective there’s a lot to say. Every ER doc that I know desperately wants healthcare reform. We went into this line of work to help people. It’s really hard to help people that have no insurance. They don’t practice routine health maintenance, they can’t afford the medications we prescribe, we can’t get them in for follow-up appointments, and forget about seeing specialists. Patient advocacy is ten times more difficult for people with no insurance. The people of this country deserve a better system, but this massive government entitlement is not the fix. In the words of my father, this thing is a dog’s breakfast.
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I had a lot of trouble figuring out which bill was the relevant one. Try Googling “I want to read the healthcare reform bill” and then sift through all the variations of the bill that have been posted online. I finally found the relevant reconciliation amendment and my computer crashed three times while attempting to download a pdf of a summary of the bill. The Table of Contents is 14 pages long! I read as much of the original bill as possible but when a document is filled with this much gobbledygook, no one can possibly understand what is being said, and I can guarantee that most members of Congress didn’t read the damn thing. (You can read all 2,310 pages of H.R. 4872 plus the 153 pages of the reconciliation act at

Why does this need to be so dense and complicated? Why didn’t Congress entertain smaller and less intrusive fixes that will serve to bring down the cost of healthcare but not set us on the road to a single payer (i.e. governmental) system? Why not allow consumers to buy health insurance across state lines? Why not allow for health savings accounts that can serve as investment vehicles? Why not allow for a variety of healthcare insurance options that provide for catastrophic coverage with flexible premiums depending on the deductible that we want to pay? Why can’t we buy our health insurance the same way that we buy car insurance? Congress and the President seem determined to establish a national healthcare system similar to the British National Healthcare System, which is the third largest employer in the world, behind Indian Railways and the Chinese army.

I’ll tell you one thing that you won’t find anywhere in this bill — tort reform. The trial layers saw to that.

There is an avalanche of legal challenges to this monstrosity and I’ll probably financially support several. I feel like I have to — the national deficit is so huge and the debt is so massive I’ll probably wind up paying close to 50 percent of my income in taxes as will my children and grandchildren. Medicare and Medicaid and Social Security are broke and we cannot afford another massive entitlement. I don’t believe what my government is telling me about how this action won’t negatively affect the economy. This is so unfair to taxpayers and future generations of Americans.

In New York, bricks were thrown through the windows of legislators that voted for the bill. I’m truly afraid for my country.


  1. Gerald- Don't send your check to support the causes working to overturn the health care reform- send it directly to the CEO of Cigna or UHC; they are the ones who are going to benefit if your cause wins. You really need to read the facts at about single payer. It is not government takeover- it is health care for all, and there is plenty of money currently to provide quality health care for all and get primary care out of the ED's and into doctor offices where it belongs.

  2. Another element that is not being addressed in all this is the cost of medical education which is on the verge of topping $200,000 to become a licensed physician. Medical school tuition cost is increasing at an alarming rate each year with no end in sight. If health care reform can't pass without adequately addressing physician cannot pass without adequately addressing educational costs. It is a HUGE consideration when some medical students begin to choose a specialty and why some student opt away from primary care. NO, it's not all about the money. The general public, politicians and those driving the reform cannot point the finger and say physicians are not being altruistic when policies so severely restrict a physician's ability to pay off a tremendous debt. Altruism is a nobel thing when the cost of such sentimentality is managable. However, it approaches lunacy when a physician must run the risk of bankruptcy and watch his own love ones suffer as he takes care of others because he cannot afford to provide for his own family. And if politicians say that they're talking all this into account as well, they're not being entirely truthful. Recent legistlation was inacted that removed a resident's ability to defer federal education loans while in Residency, leaving only forebearance as an option. What this means is a Resident's student loans are still accruing interest while in residency. This may not be a big deal if the loans are relatively small. But, if the loans are $150,000-$200,000 carried over a 3-year period (the shortest residency available)...the increase to debt-load increases to increadible amounts. Yet, that is what politicians felt was acceptable. This in conjunction with recent cuts in Medicare reimbursement leads one to ask, "Are those pushing reform in Washington D.C. really looking at the big picture? Are they going to pass legislation that makes sense?" In my eyes, the answer is "No."