"All that is necessary for the triumph of evil is for good men to do nothing" Edmund Burke, 18th century Philospher.

"A long habit of not thinking a thing wrong gives it a superficial appearance of it being right." Thomas Paine

"The welfare of humanity is always the alibi of tyrants." Albert Camus

"Choice is the essence of ethics: if there were no choice there would be no ethics, no good, no evil; good and evil have meaning only insofar as man is free to choose." Margaret Thatcher, March 14, 1977

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair

Explaining the Cause

I am a practicing obstetrician who is a strong supporter of patients rights to informed consent and refusal. I believe a patient has the right to choose her own path given true and not skewed informed consent. Following that tenet, just as a woman should be able to choose to have an elective c/section she should be able to choose not to have one, as well. The American system of hospital based obstetric practice has been eroding those choices for women for quite some time. Due to concerns of economics, expediency and fears of litigation women are being coerced to make choices that may not be in their best interest.

I have had a long relationship collaborating with midwives and find the midwifery model of care to be evidenced based and successful. I was well trained at Cedars-Sinai Medical Center in the mid 80's to perform breech deliveries, twin deliveries, operative vaginal deliveries and VBACs, and despite evidence supporting their continued value, hospitals are "banning" these options. Organized medicine is also doing its best to restrict the availability of access to midwives.

Home birthing is not for everyone but informed choice is. Medical ethics dictates that doctors have a responsibility and a fiduciary duty to their patients to provide true, not skewed, informed consent and to respect patient autonomy in decision making. Countries with the best outcomes in birthing have collaboration between doctors and midwives. This is not what has been happening in the hospitals of America. Its time for a change and the return of common sense.

The midwifery model of care supports pregnancy as a normal function of the female body and gives a legitimate and reasonable alternative to the over-medicalized model of birth that dominates our culture. Through this blog I hope to do my part to illuminate what is wrong with our maternity care system and what is right with it. I do not expect all to agree and that is OK. We must all understand that given honest data it is not always reasonable to expect two people to come to the same conclusion. Our differences should be respected.

Friday, September 11, 2009

9/12 Rally in Thousand Oaks

Here are the details:

What: "912 Protest Against Socialized Health Care and Government Spending."
Where: Hillcrest & Lynn Rd., NE corner, across from the Oaks Mall parking lot.
When: Speakers: 12:30 - 2:00 p.m. ----- Protest: 11:00 - 3:00 p.m.
M.C.: Trevor Woolley
Organizer: Carolyn Guillot -- 805-262-2477

Hope you can attend. We are all individuals with life experiences that make us unique and shape our decisions. We are not identical, our lives should not be relegated to an RVS code and one size fits all medical guidelines set by faceless panels. Having been a practicing physician for more than a quarter century I have seen the demise of personal liberty to the detriment of the individual. Whether it is big business or big government, we should not trust our lives to those motivated by economics. Surrendering personal choices and responsibility to the false god of "equality" will lead only to enslavement. Never a good thing.

You all know the issues that I stand for. Birth choices and personal responsibility. My belief is that this can best be achieved through changes in the current system and not a government run system. While dealing with insurance companies is all too often maddening beyond reason, it is so much worse trying to care for patients under the current government programs of MediAid and MediCare. Doctors cannot make a living, run a business and do what is right by their patients under this immense regulatory burden, poor reimbursement and the fear of a guilty until proven innocent audit and legal system. If an insurance company wrongs a patient or a practitioner there are avenues of recompense. And as burdensome as they might be one can sometimes prevail. You can appeal to their medical reviewers, the insurance commissioner or even sue. But who can you appeal to when the government run insurance company harms you?

So, this among many reasons is why I support the private sector with oversight. Oversight, not over regulation. Government is the problem! The reason there is no competition from out of state insurers is government regulation. The reason that the few remaining in state insurers offer one size fits all policies is government mandate. You have heard this before but here is what government can do, and within weeks, to show they mean what they say.
1) Remove blocks to interstate commerce. If you can buy your TV from Ohio why not your health insurance?
2) Remove employers as the purchasers of health insurance and thus make it portable. Would you let your employer dictate the one model of car you can have?
3) Stop insurers from cherry picking healthy patients and excluding ones with prexisting conditions. Here is where a government pool supported by charitable organizations supported by citizens freed from high tax burdens could contribute to those truly unfortunate.
4) Allow decisions to return to the patients and their practitioners who know them as individuals. I support use of outcomes data and evidenced based decision making. No panels or guidelines that dictate one size fits all policies.
And 5) The greatest restriction to meaningful reform in all areas of our lives, not just health care, is the American tort system. Fear of being sued drives up costs everywhere. you cannot have meaningful, cost saving health reform without tort reform. Liberals must capitulate on this or all other reforms, government or private, will not work. How can anyone support a system that holds a health care worker or institution responsible for an adverse outcome when the diagnosis or treatment is delayed because of bureaucratic inefficiencies?

Imagine you have a new headache. Your physician examines you and thinks an MRI is necessary. He orders one but there is a delay of 4 months before you are allowed to get it. In the meantime you have a stroke. Is the doctor at fault? In the currently proposed healthcare bill, without tort reform, he/she would be. A career destroyed. What doctor would want to practice under such a system. Even more worrisome is who is going to want to go into medical school knowing this is what awaits them. A life of living under the microscope of Monday morning quarterbacks holding a legal axe over your head. The President and Congress want to rush through a bill that few have read, almost no one understands and spend trillions of dollars faster than I could get you that MRI. Now I have a headache!! How much for a couple aspirin?


  1. Sorry Stuart, but after living in the UK and experiencing the medical system firsthand many times (including a miscarriage and a birth), I think government can run a good health care system, and a much more effective and efficient one than we have here.

    And what is proposed is not the government stepping in and running health insurance. The public option will be something people can choose if they think it would be best for them. If it is low quality or too expensive, then no one will buy it and it will die. If it is good quality and on a par or cheaper than private health insurance, then it will give the private sector some competition - something they currently have very little of. This bill plans to regulate private health insurance companies (as you mention, stop them from cherry picking the healthy), and put a limit on their overhead spending (since 33 cents on the dollar is now spent on profit and pushing paper around.)

    I agree that tort reform is essential to improving our system as well and I hope that progress will be made in that direction.

    If your story about the MRI is concern that resources will become more scarce when 50 million Americans join the health care system, then I agree that that is a concern, but I think people who are currently uninsured and their kids deserve health care as much as I do, even if the rest of us have to wait. And if they can get coverage, then hopefully they will be getting the preventative care they need, rather than holding out until it's bad enough to go to the emergency room and using far more expensive resources than they might have originally needed (and we all pay for).

    In addition, I've been told that Orange County has more CAT scan machines than Canada, so I doubt that the problem we are having in the US now is scarcity of resources, rather inability of people to access the resources because they can't afford to pay.

    And as it is, many people are experiencing huge delays in care because they have to wrestle with their insurance companies to get them to cover anything. The bill would if anything make this better by making it so insurance companies cannot deny care.

    In my opinion, health care, like education and the fire department, cannot be left to the market without at least some serious regulation. We all deserve those things, regardless of our ability to pay huge sums when disaster strikes.

  2. Would love to have a nice glass of wine and some good conversation with you to obtain clarity, not necessarily agreement, on this subject someday. I do not think we are that far apart. I concede you have more faith in government than I. We agree that oversight of the insurance industry is needed but too often regulations are lobbyist driven and corrupt. Seems we also agree that in either system there is way too much fat and red tape. Alas, my experience leads me to pessimism that anything Washington does will never make it better. Maybe, like firemen who are truly heroes, the government can hire all doctors, pay their overhead and malpractice premiums, allow them to unionize and retire with fat pensions after 20 years. Hmmmmm?

  3. Agree with me or not, please see John Stossel's report on health care.


  4. Just finished watching it...so many things to say!

    (Let me know when you are next in town, we can have that glass of wine!)

    If we are talking about waiting for health care - I waited, in labor, in a triage room at UCLA for 16 hours before I got a L&D room. Then I spent my first night with my new baby in a closet (seriously, though it had been remodeled, they were out of maternity rooms).

    My mother in law in the UK was diagnosed with thyroid cancer and had her thyroid out within the week. She started radiation afterwards as soon as she was strong enough.

    The video is implying that Obama is proposing a government take over of health care management because he said if he had it to do from scratch he would do single payer. But he doesn't have it to do from scratch, and is instead taking small steps to regulate private health insurance and give them some sorely needed competition.

    You will find disgruntled people everywhere, Canada, the UK....Mozambique, Malawi...and in the United States. I notice they did not interview any Americans who are unhappy with their health insurance (as many, including me, clearly are), or any Canadians or Brits who are happy with their systems.

    And finally, in the US we may have lots of great technology and innovation, but in so many cases it is misused and not properly tested. Take obstetrics for example...but the statistics don't lie. All this technology and money spent is not improving our outcomes. The US has the maternal and infant mortality rates of a developing country, and:

    Total spending on health care, per person, 2007: United States: $7290 United Kingdom: $2992
    Life expectancy, 2007: United States 78.0 United Kingdom: 78.8

    "The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th."
    from http://www.who.int/inf-pr-2000/en/pr2000-44.html

  5. I do understand the mistrust of government, but frankly I mistrust huge corporations just as much, and (without getting into ideology) I don't think regulation alone can efficiently contain the problem, compared with adding a fiscally self-contained public option to the mix, which has the potential to balance the excesses of insurance companies.

    I wrote up some thoughts on the video you posted at:

    Thanks for opening a discussion :)

    - Owen

  6. I have to respectfully disagree. First of all, one of the main reasons insurance companies want people to buy insurance across state lines is that most states do not require insurance to cover maternity, which your state of California does!

    I don't agree with ACOG on everything, but they figured out a little while ago that self regulation by the private industry of insurance has hurt women and obstetricians.

    If you look at places with midwifery based models, higher rates of VBAC, vaginal delivery, vaginal breeches, lower maternal and infant mortality rates and often more obstetrician autonomy are places with universal health care.