Medical Tourism to Israel

Been quite busy here of late, which has affected my posting on this Blog.  Expect heavy work situation to continue for next month, at least.  I was supposed to go into Tel Aviv today, but that meeting was scrubbed.

Israeli hospitals have long been the preferred healthcare providers to Ismail Haniyeh and his family.  Haniyeh is among the elite of Hamas, which seeks to destroy Israel and kill all the Jews.  But not all medical tourists to Israel are such hypocritical ingrates.  Indeed, Israel is a very highly rated local for medical treatment -- and medical training -- of foreigners

An old friend of the family is now here for medical treatment; turns out that the lead physician treating him was a year ahead of my wife in the same medical school.  Our old family friend is staying with his brother-in-law's family while he is here.  My wife, of course, is keeping an eye on the progress of our friend's medical adventures.  I am also helping out in various ways, including arranging to borrow a wheelchair.

The weather here has cooled down a bit, but the terrorist activities have, of late, heated up.  Bibi Netanyahu needs to start taking some definitive and visible physical measures, world opinion be damned!

And expect more medical tourists to Israel as ObamaCare continues to deteriorate.

Mixing and Matching the MDs

I've been considering the implications behind this one since my wife mentioned it.

The annual ritual of Match Day is anticipated with excitement and fear by 4th year medical students throughout America.  Medical school is only the beginning of a physician's training; there almost always is an internship and/or residency to be served.  How the newly-minted physician is matched to his or her post-graduate training program has a major impact on various life decisions, including but not limited to the nature of the physician's practice, the finances, and, quite often, geographical location.

If the 4th year medical student has a significant other, then the situation is complicated all the more; this I know firsthand, and, without getting too deeply into the specifics, will state that the geographical and financial issues of my then-fiancee's career impacted my own.  Our courtship and marriage continues to be a very viable item after thirty years, but not everyone is so lucky; the marriage between one of my law school classmates and one of my wife's med school classmates did not survive the medical residency period.

So looking at the numbers for this year's Match Day, we had 30,212  physicians competing for 41,334 residencies, a match rate of 73%.  Yes, it is true that some additional residencies will materialize, so the unsuccessful contenders are not yet totally out of luck (and some will go for a PhD or find some other gainful activity).  But let us look at what the numbers tell -- and do not tell.

Behind the official Match Day numbers are physicians who are saddled with debt for their educations.  Those physicians who matched will have some stream of income and will be able to at least make a small dent in their educational debts.  Those who did not match and who are unsuccessful in finding gainful employment, however, will find themselves in some very trying circumstances financially.

The foregoing verbiage is applicable today, was applicable when my wife did her residency match, and was applicable even a generation before, when my uncle did his residency match which sent him out of town.  Today, however, there is a new spin on the Match Day numbers, a spin that Uncle Leonard knows not from his own direct experience, but from the experience of his granddaughter, who this year was fortunate enough to get matched with the residency program that was her number two choice.

Not reflected in the numbers is the fact that the cost of a medical school education -- like any other collegiate educational program in America -- has been rising at a far, far faster rate than the consumer price index.  Not reflected in the numbers is the fact that more and more foreign-educated physicians are entering the game in America.

Not reflected in the numbers is the fact that hospitals and other health care facilities are under pressure to reduce their costs, and so, functions formerly performed by physicians are now being done by others, most notably Physician Assistants and Nurse Practitioners.  To be sure, there is much to be said for a competent PA or NP; my wife speaks quite highly of those in her own department at the hospital where she works.  But in too many instances, the PAs and NPs are being given too long a leash, and are making decisions without the benefit of a full medical perspective.

And, of course, there is the misnamed Affordable Care Act, which has created a demand for healthcare without actually increasing the supply.  If not before, then by the time a student has sat in the classroom for his or her Economics 101 course, then he or she should fully appreciate that as demand increases relative to supply, price increases.

I shall leave it to the economists and statisticians to give detailed analyses of the match numbers.  All I ask of you now, dear reader, is to remember that the Match Day statistics you read are all part of the big ObamaCare train wreck, and must accordingly be viewed in that context.

The Passover holiday will soon be upon us; wishing all a happy and meaningful one.

Playing the Race Card in a Strip Poker Game

   

I've basically been occupied, sleep-deficient, and burnt out.  Nothing to be overly concerned about, but it has sapped my creative juices, and I have come up with little worthy of posting on the blog.  Just going through one of those downer phases, I suppose.

 

Bernice Youngblood is a resident of the East Neck Nursing and Rehabilitation Center in West Babylon, NY.   She is afflicted with dementia.  The nursing home is a component of the Cassena Care Network chain of nursing homes.

 

Seems that the residents there took a vote and approved, as a recreational activity, the engagement of a male stripper performer.  This performer was photographed in the proximity of Bernice, and the photograph found its way into Bernice's belongings, and was subsequently discovered by Bernice's son Franklin.

  

So Franklin, on Bernice's behalf, is now suing East Neck.

 

Bernice/Franklin's Lawyer, John Ray, stated, "This might be great for 32-year-old single girls, but this is an 86-year-old traditional, African-American woman who doesn’t want white men sticking their private parts in her face.”

 

 

My take on the whole thing:

 

Firstly, I cannot really get upset about a nursing home accommodating the entertainment requests of its residents.  Having had to place my Dad into such a facility for the last few months of his life, and now, my Mom, I have had several occasions to observe some of these places firsthand, and even more occasions to compare notes with other Baby Boomers who are also dealing with the problems of their aging parents (including my wife, whose Mom is also in a senior residential facility and who needs a higher-than-average degree of care).  Unfortunately, there are too, too many nursing homes and senior residential facilities that do damn little to keep their residents occupied and engaged.  As with any other sample population of more than 10 people, there are bound to be a few unenthusiastic persons in the crowd for any choice of entertainment.

 

Secondly, nursing homes are expensive in the extreme, especially if the operator is a commercial venture with a motive to return profits to investors.  I do not per se object to such entrepreneurship if it is done responsibly, which Cassena seems to do at a reasonably acceptable level.  So, just as medical malpractice lawsuits are primarily a means to finance health care, so, too, are many tort lawsuits against nursing homes.

 

Thirdly, the plaintiffs' attorney, John Ray, is known to me mostly by reputation (though I have had occasion to say "hello" to him at various lawyer functions in the county).  John is not without his flamboyant qualities, but, unlike many of the legal profession who take on cases for the disadvantaged underdog, advancement of a partisan political agenda does not seem to be his primary objective in the cases he handles.  And now that John Ray has made a statement invoking race, it is relevant to note that he himself is white.

 

 

The way I call it:  The lawsuit should probably be booted out of the courthouse door with all deliberate speed.  Nevertheless, in light of my personal experiences with my parents and my mother-in-law, I do have a considerable amount of empathy for Franklin Youngblood.

 

 

Sick? Call Your Lawyer!

Even before I started law school, I was troubled by the Supreme Court decision in Bates v. State Bar of Arizona, 433 U.S. 350 (1977).  That case opinion, delivered by the late Justice Harry Blackmun, essentially legalized attorney advertising on par with advertising by any other commercial concern.  Once Blackmun opened the flood gates, the worst of our profession have been able to garner the best public attention.

[To set matters straight regarding my own promotion of my professional services to the public, I have essentially adhered to the pre-Bates standard:  A listing in the telephone directory and in Martindale-Hubbell, business cards, and ads in fundraiser dinner journals.  This suits my practice quite well, inasmuch as I have a small group of existing clients whose respective legal issues periodically require my attention, and to whose numbers I am not in any hurry to add, what with my other activities, including but in no way limited to teaching and researching for other attorneys.].

Being in the medical profession, my wife gets particularly exercised when she hears radio ads by attorneys in general, and attorneys practicing medical malpractice in particular.  Beyond this, my wife and I do differ, and have gotten into some animated disagreements, not over the obnoxiousness of advertising by doctors or lawyers (over which we agree), but over the absence of clean hands on the part of the medical profession.  My posture essentially is that the lawyer ads are obnoxious and sickening, but that the doctors they sue are getting what they deserve.

This afternoon, however, we found ourselves in agreement over an obnoxious lawyer ad by the firm of Acosta & Williams, LLC, an ad we heard on at least 4 occasions during our afternoon excursion and return.  A&W is now trying to drum up some business from patients who developed diabetes from taking Lipitor for their cholesterol.  Per the radio commercial, their targeted defendants are not the physicians, but the pharmaceutical companies.

Surprisingly, my wife agreed with me that lawyers such as A&W are the just desserts for Big Pharma, in light of Big Pharma's shifting of its advertising from the medical profession publications such as the Journal of the American Medical Association  or the New England Journal of Medicine  to the common, ordinary, everyday consumer tabloids.  Now that Big Pharma has largely cut out the physician as the facilitator, the plaintiff's injury bar is cutting out the physician and dealing directly with the drug manufacturers.

Ironically, about a year before Justice Blackmun green-lighted attorney advertising, he authored the opinion in Virginia State Board of Pharmacy v. Virginia Citizens Consumer Council, Inc., 425 U.S. 748 (1976), which allowed pharmacists to advertise the prices of drugs to the public.

One thing is clear:  As the cost of health care rises (which it cannot help but doing under the Obamacare scheme), lawsuits against physicians and drug companies will continue to play a very vital role in underwriting the procurement of medical treatments and remedies.  Though it is not my own area of practice, it cannot now be said that the legal profession is unprepared to help the public finance its healthcare expenses.

Obamacare Erosion Begins

Yesterday, President Barack Hussein Obama signed into law the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011.


BHO's statement upon signing the legislation:

"Today, I was pleased to take another step to relieve unnecessary burdens on small businesses by signing H.R. 4 into law. Small business owners are the engine of our economy and because Democrats and Republicans worked together, we can ensure they spend their time and resources creating jobs and growing their business, not filling out more paperwork. I look forward to continuing to work with Congress to improve the tax credit policy in this legislation and I am eager to work with anyone with ideas about how we can make health care better or more affordable."

What does this legislation do? It repeals the selfsame onerous tax reporting requirements imposed upon small businesses by Obama's own Obamacare legislation!

Another flip-flop for BHO!

I am pleased to no end that another misbegotten statutory creation has been removed from the books, in this case very quickly and relatively unobtrusively. But there comes a point where one must question the reliability of a President (or other official, American or otherwise) whose support for the things he advocates wavers, in such short order, on so many issues.

The Dismal Science

Notwithstanding the plurality of undergraduate and graduate credits in Economics on my transcripts, I am not, and have never aspired to be, an economist. The Econ courses I took were never my favorite courses (though I did mildly enjoy some of the ones given in grad school). Nevertheless, I do know the basics, and I do understand that we all function in an economic environment as well as a social, political, legal and climatic environment, each such environment affected by remote events and forces.

Our rabbi is away this week, so it has been somewhat of a challenge to get a minyan (English translation: At least 10 Jewish men so that a proper prayer service can be conducted). Last night, while waiting for numbers 9 and 10, the discussion came to health care. One of the guys present, who lives in Melbourne, Australia but who is here for a month visiting his mother-in-law, mentioned that he can cover the gap in Australia's socialized medicine system by purchasing insurance for his family for the equivalent of about $300 per month, which is obviously far less expensive than the equivalent coverage here in the US.

One of the other guys, who is an electronics engineer, wondered aloud why it is so much cheaper in Australia than in the United States. I said that the Aussies do not have as high an incidence of illegal aliens using the hospital emergency rooms as their primary health care providers. At which point the engineer became very angry and started screaming "What does that have to do with it? Your health insurance is for you, not the illegal aliens! The illegal aliens should not affect your health insurance rates!" And on and on.

This man is an engineer. He certainly understands that too many electronic devices place a load on an electrical circuit. How can he not understand that too many non-paying patients place a load on the health care system? And that the more the healthcare system is strained, the greater the load imposed by one more patient, paying or otherwise! [This is known in economics as the marginal cost.].

It deteriorated even further! As this engineer was advocating for socialized medicine as a cure for the healthcare system's woes, I mentioned that his plan would require even higher taxes. He said, "I don't care what my taxes are, I just want affordable health insurance!"

This is a man who is intelligent, very handy with tools on the workbench, and whom I do hold in high personal regard (he and his wife were, after all, among the first to welcome us to the community when we moved in about 20 years ago). He understands electronics. He understands physics. He even understands meteorology and the workings of storm systems on the weather. But when it comes to economics, the Dismal Science, he goes totally irrational.

What is it about Economics that alienates so many people? It's not just this engineer, but a very sizable cross-section of the population that cannot cope with the simple principles of supply and demand. Including those apparatchiks in the various education unions who, as I write this, are now planning to converge upon Albany to demand more funding and no cutbacks for education, and for lower tuition, all at a time when New York State's budget is in deficit mode.

As for that argument last night, the physician among us did the wise thing. He stayed out of the healthcare argument.