Friday, December 10, 2010

The Death of Capitalism - The Death of Healthcare As We Once Knew It

Bye Bye Miss American Pie, brought my Chevy to the levee but the levee was dry, 'em good ol' boys were drinking whisky and rye singing this will be the day that I die, this will be the day that I die........

For those young 'uns that never listened to a poet singer, and TSB is not talking hip hop poetry,  Don McLean's American Pie, a song that will live on in infamy,  was about the loss of innocence in American music. Ironically, it can also be interpreted as a loss of innocence in the America, we once knew it.  But this post isn't about music.  No fellow bloggers, this is not someone waxing nostalgia. This post is about the fundamental breakdown of America as we once knew it.  An America that was built on hard work, a country that prided itself on its ability to lead, a country that understood that everyone deserved an opportunity, an America that once stood proud.  Today, whether you like it or not, this once great country is in the throes of a class struggle between two classes, the Corporatist's and the have nots.  But before we elaborate, let's keep things in perspective.  If you're earning $250 thousand or less, you're not one of the haves, unless you're single, especially in this economy.  And unlike the perception that many of our beloved surgeons have, many of you are making $120 to $150 thousand per year, and that doesn't include being responsible for most of your own business expenses.  If you are the sole provider in a family of four, have a mortgage, have children that are going to college, need to put food on your table, gas in your cars, pay auto and healthcare insurance, and want to take a family vacation let alone two a year, most of you are living by a thread.  And, I can guarantee that many of your wives, unlike surgeons wives, are working, and, you are not living in McMansion's over looking the Pacific Palisades. So why does the TSB write an editorial on Friday morning?  Is it because I am looking to provoke you into irrational commentary?  Absolutely Not!  Because somewhere along this journey called life, we have all lost our sense of balance.

The last three or four years have made it woefully painful that we are heading in the direction of class warfare.  Witnessed by what went on in England yesterday when students attacked "the Royals" in their Rolls Royce.   No need to worry about the Taliban, or some terrorist organization, we will be the demise of ourselves, based on our greed and selfishness.  Any student of history will attest, every great dynasty eventually falls and restructures itself.  The good times in healthcare are coming to an end.  Today, American is in the initial stages of a total collapse.  If balance is not important, just look at our industry.  As the cost of delivering healthcare continues to escalate, the new game in town is called the blame game.   The insurance industry blames the doctors (those poor helpless doctors), the hospitals blame the doctors, the doctors blame tort reform, the Corporatista's blame the government and high taxes, and the sales people continue to get defecated upon, being blamed by the doctors for driving up the cost of delivering healthcare.  Why is it that the guy on lowest part of the totem pole always gets the blame?  Is it because some people don't have the intestinal fortitude to stand up to a higher authority?   Based on Monday's story in the NY Times regarding a Baltimore cardiologist who implanted as many as 30 stents in one day, and the concern that was expressed by a leading cardiologist at the Cleveland Clinic, isn't it time that some people start focusing on cleaning up their own house, before worrying about someone else's business?  Isn't this just a microcosm of what is happening in our industry?   There are many surgeons that love their calling, and are exceptional at their craft, and, I am sure that the good doctor in question is a wonderful family man, witnessed by the many testimonials given on his website, but just like any other person, money or the prospect of being the richest man in the room can obfuscate reality.  After all, we are human. It happened at Enron, it happened at WorldCom, it happened to Bernie Madoff.  So let's not fool ourselves that it doesn't happen in medicine. Once again, this is a photo-op for the government to launch another investigation into improprieties in the medical device industry, led by yours truly Senators' Grassley and Baucus.  I am not going to judge Dr. Medei, the legal system will do that, and I am sure that he has the financial wherewithal to hire the best, yet, how can one not be a skeptic let alone a cynic based on what we see on a daily basis?

What this industry needs to do is get back to basics.  If that means challenging the system, then the system must be challenged.  This means executive management teams projecting realistic forecasts based on current economic and market conditions, and not what happened fifteen years ago when they were selling in a not so saturated market.  This means developing innovative products that not only improve patients lives, but improve outcomes, and are not a product looking for an indication.  This means thinking long-term and not acting like Wall Street, this isn't a short-term industry.  This means telling your shareholders that if they want longevity, everyone is going to have to sacrifice, including those that think the only reason you invest in a company is to generate a major windfall.  Maybe that's part of the problem.  Too many executives are more concerned with their personal portfolio's rather than the direction their organizations are going.  Lastly, stop the hype.  How absurd was the total disc market as companies released their products.  We didn't have enough of  retrospective data on the efficacy of total disc arthroplasty and we were touting our devices as first generation, second generation, third generation.  Just for the record, in human terms a generation is usually thirty years and it usually means producing an offspring from the preceding device.  

As the first decade of the new millennium comes to an end and a new era ushers itself in, hopefully we will come to terms that we are all in this together, and that its okay to share the wealth, because if you don't, you all will be able to one day say that you live in a socialist state.

13 comments:

  1. well written! reveal yourself tsb muscoskeletal man!

    ReplyDelete
  2. Not sure who he is, but I always read his posts as if he were Duff Man. It makes even the most mundane posts sound impressive.

    ReplyDelete
  3. Making 120k-150k and living by a thread? What a ridiculous statement that is! Is it getting harder to pay for your escalade and your 5000 sq.ft house? Its called living within your means. Worrying about money when you make that income = jackass.

    Signed rep making 120k-150k with kids in major metro area.

    ReplyDelete
  4. Yeah, you live in a major Metro area. Try living in NYC on that money. Better yet, Chicago, San Francisco, Washington, DC. Where do you live 60 miles outside New York, or San Antonio. Get real, if your wife is not working, dude, you're hanging on a thread and that's living within your means. You saving any money for your kids college or are you depending on public assistance. Are you walking around in scrubs? You doing any lunches? Unless you're driving a Prius, even an economical car cost roughly $40 per week. You must do one case and go home. LOL

    ReplyDelete
  5. Well written TSB! Worth the long read. Thanks!

    ReplyDelete
  6. Ditto 929....driving a Prius..living in a flat in SF
    Great Blog

    ReplyDelete
  7. $120K-$150K as a 1099 will not cut it in Boston.

    Example - C Spine case at Mass Gen Hosp. capitated price at $1000. Commission $250- Parking -delivery of set $15, Parking case coverage $25, Parking pick-up set $15. Rep coverage at $30/hr. ($60K/yr) at 4 hours case due to delays etc. (not including FICA WC Health etc...)

    $120 + $55 = $175. Wow...$75. I get to pay fuel, customer service support, health, FICA, W/C, and shipping...

    How do I send to kids to college again at $45,000 each per year? I am looking for guidance... This is not everything it is cracked up to be!

    ReplyDelete
  8. Didn't know the only gig out there is 1099. A lot easier ways to make money than 1099 spine. All expenses covered - car, gas, parking, phone, internet,lunches, ect. Your an even bigger jackass if you don't have a gig like this. Oh and remember to live within your means. You could drive an Outlook or an edge and your wife could drive a caravan instead of a decked out 35k Odyssey or Sienna and live in a 3000 sq ft house. If you don't get what I'm talking about, then your confirming my point. As far as NY, Boston, San Fran, move somewhere else. Why would you piss your money away and "live by a thread"?

    ReplyDelete
  9. Hey why don't you move to Vietnam the cost of living is cheap.

    ReplyDelete
  10. well that's just plain silly!

    ReplyDelete
  11. i hope globus goes public, then i wont be living by a muther effin thread...

    ReplyDelete
  12. Hopefully you are not living on the street in the snowbelt, you will freeze to death before they ever go public, it is going to be a long cold winter.

    ReplyDelete
  13. the more I work in this industry the more I think I should go to med school.

    ReplyDelete