John Lohnes, MD

What do Caterpillar, Richard Pryor, and Penecillium chrysogenum have in common? Other than the obvious answer that they all came from Peoria, they all have been instrumental in changing the landscape of the 20th century: physically, culturally, and medically.

The advent of antibiotics, and in this case the much more productive species of Penecillium, was a game changer. Prior to the widespread introduction and use of antibiotics, getting to 50 years old was an iffy proposition. The premise of social security was founded upon the fact that the eligibility at 65 years old was above the median life span of people in the US. (Now, if we were to adopt the same standard, social security income would begin at about 80.)

Prior to this, it was pretty much a crapshoot as to whether you’d survive that pneumonia. Or injury. Or even surgery done by the best technicians in the world. In fact, because of our human, innate desire to help, as often as not physicians may have hastened the demise of their patients (the IOM had nothing on those guys).

In 1948, Truman, still largely in a WWII afterglow, jumped on the bandwagon for universal health care. It was heady times. Top of the free world, rebuilding Europe and Japan, ushering a new era of American prosperity and influence - we could do it all. The political climate in Europe, always more progressive, embraced the opportunity to develop a more intense social network as they too became more financially successful. The initial costs were low.

Not so in the U.S. We were entering the new American expansionism. Intellectually we had the best teachers, the best labs, the best companies. We made more stuff, better stuff, and on a previously unheard of scale than ever before.

We were America and we could do anything.

But just as the war for better health was won, it was lost. It transitioned to a war of attrition. And from a societal perspective that is a financial disaster.

Europe didn’t know it at the time and we didn’t acknowledge it in 1965 when the Great Society, in one of its centerpieces of legislation, passed Medicare. We thought we were just being realistic, that more folks were living longer and they retired and lost their job-based health coverage, and well, how could that be in a country like the U.S.? No one had a clue that the average life expectancy for someone born in 1900 would increase by nearly 20 years. And still continue to climb after that.

The introduction of Medicare and its reimbursement rules became the basis for all of health care reimbursement. It set the stage for the greatest jump in physician income in history. And the people were there: “It’s my right.”

“We have to do something for the structurally poor.” Medicaid, we’ll share that expense; Come on states, chip in. Clinton era: “It’s all about the kids.” The expansion of SCHIP. How could we not? Bush 2? Part D for meds.

And we were successful, both in saving people and assisting them to live longer and better. Implants and transplants. Bypasses and multiple CT passes. Many laws of unintended, and perhaps intended, consequences.

Well, in 2008 we did it. As in 1964, we gave majorities in both houses to one party that had increasingly moved in a single political direction, and a President to match. And they did it.

So thanks Mary Hunt for finding that mold that had “a pretty golden look.” The genie is out and putting it in that new bottle is gonna be a bitch.

John Lohnes, MD, FACR, is a radiologist at the Wichita Radiological Group and clinical assistant professor at the University of Kansas School of Medicine in Wichita. He serves on several local and state committees and is a self-proclaimed serial entrepreneur. 

Articles

Health Care Reform: We Can’t Afford It

I had the opportunity recently to speak before a group of college business students at our local state university. This was an upper level course. The topic was loosely centered around politics and medicine. In my opening, I first asked a question, “Who thinks healthcare is a right?” The hands all went up except for one or two of the students.

That led to a variety of questions and answers. It also served as a subsequent entry point in an internal dialogue about the whole concept.

I would contend that a right is something of unlimited and priceless value. That is, you can’t pay for it. It exists; it is tangible, even as it is not. This country and its citizens have in the past and continue to offer up as payment the lives of our men and women in the military and our police, truly a priceless offering. At the same time, a dollar value cannot actually be placed upon the very concepts that they are defending.

These are concepts in our founding documents. And none of them can be found at your local store with a price tag attached to them. This is why the country’s founders described them as self-evident human rights. These are natural rights, by definition.

The other concept then is “legal rights.” These may, and will, carry a price. These are concepts that are established by societies to put into code those things that they believe are of great importance. Sometimes, a concept falls into the middle, such as a right to privacy. A legislative construct is developed to support the idea that the rights of an individual reserve to them a certain level of institutional and other personal disinterest and non-involvement.

Now we find ourselves neck deep in a discussion as to what our societal values require of us to support as legal rights. And, how to support it. These you can find in your Congessional SuperStore, and they come with a substantial price on that tag.

“The fight to repeal the patients’ rights in the healthcare reform law is behind us.” - Harry Reid 2/3/2011

John Lohnes, MD, FACR, is a radiologist at the Wichita Radiological Group and clinical assistant professor at the University of Kansas School of Medicine in Wichita. He serves on several local and state committees and is a self-proclaimed serial entrepreneur. 

I had the opportunity recently to speak before a group of college business students at our local state university. The topic was loosely centered around politics and medicine. In my opening, I first asked a question, “Who thinks healthcare is a right?” The hands all went up except for one or two of the students.

What Is Considered a Right?

The U.S. district court judge in Florida tossed Obamacare on the basis of the individual mandate. The logic the judge used was fine; the Supreme Court will ultimately review it and it will likely be a five-four decision, although I don’t know which direction. There are at least a solid four against, and now at least a solid three and likely four in favor. I still could be surprised. 

But for those folks who are desirous of an overturn of the law, the real risk is that in the longer term it sets up the likelihood of a single-payer system. In my opinion, the law was set up to ensure failure of the insurance companies. By making the fines less than the cost of the insurance, it leaves a way for companies to not insure their employees. So it automatically ensures that businesses will take the cheaper way out, driving all of those individuals into the state pools for their required coverage.

The insurer of last resort will be the feds and the states through Medicaid. Or, they could have a raft of part-time employees and avoid the mandate entirely. Those not covered could save the money in the short term and then buy into the system when sick. Again, those folks end up in the Medicaid pool.

The GOP says they will use the marketplace to provide coverage. Could be. However, nothing will happen until after the 2012 elections. One day, when the Democrats once again find themselves in power, possibly holding both houses and the White House, then there will be a push for the single-payer system, funded by taxes (and which, unless they write something else incorrectly, not as readily reviewable by the courts). That will likely be irrespective of the Republicans getting a voucher-type system in place in the interim.

Either way, at the end of the day, we - physicians and patients alike - will end up paying for it all.

John Lohnes, MD, FACR, is a radiologist at the Wichita Radiological Group and clinical assistant professor at the University of Kansas School of Medicine in Wichita. He serves on several local and state committees and is a self-proclaimed serial entrepreneur. 


For those who want to overturn the law, the real risk is that in the longer term it sets up the likelihood of a single-payer system. In my opinion, by making the fines less than the cost of the insurance, it leaves a way for companies to not insure their employees. So it automatically ensures that businesses will take the cheaper way out, driving all of those individuals into the state pools for their required coverage.

Author | John Lohnes, MD

Articles

Health Care Reform: We Can’t Afford It

What Is Considered a Right?

With Healthcare Reform, Be Careful What You Wish For