Review of Who
Daily Observer
Sen.
Graftin Cloakroom entered the house with his cape
flowing. He handed me his cane and a
high hat with a velvetized surface that shone even in
the dim light of the foyer. Lapius had
warned me that he was coming to discuss some of the legislative aspects of peer
review, so I wasn’t exactly taken by surprise, but I wasn’t quite prepared for
his sartorial get up, black string tie and all. I placed his hat and cape in the closet and
he gave me a dime.
S.Q.
Lapius was polite but reserved. “Yes, Senator,” he said, after they had
shaken hands, “To what do I owe the honor of this visit?”
After
Cloakroom had been seated and was coddling a glass of port wine, I lighted the
fire. He muttered some pleasantries,
hemmed and hawed and then got to the point.
“Simon I want you to help us with the peer review thing. You are aware, of course, that your state
society is contemplating bringing suit in Federal court to upset the Bennett
Amendment that establishes the Professional Standards Review
Organizations. This bill will give the
government a chance to monitor its Medicare and Medicaid payments, to be sure
that the medical profession is giving good value for the dollar spent. I can’t imagine why doctors wouldn’t flock to
the standard and help out. It’s their
patriotic duty.”
“I
didn’t catch that, Senator, did you say idiotic duty?”
“Patriotic,
Lapius, patriotic,” Cloakroom reiterated sounding a
bit miffed.
“How
can I help you, Senator?”
“You
are an important member of the society, Simon.
You could talk to the leadership and try to forestall the wild hairs who are bucking this amendment.”
“Yes,
I could--.”
“Then
it’s agreed,” the Senator said smugly.
“I knew you would come around.
Any sensible man would be in favor of peer review. Not that we don’t trust the doctors, mind
you, but anyone that spends money should have available the means to be sure he
has gotten his money’s worth, and that includes government.”
“Just
a moment, Senator, I said I could – but I won’t.”
“You
mean you are not in favor of peer review?”
“On
the contrary, I do favor it.”
“But
you just said --.”
“I’m
in favor of peer review of the Congress and the executive branch of government,
not of doctors.”
“Aren’t
you being ridiculous, Simon. We are
reviewed by the voters every four years, and by the press daily.”
“Not
good enough for me. You should have
someone looking over your shoulder day and night, checking your expense
accounts, questioning your appropriations, watching your voting record. If your peer reviewer doesn’t like what he
sees he should have the power to kick you out of the Congress.”
Cloakroom
scrutinized Lapius carefully seeking signs of jest
and good humor but found none. Indeed, Lapius was frowning, no mean feat since it meant that he
had to do physical work to mobilize his heavy jowls.
“Senator,”
Lapius said slowly, “I’ve given this matter
considerable thought. Wouldn’t you agree
that the medical profession has attained a record of remarkable
proficiency? That the
practice of medicine is extremely effective. We can prevent disease, cure what once were
incurable diseases, transplant organs, replace arthritic
joints.”
“Yes,
of course I would agree with that. But
you must remember that it was the government that subsidized much of the
research that enables you to do these things.”
“Of
course it did. But the medical
profession was alert and disciplined enough to take advantage of new findings
and to incorporate them into practice.
The cooperation of industry has been important. We have remarkable drugs, electronics, plastic implements to assist us. But the important thing is that all these
advances have been brought to the patient.”
“That’s
the problem, Simon. They haven’t been
brought to enough of the people.”
“Hell
Senator, that’s not our fault. The point
is that when the government brings the people to us through Medicare and
Medicaid, these patients can get the best medical care available anywhere up to
and including coronary bypass surgery, renal dialysis – you name it.”
“Of
course that’s true.”
“Well,
damn it, Senator, if you believe that’s true why do you
want to monitor us? Do you believe there
is some sort of collusion between doctors and patients to fleece the
government? Do you believe that just
because it’s free someone is going to be willing to spend one day more in a
hospital than is necessary, or undergo a kidney transplant, or walk on
crutches?”
“Of course not.”
“Then
why look over our shoulders.”
“How
can there be too much care? Don’t the
poor have as much right to nurse their neuroses as the rich? Haven’t they the privilege of being
hypochondriacs if they want? Who are you
or any government to say just how much medicine is enough? If a patient feels better for no other reason
than that his fears are allayed, or gets moral support and reassurance from a
visit to his doctor, are you prepared to say that that is over utilization?”
“Sure
some people take advantage.”
“Sure
some people are doctor addicts – but then a visit to the doctor is what they
need. If they had money they would
support the habit. Why deny the
privilege to the poor. And keep in mind
also Senator, that some people only go to doctors when they are sick. Are you going to legislate what is
sickness? Are you going to make laws
deciding just how lousy you have to feel before you are entitled to go to a
doctor? That is what peer review will
lead to.”
“So
I take it you won’t help me,” the senator said lamely.
“Not
in peer review for medicine. But,
Senator, perhaps you could help me with a project.”
“What
would that be,” asked the disconsolate solon.
“You
could help me on the Senate floor, pass a bill that
would enable the medical profession to peer review the government.”
“You
are out of your mind, Lapius,” Cloakroom said
sternly.
“Perhaps,
but hear me out. I’ve always been
impressed with your logical mind, senator.
You have just agreed with me that the American medicine is efficient,
well disciplined and effective. We both
agree that the fact that it doesn’t reach everyone is an economic problem not a
medical problem. Right?”
I
had to fill the Senator’s glass with more of the rich port wine before he would
nod assent.
“Well,
then,” continued Lapius. “In contrast, let us consider the record of
the government since the end of World War II.
Our country has fought 10 years of unremitting warfare, in
“Yet
our government with its record of continuing failure at properly managing our affairs, now has the gall to ask the public to believe that
if it were allowed to manage the medical profession, the standards of practice
would improve. No no,
my dear Senator. It is the other way
around. The medical profession has
proved itself at its chosen task.
“Logic
demands, it seems to me, that the government should place itself in the hands
of the medical profession. After all, we
have a better record of accomplishment than you do.”
“Lapius,” Cloakroom said, “If I wasn’t sure you were joking
I’d say you lost your mind.
Incidentally, can’t you turn up the heat? This place is freezing. The fire in the fireplace can’t warm this
room.”
“Sorry
Senator. We have to conserve heat. Harry, get the senator a hot-water bottle.”