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6A Daily News – Wednesday, February 1, 2012 Opinion D NEWSAILY RED BLUFF TEHAMACOUNTY T H E V O I C E O F T E H A M A C O U N T Y S I N C E 1 8 8 5 Prescription with side effects Greg Stevens, Publisher gstevens@redbluffdailynews.com Chip Thompson, Editor editor@redbluffdailynews.com Editorial policy The Daily News opinion is expressed in the editorial. The opinions expressed in columns, letters and cartoons are those of the authors and artists. Letter policy The Daily News welcomes let- ters from its readers on timely topics of public interest. All let- ters must be signed and pro- vide the writer's home street address and home phone num- ber. Anonymous letters, open letters to others, pen names and petition-style letters will not be allowed. Letters should be typed and cannot exceed two double-spaced pages or 500 words. When several letters address the same issue, a cross section of those submit- ted will be considered for publi- cation. Letters will be edited. 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How to reach us Main office: 527-2151 Classified: 527-2151 Circulation: 527-2151 News tips: 527-2153 Sports: 527-2153 Obituaries: 527-2151 Photo: 527-2153 On the Web www.redbluffdailynews.com Fax Newsroom: 527-9251 Classified: 527-5774 Retail Adv.: 527-5774 Legal Adv.: 527-5774 Business Office: 527-3719 Address 545 Diamond Ave. Red Bluff, CA 96080, or P.O. Box 220 Red Bluff, CA 96080 It sounds like a great idea when you first hear it: Medicare is making its claims files avail- able to insurers, employers and consumer groups so they can prepare report cards on individ- ual doctors. The files will reveal such things as how many times doctors perform particular pro- cedures as well as how often their patients develop pre- ventable complications. Medicare itself will maintain a website to allow patients to compare doctors, and says it intends to one day include on the site patient satisfaction sur- veys for individual doctors. I'm all for patients making informed decisions about which doctors to turn to, but these report cards may turn out to be highly misleading. Consider this, from my own experience. Earlier in my career as a doctor, I was affiliated with Loma Linda University's med- ical school. In many ways, I had a dream practice. Patients tend- ed to be true partners in health. They typically cared about their health, ate lots of vegetables, actually used their gym mem- berships and came in for yearly checkups bearing pictures of their puppies and new grand- children. Of course my patients sometimes had serious health problems, but when that was the case, most of them did every- thing they could to get better, following treatment instructions and adjusting diets or lifestyles as advised. I'm now treating a very dif- ferent population of patients. Most of them are poor enough to qualify for Medi-Cal, but even though they receive state insurance, many don't bother to seek care until they are very ill. Few of my patients exercise reg- ularly, and substance abuse is common. The problems they bring to the examining room are complex, and unraveling them often puts me far behind sched- ule. Treating this kind of patient can be frustrating because many don't comply with medical advice. They ignore admoni- tions to avoid salt and fats, which results in worsening heart problems and high blood pres- sure. They continue smoking despite chronic lung problems. I had one patient who wouldn't do his rehabilitation exercises after a knee replacement and so is now wheelchair-bound. As might be expected, the medical outcomes for these patients aren't nearly as positive as in my previous practice. High-risk patients of the sort I now see have a great need for healthcare. Yet I know that treating them will have an effect on my "grades" in the new physician report cards, which don't take the nature of the patients into account. Not long ago, I saw a middle- aged woman who had clearly once been beautiful. But when she walked into my office, she looked about nine months' preg- nant. Her belly was filled with fluid that her liver could not process: It was too damaged from years of drug use, untreat- ed infection and alco- hol abuse. She also had diabetes and high blood pressure. My colleagues and I spent a lot of time on her case. We tried to not only educate her about how to take care of herself but also to bring her family into the treatment pic- ture. But she eventually drifted off, not showing up for appoint- ments or responding to phone calls and letters. The likelihood of "pre- Guest View Katherine Schlaerth expertise and experience of the provider and the status of the patient. If you take two cardiol- ogists, say, of equal skill, the one who treats health- ier, younger, more compliant patients is likely to have better medical outcomes than the one treating older, substance-abus- ing or noncompliant patients. The patient is not a passive entity in the equation. ventable complications" with such a patient are huge. And I shudder to think how she would fill out a patient satisfaction sur- vey. Patients who don't want to hear what a doctor has to say are rarely happy with their care. Late last year, Marilyn Tavenner, the acting administra- tor of the Centers for Medicare & Medicaid Services, touted the release of information about doctors as an action that would make "our healthcare system more transparent" and result in "increased competition, accountability, quality and lower cost." But I'm predicting another outcome as well: that doctors will be increasingly reluctant to take on the toughest patients. Outcomes in medicine depend on two main factors: the According to the American Medical Association, we are facing a scarcity of physician specialists, and this scarcity will be exacerbated as 32 million more people seek medical care under the Patient Protection and Affordable Care Act. Physicians will have to make choices about whom they provide care to, and I worry that the elderly, the non- compliant and those with multi- ple medical problems will be unable to find good doctors. Why risk a bad report card that could scare patients away? Transparency is often a good thing. But the federal govern- ment must consider the possibil- ity that physician report cards could dangerously reduce health care to those who need it most. Katherine Schlaerth is a practicing physician and an associate professor emeritus at the University of Southern California's School of Medicine. She wrote this for the Los Angeles Times. Your officials STATE ASSEMBLYMAN — Jim Nielsen (R) State Capitol Bldg., Room 6031 Sacramento, CA 95814 (916) 319-2002; Fax (916) 319-2102 STATE SENATOR — Doug LaMalfa (R) State Capitol Bldg., Room 3070 Sacramento, CA 95814 (916) 651-4004; Fax (916) 445-7750 GOVERNOR — Jerry Brown, State Capitol Bldg., Sacramento, CA 95814; (916) 445-2841; Fax (916) 558-3160; E-mail: gover- nor@governor.ca.gov. U.S. REPRESENTATIVE — Wally Herger (R), 2595 Cean- othus Ave., Ste. 182, Chico, CA 95973; 893-8363. U.S.SENATORS — Dianne Feinstein (D), One Post Street, Suite 2450, San Francisco, CA 94104; (415) 393-0707. Fax (415) 393-0710. Barbara Boxer (D), 1700 Montgomery St., Suite 240, San Francisco, CA 94111; (510) 286-8537. Fax (202) 224- 0454. Hey Canada, how about a trade? Commentary There's been a reversal of for- tunes between Canada and America, and I'm not happy about it. According to The Economist, Canada is doing well as Ameri- ca continues to struggle. Our wiser, more cautious friends to the north avoided the housing bubble and financial collapse of 2008. They returned to robust growth in 2009 and have been growing since. Unlike America, Canada's debt and deficits are in good order. Canada expects to balance its budget by 2015 — whereas America's budget comes up short every month. Canada, like America, is blessed with natural resources, such as minerals, timber and oil. Unlike America, Canada isn't afraid to tap its resources and sell them to other countries for a bundle. Heck, our president just told the Canadians he doesn't want a pipeline that would pump Cana- dian oil to U.S. refineries -- and a lot of dough into America. Canada's credit rating remains at AAA — high for eco- nomic health and stability — whereas America's was cut for the first time in history. More unemployed Americans are fleeing north, where good- paying work is available, thanks to unemployment nearly 2 per- centage points lower than ours. Though I am happy for Cana- da, this turn of events is most unsettling to me. Didn't Canada used to suffer from big-government policies and out-of-control spending, whereas America was always the great high-growth capitalist success story? Wasn't it Canadian doctors who used to skate in the dark of night across frozen lakes to accept fine-paying jobs in America's mostly private health- care system? With the advent of ObamaCare, will American doc- tors be skating north? Wasn't it Canadians avoiding their country's high value-added taxes who used to travel to U.S. shopping malls and discount stores, where they bought up all the good stuff before Americans could get at it? Every winter, their plunder- ing left Americans without ade- quate supplies of ChapStick, beef jerky and down jackets. With U.S. spending, deficits and debt completely out of con- trol, how long will it be before higher taxes are imposed here? Before somebody proposes a national value- added sales tax on Americans' every transaction? Will Americans be traveling north to do their shopping? Here's what's even nuttier: Cana- da, with its proud history of big-gov- ernment initiatives such as health care, is now led by a pro- capitalist conserva- tive, whereas Amer- ica is led by a fellow always been one that we are firm believers in the markets and we know that prosperity, through capitalism in markets, is ulti- mately what pays for all the things that we enjoy here in Canada." Tom Purcell who's trying to turn his country into Western Europe. As President Obama contin- ues to "spread the wealth around," grow government and look for ways to raise taxes to pay for it all, Canada's prime minister believes a pro-growth approach is the best way to fund his country's social programs. Here's what one of the prime minister's spokesmen told Post- media News: "I think Canada's record has Sheesh! I remember when U.S. presidents believed such things. In any event, a rever- sal of Canadian and American fortunes appears to have occurred. So I have a proposi- tion for our friends up north: Hey, Canada, want to switch leaders for a while? Isn't our president more suited to your tradi- tions, whereas your prime min- ister is more suited to ours? We'll give him back once he gets U.S. unemployment below 7 percent. writer is also a humor columnist for the Pittsburgh Tom Purcell, a freelance Tribune- Review, and is nationally syndicated exclusively by Cagle Cartoons newspaper syndicate.. Email Tom at Purcell@caglecartoons.com.