I stepped into a remodeled cardiac catheterization lab and saw a new contraption on the faucet of the scrub sink. As I donned my lead apron, the manager explained it was an eyewash station. The more I learned, the more I came to see it as a symbol of how government increases healthcare costs while decreasing quality.

The gadget is designed to shoot water into both eyes in the event of something bad splashes in them. What hazardous liquids are found in a cardiac cath lab, you might ask, since every such substance is approved by our Food and Drug association for medical use, either topically or injected, and should be safe. Yes, iodine can sting the eyes. Yes, blood can and rarely does splash in the eyes, despite the Occupational Safety and Health Administration requirement to use eyewear.  Blood is sterile in the vast majority of patients and when blood contains germs, studies show that infection of the unfortunate recipient is virtually immediate. There is typically an eyewash station in the emergency room within a minute or two of virtually all cath labs but that’s not adequate for regulators. Getting to an eyewash station in twenty seconds is not superior to two minutes for any liquid one could acquire on an eyeball in the cath lab, yet the room must have one.

The station interferes with the normal operation of the faucet and increases contamination hazard, should one attempt a sterile scrub.  Leaks are common and lead to a wet floors with a subsequent fall risk, not to mention damage to the building. 

But the story gets better. To ensure compliance with OSHA guidelines, accrediting organizations, create reporting requirements for hospitals. A weekly audit of the device is required. The person assigned to this task often must complete hours of education. A record of the weekly assessments must be made, to include inspection of the nozzle dust caps position and functionality, water temperature and pressure, and whether the pathway to the station is clear and unobstructed. If weekly assessments are not properly recorded in the correct form, inspectors issue a black mark against the institution, jeopardizing Medicare payments. 

While the inspection method and parameters are highly structured, neither OSHA nor accreditors require teaching people how to operate the device. These appliances do nothing to improve safety or quality but they drain hospitals of money. Eyewash stations are aptly named.

Government involvement has used good intent to pave the road to high cost, low quality medical care. Prime examples are government run, single payer systems of Indian Health and Veteran’s healthcare (neither of which are a topic in this article.) The government (and everyone else) wants to prevent fraud in taxpayer funded activities. In this spirit, bureaucrats adopted a wasteful, costly, and arcane medical billing system developed by a communist commune in Chicago, also known as the American Medical Association.  In it, every physician I know has committed fraud. That sounds awful. I shall explain.

Medicare pays for Evaluation and Management services. A history and physical or a doctor visit is such. There are three to five levels of payments for E&M codes. Higher levels of payment require more data points of minutia in the note that documents the service. Insurance gnomes count the data points to make sure no one cheats. The feds also require compliance officers to do the same work inside the hospitals. Doctors are not stupid. They developed a workaround using pre-filled forms to insert the required data into the electronic health record.

The result of this in real life springs out of a discharge summary on a patient who died during a procedure that I read recently.  It listed eight drugs the (dead) patient was prescribed at discharge. (Would the mandated discharge planner need a seance to follow up on compliance?) As this patient was dying, a consulting physician rushed in to help. The patient was being resuscitated but, according to his note, she had a completely normal physical exam including normal heart exam (the patient was in cardiac arrest) and was “alert and oriented” when she was essentially dead. The note hit all the points required in order to collect payment. Accuracy was optional.

Notes that were once concise now obfuscate details in five pages of useless copy-and-paste to achieve higher payment. On the other hand, physician orders that were once illegible doctor scribble are crystal clear. That sounds valuable, however, my experience is that the orders often get lost in a morass of cyber confusion. When I see a patient hours after a procedure, it’s not uncommon to find the IV fluid that I ordered stopped is still flowing rapidly into a poor soul gurgling in excess water. Computerized healthcare is the law. It costs, I have read, over $50,000 per year per physician to create this unsafe and confusing debacle. I sometimes cynically opine that the EHR is a governmental solution to global warming in that has shortened life expectancy in the US.

In order for the practice or hospital to get maximal payment, coders send me their irritations about my documentation every week. (“I can’t bill a level three because you were two items short on your review of systems. Can you go back and edit your note?”) A coder is a person who has been to coding school, (an entity that also funds the aforementioned communists in Chicago) and received a certificate. There are levels of coders in this artificial industry, and certificates in various specialties from oral surgery to proctology. I chose these specific specialties on purpose because this malicious micromanagement is flavored with idealistic intent but excreted as *** (insert preferred scatological reference here. Or, more politely, “eyewash.”)

Elimination of most of of regulations and systems that govern Medicare medical billing would result in a large drop in healthcare costs, probably improving quality of service and care at the same time.

Another accelerator of cost which is at least as bad as the regulations on providers is the FDA. Before costs are addressed, consider its abysmal record of failure with drugs. Around seventy thousand people die in the US of illicit drug use annually. Additionally, thousands more die of drug misadventures in healthcare settings. Tens of thousands more die from infections that result from antibiotic misuse.

Perhaps to overcompensate for its incompetence, the FDA creates expensive piles of *** (see above)  through which companies must slog to bring new drugs and devices to market. By requiring far more data than is needed in any other country, it may cost as much as eight times more to gain approval for drugs and devices in the US than in Europe. Because of this, the US is usually last to gain access to new drugs and technology when they are finally approved. Yet, healthcare is no safer here than in Europe. 

Combine the onerous FDA requirements with a twenty year patent duration, that begins years before the drug is approved, and it is no wonder that new pharmaceuticals are unaffordable. Politicians seem to create problems that they use for their own political gain. They rail against the high cost of drugs, a problem of their own creation.

A far lower cost solution is to accept European Union approval for drugs and devices for the US.  This would eliminate a giant swath of costly bureaucracy at the FDA making drug and device costs much lower. If the EU asks us to help fund their approval process, we could agree to do so when every country in the EU meets their NATO obligation. (Is that quid pro quo  impeachable?)

Some call for more generics and shorter patents. The latter would harm the pharmaceutical industry. Generic drugs have looser standards of purity. Reports of lower efficacy are mounting. Many generics come from China. These low cost, less pure drugs, along with a host of other sweat-shop non-medical products, force Americans to support a communist regime that aspires to eliminate our way of life. But I digress.