Although I’m not a hard core movie fan, my wife and I did see “The King’s Speech” a week before it won Best Picture at the Oscars. Another favorite flick that never won an Academy Award nomination was the 2004 “50 First Dates,” in which Lucy (Drew Barrymore) suffers from “anterograde amnesia” as a result of a car accident she was in a year earlier. The condition has left her unable to convert short-term memories into long-term memories, so she literally can’t remember from one day to the next.
Enter marine veterinarian Henry Roth (Adam Sandler), who meets her in a café, they hit it off, run into each other again the next day, but she doesn’t remember him from the day before, leaving Henry perplexed and dejected. The guy who runs the café clues Henry in on what’s going on, and Henry capitalizes on the chance to make a new first impression with Lucy every day.
There are plenty of times when I could have benefited from a second chance at the first impression. This premiere installment of Medical Sense probably isn’t one of those times, so this is my shot to make a good first and only first impression. Let me know what you think.
There are many debates going on in politics right now, and depending upon the day of the week in the news cycle, government run health care is front and center as we hit the first anniversary of the signing of the legislation by the President. As with just about any public policy debate, a topic that doesn’t always get much attention is that of the “unintended consequences” of the legislation.
The federal government generally isn’t very successful at running anything it “subsidizes,” or outright “takes over.” Delivering the mail and maintaining a national railroad are two examples that can’t seem to operate without regular infusions of taxpayer cash. Managing mortgage loans and building cars are more current examples, but all things aviation, however, are inherently governmental functions. Aircraft certification, air traffic control, and pilot medical certification generally receive passing marks from most of the user community, despite their governmental oversight.
The adverse unintended consequences of federalizing and mandating single-payer universal health care for everyone (except the special interest groups who are being granted “waivers” by the thousands) concerns me a lot. In the evolving landscape of “ObamaCare,” one scenario of government proscribing “who gets what treatment and when” has potentially serious implications for pilots who are under tighter FAA oversight of their medical certification.
Special Issuance Authorizations are issued for lots of different medical conditions, and those authorizations are contingent on the FAA getting something from the pilot on a regular basis, usually every year. Balancing the mandates of federal regulatory medicine against the accepted “Standard of Care” that our current health care system employs seems to be working fairly well. Despite the protestations of some airmen about the FAA’s requests for “unnecessary” testing to determine one’s eligibility for medical certification, the FAA is, by most accounts, balanced and reasonable in what they ask for and how often they ask for it.
A common example of this plays out with a private pilot with a third-class medical and a history of coronary artery disease treated with stents. In our experience at AOPA, pilots and their cardiologists generally have no problem in complying with the FAA’s requirement for annual reevaluation with treadmill stress test, lipid profile, and a narrative report from the cardiologist. Under our current health care “rules of engagement,” an annual follow-up examination with repeat treadmill test is an adequate and reasonable baseline study to identify possible progression of disease.
Considering the worst case scenario under a government run “rationed” managed care system, the otherwise healthy, compliant airman with good control of risk factors who submits to an annual cardiac reevaluation for renewal of his medical certificate likely would not be covered under “the Plan” and would be denied the claim for the perhaps several thousand dollars in incurred expenses for a stress test, cardiology interpretation, lab work, and the physician’s narrative report.
That airman would then have the untenable choice of paying all those costs out of pocket, or not be reissued an Authorization. Our average general aviation pilot may finally say “enough” and will no longer continue to play in the aviation arena, or will, at best, opt for Light Sport self certification. Our industry has been very resilient up to now, but in a world of a declining pilot population, forcing an additional expense on the cost of flying in the form of out of pocket medical expenses may be the tipping point for many.
The scenario places the pilot between a rock and a hard place. The DoT/FAA won’t budge on the mandate for aviation/public safety. So, we can’t expect that the FAA will no longer ask for an annual CT scan, a thyroid panel, a stress echocardiogram, or a heart catheterization from those airmen whose medical histories indicate such testing. Nor can we expect that the costs of these services will decrease under managed care, as the Administration continues to claim.
Regardless of one’s views, it’s hard not to agree that this is a dramatically new paradigm of health care in the US, and it will be interesting to see how it plays out going forward.