Surgeons get $30,000 to $50,000 for an amputation? On what planet?

I’ve been ragging a lot on some of the right wing critics of President Obama’s health care reform initiative. Without a doubt, with their talk of “death panels” and their likening the health care reform bill to the beginning of another Nazi-like euthanasia program, they deserve it. But I just saw something on YouTube that has been spreading virally among surgeons, and, depressingly, it’s President Obama engaging in a bit of nonsense of his own in support of his agenda:

Yes, it’s our President contrasting what primary care docs make treating diabetes with what docs can make if a diabetic foot ulcer progresses to the point where an amputation is required, contending that surgeons are reimbursed “$30,000, $40,000, $50,000″ to amputate a foot.

Nonsense.

The surgeon’s reimbursement for a below-the-knee amputation is nowhere near that much. Reimbursement for the surgeon for a below-the-knee amputation is in the hundreds of dollars, perhaps slightly more than $1,000, nowhere near $30,000 to $50,000. Don’t forget, also, that that is a global fee. It includes the surgery and all postoperative care in the hospital and in the office for 90 days after surgery. Moreover, it’s two different groups of doctors we’re talking about here. The primary care physician who treats diabetes and the surgeon who does an amputation don’t share incentives. It’s not as the the patient’s doctor will make more money for an amputation.

The most charitable explanation is that, as so many people do, President Obama is confusing the entire hospital charge with the surgeon charge, which is actually usually a small fraction of the total hospital charge. It’s possible that the total cost of hospital bills, professional fees, the construction of a prosthetic, and rehabilitation care may approach $30,000-$50,000, but Obama really needs to understand that a surgeon’s fee and the overall cost of a procedure and its associated hospitalization and recovery are not the same thing. It’s a misunderstanding that might not be surprising among our patients but not coming from a President who is championing a major overhaul of the health care and health insurance system. It’s also, unfortunately, an understanding behind why a some patients seem to think that surgeons are making obscene amounts of money.

True, making such a boneheadedly obvious mistake not as despicable as branding your opponents a Nazi. It may even be a relatively minor verbal gaffe to have claimed that the surgeon pockets $30,000 to $50,000 for an amputation. However, it’s self-defeating in that it provides ample ammunition for opponents to point to as evidence of ignorance, not to mention feeding the myth of greedy surgeons who are fat and happy thanks to the current system.