As a 58 year old physician I watched with interest as President Obama assumed the role as chief expositor on the way all of the "greedy" physicians use surgeries only to line their pockets when his version of the new "preventive" care model will both save money on health care and put the greedy physicians in their places. In his usual non-teleprompter fashion he chose.....poorly. His examples included tonsillectomy and amputation for diabetic foot ulcers. I don' know what he chooses as his source material but it needs to be changed immediately.

Tonsillectomy is a procedure now done much less commonly and for different indications than in the 1970s when I attended medical school. In the '70s 1 million tonsillectomies were done annually but in this decade it is more in the range of 280,000. Only 20% of these are done for recurrent tonsillitis only small numbers for acute tonsillitis (usually for life-threatening abscess), the remainder are done for sleep disorders. Actually, given the total cost of doctor visits, antibiotics, lost work and school time the procedure would probably save money if done more often. Doctors themselves felt that the surgical risks were better avoided if more conservative treatments were chosen thus decreasing the number of these procedures.By the way "Dr." Obama, there are more cosmetic breast enlargements done in America every year than tonsillectomies. Lawyer/politicians like "Dr." Obama didn't drive the decision to decrease the frequency of tonsillectomies.  By the way, the typical reimbursement to the physician for the procedure and 90 days of follow-up care is $200-$300, less than an hour's charge by most lawyers like the President, his wife, and most of Congress. Perhaps we really need legal reform. Like that will ever happen.

Amputation is an unfortunate and uncommon consequence of diabetic microvascular disease. Even the most compulsive of diabetics can suffer this problem and diabetics (as I know from my own family) vary in their ability and willingness to provide themselves with proper foot care.Doctor visits and other "preventive" measures do not stop the progression of the vascular disease. Unless the President expects the soon-to-be overburdened doctors offices (who is going to care for the additional 40 million newly insured people?) to provide this care perhaps the bill should include a "National Corps of Pedicurists". Amputations would still occur and again these are not reimbursed highly. When an amputation is done it is certainly as a last resort in virtually all cases.I have never known a surgeon-including myself- who did an amputation on a diabetic that did not feel bad about having to so significantly alter a person's life. What you seem to not understand "Dr." Obama is that the vast majority of doctors and nurses are caring individuals by their very nature. Decisions on the best course of treatment should be made by those who bear the consequences of those decisions, not by a group of bureaucrats who never have to face their patients and families.