Amputation Costs and OPS (Obama Panic Syndrome)

When Obama speaks a certain segment of the population seems to get red in the face and lose control. This seems to be a serious manifestation of OPS (Obama Panic Syndrome) which is difficult, if not impossible to treat. When Obama talked about Diabetic amputations he did make a mistake in the specifics of payment but was correct in the general cost. He said that the surgeon was paid over $35,000 immediately for the surgery. Surgeons never are paid immediately, and they receive nowhere near that amount. The American College of Surgeons states that Medicare payment to the surgeon for a foot amputation is under $800.

The cost that Obama mentioned was the total cost as declared in numerous articles, studies, and reviews on diabetic foot and limb care. The $35,000 – $50,000 or more cost of an amputation is often used. It just is not the amount the surgeon receives. When I listened to news clips, I misheard what he said as total cost. But he did mistakenly say this was what the surgeons received. Some felt that doctors and surgeons had been impugned. I did not feel that way. I believed Obama was again mentioning the benefits of limb preservation and preventative care in Diabetes as he has done before. Perhaps not as artfully as previously, but still an important and valuable reminder of the value of preventative care, which is not handled as well as it could be by many private insurance plans and even Medicare. So a reality check and a quick web search shows that Obama was mistaken about the surgeon reimbursement, and he must have meant total cost, and not physician reimbursement. There was no cause for OPS to set in.

Diabetes is a serious illness that requires careful management, dietary support, and exercise to minimize complications. The complications from diabetes can include painful neuropathy, renal failure, eye and vision problems and limb amputations. Diabetes is the major cause of the majority of non-traumatic amputations. More than 50% of those who have had one limb amputated go on to have the other amputated within 5 years.

According to Hospital Management Magazine ( and echoed by many other sources): “the direct cost of an amputation associated with the diabetic foot is estimated to be between $30,000 and $60,000. The estimated cost for three years of subsequent care for individuals whose ulcer has healed without the need for amputation has been estimated to be between $16,000 and $27,000.”

“With relatively low investment the number of amputations can be significantly reduced. Aggressive management of the diabetic foot can prevent amputations in most cases. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team. Education of people with diabetes and healthcare providers is essential. Healthcare providers need to be trained in order to detect problems early and take appropriate action.”

Medscape reports similar numbers and notes that 57,000 amputations per year (about 150/day) are performed. They also note that 5 – 17% will die during the surgery and an additional 2-23% will die within 30 days of the surgery. The 5 year survival rate is only 40% and 25% in the elderly.

If you listen closely, you’ll hear others talk about the cost of diabetes, diabetic ulcerations, and amputations in diabetics. You’ll hear them talk about preventative care and the importance of maintaining a healthy body weight, eating healthy, not smoking, and regular exercise ( 30 minutes moderate exercise x 5 days/week, 2 days/week strength training). I recently heard Mike Huckabee speak about these very issues at the Annual meeting of the American Podiatric Medical Association.  If I recall correctly he did mention the same numbers as total cost of an amputation. Huckabee also mentioned that he thought maintaining healthy life habits was worthy of an insurance discount. He said this to cheers from those assembled. When Obama says the same thing, OPS sets in, and instead of cheers, I often hear mumbles asking how will the government measure this, and why will they be in our business and private lives.

My opinion is that both the media covering this could use more physicians to help them discern truth from lie and Obama needs more physicians to help review his examples, analagies, and specifics. And we all need to rise above special interests, people who represent and are paid by special interests and keep a cool and objective head as we examine this difficult problem. Maintaining a balance between a “public” option and private insurance firms is important as is determining a fair and proper way to pay for changes. But this is clearly the time for change.

Changes – David Bowie