The Truth About Drug Companies:
"News: The author calls the pharmaceutical industry a “vast marketing machine” that thrives on monopoly rights and public-sponsored research but produces few innovative drugs. "
From Mother Jones Magazine, an interview with Marcia Angell, author of
The Truth About Drug Companies: How They Deceive Us and What to Do About It
Sunday, January 28, 2007
The Truth About Drug Companies
Daily Kos: HEALTH CARE: How to pay for single payer
Daily Kos: HEALTH CARE: How to pay for single payer:
"HEALTH CARE: How to pay for single payer"
by AmberJane
Thu Mar 30, 2006
Angry Bear
Angry Bear: "Health Care in The U.S. And The World, Part II: What do we spend the money on?"
Thanks to SarhLee on the DailyKos website for the lead...
Krugman - Death by Insurance | Physicians for a National Health Program
Krugman - Death by Insurance Physicians for a National Health Program:
"Krugman - Death by Insurance
The New York Times
May 1, 2006"
Lifted from the PNHP site.
The False Promise of Single-Payer Health Care
The False Promise of Single-Payer Health Care: "Speech October 9, 2002
Sally C. Pipes
President and Chief Executive Officer
Pacific Research Institute
Presented at St. Vincent’s College"
----------------
How many straw men can you count?
I think we need to put a dozen experts from each side in a house for a month. They can have internet access, whatever materials they need. Heck, they can even phone a friend or poll the country, but they need to rebut each other in a factually based manner until they come to some understanding. Pretty good reality show, huh?
I frankly think it will all boil down to Lakoff's model of conservative/liberal:authoritarian/nurturant world views. If you think the rich deserve to be rich and the poor deserve to be poor, you will never "accept the premise" of single payer healthcare.
Cheers.
Experts See Peril in Bush Health Proposal - New York Times
Experts See Peril in Bush Health Proposal - New York Times
Sphere: Related ContentThe economic rationale for Mr. Bush’s proposal is that too many people
have “gold-plated, deluxe” health insurance, which encourages them to use
excessive amounts of health care, driving up costs for everyone.
Many economists agree. But they doubt that Mr. Bush’s proposal would do much to hold
down costs or cover more people.Really? Is that it? Too many people running up excessive bills for their healthcare?
Mr. Bush’s proposal differs radically from President Bill Clinton’s plan for universal coverage, but experts on health benefits said they were similar in one respect: In an effort to help the uninsured — about one-sixth of the population — they would upend the system that covers most Americans.
We have a system?
Representative John D. Dingell, the Michigan Democrat who is the chairman of the Committee on Energy and Commerce, said, “The president’s proposal would do little to help the uninsured, but would undermine the employer-based system through which 160 million people get coverage.”
Almost tempting to pass whatever Bush sends down the pike, let the system implode, and then start over. Of course, that's sort of how we got the country where it is right now, isn't it?
Cheers.
Friday, January 26, 2007
As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging - New York Times
As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging - New York Times
By CLIFFORD KRAUSS
Published: February 26, 2006
Article about waiting times in Canada: below are responses from Physicians for a National Health Plan's Nicholas Skala:
1. This writer is well known for peddling fake data, and this story is no exception. For his outrageous waiting time estimates, he uses data supplied by the Fraser Institute, an ultraconservative PR firm that masquerades as a legitimate research institution. Dr. Robert McMurtry, the Canadian orthopedic surgeon who is a former dean of a Canadian medical school and served on the national waiting times commission tells me that not even the right wing Canadians take them seriously. Their “scientific” method of determining wait times consists of bulk-mailing a list of pro-privatization physicians and asking them how long they think their patients will have to wait to see them. If they return the mailing they are entered in a drawing to win a $2,000 cash prize. It’s pathetic. Unsurprisingly, Fraser comes up with outrageous waiting time estimates (17.8 weeks last year, as I recall), and is quite adept at publicizing them in the American media. Wait times are scientifically measured every year by Statistics Canada (the counterpart to the U.S. Census Bureau). I’m sure most Americans would be surprised at the results of scientific measurement: In 2005, median wait times were 4 weeks for elective surgery, 4 weeks for specialist care, and 3 weeks for diagnostic tests.
http://www.statcan.ca/Daily/English/060131/d060131b.htm
Also, the Canadian Health Services Research Foundation has done a short, scholarly critique of Fraser’s methods and compared them with real studies. (In fact, I think they’re far too kind to Fraser).
http://www.chsrf.ca/other_documents/newsletter/qnv1n4p4_e.php
2. The Supreme Court decision was bad for a number of reasons, and since has been near universally derided in the Canadian press. Follow this link:
http://www.pnhp.org/single_payer_resources/Canadian%20Supreme%20Court%20Ruling.pdf
3. As far as proposals to create a parallel private system, compelling evidence shows that more private participation leads to longer waiting times and lower quality care because 1) private insurers “cherry pick” healthy and profitable patients and leave the sick and poor to the public system and 2) physicians have a perverse incentive to move to the private sector (where they make more money), draining the public system of capacity and resulting in lower-quality care (and eventually creating a self-fulfilling prophecy for the right wing, because they then say the public sector can’t do anything right).
The Canadian Health Services Research Foundation has a couple of great fact sheets on this too.
http://www.chsrf.ca/mythbusters/pdf/myth17_e.pdf
http://www.chsrf.ca/mythbusters/pdf/myth13_e.pdf
http://www.chsrf.ca/mythbusters/
Finally (and kind of philosophically), there is a reason that rationing in Canada gets so much attention in the media. Its because the Canadian health system is held publicly accountable. Grievances aired in public are likely to be addressed by policymakers (and in many cases have, as waiting times for many procedures have dropped dramatically). This is a foreign idea to us in the U.S., where the operation is exactly reverse: no one is ultimately accountable, and the forces that profit from the system have every reason to keep problems quiet. And so, although rationing (based on the ability to pay) in the United States kills at least 18,000 Americans every year (according to the Institute of Medicine’s most conservative data…Himmelstein and Woolhandler estimate it may be 10 times that many), our media acts as though Canada’s the place with the problems.
Hope this helps.
nick
Nicholas Skala
PNHP Staff
JAMA -- Lives at Risk: Single-Payer National Health Insurance Around the World, January 19, 2005, Orient 293 (3): 369
JAMA -- Lives at Risk: Single-Payer National Health Insurance Around the World, January 19, 2005, Orient 293 (3): 369: "by John C. Goodman, Gerald L. Musgrave, and Devon M. Herrick (National Center for Policy Analysis), 263 pp, with illus, $70, ISBN 0-7425-4151-7, paper, $22.95, ISBN 0-7425-4152-5, Lanham, Md, Rowman & Littlefield Publishers, 2004."
The link is to the review of the book in the Journal of the American Medical Association by Jane Orient.
[Jane M. Orient, MD, Reviewer Association of American Physicians and Surgeons University of Arizona College of Medicine Tucson jorient@mindspring.com ]
and a reply...
JAMA -- Single-Payer Health Systems and Statistics, July 6, 2005, Starfield and Morris 294 (1): 43
and a response...
JAMA -- Single-Payer Health Systems and Statistics--Reply, July 6, 2005, Orient 294 (1): 44
And who is Jane Orient? http://en.wikipedia.org/wiki/Jane_Orient
and the AAPS : http://en.wikipedia.org/wiki/Association_of_American_Physicians_and_Surgeons
"The motto of the AAPS is omnia pro aegroto which means "all for the patient."
Your moment of Zen.
AMA Policy Finder - The "Case" Against Single Payer
AMA Policy Finder - American Medical Association:
H-165.888 Evaluating Health System Reform Proposals
Our AMA will continue its efforts to ensure that health system reform proposals adhere to the following principles:
..."(2) Unfair concentration of market power of payers is detrimental to patients and physicians, if patient freedom of choice or physician ability to select mode of practice is limited or denied. Single-payer systems clearly fall within such a definition and, consequently, should continue to be opposed by the AMA. Reform proposals should balance fairly the market power between payers and physicians or be opposed. "
Awfully dogmatic, isn't it?
The New Yorker:THE MORAL-HAZARD MYTH
Highly recommended reading:
The New Yorker: PRINTABLES:
"THE MORAL-HAZARD MYTH"
by MALCOLM GLADWELL
The bad idea behind our failed health-care system.
PDF Version: www.gladwell.com/pdf/hazard.pdf
Average Payment per Physician Report, Canada
http://dsp-psd.pwgsc.gc.ca/Collection/H118-4-2004E.pdf
Canadian data on payments to physicians. Includes specialty breakdown.
The Mythology of Health Care Reform
The Mythology of Health Care Reform
Wow. And people eat this stuff right up. Just goes to show that the left needs to really spend a lot of money developing think tanks to do rapid response to junk like this.
AMNews: Oct. 24/31, 2005. Canadian tide turns as residents return home ... American Medical News
AMNews: Oct. 24/31, 2005. Canadian tide turns as residents return home ... American Medical News
Experts say an improving climate for physicians in Canada and an increasingly hostile one in the United States are driving the change.
By Myrle Croasdale, AMNews staff. Oct. 24/31, 2005.
Deepening administrative burdens from managed care insurers and rising medical liability rates are some of the reasons more of Dr. Warner's Canadian colleagues are returning home after training or practicing in the United States.
The shift also is attributed to the Canadian government's efforts to reinvest in upgrades, such as new operating rooms, under the single-payer system. In some provinces, physicians are being offered higher reimbursements. All of this is to stem a growing shortage of doctors and increase access to quality care. Such stability follows deep cutbacks in Canada's reimbursement and health care infrastructure during the 1980s and 1990s.
----
Recent surveys from the Medical Group Management Assn. showed that physician pay is flat or declining in many specialties. Canadian salary figures were not available at press time, although CIHI data indicate that Canadian physicians have average billings about 25% less than their U.S. colleagues.
But doctors in Canada do not have the paperwork of multiple insurers or the steep increases in liability insurance premiums. In Ontario, considered a high-risk province, an ob-gyn would pay the equivalent of $65,000 for coverage, while in Florida, also considered high-risk, insurance would cost $277,000. Liability costs are increasing in Canada, though they're blunted by a tort-based compensation system, with compensation limited to cases in which fault is proven or settlement is made.
Thursday, January 25, 2007
Top Contributors to Federal Candidates and Parties: Pharmaceuticals/Health Products
sorry, another good one...
Top Contributors to Federal Candidates and Parties: Pharmaceuticals/Health Products: "Pharmaceuticals/Health Products: Top Contributors to Federal Candidates and Parties "
More from Open Secrets
More from Open Secrets
Top Contributors to Federal Candidates and Parties: Health: "Health: Top Contributors to Federal Candidates and Parties "
Donor Profiles: The American Medical Association (AMA) represents medical doctors across the country, promotes standards in care, and publishes a number of medical journals. The association has traditionally supported Republican candidates, agreeing with the GOP on such issues as medical malpractice reform. But over the last few years, the AMA has also begun to shift support to the Democrats, favoring their attempts to pass patients’ rights legislation and expand Medicare payments. "
And just for fun:
Top Contributors to Federal Candidates and Parties: Misc Business:
"Misc Business: Top Contributors to Federal Candidates and Parties "
Industry Totals: Health Professionals
From OpenSecrets.org:
Industry Totals: Health Professionals:
"Health Professionals: Long-Term Contribution Trends "
Industry Totals: Pharmaceuticals/Health Products:
"Pharmaceuticals/Health Products: Long-Term Contribution Trends "
Industry Totals: Insurance: "Insurance: Long-Term Contribution Trends "
NEJM -- Campaign Contributions from the American Medical Political Action Committee to Members of Congress -- For or Against the Public Health?
A comparison of the educational costs and incomes of physicians and other professionals. [Entrez PubMed]
Entrez PubMed Link
N Engl J Med. 1994 May 5;330(18):1280-6.
Comment in:
N Engl J Med. 1994 May 5;330(18):1311-2.
A comparison of the educational costs and incomes of physicians and other professionals.
Weeks WB,
Wallace AE,
Wallace MM,
Welch HG.
Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, White River Junction, VT 05009.
BACKGROUND. Efforts at physician-payment reform in the United States have focused largely on the relative incomes of primary care physicians and specialists, who more often have procedure-based practices. Comparisons of the incomes of physicians and other professional groups have received less attention. METHODS. We used standard financial techniques to determine the return on educational investment over a working lifetime for five groups of professionals: primary care physicians, specialist physicians, dentists, attorneys, and graduates of business schools. RESULTS. In current dollars, the difference in the average future hourly income between a given professional and a high-school graduate of the same age, after educational expenses are subtracted (average hours-adjusted net present value of the educational investment) was greatest for specialist physicians and attorneys; dentists and businesspeople had intermediate values; and primary care physicians had the lowest value. The annual yield on the educational investment over a working life (hours-adjusted internal rate of return) was 15.9 percent for primary care physicians, as compared with 29.0 percent for businesspeople, 25.4 percent for attorneys, 20.9 percent for specialist physicians, and 20.7 percent for dentists. A sensitivity analysis showed that primary care physicians did less well in terms of the return on investment than the other groups even when we varied the assumptions in our model widely and that specialist physicians did less well than attorneys working in law firms and dental specialists. CONCLUSIONS. Students can expect a poorer financial return on their educational investment when they choose a career in primary care medicine than when they choose a procedure-based medical or surgical specialty, business, the law, or dentistry.
PMID: 8145784 [PubMed - indexed for MEDLINE
Long-term financial implications of specialty training for physicians. [Entrez PubMed]
Entrez PubMed
Am J Med. 2002 Oct 1;113(5):393-9.
Links
Long-term financial implications of specialty training for physicians.
Weeks WB,
Wallace AE.
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire, USA. william.b.weeks@dartmouth.edu
PURPOSE: Given the recent changes in physician reimbursement and managed care penetration, we examined the financial returns that might be anticipated when considering different medical careers. METHODS: We used survey data from the American Medical Association and standard financial techniques to calculate the return on educational investment (as the discounted, annual hours-adjusted, net present value of additional training) over a working lifetime for six different specialties (family practice, pediatrics, general internal medicine, gastroenterology, cardiology, and general surgery). RESULTS: From 1992 to 1998, the annual yield on specialty training (hours-adjusted internal rate of return) declined for all specialty groups, especially for primary care specialties. The difference in the average income between a given specialty and general practice decreased for general internal medicine, from $5400 (95% confidence interval [CI]: $5000 to $5800) in 1992 to $1180 (95% CI: $1160 to $1205) in 1998, and became negative for family practice (from $5200 [95% CI: $1000 to $9500] to -$2500 [95% CI: -$5800 to $800]) and pediatrics (from $4000 [95% CI: $1200 to $6800] to -$6300 [95% CI: -$9700 to -$2900]). Values for surgery decreased from $33,100 (95% CI: $29,400 to $36,400) in 1992 to $27,200 (95% CI: $21,700 to $32,100) in 1998, whereas there were increases for cardiology, from $35,100 (95% CI: $30,000 to $39,700) to $36,700 (95% CI: $26,500 to $45,700), and for gastroenterology, from $30,000 (95% CI: $21,800 to $37,200) to $34,700 (95% CI: $22,700 to $45,300). CONCLUSION: Our analysis suggests that recent efforts to use financial incentives to make primary care fields more attractive have not been effective. Financial returns and the incentives they create should be carefully considered as part of health care reform.
PMID: 12401534 [PubMed - indexed for MEDLINE]
Pay for Canadian physicians [Archive] - Student Doctor Network Forums
An intersting message board exchange from 2005:
Pay for Canadian physicians [Archive] - Student Doctor Network Forums:
"Anyone have salary information for Canadian physicians?"
The New Yorker: Gawande's "Piecework"
The New Yorker: Piecework/Gawande: "
PIECEWORK
by ATUL GAWANDE
Medicine’s money problem.
Issue of 2005-04-04
Posted 2005-03-28"
Physicians and surgeons
Link to Bureau of Labor Statistics info on American physician salaries (from MGMA)
Physicians and surgeons
Physicians and surgeons
Physicians and surgeons: "Earnings[About this section] Back to Top
Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association’s Physician Compensation and Production Survey, median total compensation for physicians in 2004 varied by specialty, as shown in table 2. Total compensation for physicians reflects the amount reported as direct compensation for tax purposes, plus all voluntary salary reductions. Salary, bonus and/or incentive payments, research stipends, honoraria, and distribution of profits were included in total compensation.
Table 2. Median total compensation of physicians by specialty, 2004Less than two years in specialtyOver one year in specialty
Anesthesiology$259,948$321,686
Surgery: General228,839282,504
Obstetrics/gynecology: General203,270247,348
Psychiatry: General173,922180,000
Internal medicine: General141,912166,420
Pediatrics: General132,953161,331
Family practice (without obstetrics)137,119156,010
SOURCE: Medical Group Management Association, Physician Compensation and Production Report, 2005.
Self-employed physicians—those who own or are part owners of their medical practice—generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, and skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health insurance and retirement."
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