Was Adam Smith really a promoter of greed?
An excellent book chapter giving a more complete picture of Adam Smith's economic and moral philosophy that is not as conservatives would have you believe. Greed is not good. Laissez-Faire is not absolute.
"In reality, as Adam Smith argued, one of the main functions of government, beyond that of securing the order that allows markets to operate effectively, is that of intervening to ensure that the unwarranted excesses of commercial society do not entirely destroy the social order or the moral foundations of behaviour. As we have seen in his arguments regarding the role of publicly funded education in redressing the worst of the degrading and demoralising effects of the division of labour and reducing the possibility of revolutionary protests against an unjust social order, Smith argued that in effect ‘…the visible hand of the state would counteract the potentially stultifying effects of the invisible hand of the market’ "
Tuesday, July 31, 2007
I do not think it means what you think it means...
Martin | Fletcher
Martin Fletcher: It Pays to Be in Healthcare: Leading Recruiting Firm Releases Physician, Nurse & Allied Health Compensation Reports
"Among physicians, Martin, Fletcher evaluated more than 3,500 individuals' salaries across 17 medical specialties. The top five paying specialties are:
Position/Average/Median
Cardiology (invasive)/$460,000/$440,000
Radiology/$425,000/$392,700
Orthopedic/$424,000/$383,000
Gastroenterology/$405,000/$368,000
Urology/$380,000/$325,520
According to Martin, Fletcher research, the lowest paying positions among physician specialties surveyed include: family practitioner, internal medicine, pediatrics and hospitalist, with median salaries ranging from $146,260 to $170,980. The top three incentives used by medical groups to recruit physicians include: production-driven incomes starting year one, buy-in based on A/R and full pension for retirement."
The full report is here.
It's worth keeping an eye on this data as the debate continues...
Monday, July 30, 2007
'Sicko': Heavily Doctored, By Kurt Loder - Movie News Story | MTV Movie News
'Sicko': Heavily Doctored, By Kurt Loder - Movie News Story MTV Movie News: "Jun 29 2007 12:34 PM EDT
'Sicko': Heavily Doctored, By Kurt Loder
Is Michael Moore's prescription worse than the disease?"
I think the chief straw man Loder has thrown up here is that Moore holds up the Canadian, French or British systems as "utopia," to use his word. SICKO showed some of the serious flaws in our system and showed some of the serious benefits to others. That really is the bottom line. I've been following the media coverage closely, interviews with various experts, MM himself in interviews, etc. There are lots of complaints about what he "left out." Well, it's only a two hour movie and I think it is not his job nor his role to be the health care czar and review every nuance of health care here and abroad. He had a lot of points to make and he made them very well, very humorously and sometimes heart-breakingly poignantly. If you see it, you'll know that he didn't tell the downsides of universal access in other countries, but, frankly, as we health care providers know (I'm a critical care physician) better than the average viewer, neither did he scratch the surface of the problems so widespread in our "system." But he always says in interviews that of course other systems have problems. Our goal should be to take the best parts of each of those systems and craft an American system better than all the others. But, he makes no bones that this needs to be a single payer system at its core. He seems to have no bone to pick with physicians - he believes the focus of reform should be getting rid of private health insurance as we know it.
And finally, if you want to make the debate solely on health care horror anecdotes, you'll lose. Badly.
Cheers,
Doing Battle With the Insurance Company in a Fight to Stay Alive - New York Times
Doing Battle With the Insurance Company in a Fight to Stay Alive - New York Times: "Obstacles to Care
Doing Battle With the Insurance Company in a Fight to Stay Alive "
Thank goodness we don't ration care here in the good ol' US of A!
Doctors - Managed Care and Health Insurance - Medicine and Health - Wages and Salaries - New York Times
Doctors - Managed Care and Health Insurance - Medicine and Health - Wages and Salaries - New York Times:
Argues that physician income is a major problem in the US health system crisis, as here:
"Doctors in the United States earn two to three times as much as they do in other industrialized countries. Surveys by medical-practice management groups show that American doctors make an average of $200,000 to $300,000 a year. Primary care doctors and pediatricians make less, between $125,000 and $200,000, but in specialties like radiology, physicians can take home $400,000 or more.
In Europe, however, doctors made $60,000 to $120,000 in 2002, according to a survey sponsored by the British government in 2004."
Interestingly, according to Canadian Statistics, we're not so different.
Click on the link, and the tables reporting what physicians in Canada receive from Canadian Medicare start on page 28. And no, I'm sorry I don't have the data on their overhead, actual take home or hours. If YOU do, send me the link, please!
BTW, I will not argue that there is an unconscionable discrepancy in income among the procedure-based specialties and other physicians in the US.
Cheers!
Thursday, July 26, 2007
Lebanon Daily News - When it’s free, health care really costs
Lebanon Daily News - When it’s free, health care really costs
Dismembering a typical philistine, pig-ignorant op-ed (apologies to John Cleese)
The presidential candidates, the media and some local misguided souls have been turning up the rhetoric supporting universal or single-payer health care while cautiously avoiding the truth that such systems are simply socialized medicine.
Socialized medicine does not work anywhere.
Part II: Ignore all evidence to contrary of your opinion. Ignore OECD, Commonwealth fund, essentially all scientific literature on the topic.
It never has, and by it’s very structure, it never will. When I use the word “work,” I mean it in the context of providing what we have in the U.S. — the finest health care in the world.
Part II, again. Ignore all overwhelming evidence to the contrary. I'll try to link back to evidence soon.
Hundreds of thousands of people come to our country for their health care every year because what they need is not available where they live.
I don't think some Saudi and UAE princes count as hundreds of thousand. And they come for what is right about American medicine: the high tech, cutting edge care that cannot be BOUGHT elsewhere. That is, they can't jump the line elsewhere, like they can here.
Certainly we have problems in our current system, but the problems are fixable if all the parties in the system will step up to their part of the problem. Some uninformed people cite the insurance companies as the single problem in our health-care system. While insurers certainly are a part of the problem, they are no more of a problem than are the providers themselves. The cost of repairing botched surgeries, medical errors, hospital-based infections, allowing medical providers who have lost their license in another state to be licensed in Pennsylvania, overutilization, underutilization and a general unwillingness to purge their ranks of known, bad providers, contributes as much or more to the cost of health care as does the “greedy” insurance industry, and every honest medical provider knows it. It’s time to stop the blame game and get on with solutions.
I'm an honest medical provider, and the writer is wrong. The litany he lists all need fixed, but will be much easier to fix in a properly funded single payer system. And, sorry, the for-profit system, the same unrestrained, repugnant greed-based system that led to Enron, Tyco, and a two billion dollar surplus for Highmark alone, is by far the biggest problem.
To cite the one-sided propaganda film “SiCKO”as beneficial because it stirs debate on health care is like endorsing communism because it will make our citizens more patriotic. It’s sicko logic.
SICKO showed some of the serious flaws in our system and showed some of the serious benefits to others. That really is the bottom line. I've been following the media coverage closeely, interviews with various experts, MM himself in interviews, etc. There are lots of complaints about what he "left out." Well, it's only a two hour movie and I think it is not his job nor his role to be the healthcare czar and review every nuance of healthcare here and abroad. He had a lot of points to make and he made them very well, very humorously and sometimes heart-breakingly poignantly. If you see it, you'll know that he didn't tell the downsides of universal access in other countries, but, frankly, as we healthcare providers know better than the average viewer, neither did he scratch the surface of the problems so widespread in our "system." But he always says in interviews that of course other systems have problems. Our goal should be to take the best parts of each of those systems and craft an American system better than all the others. But, he makes no bones that this needs to be a single payer system at its core. He seems to have no bone to pick with physicians - he believes the focus of reform should be getting rid of private health insurance as we know it.
I urge everyone to see it. It engenders debate, not just about healthcare, but about who we are as a people. Are we, as Americans, about "me" or "we"? That really is the central question he asks.
For the truth about how socialized medicine does not work, go to http://www.fraserinstitute.ca/ and click on “health.” Several interesting reports are available online, but the report entitled “Paying More, Getting Less” is particularly revealing. The Fraser Institute is an independent Canadian research organization and is the only source of accurate statistics on wait times and the status of their failing system of health care.
The Fraser Institute is as reliable as the Cato Institute, the American Enterprise Institute and every other right-wing "think-tank" From Nick Scala, of Physicians for a National Health Plan ( pnhp.org)
"...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)." (Thanks, Nick!)
If you think health care is expensive now, wait until you see what it costs when it’s free.
Final bit, trot out a really stupid, non-sensical cliche. We spend nearly twice as much per capita as every other western country, and we're supposed to worry about "what it costs when it's free?"
Stan Alekna, Cornwall
Sorry, Stan, but that is a really lame rehashing of right-wing garbage that does not stand up to even mild critical analysis.
Christopher M. Hughes, MD
Sphere: Related ContentMonday, July 23, 2007
Quinn: We Can Afford Universal Health Care - Newsweek Jane Bryant Quinn - MSNBC.com
Quinn: We Can Afford Universal Health Care - Newsweek Jane Bryant Quinn - MSNBC.com
Version without all the detritis is here.
See, you can find common sense out there in MSM world!
Saturday, July 21, 2007
FDA Delay In Cancer Therapy Is Attacked - washingtonpost.com
FDA Delay In Cancer Therapy Is Attacked - washingtonpost.com:
"Oncologists do not usually need bodyguards when they present scientific data at a medical symposium."
Health Affairs Blog
Health Affairs Blog
The social contract of America as envisioned by Withrop, from Sarah Dine of Health Affairs Blog.
"We" or "me"?
Wednesday, July 11, 2007
EDITORIAL; Is Your Doctor Tied to Drug Makers? - New York Times
EDITORIAL; Is Your Doctor Tied to Drug Makers? - New York Times:
"Several states have tried to rein in abuses by requiring some form of disclosure, but every state law has defects, most notably a failure to make doctor-specific data readily available to the public. Last week Senator Herb Kohl, a Wisconsin Democrat who is chairman of the Special Committee on Aging, and Senator Claire McCaskill, Democrat of Missouri, said they would push for a national registry that would force drug and medical device companies to report their gifts and payments to physicians. Several states have tried to rein in abuses by requiring some form of disclosure, but every state law has defects, most notably a failure to make doctor-specific data readily available to the public. Last week Senator Herb Kohl, a Wisconsin Democrat who is chairman of the Special Committee on Aging, and Senator Claire McCaskill, Democrat of Missouri, said they would push for a national registry that would force drug and medical device companies to report their gifts and payments to physicians. Several states have tried to rein in abuses by requiring some form of disclosure, but every state law has defects, most notably a failure to make doctor-specific data readily available to the public. Last week Senator Herb Kohl, a Wisconsin Democrat who is chairman of the Special Committee on Aging, and Senator Claire McCaskill, Democrat of Missouri, said they would push for a national registry that would force drug and medical device companies to report their gifts and payments to physicians. "
Sounds like a plan.
CNN.com - Paging Dr. Gupta Blog
CNN.com - Paging Dr. Gupta Blog:
Someone responding to Dr. Gupta's point from Larry King Live last night:
"Hello Dr. Gupta.
I watched your discussion with Micheal last night, which I thought was quite interesting as I have the good fortune to live in Canada where we do have universal health care. This is certanly an issue that needs to be discussed. I did want to comment on one of the points you brought up last night as i felt it did not seem exactly true with my experiences. I am an advanced life support paramedic in Alberta and often treat and transport patients needing urgent angiograms. Althought weight times are an issue with urgent unstable angina type patients, it seemed you were painting a picture of emergent AMI patients were waiting six days to recieve life saving angiograms.
My experiece is nothing like that. I am proud to say that our region EMS services around Calgary have developed a system in which in feild 12-lead ECG's are read by responding paramedics and if determined that the patient is having a miocardial infarct, the 12 lead is faxed to the trauma centre and the patient is transported directly to the catheter lab, by-passing the emergency department decreasing the door to cath time.
Many incidents have seen patinets arriving for angiogram /plasty in less than an hour of onset of symptoms.
It is important to note that this service is available to everyone. As a front line health care worker paramedics experience first hand many of the delays in our healhcare system in Alberta, however, emergency situations are always dealt with in a timely manner, with no bias or discrimination based on wallet size.
humbly yours,
K. Palmer
EMT-Paramedic
Banff, Alberta Canada "
Tuesday, July 10, 2007
WSJ 2006 "The Doctor's Office" on Single Payer
Government-Funded Care
Is the Best Health Solution
Multiple Insurers, Multiple Plans
Create Expensive, Draining Hassle
April 18, 2006
"Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45% of the patients I see.
The rest are privately insured under 301 different insurance products (my staff and I counted). The companies set the fees and the contracts are largely non-negotiable by individual doctors.
The amount of time, staff costs and IT overhead associated with keeping track of all those plans eats up most of the money we make above Medicare rates. As it is now, I see patients and wait between 30 and 90 days to get paid. My practice requires two full-time staff members for billing. My two secretaries spend about half their time collecting insurance information. Plus, there's $9,000 in computer expenses yearly to handle the insurance information and billing follow up. I suspect I could go from four people in the paper chase to one with a single-payer system."
It's so obvious that it hurts.
Sphere: Related ContentAussie, Aussie, Aussie
Aussie, Aussie, Aussie: by Ian Morrison (author, consultant and futurist based in Menlo Park, Calif.)
"Somebody must be doing it right, we start to think. Well, actually, every system around the world is an ugly compromise among cost, quality, access and security of benefits, and almost all systems are in crisis according to the local news media. We in the United States have a bad bargain, maybe the worst: high costs, uneven quality, poor access and no security of benefits except for those over age 65."
Nice overview of a system we rarely hear about in discussions of universal healthcare, Australia.
Now, let me conclude this post with a prayer: Australia, Australia, Australia, We Love You. Amen. Crack the tubes!
Sicko Spurs Audiences Into Action
Sicko Spurs Audiences Into Action:
"The talk gradually centered around a core of 10 or 12 strangers in a cluster while the rest of us stood around them listening intently to this thing that seemed to be happening out of nowhere. The black gentleman engaged by my redneck in the restroom shouted for everyone’s attention. The conversation stopped instantly as all eyes in this group of 30 or 40 people were now on him. “If we just see this and do nothing about it,” he said, “then what’s the point? Something has to change.” There was silence, then the redneck’s wife started calling for email addresses. Suddenly everyone was scribbling down everyone else’s email, promising to get together and do something… though no one seemed to know quite what. It was as if I’d just stepped into the world’s most bizarre protest rally, except instead of hippies the group was comprised of men and women of every age, skin color, income, and walk of life coming together on something that had shaken them deeply, and to the core. "
Gives you faith that America will right itself after these awful six years...
NPR : Diagnosing U.S. Health Care — and 'Sicko,' Too
Terrific interview with a very knowledgeable healthcare policy expert.
NPR : Diagnosing U.S. Health Care — and 'Sicko,' Too: "Interviews
Diagnosing U.S. Health Care — and 'Sicko,' Too
Fresh Air from WHYY, July 9, 2007 · Jonathan Oberlander, a political scientist with an expertise in health-care politics and policy, discusses problems with the U.S. health-care system and considers how other countries handle health care. He'll also give us a critique of Michael Moore's documentary Sicko. Oberlander is an associate professor at the University of North Carolina at Chapel Hill."