Wednesday, August 29, 2007

We are all uninsured now - The Boston Globe

We are all uninsured now - The Boston Globe

Starts out OK, but I don't agree with tinkering around the edges that he come around to later in the piece. Is he afraid that this is somehow socialism writ large, or is he just worried about the epithets?

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Rocky Mountain News - Denver and Colorado's reliable source for breaking news, sports and entertainment: Health Care

Rocky Mountain News - Denver and Colorado's reliable source for breaking news, sports and entertainment: Health Care

Just 1 quick snippets to illustrate the point about income discrepancy in medicine.

Median salaries

2005 2006 Change

Family practice $160,729 $164,021 + 2 percent (without OB)

Psychiatry $189,409 $192,609 + 1.7 percent

Cardiology: invasive $463,801 $457,563 - 1.3 percent

Orthopedic surgery $428,119 $446,517 + 4.3 percent

Internal medicine $167,178 $174,209 + 4.2 percent

Source: Medical Group Management Association

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Response to: Commentary: What's Wacko about Sicko

Commentary: What's Wacko about Sicko
From Dr. Donald P. Condit, orthopaedic surgeon specializing in hand surgery in Grand Rapids, Mich. He also holds an MBA degree from the Seidman School of Business at Grand Valley State University. [My comments are in italics.]

Michael Moore wants socialized medicine in the United States.

Actually, he wants single payer or a Medicare for all system, not a socialized system such as Britain's.

It would, as his film Sicko suggests, give us a system that better delivers health care to those who need it. Although Moore effectively documents some deficiencies in American health care, his message is undermined by misinformation, inconsistent rhetoric, and a disingenuous agenda.

I argue that it is not his job to do a 12 hour mini-series. He had two hours to make his case, and he did. See this post for more details:

Moore's plan would result in worse, not better, health outcomes for Americans -- including the poor and underserved.

Please supply some evidence of this. Here is a bit showing you are wrong:

As a hand surgeon who treats many traumatic injuries, Moore's portrayal of a patient who amputated his middle fingertip captured my interest. He depicted this uninsured man as required to pay $23,000 to have his finger "saved." Moore lost considerable credibility here. Most hand surgeons would never consider micro-surgically replanting this table saw injury at the finger nail base. Rather, this unfortunate injury would have been comfortably and safely treated -- without reattachment of the severed bit of finger -- in an office procedure room for $1,000 or less.

Doing a Dr. Frist, here, aren't we? Diagnosing and managing via a film clip? I am encoursged that you think this kind of thing wouldn't happen where you are.

In Sicko, Moore consistently equated lack of insurance with inability to obtain care.

See here:
and here:
and here:

I'd say the problem is grossly inadequate ability to obtain care.

In Grand Rapids, Mich., where I practice, a sign on the front door of Blodgett hospital, in English and Spanish, indicates patients will not be turned away for lack of ability to pay. This is policy across the United States.

As John McEnroe might say, "You cannot be serious!" Does anybody really believe that having to show up in an emergency room, knowing that if you can't pay you'll be hounded for years to pay whatever you can, is equivalent to open access to primary care as is done essentially everywhere else in the industrialized world? No disincentive to comply with treatment there, is there?

We hear a lot about the nearly 50 million Americans without health insurance. However, approximately half of them are insured six months later with new jobs, suggesting more of a problem with our employer based health care system than with affordability.

And another 50 take their place. This happened to my brother, an engineer, while between jobs. His wife took ill and he nearly filed for bankruptcy. He had a last minute generous help from his employer. Most are not so "lucky."

Moore harshly criticizes the U.S. government. Yet he is arguing for a centrally controlled allocation of health care resources. Who does he want to run health care in this country?

Easy answer, here: NOT private health insurers! Not even "not for profit" ones!

Medical resources are not unlimited. The combination of aging demographics, technological advances and unconstrained consumption within our third party payment system has led to an unsustainable trajectory of ever increasing spending.

Unconstrained consumption? Really? How about delayed appropriate consumption resulting in later excessive costs due to inadequate treatment of manageble acute and chronic illnesses? How about the burden imposed on providers by private insurers? How about administrative costs? The lack of a national medical informatics infrastructure? The only place where I really do worry about consumption is in the last months of life. We do a lousy job of dealing with end-of-life care and our patients pay dearly for it with their suffering and angst, and society suffers under the burden of using resources inappropriately.

It is already clear that price controls have created strong disincentives to debt-burdened students considering careers in primary care.

That, and the ridiculously skewed compensation to procedure related specialties. Compared to the rest of the world, our PCP's income is comparable. It's in the procedure-intensive specialties where the big diference lies. Spread that money out more evenly and those price controls don't hurt PCP's so much.

Yet Sicko gives market oriented solutions no consideration.

What about the last fifty years makes you even a teensy optimistic?

Three individuals with ailments after admirably serving in New York rescue and recovery efforts after September 11, 2001, were transparently used in Sicko to promote Moore's agenda. This manipulation was as revolting as the stories of individuals egregiously denied care by insurance companies. Transported to Cuba, the three 9-11 patients were shown to Cuban doctors who (while cameras were rolling) appeared more than happy to provide care and subsidized prescriptions.

I think they were willing participants and understood what they were doing. I think it funny that people get exorcised that he "held up Cuba" as a fine example. I think his point was that EVEN Cuba, a communist dictatorship, pretended it had some universal healthcare. And still managed to only come in a couple slots lower than us in the infamous 37/39 slide.

This contrasted with a California hospital denying care to a child with a severe infection and a sick, elderly woman dropped off by a taxi in front of a rescue mission while still in her hospital gown. The latter two tragic situations were portrayed as illustrative examples of our domestic medical system.

You're a surgeon. I bet given 15 minutes you can come up with a half dozen anecdotes about the stupidity and callousness of our 'system,' can't you?

There is no question we need major improvement in U.S. health care. To use a few outrageous anecdotes to argue for a socialized solution, however, is a non-sequitur.

Agreed. And besides, in a contest of anecdotes, we'd lose. Badly.

Despite ostensibly compassionate intentions on the part of its backers, greater harm would result from centrally planned and controlled health care. Canada and the United Kingdom provide contemporary models: rationing occurs by decree and delay.

Rationing comes by under funding the system. That will be a serious danger here, too, when we move to Medicare-for-All. It is up to us to make sure it doesn't.

And of course, our rationing is economic. I find this indefensible and reprehensible.

Even the Canadian Supreme Court, when ruling against Canada's single-payer law prohibiting private payment for health care in 2006, stated, "access to a waiting list is not access to health care … in some cases patients die as a result of waiting lists for public health care ... and many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life."

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: (Thanks to Nick Skal, of PNHP for this bit.)

Please click on the topic Waiting Lists on the right side of my blog for more info.

Pope Benedict XVI wrote in his recent encyclical Deus Caritas Est, "We do not need a State which regulates and controls everything, but a State which, in accordance with the principles of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need."

I do not know the context of these remarks, but considering very other industrialized nation in the world has some form of universal healthcare, I expect he was specifically not talking about helathcare. But that's just a guess based upon my Catholic upbringing. And this, from Cardinal Bernadine, "Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right."

Moore and his allies would do well to take this exhortation to heart. We now have unsustainable consumption of medical resources, with third party responsibility for health care expenses. A socialized system would increase state dependency and diminish motivation for charity. Greater government bureaucracy would increase inefficiency and waste compared to doctor-patient "two-party" interaction. Socialized medicine violates the social justice principle of subsidiarity by interfering with the family, churches, charitable clinics, and other intermediate organizations

Violates social justice? You've got to be kidding, or, more likely, just defending a weary ideology not suited for this issue and rationalizing.


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Census Shows a Modest Rise in U.S. Income [BUT]- New York Times

Census Shows a Modest Rise in U.S. Income - New York Times:
"Census officials attributed the rise in the uninsured — to 47 million from 44.8 million in 2005 — mostly to people losing employer-provided or privately purchased health insurance. The percentage of people who received health benefits through an employer declined to 59.7 percent in 2006, from 60.2 percent in 2005."

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Tuesday, August 28, 2007

delawareonline ¦ The News Journal, Wilmington, Del. ¦ Patient increase, limited medical school slots make seeing doctor tougher to do

delawareonline ¦ The News Journal, Wilmington, Del. ¦ Patient increase, limited medical school slots make seeing doctor tougher to do:

"Some doctors say the problem lies not with a doctor shortage, but with an uneven distribution of MDs. New doctors gravitate toward more lucrative specialties, such as sports medicine. Specialties that require surgery, such as ophthalmology, also attract doctors because Medicare and insurers reimburse surgical procedures at a far higher rate than evaluations. Cooper said young doctors are turning to these profitable specialties at the expense of Medicare patients, who largely suffer from diabetes and arthritis and are in need of endocrinologists and rheumatologists. Medical school students also may be dissuaded from primary care. Dr. David Krasner, who works at Family Practice Associates in Wilmington, said the existing reimbursement system pays too little for cognitive evaluations by primary care physicians. 'For physicians to go into primary care in this day and age, it's akin to committing financial suicide,' he said. 'The shortage in my opinion won't get better until Medicare changes the way it reimburses.'"

Please click on some of the tags below: physician income, in particular to learn more about this topic...

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Insurance provider lowers physician reimbursements while earnings grow 08/19/07 - - Insurance provider lowers physician reimbursements while earnings grow 08/19/07:

"Although it is a not-for-profit company, Health Care Service's bottom line continues to rise at a rapid rate. According to Laura B. Benko of Modern Healthcare, in 2005 Health Care Service Corp recorded its fourth consecutive year of earnings growth, 'posting net income of $1.15 billion on $11.7 billion in revenue. Its total surplus was $4.3 billion, up 47 percent from 2004 and 227 percent from 2000.' Ms. Benko points out the company's president and chief executive officer, Raymond McCaskey, received $6 million in salary, bonuses and other compensation in 2005. I believe some of the millions of dollars the residents of this area pay in premiums to Blue Cross would be put to better use by the healthcare professionals in our community."

Non-profit for whom?

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Friday, August 24, 2007

NEJM -- Healing Our Sicko Health Care System

NEJM -- Healing Our Sicko Health Care System:

"To get around this catch-22, we will need populist anger but also
political foresight. Moore heads abroad to show us that a single public insurer
is the only hope. But one need not travel to Canada, the United Kingdom, or
France (much less Cuba — Moore's most dubious destination) to see the virtues of
combining universality with public cost control. Medicare, our country's most
popular and successful public insurance plan, covers everyone older than 65 and
people with disabilities — groups with great need for coverage and little
ability to obtain it privately. Yet it has controlled expenses better than the
private sector, spends little on administration, and allows patients to seek
care from nearly every doctor and hospital. For some reason, Moore ignores
Medicare. He talks about the post office, the fire department, public education
— but not the one public program that most resembles the 'free universal health
care' he extols.

"That's too bad, because the Medicare model is the not-so-secret
weapon in the campaign for affordable health care for all. Today, many advocates
of national health insurance have wisely started calling for 'Medicare for All'
rather than their old rallying cry, 'Single Payer.' But moving to a national
insurance plan overnight, whatever the label, means threatening the private
coverage on which so many Americans rely and requiring our cash-strapped
government to raise the highly visible taxes necessary to fund a system now
financed largely by the hidden drain on workers' paychecks. We may be moving
toward the day when we are ready to clear these hurdles in one leap, but we are
not there yet. "

A fairly reasoned discussion in all, but we need leadership of the RFK variety:

"There are those that look at things the way they are, and ask why? I dream of things that never were, and ask why not? "

(Okay, wikiquote says he lifted that from GB Shaw, but, same spirit.)

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Wednesday, August 22, 2007

An unhealthy health care plan

I only link to mock...An unhealthy health care plan -- The Washington Times, America's Newspaper By Robert Goldberg (vice president of the Center for Medicine in the Public Interest)
Pablo Picasso observed, "To copy others is necessary, but to copy oneself is pathetic." Is anyone more pathetic than Arnold Relman, the former editor of the New England Journal of Medicine, who continually writes about why America should adopt the Canadian health care system? There is. It's Arnold Relman himself, writing in Canada about why Canadians shouldn't abandon the Canadian health care system. In this case, it's Mr. Relman in the Toronto Globe and Mail opposing the Canadian Medical Association (CMA) proposal to "allow physicians to bill patients (or private insurance plans) for services that are covered by Medicare, and allowing Medicare to purchase covered services from for-profit private facilities." The goal of the CMA plan is to allow people a chance to get medical care when they need, not when the government sees fit to provide it. Canada has pumped billions of dollars into its system to reduce waiting times for specialty services, cancer care, first-time health visits and emergency rooms.

Here's the link to the article by Relman. Dr. Relman's piece speaks for itself.

But according to Health Canada and the independent Frasier Institute the waiting times and shortages have gotten worse.

Please see this previous post to read why you should discount anything from Fraser, and yet recognize that Fraser is a pernicious force to be watched and refuted at every opportunity.

In a recent incident, a child with a brain tumor headed to the states to get a MRI because he would have had to wait four months in Canada. His family paid cash because Health Canada refused to cover the cost. Mr. Relman's response? He urges Canadians to "avoid exploitation by those who would like to make profits from publicly funded health care. Canadians should not follow Americans down the path to greater privatization." The kid should die for the greater glory of socialized medicine rather than pay cash and line the pockets of profit hungry docs in America. Groucho Marx once observed, "Who do you believe? Me or your eyes?" Our eyes tell us that here and abroad government run and financed health care stinks.

Welcome to another episode of "Anecdote-Off", the great justifier of all things wrong in the US sytem if you believe people like this. As I've said many times before, if you want to debate this by anecdote, the US loses. Badly.
For waiting times,
go here.

Price controls cause shortages of doctors in the UK that in turn are filled by waiving immigration regulations that allow neurologists with bomb-making skills into the National Health Service (NHS).

Good thing we don't allow ferners to practice medicine here.

In the United States, restrictive formularies and cookbook approaches to care have undermined mental health treatment for soldiers returning from Iraq.

Got that backwards.

Medicaid reimbursement levels have increased waiting times and caused millions of children to seek care in emergency rooms.

Because we underfund Medicaid and the economics of reimbursement of course cause providors to scurry for the hills. How is this an argument against single-payer?

Meanwhile SCHIP — 10 years after its enactment — has failed to enroll 3-out-of-5 Medicaid eligible children in private health care plans and access to care has barely increased.

Again, how does this support an argument against universal healthcare? It's an argument against the stupid patch-work non-system we have here in the US, I agree.

Incredibly, Mr. Relman claims that's just a sign free market health care does not work and does not care about people. Enlighten us Arnie, how are the two connected?

Because the patch-work "free market" mess we have here does not work. Clearly Mr. Goldberg has never actually seen patients or been responsible for providing healthcare in this disaster we work in. When funded properly and overseen appropriately and by giving doctors the ability to provide care as they see fit (as opposed to insurers or underfunded goverment programs), a single payer system can not possibly be worse that what we have now. Unless someone puts the Republicans in charge of it. Then, watch out, Brownie will be in charge!

"Physicians in our commercialized, profit-driven system tend to gravitate toward the highly paid specialties, so we now face a major shortage of primary-care doctors." Well, we know how flush the NHS is with well-trained terrorists — I mean family doctors. What about Canada? It turns out the College of Family Physicians of Canada found that 17 percent of Canadians didn't have a family doctor because of a primary care physician shortage. Two million of the Canadians that Mr. Relman wishes to deny free choice of care to have attempted to find a family physician in the past year, but have failed. In the U.S., we have a market-based response to the problem.

OMG! 17% don't have a PCP. I've got an idea, let's take insurance away from 1/6 of Candians and underinsure another 1/6 so they can't afford a PCP visit, and see what happens to that shortage. The free-market will get rid of those whiners!

A rapid expansion of retail health clinics in the United States is taking place in what the Department of Health and Human Services has designated as medically underserved areas. Take MinuteClinics, a division of the drugstore chain CVS, which offers walk-in health care centers for common medical problems such as strep throat, sunburn, mono, flu, ear infections and sinus infections, and offer vaccinations, checkups, etc. People can pay cash or use their regular insurance.

"People can pay cash or use their regular insurance." Hahahahahahah!

And will Mr. Goldman and his family use this service? Of course not, because they have good insurance.

Most visits are 15 minutes or less with no appointment needed. In many cases, MinuteClinics are often affiliated with local hospital or physician practices, and will refer customers to a primary care doctor if they don't have one. Additionally, the center generates an electronic medical record that customers and doctors can access through the phone, fax or Internet. There are 200 MinuteClinics across America. Most are in federally designed medically underserved areas providing immediate care, referrals and electronic medical records for about $50 per person. Other private companies are involved in this trend as well and have been joined by the American Academy of Family Physicians in an effort to improve access to health care for millions Americans.

Well, let's take it a step further and have us (by us, I mean the U.S., our government) fund such a system. And that way, when the patient is referred to a PCP, the patient will be able to actually go to the PCP without choosing between healthcare and something else.

Meanwhile, as the marketplace makes medical care more accessible in America ...

...still can't get that idea that it should be universal rather than just "more accesible"...

Mr. Relman is telling Canadians, "One thing is certain. If medical care and health insurance are allowed to become private businesses... patients with little or no resources do not get the care they need."

And Mr. Goldberg doesn't care about those people. Why not just come out and say it?

What did Santayana say about fanaticism? It consists of redoubling your efforts when you have forgotten your aim.

Pot, meet kettle... And as John Kenneth Galbraith said, "The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness."

Fighting against medical choices that are available elsewhere in the world is a sure sign that ideological zeal has transcended compassion or the Hippocratic oath.

Uh, he's fighting for medical choice, not against it. He's advocating for compassion, not against it. And if Mr. Goldberg thinks physicians anywhere in the world compromise the spirit of Hippocrates (put the well-being of the patient above all else) more than we do in America, he is as out of touch as the rest of his piece confirms.

Mr. Relman, once a great scholar, should be pitied, not scorned.

It's Dr. Relman, and he doesn't need Goldberg's pity.
read more digg story

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Tuesday, August 21, 2007

Costly 'affordable' health care -- The Washington Times, America's Newspaper

Costly 'affordable' health care -- The Washington Times, America's Newspaper:

"John Stossel is right."

When an editorial starts out like this, and it's from the Rev. Moon's Times, you know it's going to be dead on true, don't you?

Healthcare policy by anecdote- isn't that what Michael Moore is accused of all of the time?

UPDATE: I contacted an ICU director in Brussels regarding this article. His response:

This is simply wrong - and worrisome if published in the Washington Times
(hopefully not the Washington Post)!

As stated, we have here one of the best health care systems in the world.
Much better than socialistic systems like in the UK or in Scandinavia or even
the Netherlands.

Maybe his grandfather became deaf because of an aminoside administration, but
the antibiotic choice was not restricted by costs !

Maybe it is a case of malpractice - I do not know, these can happen anywhere
- but it is not related to a limitation in health care costs.

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Sunday, August 19, 2007

Best Care Anywhere | The New America Foundation

Best Care Anywhere The New America Foundation:

This is a link to a two hour panel discussion on the VA Healthcare system, our own home-grown single-payer carve out, and it is very informative. It is lead by the author, Phillip Longman of "Best Care Anywhere: Why VA Health Care is Better Than Yours "

Below is a link to an audio only, MP3 version that you can download as well.

MP3 Audio Recording of this Event15.9 MB"

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Thursday, August 16, 2007

NEJM -- A Decade of Direct-to-Consumer Advertising of Prescription Drugs

NEJM -- A Decade of Direct-to-Consumer Advertising of Prescription Drugs:

"Results Total spending on pharmaceutical promotion grew from $11.4 billion in 1996 to $29.9 billion in 2005. Although during that time spending on direct-to-consumer advertising increased by 330%, it made up only 14% of total promotional expenditures in 2005. Direct-to-consumer campaigns generally begin within a year after the approval of a product by the FDA. In the context of regulatory changes requiring legal review before issuing letters, the number of letters sent by the FDA to pharmaceutical manufacturers regarding violations of drug-advertising regulations fell from 142 in 1997 to only 21 in 2006. "

From the discussion:

"Our study has some key limitations. We obtained data on industry sales from PhRMA, which includes in its annual reports sales data only for its members. Ideally, we would include sales of all branded drugs sold by prescription, including pharmaceutical and biologic agents, and exclude sales of generic drugs (because generic drugs typically are not promoted). PhRMA sales data may include some generic sales (if a member reports both branded and generic sales) and typically exclude sales of biologic agents, which are manufactured by companies that belong to another trade group (Biotechnology Industry Organization). As a result, the sales figures may underestimate total dollar sales for the industry. We provide data on spending on free samples valued at their approximate retail price, which is how they typically are valued in industry promotional audits. Thus, the value of free samples we present probably overstates the opportunity cost to manufacturers, which would lie somewhere between the marginal cost of production and the retail value."

A billion here, a billion there, pretty soon you're talking serious money...

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Wednesday, August 15, 2007

The Reality-Based Community: Rationing health care

The Reality-Based Community: Rationing health care:
Rationing health care
Posted by Mark Kleiman

"All this, let's recall, with the Chancellor breathing down the neck of the boss of the medical area on behalf of a full professor at the university that owns the hospital. So my experience with the system was probably about as good as it gets except for corporate executives using places like the Mayo Clinic or family members of people on the boards of directors of hospitals. (Apparently it's generally understood that if you stump up enough in the way of contributions to get on the board of the hospital, you're entitled to priority care; that's how not-for-profit hospitals raise capital.) It was only later that I discovered why the insurance company was stalling; I had an option, which I didn't know I had, to avoid all the approvals by going to 'Tier II,' which would have meant higher co-payments. The process is designed to get very sick or prosperous patients to pay to jump the queue. I don't know how many people my insurance company waited to death that year, but I'm certain the number wasn't zero. "

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The Doctor Will See You—In Three Months

The Doctor Will See You—In Three Months: "It's not just broken for breast exams. If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. 'Waiting is definitely a problem in the U.S., especially for basic care,' says Karen Davis, president of the nonprofit Commonwealth Fund, which studies health-care policy. All this time spent 'queuing,' as other nations call it, stems from too much demand and too little supply. Only one-third of U.S. doctors are general practitioners, compared with half in most European countries. On top of that, only 40% of U.S. doctors have arrangements for after-hours care, vs. 75% in the rest of the industrialized world. Consequently, some 26% of U.S. adults in one survey went to an emergency room in the past two years because they couldn't get in to see their regular doctor, a significantly higher rate than in other countries."

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Waiting Times for Care? Try Looking at the U.S. - Nurses, Doctors Say It's Time to Debunk the Myths

Waiting Times for Care? Try Looking at the U.S. - Nurses, Doctors Say It's Time to Debunk the Myths: "'There’s been a lot of clamor lately about delays in care in some other countries. But if you want to see some really unsightly waiting times, look at U.S. medical facilities,' said Deborah Burger, RN, president of the 75,000-member CNA/NNOC. While the problem has been largely overlooked by the major media, it was quietly exposed by the chief medical officer of Aetna, Inc. late in Aetna’s Investor Conference 2007 in March. In his talk, Troy Brennan conceded that 'the (U.S.) healthcare system is not timely.' He cited 'recent statistics from the Institution of Healthcare Improvement… that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable,' Brennan said. Brennan also recalled that he had formerly spent much of his time as an administrator and head of a physicians' organization trying 'to find appointments for people with doctors.' While Brennan's "

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Angry Bear on OECD Waiting Times Study

Angry Bear:

"The data shows that many countries with 'nationalized' health care systems have little or no waits for elective medical procedures. A 2003 OECD working paper entitled 'Explaining Waiting Times Variations for Elective Surgery across OECD Countries' by Luigi Siciliani and Jeremy Hurst provides some survey evidence of actual waiting times in various OECD countries. The results of that survey are presented below."

Two nice tables here explain a lot...

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The waiting is the hardest part...

Thanks to Todd Kunkler at MD Net Guide for his excellent post with links to information about waiting times!

I'll repeat the links here in individual posts for easier access. If you go to his original post, they are obviously all there for the investigating.


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US Slipping in Life Expectancy Rankings -

US Slipping in Life Expectancy Rankings - "Murray, from the University of Washington, said improved access to health insurance could increase life expectancy. But, he predicted, the U.S. won't move up in the world rankings as long as the health care debate is limited to insurance. Policymakers also should focus on ways to reduce cancer, heart disease and lung disease, said Murray. He advocates stepped-up efforts to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar. 'Even if we focused only on those four things, we would go along way toward improving health care in the United States,' Murray said. 'The starting point is the recognition that the U.S. does not have the best health care system. There are still an awful lot of people who think it does.'"

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Cost Control for Dummies - WSJ

Summary from National Center for Policy Analysis (as I don't get the WSJ)
[Source: Merrill Matthews, "Cost Control for Dummies," Wall Street Journal, August 15, 2007.]

Whenever the government controls prices, it arbitrarily determines who it will
pay, how much, and for what, explains Matthews.

Someone explain to me why this is seen as "arbitrary"? Are they tossing coins? As long as we can maintain an open debate about healthcare spending priorities, decisions will not be "arbitrary." Though, I think , the definition of arbitrary for many, is that it didn't go their way.


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France's model healthcare system - The Boston Globe

France's model healthcare system - The Boston Globe:

"National health insurance in France stands upon two grand historical bargains -- the first with doctors and a second with insurers. Doctors only agreed to participate in compulsory health insurance if the law protected a patient's choice of practitioner and guaranteed physicians' control over medical decision-making. Given their current frustrations, America's doctors might finally be convinced to throw their support behind universal health insurance if it protected their professional judgment and created a sane system of billing and reimbursement. French legislators also overcame insurance industry resistance by permitting the nation's already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by Sécurité Sociale. Indeed, nearly 90 percent of the French population possesses such coverage, making France home to a booming private health insurance market."

I think that, except for the hard core ideologues, physicians would by and large accept this bargain.

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Tuesday, August 14, 2007

Aggressive Treatments at End of Life Linked to Worse Quality of Death

Aggressive Treatments at End of Life Linked to Worse Quality of Death:

"'The more time patients spent under hospice care, the greater their quality of death,' Mr. Silverman said. 'For example, patients who received at least 5 weeks of hospice care were in less physical distress in their last week of life than those who lived less than a week with hospice, and those who received no hospice at all were in the most physical distress at the end of their lives. These results suggest that when patients are actively dying, the use of aggressive treatments should be considered with caution and only pursued with the full understanding of patients or their surrogate decision makers.' "

Another pet topic of mine, poor end-of-life care. This is especially tragic, as it represents people being egged on to continue aggressive treatments with full knowledge that there will be no substantial benefit. The resources wasted by this are secondary to the human suffering, but they are massive.


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Medicare Fraud Settlement Causes Oncologists to Lose Income

Medicare Fraud Settlement Causes Oncologists to Lose Income:

"The cases centered around a major sales promotion effort by two pharmaceutical companies, AstraZeneca and TAP Pharmaceuticals, that encouraged oncologists who received free drug samples to provide the samples to their Medicare-insured prostate cancer patients and bill Medicare the $1,200 charge for the product. Many oncologists earned an extra $100,000 annually in income with this program, and some of the busier ones earned more than $1 "

Sorry this is old news, but I'm tring to dig up information on "rebates' and the like to physicians from drug and equipment companies. Let me make it clear that this is unique to certain specialties and is not in any way routine practice for the vast majority of physicians.


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ACP Online - ObserverWeekly - 14 August 2007

ACP Online - ObserverWeekly - 14 August 2007: "Study: Expanding preventive services would save 100,000-plus lives Beefing up preventive care measures such as flu shots and cancer screenings would save more than 100,000 U.S. lives each year, a new study found. The Partnership for Prevention study found 45,000 fewer people would die each year if 90% of adults took aspirin daily to prevent heart disease, instead of the 50% taking it currently. Likewise, if 90% of smokers were given cessation advice, medicine and support by a health professional, 42,000 fewer people would die each year, the study found. Other measures that would save lives, if 90% of the target population received them, include: Colorectal cancer screenings for adults age 50 and over would save 14,000 lives. Fewer than 50% of these adults are screened now; Annual flu shots for adults age 50 and over would save 12,000 lives. Fewer than 37% get the shots now; Breast cancer screening every two years for women age 40 and over would save 3,700 lives. About 67% are screened now; and Chlamydia screenings for sexually active young women would prevent 30,000 cases of pelvic inflammatory disease annually. About 40% are screened now. The study also found African Americans, Hispanic Americans and Asian Americans were less likely to use preventive care than whites. That’s partly because many minorities lack continuity of health care or an ongoing relationship with a health professional who can help ensure preventive measures are taken, an expert said. The study was funded by the CDC, the Robert Wood Johnson Foundation and WellPoint Foundation. The Partnership for Prevention report is online here in pdf. "

Another data point for (inadequate) access to treatment and preventative services. In Sally Pipes piece, she comments about 10% of Canadians looking for a PCP. Ha!


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Court Rules Out Terminally Ill for Tests -

Court Rules Out Terminally Ill for Tests -

"Terminally ill patients do not have a constitutional right to be treated with experimental drugs, even if they likely will be dead before the medicine is approved, a federal appeals court said Tuesday. The ruling by the U.S. Court of Appeals for the District of Columbia Circuit overturned last year's decision by a smaller panel of the same court, which held that terminally ill patients may not be denied access to potentially lifesaving drugs."

Just thought I'd start gathering data points about access to treatment, as that seems to be brought up quite a lot in these discussions. My position is that these access issues will need to be carefully thought out and thoughtfully debated as we move to a single payer system.

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Monday, August 13, 2007

Most Canadians scoff at portrayal of their country as a health-care paradis

"When the government pays for healthcare, saving money is more important than saving lives. So bureaucrats have an incentive to delay - or deny - the introduction of new, costly drugs."

The people who write this stuff are a.) not involved in healthcare (at least, not seeing actual patients in any meaningful way) and b.)must have the best G-D insurance in the world. The idea that the US would come out on top in an "anecdote-off" is laughable to all of us actually in healthcare. Our US bureaucrats in our wonderful private insurance industry would make most Soviet era bureaucrats blush.

But the key is this: when the government pays for healthcare, if they don't cover what we demand, then that is a problem with the citizenry, not the bureaucrats, for not taking command of the situation. When we get to a single payer system, it will be up to us to be vigilant and oversee what is being done by our government. I know that is an odd concept to the Bushies, but that is how government needs to work. And, yet, I can guarantee that the Sally Pipes' of this world will howl the loudest when money is being spent on Rituxan for someone other than her family member because it would then be "wasteful government spending"!


read more digg story

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Saturday, August 11, 2007

10 Questions: About Health Care - Couric & Co.

10 Questions: About Health Care - Couric & Co.

>>Expanding government control over the financing and delivery of medical services will guarantee even bigger bureaucracy,<< Not necessarily bigger, just different. Ask any healthcare provider or patient which bureaucracy they'd rather deal with, Medicare or a private insurer, and you'll have your answer as to why this a bad argument for conservatives to make. We, the people, have control over our governement bureaucrats, we have none over the privateeers.

>> higher taxes,<< I know this is supposed to scare us (like invoking Castro), but the trade off is no health care premiums and higher salaries (as no more healthcare expenditures out of our total compensation). So, certainly, if this is done in a progressive manner, the top 5% may lose a little, but everyone else will be far better off.

>> and increasingly detailed regulations governing the delivery of care.<< I refer you back to my first comment.

>> Conservative candidates generally emphasize the need to re-energize the market<<
I'd say that the performance of the healthcare sector, particularly insurers and Pharma, suggest no lack of "energy."

>> and make individuals and families the key decision-makers in the system.<< Amen to that, but the author must really live in an alternate universe if he thinks that will EVER happen with private insurers!

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Wednesday, August 8, 2007 If you want great care, don't put government in charge - Wed, Aug 8, 2007 If you want great care, don't put government in charge - Wed, Aug 8, 2007

An op-ed from Grace-Marie Turner, president of the Galen Institute, which is funded in part by the pharmaceutical industry and medical industry,

Let's take this apart line-by-line:

ALEXANDRIA, Va. -- No one denies that America's health sector faces problems. Costs continue to rise, and 45 million people lack insurance. Even worse, many politicians think they've discovered the cure in a single-payer system.
But that remedy would be worse than the disease. The government-dominated health systems of Europe and Canada are struggling with serious cost pressures, inefficient bureaucracies and unmet demands for more advanced medical care.

And of course, we have none of that here. I beleive her first sentence is about cost-pressures and unmet demands for care here in the US. She forgets by the time she got to the end of her thought, I guess. Perhaps she was trying to parse "advanced" medical care. If you want basic medical care and can't afford it, that's not our problem. And if she would like to get into a contest regarding inefficient bureaucracies and hold up private health insurance as the better system, she is truly clueless. The ignorance boggles the mind.

For the privilege of their supposedly "free" care, other countries pay much higher taxes. In 2005, taxes consumed 41 percent of GDP in Canada, 42 percent in Britain, and 51 percent in France, compared to 32 percent in the United States.

Yes, the $10-15K or so it costs to insure a family is sooo much better than higher taxes. Why do these people always ignore the cost of health insurance to employers, employees, the self-employed, the un-insured, the under-insured, etc.? Do they realize that cost to individuals becomes subsumed into taxes or some other finance mechanism? I pay less for insurance (or my employer can pay me more salary), and I pay some higher tax rate. I can live with this. And, depending upon your income, 10-20% higher taxes is a great bargain compared to $10K or more for insurance.

Single-payer systems invariably involve rationing. What good is free care if the government denies access to it?

Yes, clearly much better to have private insurers or economic circumstances ration it.
What good is the most advanced high tech medical care in the world if you can't get it?

About 1 million people in the U.K. are on waiting lists for hospital care, including surgeries. And 200,000 more are waiting just to get on the waiting list.
Cancer patients in Britain have resorted to waging public relations campaigns because their government won't pay for new medications for breast and kidney cancer.

Our waiting lists are nicely trimmed by leaving 1/6 of the population out of eligibility to even get into the queue. And if there were alarming statistics indicating a significant differnce in mortality in our favor in more than a few tiny niches, this might actually matter!! And if you can't afford any medication at all beyond the $4 Wal-mart list, tough break, loser!

In Canada, the situation is no better. Long waiting lines lead to restricted access to care. There were 45 inpatient surgical procedures per 1,000 Canadians in 2003, compared to 88 in the United States. Canadians received only one-third as many MRI exams and half as many CT scans.

Again, if we could point to better outcomes, and if we didn't ration so heavily by economics, this might be important. It is a minor concern, and if we were somehow limited in our choice of single-payer to either the Canadian system or nothing, it would only be slightly greater than a minor concern.

Meanwhile, patients in Sweden have been sent to veterinarians for diagnostic tests so the government could reduce waiting lists.


Proponents of a single-payer system argue that the United States would be different -- that we could get all the money we need to finance universal health insurance by eliminating profit in the private health sector.
But that's like trying to cure a disease with arsenic. Socializing our health-care system would mean that one-sixth of our economy would operate under different economic rules, with the government setting prices, allocating resources and deciding what medical care would be available to whom and when.

Seems to work everywhere else, apart from some issues that we should address as we move forward. But, as with all these pieces, invoking the socialism bogeyman is de rigeur. Because we all know how awful Medicare turned out. Those poor elderly bastards!

There is a better way.
We should embrace competition, not stifle it. We should reward innovators, risk-takers and entrepreneurs for providing faster, better, more affordable health care. And we should recognize that progress depends upon innovation and profit. The U.S. market already is pointing the way by responding to consumer demands for more convenient, more affordable health services.

Yes, this has worked out so well, hasn't it?

Health plans increasingly are offering programs to help patients better manage chronic diseases like diabetes and heart problems that account for roughly 75 percent to 80 percent of our medical payments. The result: dramatic gains in lowering costs and improving healthy outcomes.
Small clinics are springing up in retail stores around the country, providing customers with easy access to nurses who treat common ailments like ear infections and poison ivy. These clinics cost less than a visit to the doctor or emergency room.

And yet, we still lag behind those poor suckers in almost every other country in the western world. They just don't appreciate the sublime beauty of our system.

Competition is leading to more affordable prescription drugs.

And the new Medicare drug benefit shows how competition can lower costs and provide better benefits.
When the Part D program started in 2003, Congress estimated the drug benefit would cost beneficiaries an average of $37 a month. But because private drug plans compete to deliver the Medicare benefit, prices have been far lower than predicted. The average monthly cost of the standard benefit is just $22.


Coming in below cost is unprecedented for a government program -

and for non-government programs as well [DUH!]

- and it shows the government can lower prices by encouraging competition. It's virtually the opposite of a single-payer system, in which governments shut out the private sector.
Rather than regressing to the failing systems of Europe -

Uh, they're only "failing" directly depending upon the degree of underfunding. And, oh, yeah, they're not failing: they're doing bette than we are!!!

- with waiting lines and rationing -- we must develop our own unique solution. Ultimately, that means embracing the truly American qualities of innovation and competition.

How embarrassing for her. But I'm sure she's paid well for it.

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Thursday, August 2, 2007

Physician/Adminstrator "Balance"

A great slide from PNHP's web site that speaks for itself.

The full slide show is here.

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Wednesday, August 1, 2007

From The Sheep and The Goats From Matthew Chapter 25, The Parable of the Sheep and the Goats.:

"41'Then he will say to those on his left, 'Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.'
44'They also will answer, 'Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?'
45'He will reply, 'I tell you the truth, whatever you did not do for one of the least of these, you did not do for me.'
46'Then they will go away to eternal punishment, but the righteous to eternal life.'"

How bad can single payer be that Christians can walk away from this lesson so blithely? What evil in a government sponsored single payer system is so compelling to ignore these charges of Jesus? What principles have been teased and tortured out of Christianity to trump this parable so central to Christ's call for us to take care of each other?

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