Thursday, January 31, 2008

Political self-characterization of US women physicians

Social Science & Medicine : Political self-characterization of US women physicians:

"The political self-characterization of US physicians, especially including women physicians, has been poorly described. We used data from the 4,501 respondents to the Women Physicians' Health Study (WPHS), a stratified random sample of US women M.D.s surveyed in 1993–1994, to assess US women physicians' political characteristics. US women physicians were most likely to consider themselves politically moderate (36.6% of respondents). More considered themselves liberal (28.4%) or very liberal (8.8%) than considered themselves conservative (20.5%) or very conservative (5.8%). US women physicians predominantly bring moderate and liberal voices to political discourse. Organizations that wish to attract US women physician members should consider promoting less conservative policies."

from Erika Frank at Emory (1999) (she's now at UBC, Vancouver, where she did the study of med students, below).

And another one...

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Political Self-characterization of U.S. Medical Students

Political Self-characterization of U.S. Medical Students:

Among these medical students, 5% self-characterized as politically very conservative, 21% conservative, 33% moderate, 31% liberal, and 9% as very liberal.” Being male, white, Protestant, intending to specialize in Surgery or anesthesiology/pathology/radiology, or currently or previously being married significantly (P≤.001) increased the likelihood that a student self-identified as very conservative or conservative. Disagreement or strong disagreement with the statements, “I’m glad I chose to become a physician” and “Access to care is a fundamental human right,” were also both associated with being very conservative or conservative. Being more liberal was reported by blacks and Hispanics; those intending to become ob-gyns, psychiatrists, and pediatric subspecialists; and atheists, Jews, and adherents of eastern religions.

U.S. medical students are considerably more likely to be liberal than conservative and are more likely to be liberal than are other young U.S. adults. Future U.S. physicians may be more receptive to liberal messages than conservative ones, and their political orientation may profoundly affect their health system attitudes."

from Erica Frank, Jennifer Carrera, and Shafik Dharamsi

A little more on this topic. There is hope!

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Wednesday, January 30, 2008

Physicians views on Single Payer

This is not new data, but I am just trying to get as much information into this blog as I can. So here we go, first from Archives of Internal Medicine in 2004, by Himmelstein and Woolhandler of PNHP:

Single-Payer National Health Insurance: Physicians' Views

Danny McCormick, MD, MPH; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH; David H. Bor, MD

Arch Intern Med. 2004;164:300-304.

Results Of 1787 physicians, 904 (50.6%) responded to our survey. When asked which structure would provide the best care for the most people for a fixed amount of money, 63.5% of physicians chose a single-payer system; 10.7%, managed care; and 25.8%, a fee-for-service system. Only 51.9% believed that most physician colleagues would support a single-payer system. Most respondents would give up income to reduce paperwork, agree that it is government's responsibility to ensure the provision of medical care, believe that insurance firms should not play a major role in health care delivery, and would prefer to work under a salary system.

Conclusions Most physicians in Massachusetts, a state with a high managed care penetration, believe that single-payer financing of health care with universal coverage would provide the best care for the most people, compared with a managed care or fee-for-service system. Physicians' advocacy of single-payer national health insurance could catalyze a renewed push for its adoption.

A response from Dr. Palmisano of the AMA

The Danger of Single-Payer Health Insurance
Donald J. Palmisano
Arch Intern Med. 2004;164(20):2281-2282.

Dr. Palmisano cites Dr. Ian Bogle in his "Outgoing speech as Chairman of the British Medical Association Council." Available at:

and a survey published a year earlier to make his case: "Support for national health insurance among US physicians: a national survey." Ann Intern Med. 2003;139:795-801.

Regarding the former, England has a National Health Service, not a single payer system, though I always urge us to learn from the faults of other systems. We are not doomed to repeat the mistakes of others (unless we're stupid).

Regarding the second study, which Dr. P argues "found that only 26% supported a single-payer system," here is the results section of the abstract:

Results: Sixty percent of eligible participants returned a survey. Forty-nine percent of physicians supported governmental legislation to establish national health insurance, and 40% opposed it. Only 26% of all physicians supported a national health insurance plan in which all health care is paid for by the federal government. In analyses adjusting for differences in personal and practice characteristics, physicians in a primary care specialty, physicians reporting that at least 20% of their patients had Medicaid, and physicians practicing in a nonprivate setting or in an inner-city location were statistically significantly more likely to support governmental legislation to establish national health insurance.

The editors' notes from the journal:

With the exception of family practitioners, anesthesiologists, and surgical subspecialists, more than half of physicians in major specialties supported national health insurance. Support was highest among pediatricians, psychiatrists, and general internists.

With all due respect to the authors, these questions were as clear as mud. I am very engaged and strongly favor single payer, but I don't know how I would have answered these questions. I'd suggest: "Would you favor expanding Medicare to all citizens?" for instance.

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Sunday, January 27, 2008

In Holland, Some See Model For U.S. Health-Care System -

In Holland, Some See Model For U.S. Health-Care System -

"The Dutch system features two key rules: All adults must buy insurance, and all insurers must offer a policy to anyone who applies, no matter how old or how sick. Those who can't afford to pay the premiums get help from the state, financed by taxes on the well-off."

Sound familiar? Go to the link to see the accompanying graphic comparing the Netherlands, Massechusetts and (proposed) California plans. They are not too different. What is different is the minimum wage in the Netherlands-about 1.8 times ours.

So in order to avoid the pesky problem of deciding among insurance, food, and heating your home, we'd have to do a much better job against low wages and poverty in general. Thiis couldn't happen in most states, but I wonder if California could double its minimum wage and get away with it? Not a lot of egress from california, almost no matter what. So maybe that could be the state to experimant with a mandated living wage and mandated health insurance.


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Wednesday, January 23, 2008

Daily Kos: Cheers and Jeers: Wednesday

Daily Kos: Cheers and Jeers: Wednesday:

"It's very simple, really You're sick. Very sick. Maybe life-threateningly sick. And your health insurance company has just rejected your claim. What will you do? What will you do???

Thankfully, Parade magazine is here to help. Sunday they published an article called Fight for Your Health Care. That's right: Fight. Just what every sick person enjoys doing between bouts of vomiting and dizziness and organ failure and trips to the hospital. But never fear...the process is simple, and I'll give you the lowdown here."

Nicely snarky piece on how lucky we are to live in the country with the Greatest Healthcare System in the World.(TM)

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Wednesday, January 16, 2008

A satisfying update to WSJ Editorial on US/UK liver transplantation results..

Thanks to Maggie Mahar for doing the work on this. I was willing to accept Dr. Gottlieb's facts at face value and make my case, but Mahar went the extra mile to show that, not only is the argument bogus, so are the facts! Here's the prime of the post:

But what Gottlieb omits is the crucial fact that, when the researchers went back and looked at “patients who survived the first post-transplant year,” they discovered that “patients who had suffered from chronic liver disease in the U.K. and Ireland had a lower overall risk-adjusted mortality” than patients in the U.S. In other words, survival rates for patients who had a chronic disease before the transplant were better in the U.K. and Ireland. As for patients suffering from acute liver disease, longer-term survival rates past one year were just as good in the U.K. and Ireland as in the U.S. Moreover, if you checked patients in the interval between 90 days and one year, outcomes were similar in the two health care systems.

So “equilibrated” wasn’t just a dodgy piece of jargon; it was inaccurate. When researchers checked on patients more than a year after they had the transplant, outcomes in the U.K/Ireland and the U.S. weren’t in perfect balance (or in equilibrium) with results in the U.S. Outcomes in the U.K./Ireland were just as good for one group and decidedly better for the second —assuming that if you go through the trauma of a liver transplant, the outcome you are hoping for is to live more than a year, rather than just 90 days.

Why is chronic care better in the U.K. in the years following surgery? Because the “primary care infrastructure” is stronger in the U.K. and Ireland, the article explains. Add in the fact that patients have “equal access” to health care and that the cost of care is “lower,” and this helps explain superior long-term results. As the researchers point out, “the 2002 Commonwealth Fund International Health Policy Survey found that sicker adults in the US are far more likely than those in the UK to forgo medical care and fail to comply with recommended follow-up and treatment because of costs. In the U.S., it seems, outcomes tend to turn on whether the patient has money.

Finally, what about outcomes after five years? What Gottlieb forgot to mention is that survival rates for patients who had originally suffered from chronic liver disease were similar in the two countries, while mortality rates for patients suffering from acute liver disease were higher in the U.K. and Ireland.

Thanks, Maggie!

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Health Insurance: It’s Always Something, Isn’t It?

"So long as insurance companies are for profit enterprises, their goal will not be the best health care possible. It will be this -- not paying claims. That is the truth of it, because that is how they profit. For real change, we need better, smarter folks elected to represent OUR interests, not just the lobbyists and insurance companies."

Nice post to add to our "anecdote-off" section, but it also leads to some good posts by Ian Welsh:
On Healthcare and Social Justice:

If you follow the link to Digg on this one, the Ayn Randers are out in force. It occurs to me that they represent the only philisophical school on the planet that rejects social justice in any way, shape or form. So, how some of them still delude themselves into thinking they are Christians or Jews or aven secular humanists is amazing.

And on why we don't do something about heathcare (and drug policy and...):


read more digg story

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Sunday, January 13, 2008

The Pain of Health Coverage | Philadelphia Inquirer | 12/09/2007

The Pain of Health Coverage | Philadelphia Inquirer | 12/09/2007: "Frank Manzo keeps doing the math, trying to figure out how he can still offer health insurance to his employees.
His 28-employee tech-staffing company, Computer Methods Corp., charges clients $35 an hour for help desk workers. He pays them $25 an hour.
Health insurance premiums proposed for 2008 for a family run nearly $12 an hour - up 30 percent from last year.
Forget about profit. Forget about rent on the company's Marlton offices, the electric bill, or even paper for the copy machine.
The middle-class, college-educated people at Manzo's company were on the edge of joining America's 47 million uninsured.
'Where do I find the money?' Manzo asked, his voice rising in frustration. 'What am I supposed to pay them - $10 an hour? At this point, they may as well go work for McDonald's.'
Health insurance makes everyone miserable. But among the most miserable are small-business owners."

Sorry if this is an old article to you, just appeared in my Pittsburgh paper this Sunday...

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Saturday, January 12, 2008

Measuring the Health of Nations: Updating an Earlier Analysis

Measuring the Health of Nations: Updating an Earlier Analysis:

"U.S. Ranks Last

Between 1997–98 and 2002–03, amenable mortality fell by an average of 16 percent in all countries except the U.S., where the decline was only 4 percent. In 1997–98, the U.S. ranked 15th out of the 19 countries on this measure—ahead of only Finland, Portugal, the United Kingdom, and Ireland—with a rate of 114.7 deaths per 100,000 people. By 2002–03, the U.S. fell to last place, with 109.7 per 100,000. In the leading countries, mortality rates per 100,000 people were 64.8 in France, 71.2 in Japan, and 71.3 in Australia.

The largest reductions in amenable mortality were seen in countries with the highest initial levels, including Portugal, Finland, Ireland, and the U.K, but also in some higher-performing countries, like Australia and Italy. In contrast, the U.S. started from a relatively high level of amenable mortality but experienced smaller reductions."

Just another collection of damning data to be ignored by the usual suspects...

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Friday, January 11, 2008 - Commentary: Edwards and Organ Transplants

Argues that because Americans are more likely than Europeans to get a transplant, and more likely to survive it too, that this would not be possible in an American Single Payer system.

The author argues that, "Organ transplantation, like many areas of medicine, provides a poor basis for his political thesis that single-payer health care offers a more equitable allocation of scarce resources, or better clinical outcomes."

He is partially correct; a high tech treatment like organ transplant is not a good way to decide how to reform American Health Care. The staunchest advocates for Single Payer Healthcare never, ever, disparage American medicine's ability to deliver the best care in the world in areas such as organ transplant, trauma, intensive care and other high tech endeavors. But these areas are only a sliver of overall clinical outcomes. Even at the quoted 18.5 liver transplants per million done in the US annually, this is only 5000 or so patients. So, while not being dismissive of these patients, they are not reflective of healthcare outcomes of our population. They only reflect what we already know: We spend tons of money on advancing high tech medicine and we are darn good at it. As I view the transition to single payer, I see no reason, other than "conservatives" wailing about unnecessary spending on healthcare as the system matures, for us to continue to do well in our "American specialty" of bleeding edge healthcare.

Yet, the point about a single payer system not offering a more equitable allocation strikes me as intuitively, obviously false, and I don't believe the author tries to refute the point other than pointing out that we do more liver transplants in the US than elsewhere. A strange point is also made about the threat of the government deciding who gets the organs. I think most of us would gladly take a standard set of criteria developed by the NIH, UNOS, or other agency, applied fairly and equitably across all socioeconomic and ethnic categories by a Medicare-like agency, rather than the inherently conflicted interests of a private insurer!

And finally, since we spend twice as much on healthcare, shouldn't we do twice as much of everything, not just liver transplants? Preventive care and prescription drug benefits come to mind immediately, but you can pick your own favorite.


read more digg story

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