Most Minnesota doctors like single-payer health care, academic study finds Twin Cities Daily Planet Minneapolis - St. Paul:
"In his years as a physician, he has seen a sharp change in how physicians look at health care. “Having lunch with other doctors used to mean listening to conservatives griping about the government. Now lunchroom talk is that single-payer would be a good idea,” said Adair.
A recent survey through the University of Minnesota and St. Olaf College found that 64 percent of Minnesota’s physicians support a single-payer system much like the Minnesota Health Plan. Another 25 percent said that health savings accounts were the way to go, and only 12 percent thought that the current system of managed care was adequate.
“I personally feel very angry and frustrated when I know my patients are not getting the care that they deserve,” said Dr. Elizabeth Frost, a supporter of the Minnesota Health Plan. “I hate saying to people, ‘you need this test or this study,’ all the while knowing they don’t have insurance and likely don’t have a lot of savings either.”
Of the reasons that a single-payer system is so attractive to the majority of physicians in Minnesota is that the current multi-payer, managed-care system often gets in the way of physicians’ ability to provide the care that they swore an oath to provide."
The following point is also made:
"Because of [these] barriers people often under-use the system, “as opposed to the overuse that people erroneously cite as a significant problem in the current system,” said Settgast. “This under-use leads to unnecessary human suffering and also financial waste because the cost of caring for a patient with a stroke far exceeds the cost of effectively managing someone’s high blood pressure.”
Please click on "Moral Hazard" (along the right of this blog) to see more about that last point. But the bigger point is true in my expereince too: physicians are tired of this "system" we now have and are ready to take a chance on change. It would make an interesting poll for the AMA to undertake...
UPDATE: The findings section of the paper, from Minnesota Medicine.
Findings A majority of respondents (72%) were male with a median medical school graduation year of 1979. Nearly half (46%) practiced primary medicine, followed by medical specialty (35%), surgical specialty (12%), and general surgery (6%). More than three-quarters (79%) worked in a metropolitan setting, and nearly two-thirds (65%) practiced in a clinic.
Of the 390 respondents who answered the question about which financing system would offer the best health care to the greatest number of people for a fixed amount of money, 64% said they favor a single-payer financing system, 25% preferred HSAs, and only 12% preferred managed care (Figure 1). Figures 2, 3 and 4 offer a closer look at who prefers those financing structures by sex, geographic location, specialty, and type of practice.
A single-payer system was favored by women physicians over men (female, 76%; male, 59%; p=.003); more male physicians than female preferred HSAs (male, 30%; female, 16%; p=.004). The percentage of male respondents who favored the current managed care system slightly exceeded that of female physicians (12% versus 9%; p=.553).
Geographic setting was also significantly associated across the 3 choices. Urban physicians favored a single-payer system over their rural and suburban colleagues (71%, 60%, and 54%, respectively; p=.009). Rural physicians preferred HSAs over suburban and urban physicians (34%, 32%, 17%; p=.002). Managed care garnered less than 15% support overall, with 14% of suburban physicians, 12% of urban doctors, and 6% of rural respondents favoring it; p=.217). Thus, urban physicians had the most support for a single-payer system and the least for managed care. Rural physicians were relatively enthusiastic for HSAs but least supportive of managed care.
When looking at physicians’ responses across medical specialty, those practicing primary medicine most favored a single-payer system (74%); general surgeons least favored such a system (36%). Conversely, general surgeons most favored HSAs (55%), and primary medicine physicians least favored them (20%). Managed care found greatest support among physicians who practiced a medical or surgical specialty (17% each) and the least among those who practiced primary medicine (6%). Of those who favored managed care, the significant split was specialists over generalists (17% and 7%; p=.001).
Physicians also were asked who should be responsible for providing access to health care. Nearly all (86%) believed it is the responsibility of society through government to ensure access to good medical care for all, regardless of ability to pay. Only 41% held that the private insurance industry should continue to play a major role in medical care financing and delivery.
Using a regression model, we found that physicians who agreed that it is the government’s responsibility to ensure access to medical care were significantly more likely to favor a single-payer financing system (OR 13.51; CI 2.85, 64.15; p=.001). Those who believed the private insurance industry should continue to play a major role in financing medical care were significantly less likely to favor a government-run system (OR 3.45; CI 1.35, 8.33; p=.009
Thursday, February 28, 2008
Most Minnesota doctors like single-payer health care, academic study finds | Twin Cities Daily Planet | Minneapolis - St. Paul
Capitol Hill Watch | Four Medical Device Companies Made $800M in Illegitimate Payments to Physicians Over Four Years, HHS OIG Official Says - Kaisernetwork.org
Capitol Hill Watch Four Medical Device Companies Made $800M in Illegitimate Payments to Physicians Over Four Years, HHS OIG Official Says - Kaisernetwork.org:
"Four companies that manufacture artificial hips and knees paid physicians more than $800 million in royalties and fees over four years to influence them to use their products, Gregory Demske, assistant inspector general of legal Affairs at the HHS Office of Inspector General said during a Senate Special Committee on Aging hearing on Wednesday, Bloomberg/Washington Post reports (Goldstein, Bloomberg/Washington Post, 2/28).
Demske said, 'Although most physicians believe that free lunches, subsidized trips or gifts have no effect on their medical judgment, the research has shown that these types of perquisites can affect, often unconsciously, how humans act' (Cooley, CQ HealthBeat, 2/27). He added that illegitimate payments to physicians have led to increased use of lower-quality medical devices."
Saturday, February 23, 2008
Health Net ordered to pay $9 million after canceling cancer patient's policy - Los Angeles Times
Health Net ordered to pay $9 million after canceling cancer patient's policy - Los Angeles Times:
"Calling Woodland Hills-based Health Net's actions 'egregious,' Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.
'Health Net was primarily concerned with and considered its own financial interests and gave little, if any, consideration and concern for the interests of the insured,' Cianchetti wrote in a 21-page ruling.
Patsy Bates, a 52-year-old grandmother, was at work at the Gardena hair salon she owns when her lawyer William Shernoff called with the news. Bates said she screamed and thanked the lawyer.
Then, 'I thanked God,' she said. 'I praised the Lord.'
Bates called the arbitration judge 'an angel . . . a real stand-up kind of judge.'
When Health Net dropped her in January 2004, Bates was stuck with more than $129,000 in medical bills and was forced to stop chemotherapy for several months until she found a charity to pay for it.
Health Net Chief Executive Jay Gellert ordered an immediate halt to cancellations and told The Times that the company would be changing its coverage applications and retraining its sales force.
At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved."It's difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive," the judge wrote."
Of course, this will get reduced substantially on appeal, but at least this tort case got the attention of the insurer to improve policy (for the time being, anyway).
Britain’s health care amounts to malpractice - BostonHerald.com
Britain’s health care amounts to malpractice - BostonHerald.com
I don't know of a person who advocates for universal health care in the US who advocates for a nationalized system such as Britain's that the author holds up as his bogeyman. The discussion is about which type of single payer system or universal insurance coverage scheme we should adapt to the US. As Michael Moore has stated, we aren't talking about blindly adopting another contry's system wholesale, we are talking about having a policy discussion and creating a uniquely American system, emphasizing our strengths and remedying our weaknesses.
But what really prompted me to write this were a couple of absurd statements by the author.
First, "No one can complain that the NHS is underfinanced. This year’s budget is $210 billion - about $1.05 trillion if adjusted to match America’s population." Really, no one? The Internets have this thing called "Google" and if you search for "NHS underfunded" you might find out that at least a few people (Tony Blair, for one) who believe it is underfunded. But more importantly, is there anyone who doesn't get that we spend roughly twice as much per person on healthcare and get terribly shaky outcomes for it? Specifically, is there anyone writing a piece for a major newspaper who doesn't know this?
And this: "A September 2007 Lancet Oncology article found 66.3 percent of American men alive five years after cancer diagnosis. Only 44.8 percent of Englishmen survived after five years. Across the European Union, 20.1 females per 100,000 under 65 died prematurely of circulatory disease. Among British women, that number was 23.6."
Here's an interesting table from that study, showing the UK NHS as the worst, except for Slovenia, Iceland, Poland and the Czech Republic. And I'll say it again, nobody wants to replicate the British system here. And for more comparisons on US versus other countries healthcare outcomes, go here.
And, finally, my favorite, "Within this maze, patient needs often yield to the wants of pols and medicrats." Go see Sicko, man! Are you kidding? You think we don't have pols in the hands of Pharma and the health insurance and health care industries and "medicrats" at our insurers? Who do you think draws those multi-million dollar salaries at the Blues and Aetna and the rest?
Aren't these people getting tired of flogging this dead dog? Probably not, because apparently that dog still hunts in the imaginations of some.
Cheers,
Boston herald:
But what really prompted me to write this were a couple of absurd statements by the author.
Wednesday, February 20, 2008
heritage foundation - Moral costs of socializedmedicine
Vindy.com News – Youngstown, Ohio - Moral costs of socializedmedicine:
"Anyone who considers Canada’s health system a role model for the U.S. should consider the case of Samuel Golubchuk. His case shows the inevitable collision course between government-controlled health care and the rights of private conscience."
Typical hack rubbish. My comments are on the Vindy web site below the article...
Quebec commission makes recommendations
Quebec commission makes recommendations:
"Quebec - The Castonguay task force on health care proposes a $25 charge for every visit to a doctor and an increase up to one percentage point in the Quebec sales tax to help pay for medicare.
Claude Castonguay, the chair of the task force, notes that health care, as a share of the provincial budget is growing 5.8 per cent a year, while total government spending increases 3.9 per cent annually.
He proposes capping health spending at 3.9 per cent and making up for the shortfall with a new health-stability fund, financed by the $25 doctor's charge and the sales-tax increase.
Extra billing for health care is currently illegal under the Canada Health Act, which Castonguay concludes 'hampers the evolution of the provincial public health systems.'"
In keeping with the "warts and all" approach to comparing helathcare systems...
The feedback to the story was mostly negative.
Tuesday, February 19, 2008
Jeff Weintraub: Teddy Roosevelt & Adam Smith on inheritance taxes (Susan Dunn & Sam Fleischacker)
Again, I'm off topic here, but I just love to collect interesting pieces on economics and this one is very interesting: thoughts from TR, Adam Smith and the founders on the inheritance of wealth.
Jeff Weintraub: Teddy Roosevelt & Adam Smith on inheritance taxes (Susan Dunn & Sam Fleischacker)
Thursday, February 14, 2008
Haves and Have-Nots: A Look at Children's Use of Dental Care in California - CHCF.org
Haves and Have-Nots: A Look at Children's Use of Dental Care in California - CHCF.org:
"The burden of oral disease continues to fall more heavily on children from poor, minority households. And despite growing awareness of the life-long effects of poor oral care, nearly one quarter of California children have never been to a dentist, including half of all children under the age of five.
Using the most recent data available from the 2005 California Health Interview Survey, this snapshot found that uninsured children were least likely to have had a recent dental visit and most likely to have never visited the dentist. Denti-Cal beneficiaries were least likely to have ever seen the dentist compared to those with other types of insurance."
I'll tag this with dental care so you can follow to a couple of other posts on this topic...
Another country heard from...
The Jewish Week News: "But when she makes the move, she’ll be practicing in a country where doctors earn only a fraction of what they do in the United States. In fact, most Israeli doctors have to have second jobs just to make ends meet.
“Doctors don’t move there because of a lucrative salary,” Rosner said. “We’re going because it’s the Jewish homeland, and this fellowship is making the move more doable.
“We know we are going to live a less lavish life than in the U.S., but we are not going to starve.”"
OK, maybe this a bit extreme, even for me. But, on the other hand, if private school is only $150 a month, makes you wonder what college costs...
Monday, February 11, 2008
Tax Cuts Don't Boost Revenues - TIME
Sorry, not directly a single-payer post, but I have to keep track of this stuff somewhere!
Tax Cuts Don't Boost Revenues - TIME: "If there's one thing that Republican politicians agree on, it's that slashing taxes brings the government more money. 'You cut taxes, and the tax revenues increase,' President Bush said in a speech last year. Keeping taxes low, Vice President Dick Cheney explained in a recent interview, 'does produce more revenue for the Federal Government.' Presidential candidate John McCain declared in March that 'tax cuts ... as we all know, increase revenues.' His rival Rudy Giuliani couldn't agree more. 'I know that reducing taxes produces more revenues,' he intones in a new TV ad.
If there's one thing that economists agree on, it's that these claims are false. We're not talking just ivory-tower lefties. Virtually every economics Ph.D. who has worked in a prominent role in the Bush Administration acknowledges that the tax cuts enacted during the past six years have not paid for themselves--and were never intended to. Harvard professor Greg Mankiw, chairman of Bush's Council of Economic Advisers from 2003 to 2005, even devotes a section of his best-selling economics textbook to debunking the claim that tax cuts increase revenues.
The yawning chasm between Republican rhetoric on taxes and even informed conservative opinion is maddening to those of wonkish bent. Pointing it out has become an opinion-column staple. But none of these screeds seem to have altered the political debate. So rather than write yet another, I decided to find out what Arthur Laffer thought."
He found out that Laffer still believes reagan's tax cuts paid for themselves in spite of subsequent evidence and recantments.
Implications of UPMC's ethics policy far-reaching
Implications of UPMC's ethics policy far-reaching:
"As he delivered a typical $120 lunch order to a doctor's office last week -- three chicken or salmon entrees, three appetizers, a chicken sandwich and four salads -- Robert Bishop was mindful that his business, Mobile Menus, soon would be filling fewer orders.
On Friday, he expects to lose the deliveries he makes to doctors affiliated with the University of Pittsburgh Medical Center.
A new UPMC conflicts-of-interest policy will take effect that day aimed at making doctors' decisions free from influence created by gifts or improper relationships with the drug or medical device industries.
Among other provisions, the policy bans gifts such as pens, note pads and food provided by industry representatives as they work to present information about their products at doctors' offices.
Losing that food business for the UPMC doctors he visits, Mr. Bishop said, will cut his $5,000 weekly sales by about 20 percent. He said nearly all the lunches he provides to doctors' offices are paid for by drug industry representatives."
Good on UPMC...
When Self-Interest Isn’t Everything - New York Times
Not exactlydirectly related to the subject of single payer, but sort of...
When Self-Interest Isn’t Everything - New York Times:
"Researchers at the intersection of economics, psychology, sociology and other disciplines have had interesting things to say about the anomaly inherent in collective action. Albert O. Hirschman, an economist at the Institute for Advanced Study at Princeton, was one of the first to grapple seriously with it. In his 1982 book “Shifting Involvements,” he acknowledges that self-interest indeed appears to be the dominant human motive in some eras. But over time, he argues, many people begin to experience disappointment as they continue to accumulate material goods. When consumption standards escalate, people must work harder just to hold their place. Stress levels rise. People become less willing to devote resources to the public sphere, which begins to deteriorate. Against this backdrop, disenchanted consumers become increasingly receptive to appeals from the organizers of social movements.
Eventually, Mr. Hirschman argues, a tipping point is reached. In growing numbers, people peel away from their private rat race to devote energy to collective goals. The free-rider problem ceases to inhibit them, not only because they now assign less value to private consumption, but also because they find satisfaction in the very act of contributing to the common good. Activities viewed as costs by self-interest models are thus seen as benefits instead."
The article ends with a description of Milton Friedman's dismissal of JFK's "Ask not" sentiments. Not being an economist, I've not read Friedman, and, apparently haven't missed much...
Friday, February 8, 2008
JAMA -- From Waste to Value in Health Care, February 6, 2008, Boat et al. 299 (5): 568
JAMA -- From Waste to Value in Health Care, February 6, 2008, Boat et al. 299 (5): 568:
"The United States ranks among the worst of industrialized countries for indicators of health such as infant mortality and life expectancy,1 despite spending $2 trillion annually on health care,2 more than any other nation per capita. However, higher health care spending does not correlate with higher quality of care or better patient outcomes.3-5 These sobering indicators suggest that an opportunity exists to close the value gap in the day-to-day delivery of health care by eliminating actions that impede optimal systematic performance, which result in less than perfect outcomes, extra work, or corrective work, otherwise described as waste.
Patient falls and decubitus ulcers represent waste in the form of 'never events' that create more costs and result in systemic dissatisfaction. Waste is illegible and incomplete prescriptions that consume technician, nurse, and pharmacist time and, at worst, risk the life of the patient. Waste is acute care hospitalization of patients with diabetes who received inadequate preventive care. Waste is failing to adopt evidence-based care. Waste accounts for 30% to 50% of health care spending.6-7
Over the last 20 years, quality has become a widely shared mantra in health care but with few efforts to systematically define the exact size and nature of the opportunity to improve value. This situation is somewhat analogous to when a physician determines that a patient is ill but does nothing more to diagnose or treat the patient. A better or more accurate approach to taking advantage of the opportunity would be to produce detailed problem statements that permit a locally driven but nationally connected set of interventions to close the value gap."
More about QI than cost, but they do mostly go hand in hand...
AlterNet: 10 Myths About Canadian Health Care, Busted
AlterNet: 10 Myths About Canadian Health Care, Busted:
"2008 is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Harry and Louise are back with a vengeance. Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning -- and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.
I'm both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I'm in a unique position to address the pros and cons of both systems first-hand. If we're going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.
To that end, here's the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all they're made of."
Read on...
CA: As State Bill Dies, Activists Turn to Single Payer Bill
Berkeley Daily Planet:
"Advocates of single payer health insurance in California are saying that the collapse of the Nuñez-Perata-Schwarzenegger health care bill is a good thing and are moving forward with reviving their own single-payer legislation.
“We were opposed to the Nuñez bill,” Vote Health representative Kay Eisenhower said by telephone this week. “We considered it a step backwards.” Vote Health is an Alameda County-based health care activist organization.
Eisenhower said statewide single-payer health care advocates will be holding a two-day conference in Los Angeles later this month to talk about ways to put State Senator Sheila Kuehl’s (D-Santa Monica-Los Angeles) SB 840 single-payer health care bill back on track. “SB 840’s not dead,” she said. “It’s only on ice.”
Two years ago, it seemed dead. After SB 840 passed the state legislature in 2006, Gov. Schwarzenegger vetoed it.
Kuehl revived her single payer bill a year later, and the bill passed the Senate on a 23-15 vote and the Assembly Health Committee on a 12-5 vote last summer, but it stalled in the Assembly Appropriations Committee as attention in the Assembly turned to a compromise bill being put together by Assembly Speaker Fabian Nuñez.
The bill’s summary says it “would establish the California Universal Healthcare System (CUHS) under which all California residents would be eligible for specified health care benefits. The CUHS would, on a single-payer basis, negotiate for or set fees for health care services provided through the system, and pay claims for those services.”"
NEJM -- Market-Based Failure -- A Second Opinion on U.S. Health Care Costs
NEJM -- Market-Based Failure -- A Second Opinion on U.S. Health Care Costs:
"Relentless medical inflation has been attributed to many factors — the aging population, the proliferation of new technologies, poor diet and lack of exercise, the tendency of supply (physicians, hospitals, tests, pharmaceuticals, medical devices, and novel treatments) to generate its own demand, excessive litigation and defensive medicine, and tax-favored insurance coverage.
Here is a second opinion. Changing demographics and medical technology pose a cost challenge for every nation's system, but ours is the outlier. The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization. The dominance of for-profit insurance and pharmaceutical companies, a new wave of investor-owned specialty hospitals, and profit-maximizing behavior even by nonprofit players raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of private bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent, but the more serious and less appreciated syndrome is the set of perverse incentives produced by commercial dominance of the system.
Markets are said to optimize efficiencies. But despite widespread belief that competition is the key to cost containment, medicine — with its third-party payers and its partly social mission — does not lend itself to market discipline. Why not?"
Read on...
Lawmakers take on single-payer health care backers at rally: Rutland Herald Online
Lawmakers take on single-payer health care backers at rally: Rutland Herald Online:
"But as the crowd grew more raucous (some began interrupting lawmakers and insulting legislative staff), Rep. Patricia O'Donnell, R-Vernon, staged her own interruption as she came to the front of the room and asked people to treat their lawmakers with respect.
'If you want to be listened to, you have to be respectful,' O'Donnell, a member of the House Health Care Committee, told the crowd before a chorus of people yelling 'sit down' and 'shut up' sent her out of the room, the door slamming behind her.
Maier told the crowd the criticism for legislative staff — who have researched aspects of the hospital plan for lawmakers — is off base. He added that while he doesn't 'enjoy being yelled at, it is our job to listen and to ask the tough questions and to dig down.'
'If we don't ask these kinds of questions we would be irresponsible,' he said. 'It's not our job to pass ideas and concepts.'
Racine also told the crowd that their anger is misplaced and suggested that attention should also be focused on state and elected officials who do not support universal health care. He cited the new proposed budget from Gov. James Douglas, which he said underfunds Medicaid and will result in '$5 million in new co-pays and price increases' for Vermonters.
'I know the system is not sustainable. It's a national crisis,' Racine said. 'If some folks have ideas on how to make this work, I'm all ears.'"
Going "Colonial" in Vermont...
Getting to Universal Health Insurance Coverage Conference - Kaisernetwork.org
Sweet! Follow the links to watch these lectures on your PC. Podcasts would be nice, but, hey, it's free!
Getting to Universal Health Insurance Coverage Conference - Kaisernetwork.org:
"National Academy of Social Insurance's 20th annual policy conference focuses on achieving affordable health coverage for all Americans. The conference brings together the major participants in the health coverage debate to frame the problem, compares specific policy proposals, and identifies ways of overcoming the obstacles to reform.
January 31st Sessions
Welcome and Opening Speaker
What Should Be the Role of Employers in Delivering Health Insurance?
Luncheon Speaker: The Real Health Reform Debate We Need to Have
How Should the Private Insurance Market be Structured in a Universal System of Coverage?
How Should We Balance Affordability and Comprehensive Coverage?
February 1st Sessions
Can an Individual Mandate Promote Individual Responsibility?
Point-Counterpoint: Is Medicare-for-All the Best Option?
How Can We Overcome the Barriers to Change?"
Evening Sun - Universal health care: Advocate discusses Pennsylvania single-payer plan
Evening Sun - Universal health care: Advocate discusses Pennsylvania single-payer plan:
"'The only way (health-care reform) can happen is if concerned citizens learn the facts and get their representatives to do the right thing,' she said.
The Family and Business Health Care Security Act needs 102 of 203 votes in the House, 26 of 50 in the Senate, and the governor of Pennsylvania to approve the bill in order for it to become law.
Pennachio says this is an easy bill to pass if the citizens want it. He said community members should lobby their state legislators and make them aware that that they support the bill.
For more information, visit http://www.healthcare4allpa.org."
Just wanted to get that link in there at the end...