Friday, August 29, 2008

Physicians, health, burnout | Salon

Physicians, health, burnout Salon:

"I'm tired. Really tired. I've been seeing patients continuously -- one every 15 minutes -- for five and sometimes six days a week. The pace is nothing new for me or most primary care doctors. But lately it all feels like a game of Jenga, with patients stacked on top of one another like wooden blocks, ready to come tumbling down."

I'm posting this, not so much for the article itself (about physician burnout), but for the responses/letters. To all doctors, read the letters by clicking "Editor's Choice" first, so you don't get too angry or depressed. Then read all the letters.

I just found it very interesting both the animosity and admiration physicians generate among the public. And another common thread is that the public seems to understand that we, too, are entrapped in a lousy system -- but also wonder, then, why we aren't getting the AMA to finally back serious reform.


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Thursday, August 28, 2008

Texas still leads nation in rate of uninsured residents | Dallas Morning News | News for Dallas, Texas | Dallas Business News

Texas still leads nation in rate of uninsured residents Dallas Morning News News for Dallas, Texas Dallas Business News:

"But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain's health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)

'So I have a solution. And it will cost not one thin dime,' Mr. Goodman said. 'The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.

'So, there you have it. Voila! Problem solved.'"

Wow. Breathtaking, isn't it?

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Study: Bankruptcies soar for senior citizens -

Study: Bankruptcies soar for senior citizens -

"It all worked fine for Noda, a widow for 23 years, until she was forced to undergo double-bypass surgery and deal with respiratory problems. She started using two credit cards more frequently for food and bills. Before long, she was $8,000 in debt and behind on car payments.

'I'd go to bed and all I had on my mind was bankruptcy,' she said. 'I had nothing left.'

Noda's car was repossessed, but her trailer home wasn't in jeopardy because her daughter owns it. While she's covered by Medicare and receives $968 in Social Security each month, she relied on her job for other expenses. She had no choice but to get help from Jacksonville Legal Aid and declare bankruptcy.

Most bankruptcies are still filed by people far younger than Noda, but the percentage the younger filers make up has fallen over the 16-year period, according to the Consumer Bankruptcy Project analysis, which will be published in the Harvard Law and Policy Review in January.

In 1991, the 55-plus age group accounted for about 8 percent of bankruptcy filers, according to the study, which looked at more than 6,000 cases filed in 1991, 2001 or 2007. By last year, filers 55 and over accounted for 22 percent."

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Obama and McCain Tax Proposals -

Obama and McCain Tax Proposals -

"According to a new analysis by the Tax Policy Center, a joint project of the Urban Institute and the Brookings Institution, Democrat Barack Obama and Republican John McCain are both proposing tax plans that would result in cuts for most American families. Obama's plan gives the biggest cuts to those who make the least, while McCain would give the largest cuts to the very wealthy. For the approximately 147,000 families that make up the top 0.1 percent of the income scale, the difference between the two plans is stark. While McCain offers a $269,364 tax cut, Obama would raise their taxes, on average, by $701,885 - a difference of nearly $1 million."


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Wednesday, August 27, 2008

The Richest of the Rich, Proud of a New Gilded Age - New York Times

The Richest of the Rich, Proud of a New Gilded Age - New York Times:

"The new tycoons oppose raising taxes on their fortunes. Unlike Mr. Crandall, neither Mr. Weill nor Mr. Griffin nor most of the dozen others who were interviewed favor tax rates higher than they are today, although a few would go along with a return to the levels of the Clinton administration. The marginal tax on income then was 39.6 percent, and on capital gains, 20 percent. That was still far below the 70 percent and 39 percent in the late 1970s. Those top rates, in the Bush years, are now 35 percent and 15 percent, respectively.

“The income distribution has to stand,” Mr. Griffin said, adding that by trying to alter it with a more progressive income tax, “you end up in problematic circumstances. In the current world, there will be people who will move from one tax area to another. I am proud to be an American. But if the tax became too high, as a matter of principle I would not be working this hard.”"

Yes, I know I will NOT drag my ass out of bed for less than 100 Large a day!
[Mr. Griffin made a billion dollars last year.]

This is an astounding article, however and well worth the read. One more bit:

In contrast to many of his peers in corporate America, Mr. Sinegal, 70, the Costco chief executive, argues that the nation’s business leaders would exercise their “unique skills” just as vigorously for “$10 million instead of $200 million, if that were the standard.”

As a co-founder of Costco, which now has 132,000 employees, Mr. Sinegal still holds $150 million in company stock. He is certainly wealthy. But he distinguishes between a founder’s wealth and the current practice of paying a chief executive’s salary in stock options that balloon into enormous amounts. His own salary as chief executive was $349,000 last year, incredibly modest by current standards.

“I think that most of the people running companies today are motivated and pay is a small portion of the motivation,” Mr. Sinegal said. So why so much pressure for ever higher pay?

“Because everyone else is getting it,” he said. “It is as simple as that. If somehow a proclamation were made that C.E.O.’s could only make a maximum of $300,000 a year, you would not have any shortage of very qualified men and women seeking the jobs.”


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Top US Marginal Income Tax Rates, 1913--2003 (

Top US Marginal Income Tax Rates, 1913--2003 (

A terrific table showing the top margianl tax rates since the establishment of the income tax.

You will be amazed, I gurantee!


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Cost of Covering the Uninsured: Health Affairs

Covering The Uninsured In 2008: Current Costs, Sources Of Payment, And Incremental Costs

"Providing full-year coverage to all Americans currently uninsured for any part of the year would increase their medical spending by $122.6 billion in 2008, over and above their current spending (while uninsured) of about $86 billion. The increase in total spending corresponds to 5.1 percent of total health care spending and 0.8 percent of gross domestic product (GDP). For comparison purposes, a recent analysis estimated that the tax subsidy received by privately insured workers with employer-sponsored insurance was more than $200 billion in 2006.27 The 5 percent increase is also smaller than the average annual increase in total health spending of 7.6 percent per year since 2000.28

"The estimate implicitly assumes that the uninsured's new coverage would reflect the distributions of public and private coverage and benefits held by lower-income and lower-middle-income insured people and that their medical care use would also be similar. The cost estimate would change if the new coverage were either much more generous (very low cost sharing, as in Medicaid) or less generous (high deductibles) than current coverage. Similarly, it assumes that provider payment rates and administrative costs under various public and private plans would stay largely the same. Various health system reforms, such as competing private health insurance plans within purchasing pools, greater use of public programs' fee schedules, or expanded use of health information technology, could reduce the estimated incremental resource cost of expanding coverage. A recent report from the Commonwealth Fund estimates that a menu of fifteen savings options could reduce health spending by $1.55 trillion over ten years.29"

Perhaps I am being hyperbolic, but this reminded me of Steinbeck:

"There is a crime here that goes beyond denunciation. There is a sorrow here that weeping cannot symbolize. There is a failure here that topples all our success. The fertile earth, the straight tree rows, the sturdy trunks, and the ripe fruit. And children dying of pellagra must die because a profit cannot be taken from an orange. And coroners must fill in the certificates – dies of malnutrition – because the food must rot, must be forced to rot.
" The people come with nets to fish for potatoes in the river, and the guards hold them back; they come in rattling cars to get the dumped oranges, but the kerosene is sprayed. And they stand still and watch the potatoes float by, listen to the screaming pigs being killed in a ditch and covered with quicklime, watch the mountains of oranges slop down to a putrefying ooze; and in the eyes of the people there is the failure; and in the eyes of the hungry there is a growing wrath. In the souls of the people the grapes of wrath are filling and growing heavy, growing heavy for the vintage."


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Tuesday, August 19, 2008

Report Says Merck Vioxx Study Aimed at Marketing -

Free Preview Report Says Merck Vioxx Study Aimed at Marketing - [Subscription required for full access]

"A 1999 clinical study that Merck & Co. said was done to test side effects of the painkiller Vioxx was, in fact, conducted primarily to support a marketing campaign before the drug's launch, according to a study being published Tuesday.

Researchers said their findings, based on internal Merck records disclosed during litigation, are among the first to document what many scientists suspect is a wider industry practice of using studies masquerading as clinical science to bolster marketing plans. Such behavior would raise ethical and scientific questions, from whether study participants were unknowingly -- and needlessly -- put in harm's way, ..."

More details from AMA Morning Rounds is here.

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Monday, August 18, 2008

International Comparison: Access & Timeliness

From the Commonwealth Fund:
International Comparison: Access & Timeliness:

"U.S. patients reported relatively longer waiting times for doctor appointments when they were sick, but relatively shorter waiting times to be seen at the ER, see a specialist, and have elective surgery. Specifically:

The percentage of U.S. patients who waited six days or more for a doctor appointment when sick was not significantly different from the rate in Canada (23% v. 36%), the worst-performing country.

Only 47 percent of U.S. patients were able to see a doctor on the same or next day when sick, versus 61 percent to 81 percent of patients in the four better-performing nations.

U.S. patients were less likely than patients in Canada (12% v. 24%) but more likely than patients in Germany (4%) to wait four hours or more to be seen in the emergency department.

U.S. patients were less likely than patients in four countries (except Germany) to wait four weeks or longer to see a specialist (23% v. 40%–60%) or to wait four months or longer for elective surgery (8% v. 19%–41%) (Schoen et al. 2005)."

Additionally, Americans are less likey to have a regular doctor, less likely to get prescriptions filled, less likely to get follow-up care, less likely to keep a doctor long-term, and have a harder time getting taken care of nights and weekends.

It speaks for itself.

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Wednesday, August 13, 2008

Health Care System Profiles

Health Care System Profiles:

"The work of the Commonwealth Fund's international program highlights the valuable lessons the U.S. can learn from the health care systems in other industrialized countries. These country profiles provide overviews of the health care systems of several countries, including Denmark, France, Germany, the Netherlands, Sweden, and the U.K. Each profile includes descriptions of how each country organizes, finances, and delivers health services and highlights quality, efficiency, and cost-controlling policy initiatives and reforms"

Follow the link to this page at the Commonwealth Fund website to download individual country profiles or the whole thing.

Here is a remarkable slide presentation from the Commonwealth Fund aggregating in PowerPoint form, a large quantity of data on systems around the world.

Continuing my education in international comparative health policy...

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Health Blog : Changes Brewing on Capitol Hill for Health Insurance

Health Blog : Changes Brewing on Capitol Hill for Health Insurance:

"Next year could see the biggest push in more than a decade to transform how health insurance works in this country. Obama and McCain have both proposed significant changes, and the Democrats just hammered out a platform plank that says the party is “united around a commitment to provide every American access to affordable, comprehensive health care.”

Meanwhile, Congress is busy hatching its own plans.

During the Health Blog’s recent field trip to DC, we spoke with Sen. Ron Wyden, an Oregon Democrat who’s pushing a health reform bill that would make some big changes to the system.

The bill, known as the Healthy Americans Act, would require everyone to buy health insurance. But instead of sending a check to the insurance company, the premium for basic coverage would be tacked onto your federal income tax. You’d choose from health plans offered by private insurers in your state or region. If you wanted to buy a plan
that covered more than the basics, you’d pay extra.

There’s a lot more to it than that (including various taxes and subsidies), but those are the basics. You can read the whole bill for yourself here."

We've noted this before, but it really seems we may be acheiving critical mass/crisis for big change to occur...

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Health Benefits Inspire Rush to Marry, or Divorce -

Health Benefits Inspire Rush to Marry, or Divorce -

"More than romance, the couple readily acknowledge, it is Mr. Huggins’s Blue Cross/Blue Shield HMO policy that is driving their rush to the altar."

These articles on the financial burdens of health insurance and health care are easy enough to find, and frankly, I don't even think the most dyed-in-the-wool advocates for the status quo argue about this anymore.

So, I think I'll sort of retire this category for a while and not post any further on it...

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Health Blog : Safety Net Frays as Hospitals Shift Resources From Poor

Health Blog : Safety Net Frays as Hospitals Shift Resources From Poor:

"An increase in the number of uninsured patients and competition from well-heeled hospitals is putting pressure on safety net hospitals to reduce services for the poor, according to a report by the Center for Studying Health System Change published online today in the journal Health Affairs. [cmhmd:requires subscription]

The analysis, taken from the Center’s ongoing survey of 12 metropolitan areas, comes as nonprofit hospitals are under increasing scrutiny for the amount of free care they provide for the poor. Some critics charge nonprofit hospitals enjoy billions of dollars in tax exemptions without providing offsetting amounts of charity care."

And yet, if you ask the typical advocate for the status quo, we have no access problems, no rationing of healthcare here in the US.

Go to the WSJ blog for the rest, it covers things nicely.

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Friday, August 8, 2008

Public Views on U.S. Health System Organization: A Call for New Directions

Public Views on U.S. Health System Organization: A Call for New Directions:


On behalf of The Commonwealth Fund Commission on a High Performance Health System, Harris Interactive surveyed a random sample of 1,004 U.S. adults (age 18 and older) to determine their experiences and perspectives on the organization of the nation's health care system and ways to improve patient care. Eight of 10 respondents agreed that the health system needs either fundamental change or complete rebuilding. Adults' health care experiences underscore the need to organize care systems to ensure timely access, better coordination, and better flow of information among doctors and patients. There is also a need to simplify health insurance administration. There was broad agreement among survey respondents that wider use of health information systems and greater care coordination could improve patient care. The majority of adults say it is very important for the 2008 presidential candidates to seek reforms to address health care quality, access, and costs."

Click on the link to dig into the details...

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Wednesday, August 6, 2008

Coverage & Access | NPR Series Examines Health Care Systems in Five European Nations -

Coverage & Access NPR Series Examines Health Care Systems in Five European Nations -

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Megan McArdle (July 31, 2008) - Save a dollar or save a life: choose one.

Megan McArdle (July 31, 2008) - Save a dollar or save a life: choose one.

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AMA president-elect sees more stresses on stressed-out system

AMA president-elect sees more stresses on stressed-out system: "What is the AMA's position on nationalized health care or having the government be the single payer for health care?
(The AMA's concern has been), if you had the federal government paying, you would have the federal government deciding, and patients would no longer have a choice. ... The AMA supports everyone having health insurance, but not that the government is a single payer. You need to change the tax code so that as an individual you get the same tax benefit as the employer. If you make more than $100,000, you should be required to purchase your own health care insurance ... and if not, you have a tax liability. If you make below $100,000, you get a tax credit ... to purchase your health insurance."

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Monday, August 4, 2008

AMNews: June 23/30, 2008. What's in their wallets? Health plan executives bring home the bucks ... American Medical News

AMNews: June 23/30, 2008. What's in their wallets? Health plan executives bring home the bucks ... American Medical News:

"In its analysis of S&P 500 companies, Equilar found median total compensation for the CEOs was $8.8 million. The six publicly traded health plans that are a part of the S&P 500 index all paid their CEOs more than that median: from $9.1 million for WellPoint's Angela Braly to $25.8 million for Cigna's H. Edward Hanway. The highest-paid executive in the S&P 500 2007 was John Thain, CEO of Merrill Lynch, who took home $83.8 million, most of it in stock options and stock awards granted at his hiring last year, Cwirko-Godycki said.

Of the largest publicly traded health plans, only Health Net's Jay M. Gellert was below the median, at $3.7 million. His company is not part of the S&P 500.

Heidi Toppel, JD, senior executive compensation consultant for human resources consulting firm Watson Wyatt, said health plan CEOs' pay isn't out of line by Wall Street standards. 'I would not consider the levels of pay to be stratospheric,' she said.

But she and other experts acknowledge that pay is a thorny issue for health plans, particularly as physicians question why their reimbursement should be under pressure and why they need to jump through hoops to get care paid for while health plan executives take home large paychecks."

So what is the usual, customary and reasonable compensation for limiting healthcare access and reimbursement?

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