Author: cmh

Drug Company Payments to Doctors | Dollars for Docs – ProPublica

Drug Company Payments to Doctors | Dollars for Docs – ProPublica: “Drug companies have long kept secret details of the payments they make to doctors for promoting their drugs. But eight companies have begun posting names and compensation on the Web, some as the result of legal settlements. ProPublica compiled these disclosures, totaling $320 million, into a single database that allows patients to search for their doctor. Receiving payments isn’t necessarily wrong, but it does raise ethical issue”

ProPublica has many more articles on the influence of Pharma money on medicine at this link.

Financial Ties Bind Medical Societies to Drug and Device Makers – ProPublica

Financial Ties Bind Medical Societies to Drug and Device Makers – ProPublica:

“SAN FRANCISCO — From the time they arrived to the moment they laid their heads on hotel pillows, the thousands of cardiologists attending this week’s Heart Rhythm Society conference have been bombarded with pitches for drugs and medical devices.

St. Jude Medical adorns every hotel key card. Medtronic ads are splashed on buses, banners and the stairs underfoot. Logos splay across shuttle bus headrests, carpets and cellphone-charging stations.”

Coal Cares: Who needs Global Warming?

Coal Cares:

“Why Free Inhalers? Because COAL CARES.

Coal Cares™ is a brand-new initiative from Peabody Energy, the world’s largest private-sector coal company, to reach out to American youngsters with asthma and to help them keep their heads high in the face of those who would treat them with less than full dignity. For kids who have no choice but to use an inhaler, Coal Cares™ lets them inhale with pride.

Puff-Puff™ inhalers are available free to any family living within 200 miles of a coal plant, and each inhaler comes with a $10 coupon towards the cost of the asthma medication itself.

This reminds me of the advice Jim Carey gave his client in “Liar, Liar,” “Stop polluting the air, a******!”

President Lyndon B. Johnson’s Remarks With President Truman at the Signing in Independence of the Medicare Bill July 30, 1965

President Lyndon B. Johnson’s Remarks With President Truman at the Signing in Independence of the Medicare Bill July 30, 1965:

“This is an important hour for the Nation, for those of our citizens who have completed their tour of duty and have moved to the sidelines. These are the days that we are trying to celebrate for them. These people are our prideful responsibility and they are entitled, among other benefits, to the best medical protection available.

“Not one of these, our citizens, should ever be abandoned to the indignity of charity. Charity is indignity when you have to have it. But we don’t want these people to have anything to do with charity and we don’t want them to have any idea of hopeless despair.”
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“Many men can make many proposals. Many men can draft many laws. But few have the piercing and humane eye which can see beyond the words to the people that they touch. Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of healing to the old and to the poor. And fewer still have the courage to stake reputation, and position, and the effort of a lifetime upon such a cause when there are so few that share it.

“But it is just such men who illuminate the life and the history of a nation. And so, President Harry Truman, it is in tribute not to you, but to the America that you represent, that we have come here to pay our love and our respects to you today. For a country can be known by the quality of the men it honors. By praising you, and by carrying forward your dreams, we really reaffirm the greatness of America.

“It was a generation ago that Harry Truman said, and I quote him: “Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.”

“Well, today, Mr. President, and my fellow Americans, we are taking such action–20 years later.”
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“And through this new law, Mr. President, every citizen will be able, in his productive years when he is earning, to insure himself against the ravages of illness in his old age.”
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“I said to Senator Smathers, the whip of the Democrats in the Senate, who worked with us in the Finance Committee on this legislation–I said, the highest traditions of the medical profession are really directed to the ends that we are trying to serve. And it was only yesterday, at the request of some of my friends, I met with the leaders of the American Medical Association to seek their assistance in advancing the cause of one of the greatest professions of all–the medical profession–in helping us to maintain and to improve the health of all Americans.

“And this is not just our tradition–or the tradition of the Democratic Party–or even the tradition of the Nation. It is as old as the day it was first commanded: “Thou shalt open thine hand wide unto thy brother, to thy poor, to thy needy, in thy land.”

“And just think, Mr. President, because of this document–and the long years of struggle which so many have put into creating it–in this town, and a thousand other towns like it, there are men and women in pain who will now find ease. There are those, alone in suffering who will now hear the sound of some approaching footsteps coming to help. There are those fearing the terrible darkness of despairing poverty–despite their long years of labor and expectation–who will now look up to see the light of hope and realization.

“There just can be no satisfaction, nor any act of leadership, that gives greater satisfaction than this.”

The Waiting Times Myth

The Incidental Economist Blog started talking about wait times this past week, and has several interesting posts on the topic here, here, and here. I won’t reiterate them, they speak (well) for themselves. The bottom line is that we aren’t really any great shakes with our wait times and access to care, we spend way too much time and money and use too much of our work force doing expensive procedures when we should be concentrating on primary care and reducing the need for all of those heroics. The US supply of physicians vs. specialists is inverted from high performing health systems where most doctors provide primary care.

Given this background, here’s my take.

When I discuss health care reform with friends, families, colleagues, or in public, the two most pervasive myths about health care outside the US are that in every other country, care is inferior and rationing is accomplished by intolerable waiting times. As I endeavor to dispel these myths, I am invariably told an anecdote about a person who died in Canada or England awaiting some procedure or other.

Dispelling these myths is two-fold: first, pointing out the rationing that occurs in America either by private health insurers or by lack of wherewithal to afford services, and second, by pointing out that there are more health care systems than “ours” and “theirs.”

Given that an estimated 45,000 Americans are estimated to die every year due to lack of access to health care services , rationing in America is particularly troublesome, and oddly overlooked. There are many reasons for this, but mostly it is the lack of drama and, paradoxically, the pervasiveness of this experience, especially to those of us in health care. Anecdotes are powerful things, and so I have to always tell a few of my own to counter the horror stories they’ve heard about other countries. So, a few cases of my own: a man who puts off seeing a doctor (for what he knows is diabetes), ends up in the ICU critically ill, because he is trying to get on a health insurance plan and hopes he won’t be found out; a down-sized engineer with a year long persistent cough and weeks of coughing up blood, who waits until he is near death to come to the hospital because he can’t afford to see a doctor; and finally a young man with a seizure disorder admitted twice to the ICU for unremitting seizures in just a few months because his neurologist won’t see him because he’s been underemployed and couldn’t pay his last bill. Multiply my stories by nearly a million physicians in America and you see the magnitude and pervasiveness of the problem.

Beyond anecdotes, there is actual data, such as the Commonwealth Fund study showing that “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.” Additionally, Americans are less likely 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. In another report, the Commonwealth Fund has shown the US ranks 19th out of 19 countries evaluated on preventing deaths that are amenable to adequate health care, an excellent measure of the overall performance of a country’s health care system.

That there is more than one country outside the US with a unique health system, might surprise some whose rhetoric suggests a vast wasteland of a series of Soviet style medical gulags. OECD data shows (Siciliani, 2003) that waiting times are a problem in some countries, but only about half of those in the OECD. The others are like the United States in lack of significant waiting times, but unlike us they manage to do this with their entire population covered, and at significantly lower costs.

Now, let’s do a little thought experiment. Say you are in a country that has relatively high waiting times for elective procedures, say Canada (but not England so much any more!). Take one sixth of your population and deny them access to care because, oh, they don’t deserve it. What do your waiting times look like now? Take another sixth or so, and tell them they have to choose among school, dental care, glasses, food OR preventive health care. Or even life saving health care. OK, now how are your queues?

Americans ration, all right. It is unbecoming, to say the least. It is leaving people to slowly die, to be more blunt. It is under the radar for most, but not for us, not for the millions of care givers and social workers and nurses and parents and children who have to bear witness.

That Government Takeover Thing

[Cross posted from Doctors for America Blog.]

As many of us in DFA know, one of the more fevered arguments against the PPACA, both before and after its passage, was the cri de guerre, “It’s a government takeover of health care!”

This argument left me often fumbling for an answer. I know enough about international health care, and enough about our true homegrown versions of government health care (the VA, TriCare, the Indian health Service) to know that PPACA ain’t it. Not even close. Trying to explain the difference among single payer systems and true government runs systems and private but universal systems, did not cut the mustard (or get through the neural programming, George Lakoff would say). “Obamacare” was a government takeover, and I was just a dupe if I couldn’t see it.

Apparently, the answer was in plain sight, and I just was not aware of it. While researching another topic, Google took me to an interesting, but very public place that I had overlooked before. It is on the GOP.gov web site from over a year ago, and billed as “Courtesy of the Senate Republican Policy Committee”:  159 Ways the Senate Bill Is a Government Takeover of Health Care

As you scroll through the list, you might get the feeling that every single line in the bill represents a fundamental alteration in health care as we know it, changing our current “system” into some form of crypto-socialist mockery of the free market system we’re all so pleased with. I guess a conservative minded person might indeed scroll through all of these initiatives and gasp in horror, but as I read through it, it seems like a very good list for us to trot out and show all of the good stuff actually in the bill!

The idea that various projects and initiatives to promote administrative simplification on insurance claims, to promote quality of care in the Medicaid program, to promote Patient Centered Medical Homes,  grants to support physicians and others entering primary care and geriatrics, to develop quality measures, to figure out how to align payment incentives to promote the best patient care, and on and on, that these somehow represent a sinister plot requires epic, delusional almost, paranoia.

One of our kids’ favorite books growing up was “A House is a House For Me.” It was a delightful exploration of how, when looked at with the appropriate viewpoint, everything was a house: a sock for a foot, a shell for a hermit crab, or a tree for a monkey.

So, in the minds of the GOP Senate Republican Policy Committee, any law or regulation or initiative, can be a “government takeover.” This is not new, of course, Ronald Reagan famously opposed Medicare as the clear path to Soviet style communism, and the John Birchers, now resurgent, thought former Supreme Allied Commander and then President of the United States Dwight Eisenhower was a Soviet agent. The difference now is that this is mainstream political rhetoric, even articles of faith, in many circles.

So, in our new book, “A Regulation is a Government Takeover To Me!” we will explore how there are really no legitimate functions of government, Constitution notwithstanding. Protecting air and water safety is a government takeover of drinking and beathing,  food safety rules are takeovers of eating, and promoting homework and hard work in school is a takeover of parenting. See how that works? Although, I understand that all limitations of birth control and sex education are intrinsically appropriate uses of government.

What Would Jefferson Do?…Dissent Magazine

Dissent Magazine – What Would Jefferson Do? How Limited Government Got Turned Upside Down

Surveying the wreckage of the Great Depression,
Roosevelt simply told his followers that “the average man once more confronts the problem that faced the Minute Man,” because “[a] small group had concentrated into their own hands an almost complete control over other people’s property, other people’s money, other people’s labor—other people’s lives.”

Roosevelt’s analysis of “economic tyranny” shared a critical assumption with Thomas Jefferson and James Madison and other important founders of our country: that limited government is not an end itself, but the instrument of a particular vision of society, an egalitarian vision. It was a social vision in which extremes of wealth and poverty did not exist, and a relatively equal distribution of productive property secured independence and freedom for the whole citizenry.

As historian James L. Huston writes, it was against the “political economy of aristocracy,” government organized by and for a small, wealthy elite, that supporters of the American revolution embraced the “egalitarian promise of the negative state.” The ideal, simply, was a system that restricted the legal and political power of the wealthy, in order to prevent them from combining against independent smallholders and those without property. Limited government, in other words, was a “populist” ideal, a doctrine of the many versus the few. As a group of North Carolina democrats petitioned in 1776, when “fixing the fundamental principles of Government,” the goal should be to “oppose everything that leans to aristocracy or power in the hands of the rich and chief men exercised to the oppression of the poor.”
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Clearly, for Jefferson and Madison (as for Taylor), the republican social objective of securing a relatively equal distribution of productive property was paramount in their thinking about what government should or should not do.
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OK, just go read it already!………………………

Will Record Surpluses Among Not-for-Profit Blues Plans Trigger Price Wars in 2011? (with Table: Not-for-Profit Blues Plans Hold $27 Billion in Excess Capital) | AIS Health

Will Record Surpluses Among Not-for-Profit Blues Plans Trigger Price Wars in 2011? (with Table: Not-for-Profit Blues Plans Hold $27 Billion in Excess Capital) | AIS Health:

 “Record surpluses amassed by not-for-profit Blue Cross and Blue Shield plans during the first nine months of 2010 could be used to price products more aggressively next year. And that could put pressure on competitors to hold down their rates or risk losing market share, according to one equities analyst. But other industry observers tell HPW that Blues plans are more likely to hold onto their surpluses due to increased regulatory scrutiny over rate hikes and the unknown financial impact of the health reform law.”

I mainly put this here to remind me of the Medical Loss Ratio implications of PPACA, specifically the minimum requirements coming into effect this year. The fact that NOT FOR PROFITS don’t meet these standards voluntarily, eagerly and easily tells you almost all you need to know about our broken system, but go to the link and scroll down and see the MASSIVE financial reserves these guys are amassing.