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!

Postbulletin.com: If you want great care, don’t put government in charge – Wed, Aug 8, 2007

Postbulletin.com: 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, http://www.galen.org/.


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.


Same.


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.


Hahahahahahahahahahahahahaha!

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.

From BibleGateway.com: The Sheep and The Goats

BibleGateway.com: 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?

I do not think it means what you think it means…

Was Adam Smith really a promoter of greed?




An excellent book chapter giving a more complete picture of Adam Smith’s economic and moral philosophy that is not as conservatives would have you believe. Greed is not good. Laissez-Faire is not absolute.

“In reality, as Adam Smith argued, one of the main functions of government, beyond that of securing the order that allows markets to operate effectively, is that of intervening to ensure that the unwarranted excesses of commercial society do not entirely destroy the social order or the moral foundations of behaviour. As we have seen in his arguments regarding the role of publicly funded education in redressing the worst of the degrading and demoralising effects of the division of labour and reducing the possibility of revolutionary protests against an unjust social order, Smith argued that in effect ‘…the visible hand of the state would counteract the potentially stultifying effects of the invisible hand of the market’ “

Martin | Fletcher

Martin Fletcher: It Pays to Be in Healthcare: Leading Recruiting Firm Releases Physician, Nurse & Allied Health Compensation Reports

“Among physicians, Martin, Fletcher evaluated more than 3,500 individuals’ salaries across 17 medical specialties. The top five paying specialties are:
Position/Average/Median
Cardiology (invasive)/$460,000/$440,000
Radiology/$425,000/$392,700
Orthopedic/$424,000/$383,000
Gastroenterology/$405,000/$368,000
Urology/$380,000/$325,520

According to Martin, Fletcher research, the lowest paying positions among physician specialties surveyed include: family practitioner, internal medicine, pediatrics and hospitalist, with median salaries ranging from $146,260 to $170,980. The top three incentives used by medical groups to recruit physicians include: production-driven incomes starting year one, buy-in based on A/R and full pension for retirement.”

The full report is here.

It’s worth keeping an eye on this data as the debate continues…

‘Sicko’: Heavily Doctored, By Kurt Loder – Movie News Story | MTV Movie News

‘Sicko’: Heavily Doctored, By Kurt Loder – Movie News Story MTV Movie News: “Jun 29 2007 12:34 PM EDT
‘Sicko’: Heavily Doctored, By Kurt Loder
Is Michael Moore’s prescription worse than the disease?”

I think the chief straw man Loder has thrown up here is that Moore holds up the Canadian, French or British systems as “utopia,” to use his word. SICKO showed some of the serious flaws in our system and showed some of the serious benefits to others. That really is the bottom line. I’ve been following the media coverage closely, interviews with various experts, MM himself in interviews, etc. There are lots of complaints about what he “left out.” Well, it’s only a two hour movie and I think it is not his job nor his role to be the health care czar and review every nuance of health care here and abroad. He had a lot of points to make and he made them very well, very humorously and sometimes heart-breakingly poignantly. If you see it, you’ll know that he didn’t tell the downsides of universal access in other countries, but, frankly, as we health care providers know (I’m a critical care physician) better than the average viewer, neither did he scratch the surface of the problems so widespread in our “system.” But he always says in interviews that of course other systems have problems. Our goal should be to take the best parts of each of those systems and craft an American system better than all the others. But, he makes no bones that this needs to be a single payer system at its core. He seems to have no bone to pick with physicians – he believes the focus of reform should be getting rid of private health insurance as we know it.
And finally, if you want to make the debate solely on health care horror anecdotes, you’ll lose. Badly.
Cheers,

Doing Battle With the Insurance Company in a Fight to Stay Alive – New York Times

Doing Battle With the Insurance Company in a Fight to Stay Alive – New York Times: “Obstacles to Care
Doing Battle With the Insurance Company in a Fight to Stay Alive “

Thank goodness we don’t ration care here in the good ol’ US of A!

Doctors – Managed Care and Health Insurance – Medicine and Health – Wages and Salaries – New York Times

Doctors – Managed Care and Health Insurance – Medicine and Health – Wages and Salaries – New York Times:

Argues that physician income is a major problem in the US health system crisis, as here:

“Doctors in the United States earn two to three times as much as they do in other industrialized countries. Surveys by medical-practice management groups show that American doctors make an average of $200,000 to $300,000 a year. Primary care doctors and pediatricians make less, between $125,000 and $200,000, but in specialties like radiology, physicians can take home $400,000 or more.
In Europe, however, doctors made $60,000 to $120,000 in 2002, according to a survey sponsored by the British government in 2004.”

Interestingly, according to Canadian Statistics, we’re not so different.
Click on the link, and the tables reporting what physicians in Canada receive from Canadian Medicare start on page 28. And no, I’m sorry I don’t have the data on their overhead, actual take home or hours. If YOU do, send me the link, please!

BTW, I will not argue that there is an unconscionable discrepancy in income among the procedure-based specialties and other physicians in the US.

Cheers!

Lebanon Daily News – When it’s free, health care really costs

Lebanon Daily News – When it’s free, health care really costs

Dismembering a typical philistine, pig-ignorant op-ed (apologies to John Cleese)

When it’s free, health care really costs
Editor:
Lebanon Daily News

The presidential candidates, the media and some local misguided souls have been turning up the rhetoric supporting universal or single-payer health care while cautiously avoiding the truth that such systems are simply socialized medicine.
Part I: Invoke socialism bogey-man. Betrays common ignorance of all right-wingers in not understanding the difference between ‘socialized medicine’ and single-payer systems. Also fails to understand that in the context of health-care, we all wish to have basic healthcare for ourselves, our families, and, I hope, if one claims some basic humanistic/Christian/Islamic/Jewish/Hindi/Buddhist/whatever qualities, for the ‘least among us.’ That means poor and lower income and those with previously diagnosed health conditions (for the empathy impaired).

Socialized medicine does not work anywhere.

Part II: Ignore all evidence to contrary of your opinion. Ignore OECD, Commonwealth fund, essentially all scientific literature on the topic.

It never has, and by it’s very structure, it never will. When I use the word “work,” I mean it in the context of providing what we have in the U.S. — the finest health care in the world.

Part II, again. Ignore all overwhelming evidence to the contrary. I’ll try to link back to evidence soon.

Hundreds of thousands of people come to our country for their health care every year because what they need is not available where they live.

I don’t think some Saudi and UAE princes count as hundreds of thousand. And they come for what is right about American medicine: the high tech, cutting edge care that cannot be BOUGHT elsewhere. That is, they can’t jump the line elsewhere, like they can here.

Certainly we have problems in our current system, but the problems are fixable if all the parties in the system will step up to their part of the problem. Some uninformed people cite the insurance companies as the single problem in our health-care system. While insurers certainly are a part of the problem, they are no more of a problem than are the providers themselves. The cost of repairing botched surgeries, medical errors, hospital-based infections, allowing medical providers who have lost their license in another state to be licensed in Pennsylvania, overutilization, underutilization and a general unwillingness to purge their ranks of known, bad providers, contributes as much or more to the cost of health care as does the “greedy” insurance industry, and every honest medical provider knows it. It’s time to stop the blame game and get on with solutions.

I’m an honest medical provider, and the writer is wrong. The litany he lists all need fixed, but will be much easier to fix in a properly funded single payer system. And, sorry, the for-profit system, the same unrestrained, repugnant greed-based system that led to Enron, Tyco, and a two billion dollar surplus for Highmark alone, is by far the biggest problem.

To cite the one-sided propaganda film “SiCKO”as beneficial because it stirs debate on health care is like endorsing communism because it will make our citizens more patriotic. It’s sicko logic.

SICKO showed some of the serious flaws in our system and showed some of the serious benefits to others. That really is the bottom line. I’ve been following the media coverage closeely, interviews with various experts, MM himself in interviews, etc. There are lots of complaints about what he “left out.” Well, it’s only a two hour movie and I think it is not his job nor his role to be the healthcare czar and review every nuance of healthcare here and abroad. He had a lot of points to make and he made them very well, very humorously and sometimes heart-breakingly poignantly. If you see it, you’ll know that he didn’t tell the downsides of universal access in other countries, but, frankly, as we healthcare providers know better than the average viewer, neither did he scratch the surface of the problems so widespread in our “system.” But he always says in interviews that of course other systems have problems. Our goal should be to take the best parts of each of those systems and craft an American system better than all the others. But, he makes no bones that this needs to be a single payer system at its core. He seems to have no bone to pick with physicians – he believes the focus of reform should be getting rid of private health insurance as we know it.

I urge everyone to see it. It engenders debate, not just about healthcare, but about who we are as a people. Are we, as Americans, about “me” or “we”? That really is the central question he asks.

For the truth about how socialized medicine does not work, go to http://www.fraserinstitute.ca/ and click on “health.” Several interesting reports are available online, but the report entitled “Paying More, Getting Less” is particularly revealing. The Fraser Institute is an independent Canadian research organization and is the only source of accurate statistics on wait times and the status of their failing system of health care.

The Fraser Institute is as reliable as the Cato Institute, the American Enterprise Institute and every other right-wing “think-tank” From Nick Scala, of Physicians for a National Health Plan ( pnhp.org)

“…data supplied by the Fraser Institute, an ultraconservative PR firm that masquerades as a legitimate research institution. Dr. Robert McMurtry, the Canadian orthopedic surgeon who is a former dean of a Canadian medical school and served on the national waiting times commission tells me that not even the right wing Canadians take them seriously. Their “scientific” method of determining wait times consists of bulk-mailing a list of pro-privatization physicians and asking them how long they think their patients will have to wait to see them. If they return the mailing they are entered in a drawing to win a $2,000 cash prize. It’s pathetic. Unsurprisingly, Fraser comes up with outrageous waiting time estimates (17.8 weeks last year, as I recall), and is quite adept at publicizing them in the American media. Wait times are scientifically measured every year by Statistics Canada (the counterpart to the U.S. Census Bureau). I’m sure most Americans would be surprised at the results of scientific measurement: In 2005, median wait times were 4 weeks for elective surgery, 4 weeks for specialist care, and 3 weeks for diagnostic tests.

http://www.statcan.ca/Daily/English/060131/d060131b.htm

Also, the Canadian Health Services Research Foundation has done a short, scholarly critique of Fraser’s methods and compared them with real studies. (In fact, I think they’re far too kind to Fraser).” (Thanks, Nick!)

If you think health care is expensive now, wait until you see what it costs when it’s free.

Final bit, trot out a really stupid, non-sensical cliche. We spend nearly twice as much per capita as every other western country, and we’re supposed to worry about “what it costs when it’s free?”

Stan Alekna, Cornwall

Sorry, Stan, but that is a really lame rehashing of right-wing garbage that does not stand up to even mild critical analysis.

Christopher M. Hughes, MD