A Direct Primary Care Medical Home: The Qliance Experience

Crooks and Liars » 60 Minutes: Charity Trying To Make Up For Failing U.S. Health Care System

“If you’re looking for a story that shows the abysmal state of health care in America, look no further. 60 Minutes traveled to Knoxville, TN to film a free clinic set up by a charity group called Remote Area Medical Volunteer Corps, or RAM. The charity was initially started in the 90’s by it’s founder, Stan Brock, former co-star of Wild Kingdom, to give health care relief to remote areas of Latin America, but after watching this segment it’s clear that America’s health care system doesn’t look too much different than that of a third world country.”

The video of the 60 Minutes story is available for viewing at the C&L site and it is definitely worth watching, if only to count the thousands of anecdotes available for those who like that sort of thing.

In a related anecdote, a patient I saw today with (now) advanced lung cancer, who had this gem in his history and physical: “He developed severe, unremitting left sided chest pain beneath his clavicle and along his left anterior chest about 4 to 5 months ago. He did not seek medical attention due to lack of health insurance.”

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…

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…

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)

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!

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…

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…

WSJ.com – 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.

Cheers,

Crooks and Liars » Nataline Sarkisyan passes away. Shame on Cigna!

Crooks and Liars » Nataline Sarkisyan passes away. Shame on Cigna!: “We [Crooks & Liars] posted this story yesterday with an update to the heartbreaking result. While battling CIGNA for a new liver, her family and friends fought and protested until CIGNA finally gave in, but it was too late—the seventeen-year-old Nataline Sarkisyan died.”