delawareonline ¦ The News Journal, Wilmington, Del. ¦ Patient increase, limited medical school slots make seeing doctor tougher to do

delawareonline ¦ The News Journal, Wilmington, Del. ¦ Patient increase, limited medical school slots make seeing doctor tougher to do:

“Some doctors say the problem lies not with a doctor shortage, but with an uneven distribution of MDs. New doctors gravitate toward more lucrative specialties, such as sports medicine. Specialties that require surgery, such as ophthalmology, also attract doctors because Medicare and insurers reimburse surgical procedures at a far higher rate than evaluations. Cooper said young doctors are turning to these profitable specialties at the expense of Medicare patients, who largely suffer from diabetes and arthritis and are in need of endocrinologists and rheumatologists. Medical school students also may be dissuaded from primary care. Dr. David Krasner, who works at Family Practice Associates in Wilmington, said the existing reimbursement system pays too little for cognitive evaluations by primary care physicians. ‘For physicians to go into primary care in this day and age, it’s akin to committing financial suicide,’ he said. ‘The shortage in my opinion won’t get better until Medicare changes the way it reimburses.'”

Please click on some of the tags below: physician income, in particular to learn more about this topic…

Insurance provider lowers physician reimbursements while earnings grow 08/19/07 – LubbockOnline.com

LubbockOnline.com – Insurance provider lowers physician reimbursements while earnings grow 08/19/07:

“Although it is a not-for-profit company, Health Care Service’s bottom line continues to rise at a rapid rate. According to Laura B. Benko of Modern Healthcare, in 2005 Health Care Service Corp recorded its fourth consecutive year of earnings growth, ‘posting net income of $1.15 billion on $11.7 billion in revenue. Its total surplus was $4.3 billion, up 47 percent from 2004 and 227 percent from 2000.’ Ms. Benko points out the company’s president and chief executive officer, Raymond McCaskey, received $6 million in salary, bonuses and other compensation in 2005. I believe some of the millions of dollars the residents of this area pay in premiums to Blue Cross would be put to better use by the healthcare professionals in our community.”

Non-profit for whom?

NEJM — Healing Our Sicko Health Care System

NEJM — Healing Our Sicko Health Care System:

“To get around this catch-22, we will need populist anger but also
political foresight. Moore heads abroad to show us that a single public insurer
is the only hope. But one need not travel to Canada, the United Kingdom, or
France (much less Cuba — Moore’s most dubious destination) to see the virtues of
combining universality with public cost control. Medicare, our country’s most
popular and successful public insurance plan, covers everyone older than 65 and
people with disabilities — groups with great need for coverage and little
ability to obtain it privately. Yet it has controlled expenses better than the
private sector, spends little on administration, and allows patients to seek
care from nearly every doctor and hospital. For some reason, Moore ignores
Medicare. He talks about the post office, the fire department, public education
— but not the one public program that most resembles the ‘free universal health
care’ he extols.

“That’s too bad, because the Medicare model is the not-so-secret
weapon in the campaign for affordable health care for all. Today, many advocates
of national health insurance have wisely started calling for ‘Medicare for All’
rather than their old rallying cry, ‘Single Payer.’ But moving to a national
insurance plan overnight, whatever the label, means threatening the private
coverage on which so many Americans rely and requiring our cash-strapped
government to raise the highly visible taxes necessary to fund a system now
financed largely by the hidden drain on workers’ paychecks. We may be moving
toward the day when we are ready to clear these hurdles in one leap, but we are
not there yet. “

A fairly reasoned discussion in all, but we need leadership of the RFK variety:

“There are those that look at things the way they are, and ask why? I dream of things that never were, and ask why not? “

(Okay, wikiquote says he lifted that from GB Shaw, but, same spirit.)

An unhealthy health care plan

I only link to mock…An unhealthy health care plan — The Washington Times, America’s Newspaper By Robert Goldberg (vice president of the Center for Medicine in the Public Interest)
Pablo Picasso observed, “To copy others is necessary, but to copy oneself is pathetic.” Is anyone more pathetic than Arnold Relman, the former editor of the New England Journal of Medicine, who continually writes about why America should adopt the Canadian health care system? There is. It’s Arnold Relman himself, writing in Canada about why Canadians shouldn’t abandon the Canadian health care system. In this case, it’s Mr. Relman in the Toronto Globe and Mail opposing the Canadian Medical Association (CMA) proposal to “allow physicians to bill patients (or private insurance plans) for services that are covered by Medicare, and allowing Medicare to purchase covered services from for-profit private facilities.” The goal of the CMA plan is to allow people a chance to get medical care when they need, not when the government sees fit to provide it. Canada has pumped billions of dollars into its system to reduce waiting times for specialty services, cancer care, first-time health visits and emergency rooms.

Here’s the link to the article by Relman. Dr. Relman’s piece speaks for itself.

But according to Health Canada and the independent Frasier Institute the waiting times and shortages have gotten worse.

Please see this previous post to read why you should discount anything from Fraser, and yet recognize that Fraser is a pernicious force to be watched and refuted at every opportunity.

In a recent incident, a child with a brain tumor headed to the states to get a MRI because he would have had to wait four months in Canada. His family paid cash because Health Canada refused to cover the cost. Mr. Relman’s response? He urges Canadians to “avoid exploitation by those who would like to make profits from publicly funded health care. Canadians should not follow Americans down the path to greater privatization.” The kid should die for the greater glory of socialized medicine rather than pay cash and line the pockets of profit hungry docs in America. Groucho Marx once observed, “Who do you believe? Me or your eyes?” Our eyes tell us that here and abroad government run and financed health care stinks.

Welcome to another episode of “Anecdote-Off”, the great justifier of all things wrong in the US sytem if you believe people like this. As I’ve said many times before, if you want to debate this by anecdote, the US loses. Badly.
For waiting times,
go here.

Price controls cause shortages of doctors in the UK that in turn are filled by waiving immigration regulations that allow neurologists with bomb-making skills into the National Health Service (NHS).

Good thing we don’t allow ferners to practice medicine here.

In the United States, restrictive formularies and cookbook approaches to care have undermined mental health treatment for soldiers returning from Iraq.

Got that backwards.

Medicaid reimbursement levels have increased waiting times and caused millions of children to seek care in emergency rooms.

Because we underfund Medicaid and the economics of reimbursement of course cause providors to scurry for the hills. How is this an argument against single-payer?

Meanwhile SCHIP — 10 years after its enactment — has failed to enroll 3-out-of-5 Medicaid eligible children in private health care plans and access to care has barely increased.

Again, how does this support an argument against universal healthcare? It’s an argument against the stupid patch-work non-system we have here in the US, I agree.

Incredibly, Mr. Relman claims that’s just a sign free market health care does not work and does not care about people. Enlighten us Arnie, how are the two connected?

Because the patch-work “free market” mess we have here does not work. Clearly Mr. Goldberg has never actually seen patients or been responsible for providing healthcare in this disaster we work in. When funded properly and overseen appropriately and by giving doctors the ability to provide care as they see fit (as opposed to insurers or underfunded goverment programs), a single payer system can not possibly be worse that what we have now. Unless someone puts the Republicans in charge of it. Then, watch out, Brownie will be in charge!

“Physicians in our commercialized, profit-driven system tend to gravitate toward the highly paid specialties, so we now face a major shortage of primary-care doctors.” Well, we know how flush the NHS is with well-trained terrorists — I mean family doctors. What about Canada? It turns out the College of Family Physicians of Canada found that 17 percent of Canadians didn’t have a family doctor because of a primary care physician shortage. Two million of the Canadians that Mr. Relman wishes to deny free choice of care to have attempted to find a family physician in the past year, but have failed. In the U.S., we have a market-based response to the problem.

OMG! 17% don’t have a PCP. I’ve got an idea, let’s take insurance away from 1/6 of Candians and underinsure another 1/6 so they can’t afford a PCP visit, and see what happens to that shortage. The free-market will get rid of those whiners!

A rapid expansion of retail health clinics in the United States is taking place in what the Department of Health and Human Services has designated as medically underserved areas. Take MinuteClinics, a division of the drugstore chain CVS, which offers walk-in health care centers for common medical problems such as strep throat, sunburn, mono, flu, ear infections and sinus infections, and offer vaccinations, checkups, etc. People can pay cash or use their regular insurance.

“People can pay cash or use their regular insurance.” Hahahahahahah!

And will Mr. Goldman and his family use this service? Of course not, because they have good insurance.

Most visits are 15 minutes or less with no appointment needed. In many cases, MinuteClinics are often affiliated with local hospital or physician practices, and will refer customers to a primary care doctor if they don’t have one. Additionally, the center generates an electronic medical record that customers and doctors can access through the phone, fax or Internet. There are 200 MinuteClinics across America. Most are in federally designed medically underserved areas providing immediate care, referrals and electronic medical records for about $50 per person. Other private companies are involved in this trend as well and have been joined by the American Academy of Family Physicians in an effort to improve access to health care for millions Americans.

Well, let’s take it a step further and have us (by us, I mean the U.S., our government) fund such a system. And that way, when the patient is referred to a PCP, the patient will be able to actually go to the PCP without choosing between healthcare and something else.

Meanwhile, as the marketplace makes medical care more accessible in America …

…still can’t get that idea that it should be universal rather than just “more accesible”…

Mr. Relman is telling Canadians, “One thing is certain. If medical care and health insurance are allowed to become private businesses… patients with little or no resources do not get the care they need.”

And Mr. Goldberg doesn’t care about those people. Why not just come out and say it?

What did Santayana say about fanaticism? It consists of redoubling your efforts when you have forgotten your aim.

Pot, meet kettle… And as John Kenneth Galbraith said, “The modern conservative is engaged in one of man’s oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.”

Fighting against medical choices that are available elsewhere in the world is a sure sign that ideological zeal has transcended compassion or the Hippocratic oath.

Uh, he’s fighting for medical choice, not against it. He’s advocating for compassion, not against it. And if Mr. Goldberg thinks physicians anywhere in the world compromise the spirit of Hippocrates (put the well-being of the patient above all else) more than we do in America, he is as out of touch as the rest of his piece confirms.

Mr. Relman, once a great scholar, should be pitied, not scorned.

It’s Dr. Relman, and he doesn’t need Goldberg’s pity.
read more digg story

Costly ‘affordable’ health care — The Washington Times, America’s Newspaper

Costly ‘affordable’ health care — The Washington Times, America’s Newspaper:

“John Stossel is right.”

When an editorial starts out like this, and it’s from the Rev. Moon’s Times, you know it’s going to be dead on true, don’t you?

Healthcare policy by anecdote- isn’t that what Michael Moore is accused of all of the time?

UPDATE: I contacted an ICU director in Brussels regarding this article. His response:

This is simply wrong – and worrisome if published in the Washington Times
(hopefully not the Washington Post)!

As stated, we have here one of the best health care systems in the world.
Much better than socialistic systems like in the UK or in Scandinavia or even
the Netherlands.

Maybe his grandfather became deaf because of an aminoside administration, but
the antibiotic choice was not restricted by costs !

Maybe it is a case of malpractice – I do not know, these can happen anywhere
– but it is not related to a limitation in health care costs.

Best Care Anywhere | The New America Foundation

Best Care Anywhere The New America Foundation:

This is a link to a two hour panel discussion on the VA Healthcare system, our own home-grown single-payer carve out, and it is very informative. It is lead by the author, Phillip Longman of “Best Care Anywhere: Why VA Health Care is Better Than Yours “

Below is a link to an audio only, MP3 version that you can download as well.

MP3 Audio Recording of this Event15.9 MB”

NEJM — A Decade of Direct-to-Consumer Advertising of Prescription Drugs

NEJM — A Decade of Direct-to-Consumer Advertising of Prescription Drugs:

“Results Total spending on pharmaceutical promotion grew from $11.4 billion in 1996 to $29.9 billion in 2005. Although during that time spending on direct-to-consumer advertising increased by 330%, it made up only 14% of total promotional expenditures in 2005. Direct-to-consumer campaigns generally begin within a year after the approval of a product by the FDA. In the context of regulatory changes requiring legal review before issuing letters, the number of letters sent by the FDA to pharmaceutical manufacturers regarding violations of drug-advertising regulations fell from 142 in 1997 to only 21 in 2006. “

From the discussion:

“Our study has some key limitations. We obtained data on industry sales from PhRMA, which includes in its annual reports sales data only for its members. Ideally, we would include sales of all branded drugs sold by prescription, including pharmaceutical and biologic agents, and exclude sales of generic drugs (because generic drugs typically are not promoted). PhRMA sales data may include some generic sales (if a member reports both branded and generic sales) and typically exclude sales of biologic agents, which are manufactured by companies that belong to another trade group (Biotechnology Industry Organization). As a result, the sales figures may underestimate total dollar sales for the industry. We provide data on spending on free samples valued at their approximate retail price, which is how they typically are valued in industry promotional audits. Thus, the value of free samples we present probably overstates the opportunity cost to manufacturers, which would lie somewhere between the marginal cost of production and the retail value.”

A billion here, a billion there, pretty soon you’re talking serious money…

The Reality-Based Community: Rationing health care

The Reality-Based Community: Rationing health care:
Rationing health care
Posted by Mark Kleiman

“All this, let’s recall, with the Chancellor breathing down the neck of the boss of the medical area on behalf of a full professor at the university that owns the hospital. So my experience with the system was probably about as good as it gets except for corporate executives using places like the Mayo Clinic or family members of people on the boards of directors of hospitals. (Apparently it’s generally understood that if you stump up enough in the way of contributions to get on the board of the hospital, you’re entitled to priority care; that’s how not-for-profit hospitals raise capital.) It was only later that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to ‘Tier II,’ which would have meant higher co-payments. The process is designed to get very sick or prosperous patients to pay to jump the queue. I don’t know how many people my insurance company waited to death that year, but I’m certain the number wasn’t zero. “

The Doctor Will See You—In Three Months

The Doctor Will See You—In Three Months: “It’s not just broken for breast exams. If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. ‘Waiting is definitely a problem in the U.S., especially for basic care,’ says Karen Davis, president of the nonprofit Commonwealth Fund, which studies health-care policy. All this time spent ‘queuing,’ as other nations call it, stems from too much demand and too little supply. Only one-third of U.S. doctors are general practitioners, compared with half in most European countries. On top of that, only 40% of U.S. doctors have arrangements for after-hours care, vs. 75% in the rest of the industrialized world. Consequently, some 26% of U.S. adults in one survey went to an emergency room in the past two years because they couldn’t get in to see their regular doctor, a significantly higher rate than in other countries.”

Waiting Times for Care? Try Looking at the U.S. – Nurses, Doctors Say It’s Time to Debunk the Myths

Waiting Times for Care? Try Looking at the U.S. – Nurses, Doctors Say It’s Time to Debunk the Myths: “‘There’s been a lot of clamor lately about delays in care in some other countries. But if you want to see some really unsightly waiting times, look at U.S. medical facilities,’ said Deborah Burger, RN, president of the 75,000-member CNA/NNOC. While the problem has been largely overlooked by the major media, it was quietly exposed by the chief medical officer of Aetna, Inc. late in Aetna’s Investor Conference 2007 in March. In his talk, Troy Brennan conceded that ‘the (U.S.) healthcare system is not timely.’ He cited ‘recent statistics from the Institution of Healthcare Improvement… that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable,’ Brennan said. Brennan also recalled that he had formerly spent much of his time as an administrator and head of a physicians’ organization trying ‘to find appointments for people with doctors.’ While Brennan’s “