A Doctor’s View on the Health Care Debate

I found this to be refreshingly honest. I’ll quote a snippet:

Which brings me to my problem with the president’s plan: despite being an admirer, I just don’t see how the president can pull off the reform he has in mind without cost cutting. I recently came on a phrase in an article in the journal “Annals of Internal Medicine” about an axiom of medical economics: a dollar spent on medical care is a dollar of income for someone. I have been reciting this as a mantra ever since. It may be the single most important fact about health care in America that you or I need to know. It means that all of us—doctors, hospitals, pharmacists, drug companies, nurses, home health agencies, and so many others—are drinking at the same trough which happens to hold $2.1 trillion, or 16% of our GDP. Every group who feeds at this trough has its lobbyists and has made contributions to Congressional campaigns to try to keep their spot and their share of the grub. Why not?—it’s hog heaven. But reform cannot happen without cutting costs, without turning people away from the trough and having them eat less. If you do that, you have to be prepared for the buzz saw of protest that dissuaded Roosevelt, defeated Truman’s plan and scuttled Hillary Clinton’s proposal. The good news is that the AMA, representing perhaps 15% of active practicing physicians, is not as powerful as it was in Truman’s time, and in the eyes of the public and many in medicine, it’s identity in the reform debate, is that of a protectionist, self-serving, organization; as a result, even their most progressive statements are viewed with suspicion. I’ve found the views of the American Medical Student Association particularly exciting—the next generation of physicians I sense has a deeper commitment to affordable health care for all than ours; they are, simply put, better people.

We may not like it, but the only way a government can control costs is by wielding great purchasing power to get concessions on the price of drugs, physician fees, and hospital services; the only way they can control administrative costs is by providing a simplified service, yes, the Medicare model (with a 3% overhead), and not allowing private insurance to cherry-pick patients (some of them operating with 30% overheads, the cost passed on to you).

Contrary to what we might think, comparative studies show us that the US when compared to other advanced countries, does not have a sicker population: we actually use fewer prescription drugs and we have shorter hospital stays (though we manage to do a lot more imaging in those short stays—got to feed the MRI machines). The bottom line is that our health care is costly because it is costly, not because we deliver more care, better care or special care. Alas, a solution that does not address the cost of care, and negotiate new prices for the services offered will not work; a solution that does not put caps on spending and that instead projects cost-savings here and there also won’t cut it. Leaders have to make tough and unpopular decisions, and if he is to be the first President to successfully accomplish reform there does not seem to be much choice: cut costs.

In short:

1. Cost cutting means taking away some other people’s salary. Expect these folks to resist.

2. Prevention: it isn’t always cost effective. There is a wonderful paragraph in the above article where it talks about giving a cholesterol test to a “well” patient in order to screen for potential heart disease problems. Yes, a high number may well indicate a future problem, but only in a tiny minority of those who get the high reading. In short, you need to do this hundreds of times (at least) to catch one “true” problem early. Is the cost “worth it”?

Of course, good lifestyle choices (weigh, exercise, not smoking) are worth it.

This problem isn’t an easy one to solve.

If any other MDs are reading this, I warmly welcome your input, even if you flame me.

23 June 2009

Workout notes 3.75 mile walk to yoga (no birds), 3.25+ mile walk back (about 43 minutes back via 2-1) I was sweating like a pig; minimal behind the knee pain (weather change is impending). Shortening my stride and focusing on the push-off really helps.

Blood donation today: I am recording this so I can record when I fully “recover” from it.

Posts
The governor of South Carolina “takes a hike”. Literally.

Science: check out this mushroom cloud: from a volcano. Also, check out the shockwave (almost a perfect disk) formed in the clouds.

Health care: Robert Reich advises President Obama to get some LBJ in him and get us a public option. Forget the Republicans; we need enough D votes.

Note: Professor Reich slams President Obama’s bank plans. He is no “yes person”.

2012 Republican Candidates for President?

Just for grins, I revisited a 2005 article about possible Democratic candidates for President in 2008.

Notice anything?

Oh wait, I had something to say as well.

I’ve dug up some more websites on Democrats who might be presidential candidates in 2008 (I am neglecting Senator Obama as he is more like 2016 material):

* Dennis Kucinich, reelection site and blog.
* Russ Fiengold, blog and PAC.
* Mark Warner
* Joe Biden (who has at least announced that he is running)
* Evan Bayh (his PAC)

Ooops!

22 June PM quips

The above was seen at a event:

On Saturday, Pat Buchanan hosted a conference to discuss how Republicans can regain a majority in America. During one discussion, panelists suggested supporting English-only initiatives as a prime way of attracting “working class white Democrats.”

Here Mr. Buchanan is with a white nationalist. Read the sign. FAIL.

Health care
What is wrong with “Free Market only” insurance plan. In short: insurance companies deny coverage to those with preexisting conditions and they look for ways to avoid paying out claims.