Impeding changes to our Health Care system
 

I have no idea where it is going but there are some interesting points in this article from the NYT today.

March 3, 2008
News Analysis
About Those Health Care Plans by the Democrats ...
By ROBERT PEAR
WASHINGTON — While Senators Hillary Rodham Clinton and Barack Obama fight over who has the better health plan for the uninsured, they say little about a more immediate challenge that will confront the next administration, whether Democratic or Republican: how to tame the soaring costs of Medicare and Medicaid.

The two programs, for older Americans and low-income people, cost $627 billion last year and accounted for 23 percent of all federal spending. With no change in existing law, the Congressional Budget Office says, that cost will double in 10 years and the programs will account for more than 30 percent of the budget.

Economists and health policy experts say the federal health programs are unsustainable in their current form, because they are growing much faster than the economy or the revenues used to finance them. The Medicare program is especially endangered; its hospital insurance trust fund is expected to run out of money in 11 years.

But the need for cutbacks is not a popular theme for political candidates wooing voters who want more care at a lower cost.

The Democrats do not say, in any detail, how they would slow the growth of Medicare and Medicaid or what they think about the main policy options: rationing care, raising taxes, cutting payments to providers or requiring beneficiaries to pay more.

Nor do they say how they would overcome the health care industry lobby, which has blocked proposals for even modest reductions in Medicare payment rates.

Instead, scores of lawyers and lobbyists are continually urging Congress to expand Medicare coverage of specific drugs, medical devices, tests and procedures.

The leading edge of the baby boom generation becomes eligible for Medicare in three years. The number of beneficiaries, now 44 million, is expected to reach 49 million in the first term of the next president and then climb to 55 million by 2017.

Those numbers, while daunting, are less significant than other factors.

Peter R. Orszag, director of the Congressional Budget Office, said, “The bulk of the projected increase in spending on Medicare and Medicaid is due not to demographic changes, such as increases in the number of beneficiaries, but to increases in costs per beneficiary.”

And what is driving those costs?

“Most of the long-term rise in health care spending is associated with the use of new medical technologies,” the budget office said in a recent report. It suggested that more selective use could save substantial amounts — a prospect that alarms manufacturers of some medical devices.

“Medical technology has saved and improved countless lives by reducing disability and death rates from cancer, heart disease and other conditions,” said Stephen J. Ubl, president of the Advanced Medical Technology Association, a trade group.

Spending on Medicare and Medicaid tends to increase in tandem with health spending generally.

“Federal health spending trends should not be viewed in isolation from the health care system as a whole,” said David M. Walker, the comptroller general of the United States.

When Medicare and Medicaid squeeze payments to doctors and hospitals, health care providers often try to increase charges to other patients, Mr. Walker said. To rein in the costs of Medicare and Medicaid, he said, it will be necessary to slow the growth of health costs generally.

For several years, an independent federal panel, the Medicare Payment Advisory Commission, has recommended that Congress reduce payments to private health plans. Those payments are about 12 percent higher, on average, than the cost of caring for similar patients in the traditional fee-for-service Medicare program.

Insurance companies, working with satisfied customers and lawmakers who want to preserve access to such plans, have successfully resisted the proposal.

To help pay for their coverage plans, Mrs. Clinton and Mr. Obama both say they would roll back the “Bush tax cuts” for the wealthiest Americans. But major provisions of the tax cuts, adopted in 2001 and 2003, are already scheduled to expire at the end of 2010. Democratic lawmakers, moreover, have committed the savings from the elapsed tax cuts several times to other pet programs, like eliminating the alternative minimum tax.

Some experts say the only real way to tame health care costs is by limiting access to expensive treatments or by requiring affluent Americans to pay for more of their health care.

Medicare has generally not taken costs into account in deciding which services to cover. If officials even suggest that Medicare should deny payment for an expensive treatment that could produce a small improvement in a person’s condition, they are accused of rationing care.

Researchers at Dartmouth Medical School have found large variations in the amount of hospital care and other services that people with the same condition receive in different parts of the country. In some regions, where doctors favor more intensive treatments, Medicare spends much more without getting better results for patients.

This research “suggests that about 20 percent of Medicare spending could be eliminated with no adverse effects on health,” said Prof. David M. Cutler of Harvard, an adviser to the Obama campaign. Identifying that 20 percent would be “very difficult,” he acknowledged.

President Bush says high-income people should pay higher premiums for the Medicare drug benefit, and at least some liberals are willing to discuss the idea.

“We can go further in setting Medicare premiums at higher levels for affluent beneficiaries without unraveling the universal nature of the program,” said Robert Greenstein, executive director of the Center on Budget and Policy Priorities. But, he insists, “we should also eliminate billions of dollars in overpayments to private Medicare plans.”

The Democratic candidates do believe they can wring savings out of an inefficient health care system that spent an average of $7,400 a person last year, far more than any other country.

Mr. Obama says his plan can achieve “tremendous savings” by making the health care system more efficient. Mrs. Clinton says her plan will save more than $50 billion a year with “efficiency reforms.”

To this end, Democrats and some Republicans are coalescing behind proposals intended to improve care while lowering costs. These proposals call for greater use of health information technology, including electronic medical records, programs to manage the care of people with multiple chronic diseases and research to compare the effectiveness of different treatments.

Senator John McCain of Arizona, the presumptive Republican nominee, describes Medicare as a “fiscal train wreck.” He voted against adding a prescription drug benefit to Medicare in 2003 because, he said, it added huge costs to a program going broke.

Mr. McCain says he, too, wants to cover more people. But he has not explicitly embraced the goal of universal coverage, saying he worries more about costs.

Public opinion polls show broad support for federal action to cover the uninsured. But Robert D. Reischauer, a health policy expert and president of the Urban Institute, said, “It will be difficult for Senator Clinton and Senator Obama to retain popular support for their plans once the details are specified.”

I posted about this a while back and now we are seeing some fallout as plans move forward. One thing discusssed during the run up to the election was how the Obama plan was going to provide care for not only the un-insured but the under insured. And if the government provided plans available to all that was cheaper than what companies provided there would be no incentive for companies to offer care and they would shuffle the people over to the government plan and save millions. Who wins? Big business hands down. Walmart already does this and does not offer health plans for the average worker. Who loses? Patients and health plans that offer insurance better than what you get with the current government plans. Providers will also lose. The government can barely manage medicaid and medicare. The formation or additon of millions of people onto another governent health plan will do little to provide access to care. Medicare and Medicaid patients are limited as to who they can see for care. This may be the straw that breaks the camel's back. Time will tell.

A national healthcare reform primer
The many issues confronting President Obama as he tries to achieve insurance coverage for all Americans.

http://www.latimes.com/features/prin...,1986914.story

Mass. healthcare reform is failing us
By Susanne L. King, MD, March 2, 2009

An interesting discussion:

An interview with John Goodman on the future of health care

continues:
http://www.citizen-times.com/apps/pb...D=200990223030

This might actually be a good thing if he can pay for it. Although it might be cheaper to just pay for those who have the facilities to do the work rather than re-invent the wheel. The problem is that most providers are maxed out so I don't see where they are going to get the people to do the work.

Obama pushes centers as one focus of health reform

http://www.reuters.com/article/gover...090302?sp=true

Another interesting opinion piece from a physician ran in the WSJ.

When Doctors Opt Out
We already know what government-run health care looks like.

Wait till doctors start accepting "cash only"

I guess we're just going to have to spend less on bombs.

Is the typo in the title a freudian slip Merc?:P

I have one. Smoothest running office ever. The staff is cheerful and friendly and they certainly don't have a shortage of patients.

We need to just get rid of ALL insurance companies and figure out some other way to do this - maybe have a government insurance program where you pay them every month, and they pay out claims - because they are ALL corrupt.

My mother's homeowners insurance is dropping her because she made two claims in the past three years. The two claims totalled $2800. And she has been paying them for many, many years. Like, decades. I just don't understand how they can drop her for having to pay out a little money after she has paid them tens of thousands of dollars over the years. :mad2:

There will always be some unless they are forced by law:( or competition. If too many doctors go that route they won't have enough patients to go around

Did the company give you that reason, or are you/she speculating?

:lol2:

That is the reason they gave in the letter they sent informing her they were dropping her. I called the state insurance person to report it and see if there is anything we can do, but they said insurance companies are allowed to drop you if you file 2 claims within a 3 year period. It seems ridiculous, seeing as how small the claims were.

What? You think the insurance industries aren't corrupt to the bone? A-I-G. nuff said.

Sugah - re-read the part of your post I quoted. It can be taken a completely different way with your use of pronouns.

Many already do. They take limited private insurance whom they have contracts with and cash, no Tricare, no Medicare, no Medicaid.

The doc who did my radiation (Edward Hughes) and I had a talk about this very dilemma. He takes medicare AND medicaid and said, "People who don't understand this problem, people who are cavalier about it, are people who have never had to DEAL with this problem. I firmly believe that their time will come and either they themselves or a family member will experience a short-fall and THEN they will understand the need for compassionate, reasonable health care costs. But not until then."

I hope no one has to go without care because they cannot afford it. I hope no one's goddamn balloon bursts. I hope everyone just floats along without any snags in their life. Christ on a cracker, look who's lining up to decide who gets care and who doesn't.

pathetic.

why do I come here? It makes me sick. and I can't afford sick.

No, you come for the blue stones. You lurvs blue stones.:p

I thought the same thing, and figured someone would beat me to mentioning it. I thought: how ya gonna stop 'em? This should be interesting! :)

Our dentist currently runs his office this way, as does my son's clinic. They give you all the forms you need to file your own claim and try to get reimbursed, but they simply won't deal with it themselves.

Naw, just a stupid typo on my part. Maybe it was my unconscious Id taking over my fingers.

"Was it a Freudian slip?"
"No. Maybe it was a Freudian slip."

Yep. That is what I said. :p

nah - It was Bush's Freudian slip/fault

The answer to Medicaid et al is simple, as I see it. Government doctors. Government hospitals. they can have their "free" managed care for those who wan it and private doctors for those who don't.

The doctors can be paid a flat salary , perhaps with some enticement such as tuition reimbursement thrown in to sweeten the deal.

As long as there is a choice for the person in question, I fail to see the problem.

They would have a hard time staffing the hospitals with people at a competitive rate. The VA and Military hospitals really struggle with this now. They really could not afford to start their own hospital system.

Merc, I can't believe you are behind the system when you actually work in it. Every doctor I see wants the system to change, because they understand it is severely broken. shit, even Talc started admitting it over at SMN. Remember?

I know first hand how broken it is. I also know some details about various fixes that are being proposed. We have had extensive discussions about obama's smoke screen over electronic record keeping and pretty much blew that baby out of the water as being nothing more than a big black hole that money is going to be poured into. We all want change. Just not the kind you think you want.

If private insurance cos could be forced to do the right thing and stop charging so much, then I am all for it. It seems all they care about though is profits and big salaries, just like the people on Wall Street. I watched something on (it was either) Dateline or 60 minutes the other night about AIG, and how they are forcing veterans from Iraq and Afghanistan to fight for their benefits. it was sickening. And that is business as usual with insurance cos. It has to stop.

If hospitals were required to put cameras in operating rooms, it might cut down on frivolous lawsuits against doctors, because there would be proof of any wrongdoing. That would make doctor's insurance premiums go down significantly, I think. It would also weed out the bad doctors who give all doctors a bad name. What do you think of that idea?

Then there are the general costs. Why does an aspirin cost so damn much in a hospital? It's ridiculous, the fees they charge for certain things. Health care should not be about profit. That is when it all started going to shit. Of course it is a business, and every business has to make some profit, but not the way is it now.

I won't even get started about big pharma cos.

Because they charge those with insurance and cash paying people to cover the costs of those without insurance plus profit for everything.

Why not?

Typical General Surgeon training:

Goes to High School. Works harder than most, makes good grades at an early age. Works hard to go to college.

Goes to college. Takes all the Pre-med track to get into Med School, generally studies pretty hard to get into a good medical school. A much harder track than most. Has to apply to Med School and interview at everyone they want to apply to. Needs pretty good grades to get into a good one.

Gets into medical school. Now has to study pretty hard for four straight years, including most summers or a portion of, to get into the specialty they want. For general surgery needs pretty darn good grades in medical school.

Graduates and immediately goes into a 1 year transitional internship. All the time trying to get accepted into a Surgical residency. Say they pass the mustard to get in and you have to work pretty darn hard because there are not that many slots and you get in.

Now you do 5 years, balls to the wall non-stop residency training, no breaks, no summers off. 16 to 20 hour days are the norm. Try that with a family, many do.

Now say you graduate and pass all the bs. Now you go into your case collection period of 1 to 2 years to become board certified, after 1 year you sit for a written board (written test). If you pass that you get to continue to do case collection (fancy way of doing lots of surgery and documenting every single case). After another year you are eligible to sit for oral boards. Here you get to stand in front of a group of people who wrote the text books and defend the cases cases you did as well as answer any question to the exhaustion of what you know. If you do well you pass and become "Board Certified", if you fail you try again the next year and study harder. Many do not pass the written test, nor the orals and cannot become Board Certified.

Each specialty is different for the length of the Residency but the process is generally the same for every physician.

If you want to become a plastic surgeon you do the same as above and then apply for a fellowship and do an additional 2 years, rinse and repeat through the board certification process.

Anyone want to give it all up and be a doctor?

All I got from that was that they have to work pretty darn hard and get pretty darn good grades. Sounds pretty darn prohibitive, for most. ;)

Oh, and if they don't pass the mustard, they're screwed. Those hot dogs won't flavor themselves, you know.

Yea, you can pretty much be dumped at any step along the way and have to at least go back to the beginning of your immediate starting point. Anyone want to buy a hot dog?

Merc, I am not saying doctors don't deserve high salaries, because I think they do. I think some of them overcharge significantly, but still, I don't think doctors are the problem. INSURANCE is the problem.

And you still haven't answered my question about cameras in operating rooms.

No one is going to agree to cameras in an OR. Forget that. It will not happen.

They overcharge becase of all the patients they care for who do not pay or for the underpayment by federal health insurance programs. No different than what hospitals do to stay solvent.

Well then, why do we pay SO much more per capita in this country for health care than any other country on earth? It's friggin' ridiculous, how much the cost of health care has risen over the past decade. We should have done something back in Clinton's first term, but the insurance cos put all those commercials on TV that scared the crap out of people. I think a majority of people today want a single payer system, but Congress will never pass it. The insurance industry is too important to them. (BIG money)

Why is it that hospitals will never agree to cameras in ORs?

could it be because they know they'll get the crapped sued out of them left and right if they do that?

Essentially, yes. They stopped video in the OR a long time ago. 99.999999999999999999999% of the time there is no mistake and no problem. So why give the lawyer ammo when something comes up?

I would consider it, bu I certainly don't want it to be run by the Gov't :headshake

ummmm, having video in the OR would stop most lawsuits if there is no mistake 99.9% of the time. so again, why don't they put them in the OR? The if there IS a mistake, they can go ahead and settel out of court. it would be a lot cheaper.

I don't believe it has to run by the government, it just has to be paid for by the government. They could have a private industry running it, and it could be overseen by the government.

Because provider will not allow it. I do not allow myself to be filmed during procedures. I rarely allow pictures.

Why? I don't get it. If it will help you avoid a lawsuit in the future...

A nice independent organization like... say... nuts?

If you put cameras in the operating room, then standardized procedures suddenly become open to subjective opinion. WTF does a lawyer know about the best way to suture something? Nothing--but if he can convince 12 other people who don't have a medical degree that those sutures "don't look like they're being done right," that doctor will lose a lawsuit that never should have existed. Quite frankly, sugarpop, you are the exact type of person who would look at an operation room video with your emotions, and just feel in your heart that some sort of malpractice is taking place rather than acknowledge you didn't know what the hell you were talking about.

:notworthy

Clod said it best. There was a short time when people use to actually film and record laproscopic procedures when they first started doing them, specifically cholesystectomies (gall bladder removal). They stopped doing it soon after they started.

It would have to looked at by other professionals, not lawyers.

Unfortunately that is not how our system is set up. A jury of your peers is hardly ever composed of your peers.

No, but they have to have expert testimony.

Even with that a clever lawyer can get answers to questions they want while they supress others. That is the art of a good lawyer. If Doctors had juries made up of only doctors I think you would have a much different outcome in many cases.

Expert testimony, like that given by a medical expert leading to the wrongful conviction of numerous women because of a series of (criminally) mistaken diagnoses of so-called shaken baby syndrome.?

huh? Shaking a baby is bad. It can be very damaging to their tiny brains.

Yes. Shaking a baby is bad. But a medical expert's evidence led to several women being convicted of murdering either their own children or the babies in their charge (one very prominent case was of a babysitter). That evidence was shown in the end to have been entirely misleading.

In one case, (the babusitter I mentioned) the evidence given was that she must have shook the child so violently and then swung it against the bannister rail of the stair with a force equivalent to a car hitting a stationary object. There was no bruising consistent with this. Nor was any attention paid to several other very important details. It was purely by chance that a doctor watching a programme about it and seeing aphoto of the kiddie in question before he died, noticed his eye drooping slightly and beginning to turn in. Turned out the child had some very serious and undiagnosed health problems. There was no violence involved in his death. It was just a tragic situation.

The same doctor who insisted that this child's injuries were consistent with the kind of injuries 'expected' in 'shaken baby syndrome' has also provided the mostdamning evidence in other cases involving mothers whose children had died of cot death. he was insistent that actually they were shaken to death. He has even made suggestions to the effect that most cot-deaths are in fact abuse.


Hiss was a very prominent case and I believe he has been struck off now as a medical practitioner. His evidence was not just inadequate it was in some cases actually dishonest. But...he was an expert witness. The fact he'd been an expert witness in so many cases only served to increase his prestige until the miscarriages of justice began to come to light. He was an expert witness, and on the basis primarily of his evidence juries convicted several women of murder, including some who'd actually lost their baby to cot death and were still grieving.

There are some doctors who provide "expert" evaluations that are anything but. IMO the solution is to get them out of the system.

yup - thats why they don't need nor want no stinkin cameras.

When a case that requires experts goes to trial, we get an expert for our side. They get an expert for their side. Usually, the two experts will contradict each other. You can almost always find a qualified expert to oppose a position. Just look at the global warming "debate."

No problem, have each expert present their case and the Cellar will decide their validity. We Rule! :lol2:

I will not be presented by any experts and I don't need anybody to decide whether I am valid, thank you very MUCH! :p