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The Cost Conundrum
derF
Lots of spoken and printed words available all over about the current state of America's medical system. We are led to believe that greedy health insurance companies and pharmaceuticals are to blame. Here is a very interesting albeit necessarily long article from The New Yorker. It was written by Atul Gawande, a doctor and professor at the Harvard Medical School.

http://www.newyor...ct_gawande

He studied population centers that ranked highest and lowest in costs to medicare and found that those that were ranked the most expensive areas actually provided the lowest quality of medical care whereas those that were ranked the least expensive actually provided the best medical care. It is a bit complicated and takes a bit of time to read but I think there will be a few eyebrows raised for those who take the time to read this article. I heartily recommend it.
I'll drink to that. Or anything else for that matter.
 
RayvenAlandria
The article didn't surprise me in the least. It's well known that low income areas scam the federal government for healthcare related freebies. My reaction to the article was "Well, duh". It's stems from the welfare mentality we have in this country. To make themselves feel nice and fluffy many people tolerate the overspending on welfare and those who take advantage of the system are very good at doing so. Those who take advantage are not always individuals either, they are crooked county governments, businesses, professionals who cater to low income etc...
 
derF
And thus ends another thread on a rapidly shrinking forum.
I'll drink to that. Or anything else for that matter.
 
RayvenAlandria
What are talking about derF? What was your take on the article? Maybe you got a different impression than I did when I read it. What conclusion did you come to?
 
catman
derF: Read and noted. Don't get your knickers in a twist. I'm still in favor of a single-payer system, but it could be abused just like any other without proper oversight.

Maybe we need some fundies to argue with.
"If I owned both Hell and Texas, I'd live in Hell and rent out Texas." - General Sheridan
 
RayvenAlandria
I must have missed something. I did read it in a hurry. I'm interested to know what point you wanted to get across derF, what was it?
 
Bob of QF
derF wrote:
Lots of spoken and printed words available all over about the current state of America's medical system. We are led to believe that greedy health insurance companies and pharmaceuticals are to blame. Here is a very interesting albeit necessarily long article from The New Yorker. It was written by Atul Gawande, a doctor and professor at the Harvard Medical School.

http://www.newyor...ct_gawande

He studied population centers that ranked highest and lowest in costs to medicare and found that those that were ranked the most expensive areas actually provided the lowest quality of medical care whereas those that were ranked the least expensive actually provided the best medical care. It is a bit complicated and takes a bit of time to read but I think there will be a few eyebrows raised for those who take the time to read this article. I heartily recommend it.


Read most of it.

My personal take on the issue goes back to the idea of medicine for profit.

Once upon a time, medicine was considered a service: it was done because it needed doing, and the cost was *only* that: cost to cover expenses.

Now? It's a thriving for-profit business, with profit margins, capitol gains, etc.

Anytime you factor in GREED (the real name for profit) you're GOING to eventually corrupt the system into something other that what it was originally.

I'm not against a profit motive where appropriate. Such as in goods. Goods are inherently a for-profit situation, and the for-profit can actually help improve the quality of the goods, if there is competition.

But for much-needed services like health care? A for-profit model ought to be punishable by death.....

...for it is LITERALLY banking on the ills and suffering of people who have no control over what is happening to them...

Personally? I blame the Republicans..... <eyeroll>
Quantum Junction: Use both lanes

Reality is that which is left, after you stop believing.
 
Bob of QF
Follow-up. I went back and continued to read the article.

On page 6, the Mayo Clinic's model is exactly backwards from the high-cost models. That is, the Mayo's model is "patient's needs first, all else second".

It has among the lowest cost, and among (if not the-) highest quality care anywhere.

More proof that medicine should never be for-profit.

I can only imagine that the Republicans had nothing to do with the Mayo Clinic..... Grin
Quantum Junction: Use both lanes

Reality is that which is left, after you stop believing.
 
RayvenAlandria
Page 6? Oh hell, that means I didn't read it all. When I have time I will go read the whole article. I didn't see any links to other pages and must have only read one page.
 
catman
It has eight pages. Medicine should be socialized.
"If I owned both Hell and Texas, I'd live in Hell and rent out Texas." - General Sheridan
 
derF
It was a long article. I warned all that such was the case. But the fact is that not only were poor, disadvantaged areas guilty of abusing the system but that communities that were not in desperate need of government assistance for their health care were also guilty of abusing the system. The point was that if Doctors approach health care as a business rather than as a discipline that was established to attend to the medical needs of the general public then it is doomed to failure. Or, probably, more accurately, WE are doomed if a health care system is completely unconcerned with the public's health and only concerned with its ability to enrich itself and is allowed to continue.


Edited because I never seem to get it right the first couple of tries.
Edited by derF on 06/01/2009 02:55
I'll drink to that. Or anything else for that matter.
 
RayvenAlandria
The kids and I are going to Greenville to house hunt today, but when I get some free time I will read the whole article. Apparently I missed most of the important data.

My pre-read opinion...

I agree that the health care system is totally messed up. There are some doctors who are doctors because they genuinely care for people but I suspect most became doctors for the money. I used to think we should socialize medicine but then I realized that many of the people intelligent enough to become doctors would pursue other careers and we'd have severe shortage of healthcare workers. The solution to that would be some kind of half socialized system in which doctors/nurses and others were paid to go to school and paid a government subsidized salary that was LARGE enough that those in it for the money would still be attracted to the field.

Idealistically I'd prefer healthcare workers who are in it because they care, but realistically there are not enough of those kinds of people with the high IQ necessary to be doctors, surgeons, specialists, etc...
The reason those in it for money can still be decent physicians is because they also tend to be the kind of people who hate being wrong, so they have a motivation to give you a proper diagnosis because to be wrong would embarrass them in front of their colleagues. Not always, but enough to make me think that it's not totally bad to have physicians practicing who are in it for money and glory. If we socialize medicine we have to ensure that salaries are still very, very high to attract those kinds of people to the field or we simply won't have enough doctors to go around. (We already have that problem, but it'll get worse).

I do think the large medical corporations are greedy and could care less about patients. I'll read this article later and see what data they uncovered.
 
RayvenAlandria
Okay, I read the article while waiting for my son to get back from the bank. It's interesting but has huge data gaps that could be relevant.

My first reaction still stands and I don't understand why you got so pissed derF. It's obvious from the article that many doctors, hospitals, and patients are taking advantage of the welfare system (medicare). In low income areas they order unnecessary tests because Medicare pays the bill.

I've read many reports of the abuse of the Medicare system. It's a cash cow for many low income areas. The greedy doctors and hospitals take full advantage of the system but they are not wholly to blame, many patients demand unnecessary tests because they aren't the ones paying the bills. Also, there was an outbreak of low income people in certain communities suing doctors and hospitals for discrimination. Some of the claims were certainly legit, but I suspect most of them were scams. Certain types of people look for opportunities to sue. Kind of like the people who *accidentally* fall down in Walmart and then sue for millions. This also added to the problem. Many doctors order unnecessary tests to protect themselves from lawsuits.

I suspect that frivolous lawsuits were a larger factor than the article touched on. They didn't go into great depth about this in the article, but that info is out there if you want to find it. The healthcare industry in South Texas almost collapsed a decade ago because of frivolous lawsuits. After laws were passed to stop the problem things changed a bit but the after affects are still there. There is an adversarial relationship between doctors and patients that stems from distrust and fear. If doctors fear patients are out to get them they aren't going to be good doctors and if patients fear doctors don't give a shit about them they are more likely to be unhappy with treatment. It's a bad system. In Southern Texas this problem was especially bad, and probably still is.

Also, there is no mention in the article of race ratios, so I think the article has huge holes which could be relevant. What was the ratio of white doctors to non-white patients? This data is relevant, although most people don't like to talk about those things. Because the author chose to stay PC and avoid those uncomfortable subjects it makes me more critical of the article. It comes across as biased and makes me wonder if he had an agenda going in. (even if I have the same opinion, I still don't like manipulative articles).

I totally agree that the system is disgustingly corrupt and needs to change. I think it's much more complicated and convoluted than this article suggests though, they left out too many relevant factors. The Mayo structure seems to be superior but there may not be enough non-greedy doctors and hospitals to go around. They need to change the system from the ground up. Government should pay for medical school, completely, if someone agrees to contract with Government run Mayo type clinics. (Sort of like how the military does it, but not everyone wants to join the military to get med school paid for).

Something needs to be done, that's for sure, but I don't have an easy answer.
 
Bob of QF
derF wrote:
It was a long article. I warned all that such was the case. But the fact is that not only were poor, disadvantaged areas guilty of abusing the system but that communities that were not in desperate need of government assistance for their health care were also guilty of abusing the system. The point was that if Doctors approach health care as a business rather than as a discipline that was established to attend to the medical needs of the general public then it is doomed to failure. Or, probably, more accurately, WE are doomed if a health care system is completely unconcerned with the public's health and only concerned with its ability to enrich itself and is allowed to continue.


Edited because I never seem to get it right the first couple of tries.


I agree 100%.

Medicine should NEVER, EVER be based on "for profit" business model.

Ever.

For that would mean that peoples' SUFFERING was being profited by...

...which I think is just evil.

Expenses should be met. Salaries should be paid commiserate with education AND experience, adjusted to reflect the local cost-of-living.

But profit sharing? Evil.

Stocks and bonds issued on the medical facility? Evil.
Quantum Junction: Use both lanes

Reality is that which is left, after you stop believing.
 
Bob of QF
RayvenAlandria wrote:
.... If we socialize medicine we have to ensure that salaries are still very, very high to attract those kinds of people to the field or we simply won't have enough doctors to go around. (We already have that problem, but it'll get worse).



In the interests of harmony, I should state the following is my opinion.

I disagree.

What we have is too few nurses. And physicians assistants. And such.

And, we do have too few generalists.

What we have is far, far too many specialists. Too many by orders of magnitude.

As result, many MANY conditions are miss-diagnosed because the "correct" specialist never got involved, and no generalist was on-hand to consider other possible maladies.

So the wrong symptom is "treated" often creating additional conditions-- JUST DUE TO THE "TREATMENT"!

Couple this with a VAST kick-back to doctors from pharmaceutical companies to encourage them to prescribe...

....there are any number of examples, of people taking drugs JUST TO ALLEVIATE THE SYMPTOMS OF OTHER DRUGS THEY ARE TAKING!

The days are LONG gone where a doctor can have complete knowledge of all the drug interactions-- even the pharmacists use huge databases and they don't catch everything.

Couple this with the FACT, that MOST of the "knowledge" a doctor has about a given drug comes from the ads--erm--pamphlets provided by the drug companies themselves! These slick color brochures rarely cover the possible side-effects or drug interactions....and never in detail. They are strictly a selling tool by the drug companies.

Who....are in it for the money.

Which is why it's EVIL.

Back to that.....
Quantum Junction: Use both lanes

Reality is that which is left, after you stop believing.
 
RayvenAlandria
Well I can agree with those points. It bothers me when doctors have a financial stake in hospitals. Living in Tulsa it caught my attention that some doctor there said he sends well insured patients to the hospital he owns stock in (or whatever it was) and those who are underinsured to another hospital. That pissed me off and I wish they had named the doctor so I could avoid him.

You have a good point about prescriptions too. I am severely allergic to Sulfa, sulfates and sulfites. Sulfa will kill me if I take it and the other cause us to have bad reactions, but on more than one occasion some dumbass prescribed a sulfa drug to me or one of my kids. They prescribe sulfates and sulfites to us on a regular basis because they don't bother to check what the preservatives are. (they are commonly used in eye and ear drops and we get a lot of ear infections). I have to research every medication we're given because I can't trust the stupid doctors. It's highly annoying.

I do wish profit were removed from healthcare but in a capitalist society such as ours how do we go about changing such a huge system?
 
derF
Some of you may know that I recently completed a 48 week chemo therapy after I was diagnosed with Hepatitis C. I have Blue Cross insurance and even with that I was shelling out 400 bucks a month just for the two drugs I was prescribed. One was injected weekly the other taken orally 6 times a day. Even with health insurance this was a pretty good fraction of my yearly income. And that's just the medication. In the beginning my doctor told me that I would have to come to his office twice a month which I did for a while. But when I went to his office I was seen by a nurse practitioner who basically did no more than ask how I felt and how I was doing. I was then charged a 50$ deductible and my insurance company had to shell out an additional 100 bucks. And when I saw my copy of the bill it stated that I had seen another doctor in that same office that I have not laid eyes on to this very day.

I brought my complaints to the doctors office and he suddenly ceased being my doctor. He wouldn't even renew my prescription for Vicodin while I still had several months left in my treatment. I finished my therapy with out any prescription strength pain relievers. I have been through now for going on 2 months with out even a call or letter asking me how I was doing. So much for the Hippocratic oath. You can see why I am so sensitive about the topic. I was told that I needed a blood test 6 months after completion of my therapy and when I called the doctors office I was informed to consult my REGULAR doctor as if I had one.

This is a very well to do area what with Pebble Beach and Carmel a part of the community and yet the local doctors are merrily milking the system for every penny they can squeeze out of it. Medicine has definitely got to be a not for profit endeavor.
I'll drink to that. Or anything else for that matter.
 
catman
derF: I had no idea. I can certainly understand why you are so interested in this topic. That doctor deserves to be incarcerated and stripped of his license to practice medicine. I've had Hepatitis A before, but that's nothing compared to the C variety. All my best.
"If I owned both Hell and Texas, I'd live in Hell and rent out Texas." - General Sheridan
 
derF
Thanks, Cat. Much appreciated.

Yeah, I hope the jerk goes belly up in his new, large and expensive office building in a trendy new development just outside of town. But I fear that that will not be the outcome. We all need to use the power of our numbers to influence change that will favor the middle and lower classes. That is our only hope and the most precious gift the founding fathers left to us common folk.
I'll drink to that. Or anything else for that matter.
 
RayvenAlandria
Wow derF, I'm so sorry. That doctor is a total piece of shit. Is there any way for you to get a new one? Maybe your insurance company can help. Even though that particular treatment is over you will need a decent doctor for the future.
 
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