“If you like the Post Office and the Department of Motor Vehicles and you think they’re run well, just wait till you see Medicare, Medicaid and health care done by the government.”To counter this anti-government prejudice, two-time Pulitzer Prize winner, Nicholas Kristof, wrote an article in the NY Times recently pointing out that:
The part of America’s health care system that consumers like best is the government-run part.Even though the status quo side keeps dragging out the "Obama wants to turn our healthcare system into Canada or England" argument as if that is a bad thing, studies have shown that patient satisfaction is higher in Australia, Canada, New Zealand and the United Kingdom compared to the US.
Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.
Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting.Here in Southern California, the socialized, single-payer, government-employed firefighters have been doing an extraordinary job knocking down the largest brushfire in Los Angeles County history. If the status quo backers treated public fire safety like they treat public healthcare, they'd let the free market forces figure out how to make a profit out of charging people for fire insurance and then cutting off their coverage as soon as their houses burned down.
So almost every country moved to what today’s health insurance lobbyists might label “socialized firefighting.” In effect, we have a single-payer system of public fire departments.
We have the same for policing. If the security guard business were as powerful as the health insurance industry, then it would be denouncing “government takeovers” and “socialized police work.”
Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care.
A public role in health care shouldn’t be any scarier or more repugnant than a public fire department.I heartily agree, and I have confidence that the American public can see this too. Because not everyone is stupid.
“Obama’s plan is most popular among younger Americans and least popular among senior citizens,” CNN Polling Director Keating Holland said. “A majority of Americans over the age of 50 oppose Obama’s plan; a majority of those under 50 support it.”
Anti-health-care-reform activist, reportedly injured in a fight at a town hall meeting last week, is collecting donations to pay his medical bills because he was recently laid off and lost his health insurance.It gets even stranger:
UPDATE: The man’s lawyer says he’s just unemployed, but has health insurance through his wife, and that he’s collecting donations to profit from the alleged attack.Daring Fireball also points out the editorial (before it was edited) that claimed that a physically disabled genius like Stephen Hawking "wouldn't have a chance" had he lived in the UK where their nationalized system rations healthcare. Except that he has lived in the UK. His entire life. And is still alive. At age 67.
There is a revolt afoot across the land.
Doctors are rebelling against the burden of health care insurance paperwork. They are rebelling against having to deal with upward of 12,000 procedure and drug codes that add expense and time to their practices, keeping them from giving full attention to patients.
This means fewer and fewer doctors are going into general practice, opting instead for specializations, which double their income and insulate themselves, to some degree, from the burden of health insurance paperwork.
Your doctor: you have to wait some time for an appointment. Your doctor spends less than 15 minutes with you before referring you to a specialist who, in turn, takes a long time to see.He has been a big supporter of my practice for years, and I appreciate his efforts in helping to spread the word about alternatives to the current dysfunctional healthcare system we have now. He is a much accomplished man, a veteran, a captain of the financial industry, a man of letters with a sharp wit, a loving husband, a doting father and grandfather, and a friend.
My doctor: I can have an appointment the same or next day or whenever is convenient for me. My doctor will spend as much time with me as we both feel is necessary.
Your doctor: You check in with a receptionist who gives you forms to fill out. You stew in the waiting room for some period of time before being ushered into an examination room by a nurse who asks all the same questions you already provided. You wait for another interminable time (without the out-of-date medical journals and golf magazines that were outside).
My doctor: He meets me at the door since he has no nurse, receptionist or other staff, which keeps overheads -- and his charges -- low.
Phase 1: Provide primary care (or collect underpants, your choice)It's that Phase 2 part that's killing off primary care.
Phase 2: ???
Phase 3: $Profit$!
During a typical visit to the doctor, most people spend more time in the waiting room than in the examination room.Unlike the glacier-like progress of healthcare reform taking place in Washington, DC, Ideal Medical Practices are bringing a better and more satisfying experience to patients NOW and will continue to do so regardless of what changes eventually take place.
On average, a physician spends about 10 minutes with a patient, according to one doctor in Anchorage who's working to change that.
At Steward Family Medicine, Dr. Daniel Steward makes time for every patient -- the shortest appointment lasts 30 minutes.
"You have so much time to talk with him and can cover any issue that you could possibly have because he doesn't rush you out of the office," patient Tahneta Stroh said. "He's a fantastic doctor."
Steward has jumped on board a grassroots movement sweeping across the nation known as an "ideal medical practice."
They went to villages in trouble and got the villagers to help them identify who among them had the best-nourished children—who among them had demonstrated what Jerry Sternin termed a “positive deviance” from the norm. The villagers then visited those mothers at home to see exactly what they were doing.Gawande then goes on to explain how the United States is now that village, with our crumbling economy, rising unemployment, and auto, financial and housing industries in serious trouble.
Just that was revolutionary. The villagers discovered that there were well-nourished children among them, despite the poverty, and that those children’s mothers were breaking with the locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea; giving them several small feedings each day rather than one or two big ones; adding sweet potato greens to the children’s rice despite its being considered a low-class food. The ideas spread and took hold. The program measured the results and posted them in the villages for all to see. In two years, malnutrition dropped 65 to 85 percent in every village the Sternins had been to. Their program proved in fact more effective than outside experts were.
More than that, though, we in medicine have partly contributed to these troubles. Our country’s health care is by far the most expensive in the world. It now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government at every level—squeezing out investments in education, our infrastructure, energy development, our future.While a large part of those costs are administrative costs, the bulk of extra spending is due to extra tests, procedures, specialist visits and treatment —things that doctors control.
As President Obama recently said, “The greatest threat to America's fiscal health is not Social Security, though that's a significant challenge. It's not the investments that we've made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation's balance sheet is the skyrocketing cost of health care. It's not even close.”
Yet studies find that in high-cost places—where doctors order more frequent tests and procedures, more specialist visits, more hospital admissions than the average—the patients do no better, whether measured in terms of survival, ability to function, or satisfaction with care. If anything, they seemed to do worse.He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. But while he zooms in to some degree of some unique models, he doesn't zoom in close enough. I think the "positive deviants" he and the rest of the country are looking for are IMPs—Ideal Medical Practices.
No one talks to you about money in medical school, or how decisions are really made. That may be because we’ve not thought carefully about what we really believe about money and how decisions should be made. But as you look across the spectrum of health care in the United States—across the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. And as you become doctors today, I want you to know that you are our hope for how this battle will play out.I graduated from medical school in 1987. One of the reasons that I went into medicine was because I didn't want to go into business. I never thought that medicine would turn out to be one of the biggest business battlegrounds ever. And yet, as in Tolkien's epic Lord of the Rings, the battle may ultimately be decided by someone small and seemingly insignificant.
One, we don't know how much [a reform package is] going to cost and who's going to pay for it," he said. "Secondly, it will be the first steps in destroying the best health care system the world has ever known."The best health care system the world has ever known?
LILI SACKS, a primary care doctor in Seattle, says she began thinking differently about her work on the day she realized she was beginning each appointment with the words, “Sorry I’m late.”
Scheduled to see as many as 25 patients a day at a large clinic, she lacked the time for thorough examinations and discussions. Because of this, she said, primary care doctors are often forced to order tests and send patients to specialists.
“Could I have helped some people without specialists and tests? Absolutely,” said Dr. Sacks. “Would it have saved the patient and the insurance company both money? Absolutely. Is the system set up for the best care and cost efficiency? Absolutely not.”
Dr. Sacks said she worried that seeing so many patients would lead to errors. Last year, she moved to a clinic that focuses on longer patient appointments, 30 to 60 minutes. This translates to 10 to 12 patients a day. Patients also communicate directly with her by phone or e-mail.
What this study is suggesting, in other words, is that the convictions of your heart and the actual contents of your thoughts are less important, in the end, in guiding your actions than the immediate context of your behavior. The words, "Oh, you're late" had the effect of making someone who was ordinarily compassionate into someone who was indifferent to suffering -- of turning someone, in that particular moment, into a different person.
This time Elsevier Australia went the whole hog, giving Merck an entire publication which resembled an academic journal, although in fact it only contained reprinted articles, or summaries, of other articles. In issue 2, for example, nine of the 29 articles concerned Vioxx, and a dozen of the remainder were about another Merck drug, Fosamax. All of these articles presented positive conclusions. Some were bizarre: such as a review article containing just two references.and
Things have deteriorated since. It turns out that Elsevier put out six such journals, sponsored by industry. The Elsevier chief executive, Michael Hansen, has now admitted that they were made to look like journals, and lacked proper disclosure. "This was an unacceptable practice and we regret that it took place," he said.At least drug companies have stopped giving out free pens, notepads and other trinkets. Hopefully I'll never again have to see a sight as embarrassing as when I saw a physician carrying 8 bags loaded with drug company freebies at a meeting a few years ago. (Yes, she was Asian and female and probably shares the same gene that causes my mom to hoard free bananas from the hotel breakfast buffet when on vacation, but it's still mortifying.) Anyways, anything that decreases drug company influence (and the need for a shame transplant) is good to me.
At Loma Linda University Medical Center near San Bernardino, emergency room workers have set up a tent in the parking lot to handle a crush of similar patients. In Chicago, ER visits at the city's biggest children's hospital are double normal levels, setting records at the 121-year-old institution.I can't help but wonder what this situation would look like if patients had a personal primary care doctor they could go to or call or e-mail, instead of going to the ER.
So far, few of the anxious patients have had more than runny noses. But the widening outbreak of swine flu, also known as H1N1 flu, is exposing a potentially critical hole in the nation's defenses.
Across the country, emergency care facilities are straining at the seams even though the outbreak is relatively small and the federal government has launched a mammoth disease-control effort -- dispatching antiviral drugs to states, attempting to contain the limited number of cases and beginning to develop a vaccine against it.
"It is a major Achilles' heel in our state of readiness," said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University. "If we get a situation that is really out of hand with large numbers of people affected, I fear that our hospital and healthcare facilities simply won't have the materials or even the staffing to respond," he said.
So help me out here. I got a call from Wyeth — from a David Ross. Wyeth sells single dose Prevnar in other countries where "there is low demand". They are not very open to doing that here.
I told this man, "Look, this is a win-win. You want to sell Prevnar, I want to buy it." He goes on and on about how he cannot believe practices would need so few doses over a few years. So I say, OK, look, help me out here! I tell him about primary care. I point out that I ANSWERED the phone!! He repeatedly tries to deflect me — "This is about reimbursement". Well, no it isn't. Blue Cross pays for the vaccine just fine. It does not pay for 9 doses sitting in the fridge rotting.
SO anyway I say, here is an alternative. Sell it to Cardinal Health. THEY supply my drugstore. The drugstore will buy 10 doses from you and lots of us can use them.
He then says, well, he would have to know that there was more than one doctor in the USA who had need for small amounts of Prevnar. So aha! I say, oh really?? How many do you need to hear from? I have 700 friends.
"Uh uh, I dunno."
So PLEASE call up David Ross (484-865-6057) and plead the case to sell Prevnar EITHER to drugstores OR in single dose units to physicians. PLEASE?
Love, Jean
I was tickled to hear that the insurance industry is beginning to commence to start to think about lifting bans on the pre-existing conditions that keep a slew of Americans from getting health coverage. This has always been on the deep end of a pretty wacky system.
But there is a pre-existing condition that hasn't garnered nearly as much attention in the health care debate. It's the condition we all share: being a human being. As opposed to, say, being an organism subdivided into parts and scattered over the medical landscape from neurology to podiatry.
Read the entire article here.
Consider one of the least secret medical records in the country: the erosion of primary care doctors. A half-century ago, we had an equal number of generalists and specialists. Today there are two specialists for every generalist.
In clear view and with all undeliberate speed, we developed a system that rewards procedures over primary care. As analyst Robert Blendon puts it bluntly, "It's absolutely clear that payment systems have been negotiated that reward specialty time and use of equipment." The incentives tip toward the kind of medicine that is performed with hands, tools and technology over the medicine that is practiced with eyes, ears, and mind.
The average generalist now earns 55 percent less than the average specialist. Many students apply to medical school to connect with and take care of sick people. They graduate to become what one doctor slyly calls "proceduralists." They enter with a strong desire to look after families and exit with a ticket to X-ray femurs.
"Speaking on behalf of over 100,000 doctors, we're ready to do our part. We very much believe that we need to expand coverage in this country to everyone, and we need to fix the work force, sir, so that all those patients have a place to go.
We'll roll up our shirtsleeves and do everything possible to make this work. Because it is the right thing to do, and I applaud you and this body for doing this today, to do it this year. And we must do it. Thank you."
INDICATIONS AND USAGE: Marriage is the therapy of choice for treatment of the condition of being unmarried. Marriage is approved to manage the dread of growing old alone and missing the opportunity to have dinner every night with a special someone, but without talking. Clinical trials indicate that marriage is recommended if you have found either a true soul mate or someone who has an excellent 401(k).
For all that, the majority of state residents would not go back to the old system. I’m among them. For years, about one in ten of my patients—I specialize in cancer surgery—had no insurance. Even though I’d waive my fee, they struggled to pay for their tests, medications, and hospital stay.
I once took care of a nineteen-year-old college student who had maxed out her insurance coverage. She had a treatable but metastatic cancer. But neither she nor her parents could afford the radiation therapy that she required. I made calls to find state programs, charities—anything that could help her—to no avail. She put off the treatment for almost a year because she didn’t want to force her parents to take out a second mortgage on their home. But eventually they had to choose between their daughter and their life’s savings.
For the past year, I haven’t had a single Massachusetts patient who has had to ask how much the necessary tests will cost; not one who has told me he needed to put off his cancer operation until he found a job that provided insurance coverage. And that’s a remarkable change: a glimpse of American health care without the routine cruelty.
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