Discovery Health

Med Innovations goes on the attack about the NYTimes’ reporting of medical stories and wishes they were more in line with his beliefs about the true America:

It all comes down to altitude and attitude. From their lofty perch, The New York Time’s editorial staff has yet to tumble to the reality America is basically a conservative nation, distrusts centralized government, wants choices of care and providers, demands access to the wonders of high tech medicine, and believes a market-based system, with all its faults, such as profits for entrepreneurial and innovative health care companies and doctors, are worth the price and value received.

He is talking about the United States of America, right? I was wondering why this poll didn’t get more coverage on the medical blogosphere showing that two thirds of Americans believe the government should provide national health insurance even at the cost of higher taxes. I don’t think our country is at all as “basically conservative” and distrustful of centralized government as Med Innovations thinks. I don’t think the country believes in a market-based system either.

I think the country knows that the health care system sucks, but many are scared of change or reform because they would have to risk their coverage to provide it for everyone. They know someone in the middle class or have read about someone with cancer–or even a kid with asthma–losing their wonderful “market-based” coverage after having paid into the system for years, and they’re worried they could be next. And they know if you’re uninsured and really sick it can devastate you not just physically and emotionally, but financially too, and that’s not something people should have to risk, especially kids. They worry about waiting times because everything everyone talks about is waiting for elective hip replacements in Canada.

I think they want their health care to work like I want my electricity does–when I flick the switch, the light should go on. That is, if Medicare or a single-payer or whoever can keep the level of quality and choice the same but provide coverage to everybody, then we should all get it–they’ve been screwed over by HMOs and for-profit HMO billing fraud and drug company lobbying enough. They know the “efficiency” of the “market place” is crap in health care, because they’ve spend 30 minutes on the phone with a claims reviewer getting something covered that should’ve been covered in the first place. And they know that “pre-existing conditions” are an America-only concept created only to maximize profits and resist providing medical coverage for actual medical problems.

Do you think the government should provide a national health insurance program for all Americans, even if this would require higher taxes?
Yes 64%
No 35%
No opinion 2%

Do you think the government should provide a national health insurance program for all children under the age of 18, even if this would require higher taxes?
Yes 73%
No 25%
No opinion 2%

(In which we mostly correct the Panda Bear.)

Major points to Panda Bear for his passion, but his health policy leaves something to be desired, I must admit. His latest rant is good–and I agree some of it in theory, but he doesn’t seem to be well-versed in the single-payer “woo,” so here we go:

The key thing to keep in mind is that the various plans proposed to insure the entire nation will do nothing to lower the cost of medical care because they are just another scheme to shift the costs from one set of consumers to the other.

Actually, that’s not correct, Panda. Single-payer plans have consistently been evaluated and shown to cover everyone while saving money. They do this by cashing in on the massive savings associated with administrative waste (probably at least $100 BILLION), allowing drug price negotiating, and setting global budgets for health spending. (See the California Health Care Options Project, The Vermont Single-Payer Study, The Maryland Single-Payer Study, Massachusetts Health Care Studies, and Maine’s Single-Payer Microsimulation.) Just to be clear, these analyses were done by The Lewin Group and Mathematica Consulting, not single-payer supporters.

The only difference will be that instead of half, every single health care dollar will take a trip through the federal sausage mill.

60% of health care dollars already take a trip thru the federal sausage mill–yes, 60%–and when they go to the Medicare mill, you actually get more sausage (health care) for your buck. There’s lower overhead costs compared with most private insurers–no advertising, no huge executive salaries, no profit demanded by investors.

The money is going to come out of somebody’s pocket and it’s not going to be the government which has no pockets, just hands to grab from one to give to another

This is how insurance works–not just health insurance, but car insurance, home owner’s insurance–all of it. It’s risk pooling. And the bigger your risk pool, the better to keep the system going. Money for our health care system comes from the citizens, whether it’s from Medicare taxes or loss of income from businesses providing health insurance (the businesses get to write off the health insurance bucks).

This is why the concept of Health Savings Accounts (not to mention privatizing Social Security) invokes such howls of rage from our ruling elites. Not only do they hold the people in contempt thinking them incapable of planning for their own future but the money tied up in these accounts and owned by citizens is just another chunk of money that cannot be stuffed into the voracious maw of the political influence machine.

I’m against HSAs because they won’t do squat for our problems. 80% of health costs are from 20% of patients–those are obviously our sickest patients–and they’re going to spend thru their HSAs within the first 2 days. HSAs are a great tax-free way for the rich to protect their money from taxes, but like I said before, they’re focusing on a leaking faucet when there’s a Niagara Falls right next door. Also, sure, an HSA might make someone think, “Should I really go to the doctor for this cold? Maybe it’s a virus.” Okay, so you’ve saved the system 50 bucks. But what consumer patient, when truly sick, is in any state of mind to decide if he needs the CT scan the doctor is recommending? Or if she should be admitted? Come on. (It’s a myth that more consumer information improves health care decisions, anyway.)

It would be demoralizing to our nation to have the disparities of medical access so wide that the poor and ignorant suffer or die from conditions that those who can think and plan ahead easily eacape. We will, unfortunately, always need to give medical care as charity.

Awkward! 18,000 people die each year from lack of access to proper health care. You’ve never seen an uninsured diabetic come into your ER with a nasty foot ulcer or infection that eventually leads to amputation, Panda? Come on. And survival rates after amputation suck.

I don’t think we will, fortunately, always need to give medical care as charity. There are tons of other nations able to provide for health care for their citizens, because it’s a priority for their countries. We can make it one too, if we want to.

There are many conflicting forces in medical care, each one trying to stiff the other with the bill. The insurance companies want to pay as little in claims as possible which is understandable given the nature of their business. The medical industry, from physicians to the lady mopping the hospital floors, would like to get paid fairly for their services. The government wrings its hands at the cost but at the same time would like as many people dependent on government as possible. The people want all the medical care they can eat but they want somebody else to pay for it.

You’ve really gotta read Money-Driven Medicine, Panda. You’ll love it.

I’ve been reading Maggie Mahar’s Money-Driven Medicine and wow–if you need any more evidence that our health care system is a mess of perverse incentives and profit drive, Mahar will give it to you, plain and simple. The book makes a fantastic case from both economic as well as social justice and ethical viewpoints.

Several really important concepts that she nails, which may just have to become their own posts:

• We spend almost twice as much per person on healthcare in the US than in other countries, but we clearly aren’t getting a system that’s twice as good, if better at all.
• Economic theory demands that in order for a consumer to make a purchasing decision, he or she must have information about the good or service and its value. “This is what makes the purchase of health care so different from any other purchase: it is a transaction based on trust.” This speaks greatly to our duty and professionalism as physicians.
• “Insurance companies possess neither the expertise nor the standing to set the nation’s health care priorities.”
• Medical ethicist Daniel Callahan: “The market is far better at meeting immediate short term private interests than long-term collective needs.”
• Economic theory often doesn’t apply to the health care industry. Hospital mergers, one would expect, should reduce the cost of business through economies of scale. Instead, they often lead to duplication. Hospitals merge to improve their bargaining power with insurers, not to reduce costs or save money.
• More care is not necessarily better care.

Another concept I’ve materialized myself, as the saying goes:
If you’re a Democrat when you’re young, and a Republican once you get a mortgage, then you’re for private health insurance when you’re well, and you’re for health care reform when you’ve developed chronic disease.

We spent $875 MILLION (that is *not* a typo) to fund abstinence-only education over the last 10 years. The results? Absolutely no differences in abstinence between control groups and abstinence-only education groups. (Okay, actually, those in the abstinence-only group were 1% more likely to have 4 or more sexual partners. Oops.)

Can we go back to teaching safer sex practices now?

Healthbolt’s got the graphs.

Dr. Sid takes on direct to consumer advertising, which apparently is now advertising implantable defibrillators. I don’t blame him. All of it should be banned—only the US and New Zealand allow it—to our detriment.