Comments

1. #1 Mike Haubrich, FCD

   June 14, 2009

   Done!

2. #2 MattBowdish

   June 14, 2009

   Everyone in Congress is bought and paid by “big pharma” or some other interest group.

   http://www.nytimes.com/2009/06/14/us/politics/14cong.html

   Why single out the GOP? It sounds to me like you’re using boogie-man terms and are quite biased.

   What I am concerned about is how health care reform will affect my ability to deliver high-quality care to my patients. That’s the ‘right thing to do’ in my book.

   I have doubts that the creation of a medicare-like public insurance option will compete on an even playing field with private insurers and will lead to the death of the private insurance industry.

   For example, if the taxes that govt puts on employers who don’t cover their employees are lower than private health insurance premiums, corporations will dump their employees in the cheaper govt option. It will be one of the biggest corporate welfare give-aways we have ever seen.

   So if you’re happy with your private insurance coverage, as 8 of 10 Americans are in a recent CNN poll, then where’s the choice in being dumped into a govt program?

   And how do we pay for the added $1 trillion to our obligations under this plan? Surely, it can’t be through EMRs and cost-benefit analyses. If that were the case, we would already being doing that with medicare and medicaid, both of which are unsustainable.

   What happens to American innovation of health care when you remove incentives for ‘big pharma’ to develop new drugs? Who will develop new treatments, prostheses, artificial organs, etc? Certainly not Canada or Britain or France to any great extent. They are currently free-loading off of our market.

   No, I will remain skeptical despite your fear-mongering.

3. #3 sailor

   June 14, 2009

   First off, I think people should appreciate that while many congressmen and senators complain about government health care, I believe that is exactly what they are all on and love it.
   Last figures I saw big pharma spend more money on advertising and profit than research. One good way to cut their expenses without affecting research would be to save them a bunch of advertising money. Ban direct ads to the public and have controls on how they advertise to the profession.
   Many many years ago I knew a Swede, a government employee who had invented for that time a state of the art arm prosthesis that looked real and had a hand that gripped well. At that time the ones in US either looked good and did nothing or gripped and looked mechanical. He came to the US to try and sell it on behalf of the Swedish govt, and found no interest from anyone, because they were all tied financially into their status quo.
   Competition does no work very well in the medical profession in the USA, for lots of reasons, including that is almost impossible to find out what a procedure will cost.
   Matt makes out like the US is the only place doing research and everyone is freeloading. Bullshit! there are advances all over the world. Right now Canada and Europe have a way of destroying the prostate that uses laser produced heat and may avoid some of the problems of other treatments. It is still undergoing tests in the USA.

4. #4 Dan J

   June 14, 2009

   “What I am concerned about is how health care reform will affect my ability to deliver high-quality care to my patients.”

   That’s definitely a well-placed concern. Health care reform will affect all of us, whether consumers or providers.

   I’m just hoping that there might be something coming out of all this that actually allows me to afford health insurance. My wife and I are not covered at all, and have not been for several years. We both work, but our employer (a small company) doesn’t provide health insurance, and we don’t make enough money to afford insurance on our own (Okay, maybe we could, but there are little luxuries to think of too, like eating, and heating our home).

   I’m all for a single-payer system. I’m all for “socialized medicine”. If the senators and congressmen accepted donations on behalf of big insurance and big pharma, that’s too damn bad. They aren’t under an obligation to them, they’re under an obligation to me.

5. #5 Jadehawk

   June 14, 2009

   what I’m curious about is how this new program will treat “uninsurables” (i.e. ME). I am sick of not having health insurance, and at the moment there’s shit-all I can do about this.

   and I’m hardly unique, I think. (incidentally, I wonder if that “8 in 10 americans like their insurance” simply includes people who are fucking glad they managed to have any insurance at all… any pot in a storm, and all that; not to mention it leaves out the 1 in 7 Americans without insurance)

6. #6 MattBowdish

   June 14, 2009

   Sailor- A few points…First, free samples are also included in ‘advertising costs,’ so cutting that would keep me from giving many without prescription drug coverage the meds they need.

   Second, you can usually ask different hospitals or providers what they charge for elective procedures and compare these locally and nationally. My patients do it all of the time. But the numbers depend on several factors (what insurance you have, the technology available, etc). Also, if you are paying out of pocket, you can often negotiate with private providers on the bill, as we do all of the time. We would rather get less cash right away than wait 60-90 days for the billed income to return.

   Third, I would suggest a review of the literature before you call “bullshit.” You offer only anecdotes regarding which countries invent new technologies. Did I say Sweden produces absolutely no new meds? Hardly. But according to several studies, even one here from the EC (Gambardella et al 2000, “Global Competitiveness in Pharmaceuticals: A European Perspective,” Report Prepared for the Directorate General Enterprise of the European Commission, 2000-you can find it online) Sweden makes about 3% of the world’s new pharmaceuticals. Canada makes even less. In contrast the US makes 46%, and we invest much, much more in R&D that other countries don’t (0.23% GDP vs others France 0.06%, Germany 0.03% and UK the most at 0.10%) [OECD Science, Technology and Industry Scoreboard (2003)]. Price controls limit the amount of money spent on innovation. That’s good for the elderly of today. But it isn’t good for our fight to cure disease in the future.

   Dan J & JadeHawk – I have lots of folks like you as patients and I know it’s difficult. You make too much not to qualify for medicaid and too little to think you can buy insurance privately. But my fiance has a private anthem-blue cross that costs $200/month. That’s a lot of money, but I find that when you really sit down and budget, it’s do-able for most people. There are also low-cost options with community health programs, etc.

   The issue with allowing govt to make more decisions about your health care is that it puts yet another roadblock between doctor and patient, in addition to quashing innovation. For example, I can almost always get a ‘non-approved’ med from a private insurer if it’s reasonable. But I have a devil of a time getting non-approved meds from govt insurers.

   It seems that you all are willing to sacrifice one set of difficulties for another. OK, fine. But how about a challenge to you ‘big govt’ types. If we are going to move towards one of these models, why not first reform the currently unsustainable govt health insurance plans (medicare, medicaid) before ruining our messy but stunning healthcare industry and indebting our nation even more? You think govt can do it better. Prove it. Reform Medicare first.

7. #7 Sailor

   June 15, 2009

   Well Matt, correct me if I am wrong but if Sweden is producing 3% of the world’s pharmaceuticals with a population of 9 million they are more than pulling their weight in comparison with the USA which produces 46% with population of 300 million.
   My main contention with regards to advertising is that drug advertising should be banned to the general public. This is not say drug companies should be prohibited from having web sites with information to which the public can go if they seek information, but all this “Might xvor be the right drug for you” on TV probably helps neither the patient nor he doctor, who can end up prescribing what the patient demands rather than what they need. That advertising budget also increases the cost of the drugs they sell.
   All this stuff about a roadblock between the doctor and the patient would make more sense if we were all private patients with no insurance. As it is managed care providers create just the same kind of road of roadblock as the government would.
   Insurance agencies and the government all negotiate for different rates for different procedures so a private patient can end up paying 5 or 6 times as much for a procedure as an insurance giant. Same work being done in both cases, less paperwork for the private guy. That makes no sense at all. If we had some transparency it would help. For example if hospitals had to publish the rates they accepted for procedures from various groups, I suspect the discrepancies would soon disappear. This is all part of the competition not working that I am talking about.

8. #8 Dan J

   June 15, 2009

   Reform Medicare? A noble task, indeed. I don’t think it’s possible in the current situation though.

   As Sailor mentioned, the rates charged for procedures are negotiated for not only each insurance provider, but each plan under that provider. I would welcome some transparency in this regard, but I don’t think we’re going to see it.

   The health insurance companies have a primary goal, and it’s not to provide you with the best coverage at the best prices. It’s to make a profit. It’s the same with most hospitals, and most provider groups. Money is what drives today’s system. I’m not begrudging the physicians the money they make. They deserve every penny of it, and many deserve a lot more than they’re currently getting.

   There are relatively few independent physicians in my community. Most of them in this area are directly employed by one of two clinic associations. Guess who dictates how many patients the physician is supposed to see every hour. Guess who dictated that that number had to be raised recently at one of these clinics. Was this decision made in order to better server patients’ needs? I don’t think so. I think that decision was made in order to benefit the company’s bottom line. Rising costs will be cited as the reason this needed to be done. Why higher costs? Could it be the number of new multi-million dollar buildings constructed in the past couple years by both clinics? Could it be the lower rates that the insurance companies are negotiating in order to improve their bottom line?

   This country’s health care industry has changed its primary goal from providing the best possible care for its patients to providing the best possible return for its investors. The bean counters have usurped the position of the physicians as the people trusted to make health care decisions. I think it’s time for that to change.

9. #9 Jadehawk

   June 15, 2009

   “You make too much not to qualify for medicaid and too little to think you can buy insurance privately. But my fiance has a private anthem-blue cross that costs $200/month.”

   you don’t know what an uninsurable person is, do you. even if i threw my entire monthly income at an insurance company, they wouldn’t take me. I’m too big of a risk to them.

   incidentally though, I don’t see how spending $200, i.e. 1/5 – 1/4 of my monthly income, on health insurance could even remotely be considered manageable

   and I’m not even touching the “compare prices nationally” and “elective procedures” part of that ignorant screed.

10. #10 Stephanie Z

    June 15, 2009

    Then there’s the fact that any insurance Jadehawk could get (by some nonexistent miracle) wouldn’t cover anything preexisting for the term of an annual contract–and wouldn’t be required to renew that contract after that term.

    Of course, I would expect a doctor to know that. Just as I’d expect a doctor to understand “uninsurable.”

11. #11 MattBowdish

    June 15, 2009

    Jadehawk & StephanieZ- I was using my last post as a starting point to ask you and DanJ about your circumstances. I deal with these issues everyday and I am pretty good at getting my patients the healthcare they need. I was hoping to help. Now, I don’t know if it is the anonymous aspects of screen names on the internet, but I don’t understand, nor do I appreciate your rudeness. “Ignorant screed?” You don’t seem interested in answers, only agreement. And if you are making $800-$1000/month, then in most states you would qualify for medicaid.

    Sailor- You made my point on Sweden. They ARE doing everything they can given the price controls built into their system. My point was that’s not enough for our future innovation (or theirs). As for advertising, I actually have many patients ask about specific medicines they’ve seen on TV or radio, and it has been a way to open communication on several fronts, especially (not surprisingly) on erectile dysfunction. Guys will use a commercial to open a dialogue with me that they might have been too embarrassed to bring up. I don’t prescribe a medicine because a patient is interested in it. I prescribe it because there is no other option, and I work with what coverage they have. You’re right that the advertising increases costs. That’s true for any product or service. Re: roadblocks. Yes, managed care companies create many roadblocks. But it’s been my experience from working at a VA, dealing with medicare and state medicaids, that private insurers are much more flexible than govt insurers. That’s just my experience…So why would I want to turn over more decisions to them? Why would you? Wouldn’t you want reform that stressed more competition, or real competition, for that matter rather than a one size fits all approach? I definitely agree with you on your hope for health care pricing information to be more transparent. That would be helpful for docs as well as patients. That should count for doctors’ adverse outcomes too. But these ideas are not what are in this new bill, as far as I have read.

    DanJ- Not possible to reform Medicare? Then how can we add another $1-2 trillion plan with no tract record of being able to be sustainable. Furthermore, to suggest that insurance companies don’t have a stake in promoting high-quality care makes for good political slogans, but it doesn’t hold true from what I have seen. Otherwise, why would 8 out of 10 Americans who are covered be satisfied with the services/coverage they receive, despite wanting it cheaper? If the insurance companies only cared about profit, then many of their customers (including employers) would switch to another plan. As for the number of patients I see per hour, I decide that, not some insurance company. I could see less folks and make less. But you are arguing for a public plan that if it’s anything like medicare, will reimburse 70-80 cents on the dollar than private payers. How many more patients would doctors have to see then to make the same income?

    DanJ, I also disagree with you that doctors deserve every penny they (we) make. I think much of what we do doesn’t have great evidence behind it. I think too many tests are ordered to prevent lawsuits and I think some specialists have political clout that has skewed reimbursements. Those should all be part of comprehensive reform that builds on what we do well and strengthens the relationship between physician and patient. Again, these issues are not dealt with in the current bill, which is another reason why physicians are leery of it.

    Anyhoo, enough of my ‘ignorant screeds.’ I have put in as much utility as I can here. Best of luck to all of you.

12. #12 MattBowdish

    June 15, 2009

    Jadehawk & StephanieZ- I was using my last post as a starting point to ask you and DanJ about your circumstances. I deal with these issues everyday and I am pretty good at getting my patients the healthcare they need. I was hoping to help. Now, I don’t know if it is the anonymous aspects of screen names on the internet, but I don’t understand, nor do I appreciate your rudeness. “Ignorant screed?” You don’t seem interested in answers, only agreement. And if you are making $800-$1000/month, then in most states you would qualify for medicaid.

    Sailor- You made my point on Sweden. They ARE doing everything they can given the price controls built into their system. My point was that’s not enough for our future innovation (or theirs). As for advertising, I actually have many patients ask about specific medicines they’ve seen on TV or radio, and it has been a way to open communication on several fronts, especially (not surprisingly) on erectile dysfunction. Guys will use a commercial to open a dialogue with me that they might have been too embarrassed to bring up. I don’t prescribe a medicine because a patient is interested in it. I prescribe it because there is no other option, and I work with what coverage they have. You’re right that the advertising increases costs. That’s true for any product or service. Re: roadblocks. Yes, managed care companies create many roadblocks. But it’s been my experience from working at a VA, dealing with medicare and state medicaids, that private insurers are much more flexible than govt insurers. That’s just my experience…So why would I want to turn over more decisions to them? Why would you? Wouldn’t you want reform that stressed more competition, or real competition, for that matter rather than a one size fits all approach? I definitely agree with you on your hope for health care pricing information to be more transparent. That would be helpful for docs as well as patients. That should count for doctors’ adverse outcomes too. But these ideas are not what are in this new bill, as far as I have read.

    DanJ- Not possible to reform Medicare? Then how can we add another $1-2 trillion plan with no tract record of being able to be sustainable. Furthermore, to suggest that insurance companies don’t have a stake in promoting high-quality care makes for good political slogans, but it doesn’t hold true from what I have seen. Otherwise, why would 8 out of 10 Americans who are covered be satisfied with the services/coverage they receive, despite wanting it cheaper? If the insurance companies only cared about profit, then many of their customers (including employers) would switch to another plan. As for the number of patients I see per hour, I decide that, not some insurance company. I could see less folks and make less. But you are arguing for a public plan that if it’s anything like medicare, will reimburse 70-80 cents on the dollar than private payers. How many more patients would doctors have to see then to make the same income?

    DanJ, I also disagree with you that doctors deserve every penny they (we) make. I think much of what we do doesn’t have great evidence behind it. I think too many tests are ordered to prevent lawsuits and I think some specialists have political clout that has skewed reimbursements. Those should all be part of comprehensive reform that builds on what we do well and strengthens the relationship between physician and patient. Again, these issues are not dealt with in the current bill, which is another reason why physicians are leery of it.

    Anyhoo, enough of my ‘ignorant screeds.’ I have put in as much utility as I can here. Best of luck to all of you.

13. #13 Jadehawk

    June 15, 2009

    “And if you are making $800-$1000/month, then in most states you would qualify for medicaid.”

    Only in states I couldn’t afford to live in. and I’m sorry if you find my answers rude, but your answers seem incredibly ignorant and arrogant indeed.

14. #14 Dan J

    June 16, 2009

    “And if you are making $800-$1000/month, then in most states you would qualify for medicaid.”

    Where are these “most states”??? I certainly don’t live in one of them. Illinois is a nice place, but they’re not generous enough to help me out.

    I agree that the political clout of the specialists is way over the top. GPs are on the low end of the totem pole, and the pay scale. I think it’s highly unfair.

    Insurance companies care about profit, period. Their service has declined while rates have skyrocketed. They don’t give a shit about you, me, or any other patient or doctor out there. The almighty dollar holds sway. And if you honestly believe differently, we’ll just have to call it a difference of opinion, but I’m still going to think you’re deluding yourself.

15. #15 sailor

    June 16, 2009

    “Sailor- You made my point on Sweden. They ARE doing everything they can given the price controls built into their system. My point was that’s not enough for our future innovation (or theirs).”
    No Matt, I don’t think I made your point. You point was that allowing drug companies to gouge patients in the USA resulted in a tremendous amount of research.
    Now Sweden creates 3% of new drugs with a population of 8 million. The USA produces 46% with 300 million. Let us see what would happen if these countries continued output at he same rate per capita but reverse their populations. Sweden would produce 111% of the new drugs we are now producing, the USA would produce 1.2%. On this statistic at least it is clear that the system in the USA is way less efficient than whatever they do in Sweden. There is nothing here to indicated to me that either 1. Sweden is freeloading (it seems the other way round) or 2. the USA system is in any way better.