healthcare
purepedantry | December 2, 2008Some doctors are considering dropping vaccinations because some are vaccinating at a loss from insurance reimbursement.
About one in 10 doctors who vaccinate privately insured children are considering dropping that service largely because they are losing money when they do it, according to a new survey.
A second survey revealed startling differences between what doctors pay for vaccines and what private health insurers reimburse: For example, one in 10 doctors lost money on one recommended infant vaccine, but others made almost $40 per dose on the same shot.
The survey was revealing even to…
mikethemadbiologist | November 17, 2008One of the arguments for keeping private insurers in the healthcare system is that they will incentives to control costs. In Massachusetts, erm, not so much. First, some background:
Call it the best-kept secret in Massachusetts medicine: Health insurance companies pay a handful of hospitals far more for the same work even when there is no evidence that the higher-priced care produces healthier patients. In fact, sometimes the opposite is true: Massachusetts General Hospital, for example, earns 15 percent more than Beth Israel Deaconess Medical Center for treating heart-failure patients even…
mikethemadbiologist | November 10, 2008While the talk about symbolism is important, a president actually has to do stuff. I've been hoping that somewhere there are a bunch of smart people figuring how to unfuck all the stuff that Little Lord Pontchartrain has fucked up using the power of the Executive Branch (here's one example)--hell, just coming up with a list of said fuckups would be a challenge. So I'm delighted to read this in the Washington Post:
Transition advisers to President-elect Barack Obama have compiled a list of about 200 Bush administration actions and executive orders that could be swiftly undone to reverse…
purepedantry | October 23, 2008Whenever you are having a debate -- particularly a policy debate -- it is always important to check your premises. That is why I found this article in the Journal of the American Medical Association refreshing.
Emergency Department utilization is clearly on the rise in the US, and this rise in use is leading to longer wait times and diminished quality of care. One assumption that the cause of this problem are the uninsured, i.e. the uninsured are using the ED as an alternative to primary care and causing overcrowding.
However, Newton et al., in what will likely be a provocative article,…
mikethemadbiologist | October 9, 2008Since it's election season, it's pretty much guaranteed that the price of medical drugs will come up. While I'm on vacation, this post from the archives is pretty interesting. Keep in mind, the person making this claim is a former CEO of Pfizer, so he might know what he's talking about...
This is a headline from the June 1st, 2005 edition of ScripNews (subscription only; so I'm a little behind in my reading-what scientist isn't?). Here's the punchline for lazy stupids that don't like to read: the head of Pfizer has admitted that the cost of making a drug has nothing to do with how much drug…
mikethemadbiologist | September 21, 2008If it's wrong when the government gets into the health insurance business*, why it is right when the government gets into the financial insurance business? Surely, physical health is as important as financial health?
Never mind.
*Of course, government is already in the health insurance business in a really big way to begin with.
mikethemadbiologist | September 21, 2008
Clearly, John McCain isn't reading the blog. Consider this McCain utterance by way of Josh Marshall:
"Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation."
We've been through this before, but the key point is this: people don't want exciting 'health insurance products', they want adequate care when they are sick. Also, how are we supposed to choose the 'right' healthcare? From the Mad Biologist's…
purepedantry | September 11, 2008The New England Journal of Medicine compares the candidates visions for health care reform. (Hat-tip: PalMD)
On John McCain:
The McCain campaign emphasizes key advantages of this approach. First, the current tax exclusion disproportionately benefits higher-income Americans, since its value depends on a worker's tax bracket. Providing an equal credit to all Americans is a fairer allocation of federal revenues, and since the credit is refundable, even those who do not pay taxes would qualify for federal payments. Second, the tax exclusion benefits only persons with employer-sponsored insurance…
mikethemadbiologist | August 6, 2008By way of Matt Yglesias, I came across this post by Tyler Cowen claiming that the dislike towards HMOs is due to "they [patients] could be told they can't get all the care they want." Cowen is wrong: the dislike towards HMOs and for-profit healthcare in general is often a reasonable conclusion after patients fail to receive the care that they need. Two personal examples come to mind.
One loyal reader, a few years ago, who had been on complete life support for eight days, was removed from the ICU days before any of the ICU doctors, nurses, or the primary care physician thought was…
mikethemadbiologist | July 16, 2008From the NY Times editorial page comes this explanation of a government healthcare boondoggle (italics mine):
Private health plans were promoted in the 1980s and 1990s in the belief that they could reduce costs and improve care through better management. And for a while they did. But policy changes that were championed by the Bush administration and a Republican-controlled Congress led to exactly the opposite outcome.
These private plans -- that now cover a fifth of the total Medicare population -- receive large subsidies to deliver services that traditional Medicare provides more cheaply and…
purepedantry | June 19, 2008Well that is not good:
In a survey last year of nearly 2,400 physicians conducted by a physician recruiting firm, locumtenens.com, 3 percent said they were not frustrated by nonclinical aspects of medicine. The level of frustration has increased with nearly every survey.
...
In surveys, increasing numbers of doctors attest to diminishing enthusiasm for medicine and say they would discourage a friend or family member from going into the profession.
The dissatisfaction would probably not have reached such a fever pitch if reimbursement had kept pace with doctors' expectations. But it has not.…
mikethemadbiologist | June 7, 2008In the midst of every bout of interest in healthcare, there's always mention of primary care physicians who serve as 'gatekeepers' of healthcare. While it makes sense, there's one catch--you have to have enough primary care physicians:
But there's one important ingredient missing from that equation -- enough primary care doctors to take care of all these newly insured people. And the big reason behind the lack of primary care docs is the fact they get paid shit -- relatively speaking. Unlike the rest of the civilized world, physicians in the US are rarely salaried employees. With rare…
mikethemadbiologist | May 2, 2008
Magic ponies: they're not just for Iraq, but healthcare too! (from here)
Yesterday, I described how families would pay more under McCain's healthcare plan. But one point that I neglected to mention is that this is supposed to be a good thing. The logic (of a sort) is that if you end up paying more for treatment, then you will choose not to receive unnecessary treatment.
Like heart surgery. Roger Hickey explains:
...McCain wants to tax workers' health care premiums that are paid for by employers. Ask any expert, conservative or liberal, and they will tell you the result will be…
mikethemadbiologist | May 1, 2008I was going to discuss why I don't think the STAAR Act is particularly useful for combating antibiotic resistance, but McCain's healthcare plan is so ridiculously stupid, it requires comment.
McCain's proposal would give a five thousand dollar tax credit to every household to pay for healthcare. (It's not clear how this would lead to the claimed $3.6 trillion in savings, since we 'only' pay $2 trillion annually for healthcare). The ultimate goal is to move away from an employer-based system. That means, in plain English, McCain's ultimate goal is that you will have to pay the entire cost…
mikethemadbiologist | April 13, 2008I've never understood why so many liberals and progressives think the Democratic field is strong. Yes, the candidates aren't insane, but neither of them are particularly good on economic issues. There is nothing in either Clinton's or Obama's records or speeches that suggests that they will do anything significant to reduce income inequality, other than perhaps letting the Bush tax cuts expire (and Obama has even been waffling on that).
And keep in mind, that income inequality isn't just a matter of economically integrating more people into society. That's not some gushy, "it's not fair"…
mikethemadbiologist | April 9, 2008While many laboratory experiments have shown that antibiotic resistance imposes a fitness cost on resistant bacteria, it's far less clear if this is the case in natural populations. In Europe, the phasing out of a vancomycin analogue, avoparicin, resulted in a dramatic decrease in vancomycin resistance in enterococci bacteria, from roughly seven percent to about three percent. However, the drop doesn't appear to have continued further (although the economic and health burdens of treating vancomycin resistant enterococci make this decrease a good thing).
One of the problems with most studies…
purepedantry | March 25, 2008You be the judge. Over at Justice Talking, Russell Roberts from Cafe Hayek debates Dr. Quentin Young of Physicians for a National Health Program.
The mp3 is here.
Hat-tip: Cafe Hayek
purepedantry | March 7, 2008Unbelievable.
Unbelievable is simply the only word that can describe this article in the Lancet. Citing problems with retention of doctors in under-treated populations in Africa, Mills et al. argue that direct recruitment of doctors by groups in the West should be criminalized and the individuals perpetrating it prosecuted in the International Criminal Court.
The authors present clear and compelling data to support the assertion that there is a brain drain of health care workers from Africa. Further, they show that this brain drain is exacerbating an already severe doctor shortage in…
mikethemadbiologist | March 3, 2008In the most recent edition of the New England Journal of Medicine, there is a perspective piece by Sara Rosenbaum that bluntly describes how the Bush Administration's opposition to S-CHIP (the State Children's Health Insurance Program) is based on ideology and not economic cost (italics mine):
Why would the President veto bipartisan legislation that does precisely what he insisted on -- namely, aggressively enroll the poorest children? One might blame the poisonous atmosphere that pervades Washington these days, but other important social policy reforms have managed to get through.
One answer…
mikethemadbiologist | March 2, 2008I'll have a post tomorrow about the Republican opposition to S-CHIP, a federally-funded health insurance program. While writing the post, a question occurred to me:
Why is private health insurance not called corporate health insurance?
Private health insurance connotes an image of a small mom-and-pop business which insures a few hundred people. Of course, even the smallest health insurance corporations are much larger than what would be considered a small business. All health insurance corporations are huge (although some are gargantuan).
Those of us who favor healthcare reform will find…