There’s more to the value of health care than clinical effectiveness for patients and cost-effectiveness for individuals and governments. As we imagine the future of heatlh care, a welcome addition would be to plan for wider benefits to society. At this point in time in the US, it’s hard to imagine overcoming the political difficulties involved in reaching an agreement on what would benefit society. But it’s worth anticipating the possibility of a better future – the future we would want for ourselves and our children. Read more
Tag Archives: health care
What gets lost in the bureaucratization of medicine
The bureaucratization of medicine with increasingly complex rules, codes, algorithms, prompts, bylaws, schedules, and administrative structure is leaving its mark, but medicine at its fundamental is still about suffering, healing, and comforting; it is about individuals; it is about relationships and trust; it is about stories. Read more
Patient safety and corporate profits
A corporate board, on the other hand — whether it governs a hospital, a pharmaceutical company or an insurance giant — is legally required to give priority to stock holders over patients. When it comes to matters of health – which is to say life, death, and disability – it seems obvious to me that corporate boards are the least desirable level at which decisions about patient safety should be made. Decisions like increasing product sales at the expense of patient safety.
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The emotional burdens of patient care
How are we to protect ourselves from the emotional hazards of the practice of medicine? How are we to stand with our patients through the very worst while avoiding depression, significant stress reactions, and even substance abuse or addiction? Read more
There’s more to life than the pursuit of health
The obsessive pursuit of health is itself unhealthy. We can locate ourselves at the enjoyment of health end of the spectrum or we can pursue disease. There are many influences in our lives that lead us unconsciously to pursue disease. To consciously choose the enjoyment of health we must recognize and resist these influences. Read more
From healthism to overdiagnosis
To be fair, many of these experts may be true believers, people who want to do everything they can not to miss anyone who could possibly benefit from diagnosis. But the fact that there is so much money on the table may lead them to overestimate the benefits and ignore the harms of overdiagnosis. These decisions affect too many people to let them be tainted by the businesses that stand to gain from them. Read more
It’s cheaper to let the sick die
Unfortunately, he [Gawande] dismisses what, from the standpoint of reducing total health-care expenditures, is the single most serious drawback to such an approach; namely, the probability that effectively case-managed patients will survive longer than they would without intensive ambulatory care and will thereby offset their reduced frequency of hospitalization with an increase in their time at risk. If an intervention reduces a patient’s frequency of hospitalization from ten admissions annually to five, but simultaneously increases that patient’s survival from one year to two, the intervention is fully justified medically but is a wash from a cost perspective. If it increases that patient’s survival to two years and one month, it’s a net liability. Read more
Doctors eliminate the middle man: Insurance
The real beauty of direct-pay primary care is not only that it’s attractive to patients. It can be a way for struggling primary care physicians to maintain a financially viable practice. The average patient pays $700 to $800 a year for membership. According to a report from Kaiser Health News, this is three times more than a doctor makes for each patient in an insurance-based practice. Not to mention the extra time and the absence of aggravation that comes when doctors eliminate insurance companies. Read more
Robots dispense drugs and remove prostates
The University of California, San Francisco (UCSF) has a team of robots that fills prescriptions for its medical center. Orders are submitted electronically. The drugs are retrieved from a secure, sterile environment. The dosage is as exact as a computer is logical. Medications are packaged for each patient – even assembled into 12-hour packets for the day. It eliminates possible errors by both pharmacists and nurses. Read more
From MD to MBA: The business of primary care
The public may not readily appreciate the adverse financial consequences of a health care system in which the majority of doctors become specialists. But it would understand the story of a primary care physician who chose to end her practice because she was undervalued, overworked, frustrated, and underpaid. Read more
JAMA announces new editor-in-chief
JAMA is much more stodgy than NEJM, at least in my opinion. During the presidential election and then during the debate over health care reform, NEJM published timely commentaries on the issues and made them available online to non-subscribers. It continues to cover topics such as the legal challenges to the health care bill. Not only does JAMA give less space to these issues. Articles in JAMA are not available online without a subscription ($165 for 48 issues). Read more
Why are there so many cosmetic surgeons?
Well, one reason is that primary care physicians are being financially squeezed out of practicing their profession. There’s a good post at KevinMD on how physicians are responding, along with an acknowledgment of this sad truth in the comments. The post is called “Primary care physicians are rebelling against the system.” Read more
Obama supports Wyden-Brown bill
On the PBS Newshour last night, Judy Woodruff interviewed first Kathleen Sibelius and then Orrin Hatch on the issue (Sibelius being the Secretary of Health And Human Services (HHS) and Hatch the conservative Republican senator from Utah). Woodruff repeatedly tried to confront Hatch’s opposition to the proposal. She would cite a state governor who wanted the flexibility of the 2014 waiver option — for example, someone who thought his state could do better than the federal plan if it offered a single-payer system – only to have Hatch repeat, over and over, that the states can’t afford to implement health care reform, so there’s no point in talking about it. It’s all “bull corn.” Read more
Sex, lies, and pharmaceuticals
Most people experience times when as much as it’s blindingly obvious a problem is not theirs alone, it’s up to them alone to fix it – and a pill is often the quickest or only means.
That’s exactly what Margaret Thatcher and Ronald Reagan wanted us to believe. “There’s no such thing as society.” Unfortunately, many medical distorders do have social, not biological causes. Like poverty.
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Out of Practice: The demise of the primary care practitioner
[T]he government and private insurers had begun a concerted effort to contain the escalating cost of health care by fiat. The kindly family doctor was diminished, downgraded, and de-professionalized to a “provider,” a bland descriptor on a clerk’s requisition form. Even worse, New York State’s Medicaid, insuring the indigent, classified me as a “vendor,” a term which sent me into orbit then, and which today still rankles. Hemmed in by profession-specific price controls, reams of restrictive regulations, heavy-handed threats of federal penalties and expulsion from Medicare participation for suspected infractions, I became disheartened. Read more
The states’ rights argument against health care: An ugly tradition
“Opponents of health care reform are not really seeking to vindicate the power of states to regulate health care. Rather, they are counting on the fact that if they succeed with this legal gambit, the powerful interests arrayed against health care reform—the insurance industry, doctors, and drug companies—will easily overwhelm any efforts at meaningful reform in most states. Unless the Supreme Court is willing to rewrite hundreds of years of jurisprudence, however, they will not succeed.” Read more
Constitutional law will trump politics on health care reform
“Since the New Deal, the court has consistently held that Congress has broad constitutional power to regulate interstate commerce. This includes authority over not just goods moving across state lines, but also the economic choices of individuals within states that have significant effects on interstate markets. By that standard, this law’s constitutionality is open and shut. Does anyone doubt that the multitrillion-dollar health insurance industry is an interstate market that Congress has the power to regulate?” Read more
A doomed and dysfunctional medical culture
J.D. Kleinke is a medical economist, health information industry pioneer, and author of the forthcoming Catching Babies. In a dramatic, powerful, and beautifully written post on The Health Care Blog, he captures the essence of what’s wrong with modern medicine. “Who would not find great drama in a medical culture so doomed and dysfunctional, and so utterly driven by the conflict between patient preference and provider prejudice.” Read more
Are doctors tired of practicing medicine?
In the mid-20th century, physicians were among the most highly admired professionals, comparable with Supreme Court justices. … Depictions of physicians on television were overwhelmingly positive. Doctors were able to trade on this cultural perception for an unusual degree of privilege and influence.
Today, medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future.
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The up side of health care repeal
A repeal or strike-down of Obamacare would likely lead to the US doing nothing for a few more years, then the system hits the point of complete crisis, and then there’s enough support for actual healthcare reform along the Medicare for all lines. Read more
Act now to prevent the economic meltdown of medicine
The widespread assumption that we should blame personal lifestyles for our health problems allows corporations and the governments who fail to regulate them off the hook. It’s not politically or economically comfortable to acknowledge the underlying causes of disease — poverty, inequality, air and water pollution, contaminated food, unsafe working conditions, an obesegenic environment — and take responsibility for them. Read more
Fla judge rules against health care bill (& broccoli)
A conservative federal judge in a conservative area of the conservative state of Florida ruled today on the health care reform act. Not only did he rule that the individual mandate – the requirement that everyone have insurance – was unconstitutional, which was expected. He declared the entire bill unconstitutional. Read more
Can better care for the neediest patients lower costs?
In yet another inspiring, beautifully written, and potentially influential New Yorker article, Atul Gawande tells the story of pilot projects by rogue doctors who reduce medical costs by attending to the sickest and neediest patients. … Brenner and his team are out there on the boulevards of Camden demonstrating the possibilities of a strange new approach to health care: to look for the most expensive patients in the system and then direct resources and brainpower toward helping them. Read more
Czech doctors resign in protest
The average monthly wage in Czechoslovakia is about $1200. Newly graduated doctors earn just over $866 a month. According to oncologist Peter Papp, whose salary has never broken the 20,000 koruna ($1,051) threshold, “My friends include a tinsmith, a cook. When we go out, they pay my bill. They say: ‘You are only a doctor.’ “ He earns 88 koruna an hour, or 2 koruna less than when he had a job labeling frozen chickens in his student days. Read more
Health care, climate change, and the myth of the free market
Even supposedly serious economists lend support to these views, arguing that the dysfunctional health-care industry is best left to its own devices. … This is what comes of forgetting the critical role that states have played in nurturing, protecting, and financing their industries, as well as in taxing and taming them. The greatest danger that Western prosperity now faces isn’t posed by any Beijing consensus; it’s posed by the myth of the free market. Read more
Misc Links 1/7/11
Is the food pyramid illegal? That’s what this lawsuit claims (LA Times)
A doctors’ group sues federal government to replace the food pyramid with a vegetarian alternative. Group supports animal rights
Calling the Health Bill a “Job-Killer” is “Inflammatory Rhetoric” (Health Beat)
Report from the Center on Budget and Policy Priorities refutes Republican claim
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Health care in America: You get what you deserve
More than most societies, Americans believe that people rise or fall as a result of their own efforts, and therefore get what they deserve. Critically, when we say this is a nation of individualists, we don’t just mean Americans embrace individualism as a social ethic. Underpinning this ethic is tendency to interpret the world in highly individualistic terms. We distribute blame and praise to individuals because we believe that it is their individual actions, for better or worse, that matter. People get what they deserve. Read more
Why the US doesn’t have universal health care
Most high-income countries today have some form of national health insurance. Why is the US different? What stands in the way? … How to explain American opposition to universal health care. “Nearly every time this country has expanded its social safety net or tried to guarantee civil rights, passionate opposition has followed.” Read more
Carbs are the new no-no
To see doctors and nutritionists give voice to so much common sense is truly encouraging. Actually, most of them have been saying something like this all along. Their message to eat a balanced diet just wasn’t titillating enough to get the press coverage it deserved. Read more
Can Congress Force You to Be Healthy?
Yes, we want affordable health care. No, we don’t want the government interfering in our personal lives. Don’t get emotionally manipulated into believing we can’t have the first without the second. Read more