Sell your house;
clasp your bible and gun to your chest;
buy a coffin with room for your rifle grasped by your rigor mortised paw;
vote for a lackey in the pay of the the filth controlling the present health system;
join the army;

or…
move to Canada, England (sic) or any modern country… yes, you will love it although most of these countries do not have as much experience treating gunshot wounds.

Shame on NPR for not properly informing U.S. citizens.

I fully agree that you can’t shop around while you’re having a critical medical issue. I know this from painful experience!

However, I’ve heard that one of the more expensive things you can do is die in a hospital. You might be riddled with cancer, but they’ll try to resuscitate – often at great cost.

It seems heartless, but these are the cases I’m thinking of. If someone is going to die anyway, why keep them superficially alive – only to have loved ones make the decision to pull the plug.

But as you point out, medicolegal issues should never obscure the goal of the physician-patient relationship, which is to arrive at an accurate diagnosis and implement a timely and effective treatment plan to return the patient to wellness.

I’m not convinced that most instances of ordering lots of tests is necessarily the result of MD’s practicing legal CYA, as you’re suggesting.

My doctors are currently trying to get a handle on some diffuse left-abdominal symptoms I’m having and have ordered a C-T scan, upper-and lower endoscopies and bloodwork. We’re blowing through a lot of money here but so far we don’t know what’s going on. Last year my wife had diffuse abdominal symtoms for a long time and lots of tests before we found out she had a rare form of cancer! I think we ate through $40-50K (including surgery) before we knew what she had!

I once had a complete cardiac catheterization based on a mis-diagnosis of a heart-attack (it revealed that I have the coronary arteries of a 22-year-old even though I’m 55).

You’re an MD so I’m surprised that anyone has to tell you that making an accurate clinical diagnosis is HARD, and the failure to do so has consequences for the patient, not just for the doctor’s legal record!

To give you an orthopaedic example (your specialty) – earlier this year I developed achilles tendinitis shortly after completing a course of a fluoroquinolone antibiotic – a class of drug known to sometimes induce spontaneous achilles tendon rupture. I was about to embark on a weeklong backpack in the Sierras and questioned the wisdom of this so my orthopaedist ordered an MRI for me. I thought of that as protecting ME, not his legal status!

I will try to be brief. I listened to most of your hour re-broadcast tonight as the Healthcare Czars for McCain and Obama defended their respective plans. I did so while driving home from my 14-hour day as an orthopaedic surgeon. There has been enough information surface in the past couple of years regarding an extremely pertinent aspect of this discussion that was nonetheless completely ignored tonight. That is, the enormous cost of “defensive medicine” as it has come to be known. Various calculations, including my own, have placed the cost of defensive medicine at hundreds of billions of dollars annually. This amount of money could bail out Wall Street or insure every uninsured American with standard PPO/HMO health plans annually. Why does this remain a non-issue? It is because the trial lawyers association is one of the most generous campaign contributors in the health care industry coupled with the fact that the majority of our Senators and Congressmen are lawyers. This is as untouchable as Social Security or Medicare.

What is “defensive medicine anyway,” you ask? Defensive medicine is the act of overcompensating in the face of frivolous lawsuits . It is reflexively ordering x-rays, and MRIs, and blood tests on every patient “just to confirm” or because “the patient requested it.” It is ordering a neurology consult to corroborate an already unequivocal diagnosis. It is both consciously and unconsciously jettisoning the art of clinical diagnosis just to protect one’s backside. It is giving that patient an extra week or two out of work, so they will not resent you and later sue you. It is refusing to assist a colleague in a very difficult case, because your name would then be in the hospital record, making you legally liable as well. It is admitting a patient to the hospital with a mild infection just to be extra safe when, if it was your mother, you would send her home and call the next day to see how she was doing.

So let’s see. If i see 80 patients per week and order (above what I truly need but to make sure that I am medicolegally protected) 10 extra sets of x-rays at $200 each, 5 extra MRIs at $500 each, 2 extra neurology consults with nerve testing at $400 each, this totals $9,300 per week, or roughly $465,000 per year per physician! If only the 300 orthopaedic surgeons practicing within the 5 boroughs of NYC were practicing such defensive medicine, the annual cost for NYC comes to over 139 million dollars annually. Calculated another way, if only one of every three Americans has just one superfluous, defensively generated $300 health care cost per year because their doctor is practicing basic, legally referenced medicine, that would amount to 30 billion dollars per year. This grossly underestimated number would pay the private insurance premiums (avg. in 2004 = $2240) for 11 million individuals (many more if through family plans).

This is the elephant in the tulips!

Sincerely yours,

Alton Barron, M.D.

In the last 15 year, the percentage of the money spent on medical care that goes to the insurance industry, rather than to the medical professionals and facilities that provide the care has grown from 30 percent, to fifty percent. In 1967 just 17 percent of the money spent on health care was the profit that went to the insurance industry. By 1993, it was 30 percent, and currently it is approaching fifty percent. Out of more than two trillion dollars spent in the health sector, more than a trillion is profit to an industry that plays no part in providing health care.

That is to say that half of all the two trillion plus dollars that are spent on medical care in the U.S. are not in any way spent on health care, but provide profits to investors.

What has been occuring in the health care industry closely parallels what has been occuring in the bannking industry. Similar investment instruments have also been created by which money invested in the health sector is packaged and repackaged, and speculation in these investments is driving up the cost of health insurance.

On the other side of the equation, the cost of actually providing health care is not increasing, but is in fact dropping every year and has been for over a decade.

The actual cost of providing an MRI, CAT scan and almost every other medical procedure has gone down, on average, about eight percent per year.

The single factor responsible for the rapid increase in health care costs and premiums does not lie in the cost of providing care, but is in fact caused by the desire of investors for more and more return on those investments.

Every Health Care and Human Services Policy and Consulting firm hired by hospitals, government and private businesses to analyze what is causing the crisis in health care coverage in the United States has pointed to a single source and that is the insurance industry.

Just as it was the insurance industry that cause the recent crisis in the banking and finance sector of the markets, threatening to throw the U.S.into a recession or worse, it is the same industry that is largely responsible for the increases in the cost of health care, and the rising number of uncovered workers in the United States.

As it stands, 44 percent of all Americans are already covered by government, either by Medicare or Medicaid, as well as employees who work for state, local and federal government. Only half of the remaining 56 percent of the population of the United States is covered by their employers, and the remainder is the roughly 46 million Americans who are not covered.

Senator McCains plan is pretty much the same plan that George Bush offered in both 2000 and 2004. Bush offered a 1900 dollar tax credit in 2000 and a 2400 dollar tax`credit in 2004. As is usual with most Republican programs with regard to the health care crisis, George Bush forgot about those plans the minute he won the elections.

In both 2000 and 2004, those who examined the Republican plans stated that the tax credits being offered were too low to actually make a difference. Those who did not have insurance could not afford to purchase it even if they were given the tax credit. Most Americans who are not offered the tax credits could afford to purchase health insurance with the credits. The only people who would benefit from the credits are those who earn over 60,000 dollars a year and this group is the one that is already insured at the highest rate, with 85 percent of people earning over 60,000 a year getting employee provided insurance. This group is also provided the best quality insurance.

The sort of insurance that the average worker who does not have health insurance offered at the work place might be able to afford with the tax credit being offered by McCain would be a high deductable policy that usually excludes both obstetric or gynecological coverage.

The Lewin Group, which is the largest and most respected health care consulting firm in the United States has been hired to analyze most plans designed to deal with the health care crisis in the United States has repeatedly found that the major bottleneck to dealing with the health care crisis in the United States is in fact the insurance industry and the same greed and desire for greater and greater profits demanded by investors. This has led the insurance industry to act as “gatekeepers” for health care, rationing the amount of care a patient can get, while increasing premiums. Along with the cost of premiums, another hidden cost of health care is the “investment insurance” which those who invest in the health care sector purchase in case the lose money on any investment in the health sector, much like the policies that led to the collapse of AIG.

There has not been a single plan that has been offered by either party that can be called either “Socialized Medicine” or “Nationalized Medicine” All of the plans operate like Medicare, where there is a large pool of money, collected by the federal government. From this point the government hires a private company that administers the assignment of benefits. The way every Single Payer plan works is very much like plans offered by companies that “Self Insured” do.

The private sector learned the benefit of getting the insurance industry out of the process of providing health care for their employees. Large private corporations do not purchase health insurance policies for their employees. They hire a company to analyze the needs of their employees. They design a health care program, but the company “self insures” by putting a fixed sum of money aside each quarter for their employees health care, and either collects part of the premiums from their employees (or does not depending on whether they choose to cover all costs) and this along with co-pays covers the cost of paying for the health care. Along with this self insurers also purchase insurance called “stop loss” insurance in order to cover the medical expenses of their employees if during any particular quarter, the amount that they have to pay out for employees health care exceeds what they have put aside for their employees, collected in premiums and copayments.

All in all, this ends up being much less expensive than purchasing a health insurance policy directly from a company, and also is insured for times when the amount of money they have in their accounts is not enough to pay for employee medical care during any particular period.

This is in fact, the way Medicare operates. Health care providers like Blue Cross make a good deal of money by administering self insured companies as well as by administering Medicare.

This would be how any “Single Payer” plan would operate. The private sector would still be involved, but only those areas of the private sector that actually are part of the medical industry and providing health care to patients.

A company like Blue Cross administers the actual payment of benefits and operation of the program for these large, self insured companies, and takes a small percent of each transaction as an administrative cost.

As it stands, the health insurance companies make a lot of money by adminstering Medicare and Medicaid, as well as the programs of self insured companies.

The proof of the pudding is in the eating. Most hospitals and doctors offices make the largest amount of their annual income off of Medicare patients, as well as patients who work for large, self insured companies. Most would go out of business if Medicare was not available, because it cost them less to deal with Medicare than any other insurance program.

Finally the largest number of hospitals that have gone out of business or filed for bankruptcy protection in the last decade have been private hospitals, those that do not accept Medicare or Medicaid. It has been the “not for profit” hospitals that have been surviving during the last decade of health care crisis. Hospitals that lose their government approval to be paid by Medicare usually end up in serious trouble as other insurers use the Medicare authorization as the “Gold Standard” A hospital that loses its Medicare authorization will be dropped from other insurers lists of hospitals in their “networks” almost immediately.

Republicans have made much capital attacking “Single Payer” insurance as “Socialism” when it is nothing of the sort. Single Payer would not only improve medical care, it would eliminate the insurance gatekeeper that comes between the doctor and patient, as well as free up money to be paid directly to those people and organization that actually provide health care by getting rid of the elements that currently exist in the system that play no part in actually providing any health care to those covered by the current system at all.

This would allow more of the profits to go directly to those who do provide it, doctors, nurses, heath care associates, hospitals and medical centers.

It is simply time to get those industries that have not part in directly providing health care out of the process. They are now responsible for almost all of the rising costs of medical coverage.

The problems that exist in Europe and other nations that have what is called “Socialized Medicine” has nothing to do with the program and actually has more to do with the rather smaller amounts of their budgets that they are willing to put into their health care systems. Not a single program that has been offered in the United States reduces the amount of money spend on health care, but rather, but using the same money more effectively, by making certain that the profits go directly to those who provide heath care, rather than to an industry that does not, actually increases the number of people covered, but also allows people who currently are covered to have better coverage.

This has been asserted by virtually every expert in the field who does not have political motivations to protect the insurance industry.

I don’t see any practical way to do that. Maybe for minor stuff like flu shots, but the big money is for big expensive procedures regarding life-threatening conditions. If someone is having a heart attack there’s no chance to shop around, and you can blow through $50K or more in the first day. Ditto with major trauma like a car accident where you can consume $100K in the first few days.

If you’re diagnoseed with cancer you want the best care you can get – you won’t be trying to save money on that either but your care can easily go into the $100K-200K+ range.

I also don’t see that mediacal savings accounts can make much of a dent. How much can the average person put into one? As I mentioned above, I’ll probably eat $15K -worth of medical tests in the next couple of weeks.

Also, medical care is COMPLEX – the average consumer wouldn’t even know what to ask. You can’t just ask what a C-T scan costs – it depends on the views, the types of contrast agents, the actual protocol being used, and usually the interpretation is billed seperately. As an exercise I just did this on Monday for a C-T scan I had yesterday, and the price chart was a page of detail! Also, I have a bioscience background so I speak the lingo – I know what the terms mean – most people would not understand it.

So bottom line – at the level of ordinary consumers I don’t see how market signals can have more than a tiny impact. Republicans who think consumers can shop for medical care like they shop for a TV are dreaming.

He begins this segment by playing a cheerleading convention attack by McCain on a distoted cipher of the Obama plan. To represent Obama he plays a short snippet of an Obama ad that is apparently controversial (if you believe Wilensky) for something extraneous to health care policy. He ridicules the music (which we can’t even hear since the ad was cut off short) and later parrots the ad in a mocking tone to Willensky’s expressed pleasure since she gets to accomplish some obscure, off-the-subject, political sniping. Ashbrook never does let us hear even a snippet of an actual Obama response to McCain’s proposal.
Wilensky is then allowed to present the McCain plan completely unchallenged and uninterrupted. Cuttler, however is stepped on several times by Ashbrook voicing rebuttals on McCain’s behalf. Ashbrook talks over a caller who worries about the length of time it would take to get insurance under a McCain plan. He interrupts saying, “I’m sure, Samantha, that John McCain would do it much sooner and would say he could help you get insurance”

Wilensky’s response which asserts (falsely-since it is unfunded) that the McCain plan offers a subsidy for those who pose a bad insurance risk goes completely unchallenged by Ashbrook.

Apparently the bulk of the Mcain plan consists of a tax credit which the taxpayer can immediately turn over to an unregulated insurance company with no requirement to cover a bad risk. The credit will cover only a fraction of the total cost of a policy if the he or she can can get one at all.

I can’t imagine why anyone but an insurance exec would support this but Ashbrook clearly does. He slings his quota of code words to supress real discussion. When a caller suggests that, in light of proposed Wall Street bail-outs, the government might consider a role in providing health insurance, Ashbook’s voice bursts with incredulity as he asks, ” do you really want,” voice dripping with contempt, ” socialized medicine???” He then dismisses the call.

Throughout the show, both Ashbrook and the other commentator (Ravner?) chacterize both plans simplistically as representing cost containment vs broader coverage. Ashbrook discourages any substantive discussion of health care in general and even of these limited plans by reducing caller remarks to simple-minded political cliches which he selectively presents to his guests.

If only Ashbrook would let his guests and the callers speak for themselves with equal time we might get some better ideas in play. He deserves some credit for sometimes having guests who can intelligently inform or provoke us but he really should keep his own narrow, viewpoint out of the way. Listeners really don’t need his tendentious and reductive rephrasing of every comment or call. The evidence from the callers shows that they are usually able to think in more courageous and complex terms than Ashbrook will allow into his limited range of discussion.

McCain’s plan to let families shop for insurance using a $5,000 tax credit will do nothing but let insurance companies make even more money. If you do not believe that, just look at the Medicare Part D mess. Although Obama’s plan is better than McCain’s, it does not solve the problem. What we need is federally mandated price controls on how much drugs and Medical procedures can cost. That is what has worked well in other countries. For those in love with the free market, that does not eliminate competition and profit. It instead fosters an environment in which hospitals and drug companies compete more on the quality of the products and services they provide.

I think we still want market signals involved in health care. It’s not a great way, but it’s the only way we know of to regulate cost. There are tradeoffs I might make that another might not. And end-of-life costs might have to be re-examined.

I also don’t want a Bush/McCain-style plan where everyone fends for themselves in the open market. My experience with insurance companies is absolutely abysmal. Many hospitals are almost as bad. And while I’ve had some wonderful doctors, there are others who would be out of business if they were running an auto shop.

Could it be that flexible spending accounts with a high deductible insurance might work best? I think the govt would have to provide regulations and transparencies (and perhaps streamlining of paperwork?) in the insurance industry, as well as some way to “grade” hospitals and doctors for this to work.

I agree wholeheartedly with this. For-profit managed care companies have strong incentive to limit or deny care. Thank about it: their revenue (premiums) is essentially fixed, so they increase profitability by reducing costs, e.g. reducing care.

BTW, did you guys know that McCain wants to tax you on the money your employer pays for your health care as ordinary income? And he claims to be cutting taxes!

Auto insurance works because it’s a luxury, not a neccesity. You can pick what type of car you drive and what level of insurance you want with it. You can’t decide on whether you want to fix your child’s broken arm or whether or not you go to the hospital when suffering from a stroke or heart attack.

A co-worker relayed a story of hiking in New Zealand with his wife. She broke her ankle and when they went to the hospital they where not asked for any insurance.
They just took care of her.

People living in or visiting the most powerful country on the planet (well maybe not anymore) should not have to worry about insurance when ill. Oh I forgot; if we took care of our citizen’s health care we’re talking socialism but it’s ok to bail out the richest bankers on the planet.

I share your opinion about the poor assessment methods used by managed-care companies but I think your profession bears some of the responsibility.

The teachers’ unions closed ranks and refused to propose realistic methods of evaluating school system and teaching performance, so they got standardized testing shoved down their throats by legislators. Likewise healthcare professional organizations are reluctant to propose any methods that might show any of their members to be better or worse than other ones in efficieny or outcomes. So they are essentially handing that responsibility over to the insurance companies.

As I said previously, we have a legitimate need as a society and as individual patients to know that our providers are efficient because our premium dollars are at stake and the amount of time we spend in treatment or the number of tests and procedures we have depends on it.

I don’t know that I agree with this. Whoever is paying for the care, whether it’s the insurance company or the taxpayer has a legitimate interest in knowing that their money is being spent efficiently.

This is a little bit like the debate over standardized testing in schools. The opposition argues that since every child is different a standardized test is not appropriate. Yet society does have a legitimate interest that every child is well educated and every school’s methodology and curriculum is as good as it can be. So opponennt of standardized tests have an obligation to explain how else we might achieve that confidence.

So granted that every patient is different and meeting-to-meeting metrics may not properly measure progress, but how should the people paying for the care (insurance companies or taxpayers) assure themselves that the care is being provided efficiently and with the highest probability of a successful outcome?

Collective, universal systems work because they pool risk. The low needs of the young and healthy balance the greater needs of the elderly and chronically ill. Nobody is turned away because of a “pre-existing condition,” ie because they are sick. How insane is it that a so-called “health care system” actually discriminates against people because they need care?

McCain’s individual market-based approach addresses none of these problems, and in fact may make them worse: anxious, sick people making choices between heating and health care do not make savvy consumers, and the benefits of collective coverage are lost. And his line about “Do you want a bureaucrat standing between you and your doctor?” is laughable. No, of course we’d rather have a nice friendly agent of the insurance company, who’s under pressure to deny us coverage if at all possible. Obama’s plan doesn’t go far enough, but at least offers more coverage to more people, which is a start.

As another called pointed out, now Wall Street has been socialized, it’s time to do the same for health care. It’s really time this country got over its fear of socialized medicine. It’s not so terrible: it simply means that you are not at the mercy of the market when you are most vulnerable, and that the whole society shares the responsibility of ensuring that everyone enjoys the basic human right of access to affordable, quality health care.