Comments on: Costly Care in a Texas Town http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town On Point is a live, two-hour morning news-analysis program, produced by WBUR 90.9 and NPR. Sat, 21 Nov 2009 21:59:14 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Bob http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-19547 Bob Mon, 15 Jun 2009 19:22:23 +0000 http://www.onpointradio.org/?p=14419#comment-19547 What "surgeon/author Dr. Atul Gawande" provides is an inaccurate, non-scientific diatribe based upon misleading data. His primary hypothesis centers on the following statement: "Nevertheless, if you have the patience to pore over nationwide Medicare data...In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average,” Gawande notes. “The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.” AND THIS IS EXACTLY WHERE Dr. Gawande is misled, and carries forth with a cacophony of error. Nowhere in his article does he address the "Winter Texan" aspect of Healthcare provision in McAllen, nor how this fact skews the Medicare data upon which he bases his over simplified analysis. The fact that each winter McAllen sees a near doubling of its Medicare age population certainly accounts for this differential. Maybe in his next analysis, he could understand the data before jumping to his predetermined conclusions. It is no wonder that Dr. Gawande seems to favor the non-scientific literature, and "Imperfect Sciences". He also failed to disclose his conflicts of interest relating to his personal bias for Clinton Era socialized healthcare. What “surgeon/author Dr. Atul Gawande” provides is an inaccurate, non-scientific diatribe based upon misleading data. His primary hypothesis centers on the following statement: “Nevertheless, if you have the patience to pore over nationwide Medicare data…In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average,” Gawande notes. “The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.”

AND THIS IS EXACTLY WHERE Dr. Gawande is misled, and carries forth with a cacophony of error.

Nowhere in his article does he address the “Winter Texan” aspect of Healthcare provision in McAllen, nor how this fact skews the Medicare data upon which he bases his over simplified analysis. The fact that each winter McAllen sees a near doubling of its Medicare age population certainly accounts for this differential. Maybe in his next analysis, he could understand the data before jumping to his predetermined conclusions.

It is no wonder that Dr. Gawande seems to favor the non-scientific literature, and “Imperfect Sciences”.

He also failed to disclose his conflicts of interest relating to his personal bias for Clinton Era socialized healthcare.

]]> By: brennan http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-19476 brennan Sun, 14 Jun 2009 23:09:10 +0000 http://www.onpointradio.org/?p=14419#comment-19476 if you don't think about it fundamentally and "prevention-quantification=wise" then you're just begging for pills or $$$, but we have diversity and """geographic""" options!!! for our critical youth and invisible pathogenic REGIONAL NORMATIVE VALUES. Historic mentality/rationalization and intellectual grappling of medicine/socialization by-proxy of geographic location and HEALTHY..... EXCHANGE STUDENT PHILOSOPHY . LIVE SOMEWHERELSE as a teenager and weave the fabric of civil society. but help the lost normative teen FLIGHT "man. dest."loophole! , prevention location, family exchange-student teen :,NO!$$$ ; :culture kryptonite!!! if you don’t think about it fundamentally and “prevention-quantification=wise”
then you’re just begging for pills or $$$,

but we have diversity and “”"geographic”"” options!!! for our critical youth and invisible pathogenic REGIONAL NORMATIVE VALUES. Historic mentality/rationalization and intellectual grappling of medicine/socialization by-proxy of geographic location and HEALTHY….. EXCHANGE STUDENT PHILOSOPHY . LIVE SOMEWHERELSE as a teenager and weave the fabric of civil society. but help the lost normative teen FLIGHT “man. dest.”loophole! , prevention location, family exchange-student teen :,NO!$$$ ; :culture kryptonite!!!

]]> By: brennan http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-19475 brennan Sun, 14 Jun 2009 22:42:31 +0000 http://www.onpointradio.org/?p=14419#comment-19475 I grew up in california "beanerville" and culture, is based on LOCATION! and "prime case" relief . circulation of aliens [average european-americans"] my grandpa was a 3rd gen doctor in milwaukee wi , who "never raised his rate$" and was confident with basic german and french language skills to help most all, in '70s or 80's spanish overcame immigration "Standards" exchange students often went to "latin amer" not euro-lingual standards... mani-"festering" destiny may need a critical medical quantification to prevent defeating ourselves. and fooling ourselves by-proxy!!! location, youth, beliefs , subtrafuge , sweet conspiracy. make ones own culture rise above THE LOCATION!!! OF FOLLY!!! UN-REALITY by-PROXY . microscope sociological intervention, unbelievable , salvation quick quiet. location is fixable, but shameful to take flight without wit-hout WINNING and proving you are good enough and heroic to leave for heavy culture [YOUR CULTURE! that is definately the fix! but seems awkward to even think about, cultural normative values and provable statistics, and historic new-amer-bastard...FAMILY-"COP OUT",=irish/Eng...X...euro=Amer! soc-econ, class GEOGRAPHIC INTERVENTION....invisible pathogen of fundamental normative solution and perfect flow [exchange 1% quantified teens] and manifest destiny vs "THE child left behind" assure mental ""fair-play!!!"" health in love not by destiny but geo-science, poli-geographic CULTURE VACCINE!!! by-proxy, 1% effects, affects, offects, infects, insects??? "rats"? it's a jungle in latin-U.S.A. where, who, when, why, $$$HOW, teen, cultural normative value, location most critical PREVENTION OBLIGATIONS...$,i.Q.phy$eek.... zen in atlantic? hari-kari? writing on the wall's, is for the bravest of readers only! to find civil societal , peace that has no conspiracies bigger than the "stereotypical gods"[quetzal] , obligation to prevention A.N.N.Y.T. is a fundamental quantification adaptable to both ocean regions of u.s.A. ["P.O.W. victim of cultural location of theoretical confrontation; 1% that must go! at YOUTH TEEN!!! emotional norm.:,. high quality case studies . very effective intervention A.N.N.Y.T.... Dr. Doogy Hauser MD, Boy genius!"go!" I grew up in california “beanerville” and culture, is based on LOCATION! and “prime case” relief . circulation of aliens [average european-americans"]

my grandpa was a 3rd gen doctor in milwaukee wi , who “never raised his rate$” and was confident with basic german and french language skills to help most all, in ’70s or 80’s spanish overcame immigration “Standards” exchange students often went to “latin amer” not euro-lingual standards…

mani-”festering” destiny may need a critical medical quantification to prevent defeating ourselves. and fooling ourselves by-proxy!!! location, youth, beliefs , subtrafuge , sweet conspiracy. make ones own culture rise above THE LOCATION!!! OF FOLLY!!! UN-REALITY by-PROXY . microscope sociological intervention, unbelievable , salvation quick quiet. location is fixable, but shameful to take flight without wit-hout WINNING and proving you are good enough and heroic to leave for heavy culture [YOUR CULTURE! that is definately the fix! but seems awkward to even think about, cultural normative values and provable statistics, and historic new-amer-bastard...FAMILY-"COP OUT",=irish/Eng...X...euro=Amer! soc-econ, class GEOGRAPHIC INTERVENTION....invisible pathogen of fundamental normative solution and perfect flow [exchange 1% quantified teens] and manifest destiny vs “THE child left behind” assure mental “”fair-play!!!”" health in love not by destiny but geo-science, poli-geographic CULTURE VACCINE!!! by-proxy, 1% effects, affects, offects, infects, insects??? “rats”? it’s a jungle in latin-U.S.A. where, who, when, why, $$$HOW, teen, cultural normative value, location most critical PREVENTION OBLIGATIONS…$,i.Q.phy$eek…. zen in atlantic? hari-kari?
writing on the wall’s, is for the bravest of readers only! to find civil societal , peace that has no conspiracies bigger than the “stereotypical gods”[quetzal] , obligation to prevention A.N.N.Y.T. is a fundamental quantification adaptable to both ocean regions of u.s.A. [”P.O.W. victim of cultural location of theoretical confrontation; 1% that must go! at YOUTH TEEN!!! emotional norm.:,. high quality case studies . very effective intervention A.N.N.Y.T…. Dr. Doogy Hauser MD, Boy genius!”go!”

]]> By: Ruben Zamora http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-19468 Ruben Zamora Sun, 14 Jun 2009 16:18:00 +0000 http://www.onpointradio.org/?p=14419#comment-19468 I will be brief; I hail from the Rio Grande Valley, know the people and the medical profession; also spent 29 years in healthcare sales. The malady in this area is the same one that afflicts other areas of the country: a lack of accountability and poor enforcement of the laws in place. People here are sicker and there are some opportunities for better education but there is NO reason for this to exist. The current situation is a perpetuation of a culture that has existed for many years and until we, collectively, demonstrate the cojones to put a stop to this, we will have many "Gawandean" articles with the same theme in the future. Let me repeat, the solutions suggested apply to most areas of the country! I will be brief; I hail from the Rio Grande Valley, know the people and the medical profession; also spent 29 years in healthcare sales. The malady in this area is the same one that afflicts other areas of the country: a lack of accountability and poor enforcement of the laws in place. People here are sicker and there are some opportunities for better education but there is NO reason for this to exist. The current situation is a perpetuation of a culture that has existed for many years and until we, collectively, demonstrate the cojones to put a stop to this, we will have many “Gawandean” articles with the same theme in the future. Let me repeat, the solutions suggested apply to most areas of the country!

]]> By: Jonathan Blaze http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18979 Jonathan Blaze Tue, 09 Jun 2009 18:49:22 +0000 http://www.onpointradio.org/?p=14419#comment-18979 Sorry former PCP, but there is no career choice which absolutely guarantees a six figure salary besides medicine. You may work hard to get there, but once you do, it is EASY MONEY with LITTLE WORK. The whole "if I wanted money I would have gone into finance" is a crock argument. Finance and banking are not guaranteed 6 fig salaries and you don't have job stability as you do in medicine. There is no comparison. In America, MEDICNE = MONEY = RESPECT. This is why people do it. As for all the time it took, face it, Residency is nothing but PAID TRAINING. Don't expect such sympathy because of that. You got paid to learn. Not many jobs will offer years of paid training. And please stop complainig about loans. You can usually pay those off within the first couple years of financially RAPING your patients I know many doctors, residents, and med students. While they love to complain, just like you do, I can get them to admit that they have it GREAT --> overinflated salaries with flexibility and manageable hours. Your industry is CORRUPT, thanks to the AMA and other organizations which work HARD to LIMIT the supply of doctors. "Do no harm" is a crock. Medical bills RUIN PEOPLE'S LIVES so doctors can maintain their hedonistic lifestyles. Sorry former PCP, but there is no career choice which absolutely guarantees a six figure salary besides medicine. You may work hard to get there, but once you do, it is EASY MONEY with LITTLE WORK.

The whole “if I wanted money I would have gone into finance” is a crock argument. Finance and banking are not guaranteed 6 fig salaries and you don’t have job stability as you do in medicine. There is no comparison. In America, MEDICNE = MONEY = RESPECT. This is why people do it.

As for all the time it took, face it, Residency is nothing but PAID TRAINING. Don’t expect such sympathy because of that. You got paid to learn. Not many jobs will offer years of paid training.

And please stop complainig about loans. You can usually pay those off within the first couple years of financially RAPING your patients

I know many doctors, residents, and med students. While they love to complain, just like you do, I can get them to admit that they have it GREAT –> overinflated salaries with flexibility and manageable hours.

Your industry is CORRUPT, thanks to the AMA and other organizations which work HARD to LIMIT the supply of doctors.

“Do no harm” is a crock. Medical bills RUIN PEOPLE’S LIVES so doctors can maintain their hedonistic lifestyles.

]]> By: Former Primary Care Physician http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18978 Former Primary Care Physician Tue, 09 Jun 2009 18:21:35 +0000 http://www.onpointradio.org/?p=14419#comment-18978 I want to dispel some of the misinformation regarding physician pay here. I am saddened by the news of some physicians who are more profit-minded than others. However, I can assure those who read this that most of us are not motivated by profit. If we were, we would have gone into Finance/ Banking, not Medicine. I trained for a full 7 years after completing my 4 year undergraduate degree to become a General Internist. That makes 11 years after high school just to begin a job. For at least 4 of those years I was awake approximately every 4th night, often for a grueling 36 hours straight and others with only a few hours of sleep. And yet, my training as an Internist was still easier than that of my surgical colleagues. During my duty hours I ran between patients, some dying in front of me despite my best efforts. I dreaded the 2am code pager call when I would race to the bedside of someone turning blue and have to take charge of resuscitation efforts. I spent countless hours poring over medical histories and exams and reading. I loved my patients. That is why I did what I did. I sacrificed my youth to be in school and in the hospital for this. Once I completed my schooling I had over $100,000 in loans to repay. I did not come from a wealthy family. I have worked for 5 years now. I am forced by administrators and insurance companies to work in a factory-like atmosphere seeing patients every 15 minutes with the constant threat of a lawsuit that could take away my little savings and career if I were to miss something in that 15 minute encounter or if a patient simply feels like suing me. This factory-like job reminds me of the jobs I had working in restaurants as a teenager, but now I have a lot more responsibility. I still have $20,000 in debt and no children even. My actual salaried wage when I was working in my last job worked out to around $35/ hour. I did not go into Medicine to become rich. I drive a Honda, not a Lexus. I worked many, many hard hours to get to where I am. My surgical colleagues worked every other night for 5 to 7 years sometimes to get to where they are. They deserve a $500,000 salary, far more than a manager who pushes paper all day and has had only 2 years of extra schooling after an undergraduate degree to get to where they are. I am not asking for your pity or sympathy. I am asking for your respect and not to be accused of unethical intentions. I am leaving the practice of General Medicine now primarily because of the lack of autonomy in my professional practice. I simply cannot stand the fact that I am not allowed to sit with the patients and give them the time they need for the best care. It is heart-breaking for me since I have put so much of my life into this ideal of being "The Doctor." Younger physicians and medical students see what is happening in Primary Care and they are smarter. They will not be joining General Medicine in its current form. If they are already in medical school, they will choose those specialties that offer a better lifestyle and ability to pay off loans and have security for the future. I don't blame them. I implore anyone who is reading this to try to understand the training a doctor actually goes through. I had no doctors in my family, so I did not know what it is like. There are many very hard jobs out there. I know that. It takes more grueling training time to become a practicing physician than many other professions, however. Please don't forget that when you are writing about doctors' intentions. If I were a "crook," I would have taken an easier route. I want to dispel some of the misinformation regarding physician pay here. I am saddened by the news of some physicians who are more profit-minded than others. However, I can assure those who read this that most of us are not motivated by profit. If we were, we would have gone into Finance/ Banking, not Medicine. I trained for a full 7 years after completing my 4 year undergraduate degree to become a General Internist. That makes 11 years after high school just to begin a job. For at least 4 of those years I was awake approximately every 4th night, often for a grueling 36 hours straight and others with only a few hours of sleep. And yet, my training as an Internist was still easier than that of my surgical colleagues. During my duty hours I ran between patients, some dying in front of me despite my best efforts. I dreaded the 2am code pager call when I would race to the bedside of someone turning blue and have to take charge of resuscitation efforts. I spent countless hours poring over medical histories and exams and reading. I loved my patients. That is why I did what I did. I sacrificed my youth to be in school and in the hospital for this. Once I completed my schooling I had over $100,000 in loans to repay. I did not come from a wealthy family. I have worked for 5 years now. I am forced by administrators and insurance companies to work in a factory-like atmosphere seeing patients every 15 minutes with the constant threat of a lawsuit that could take away my little savings and career if I were to miss something in that 15 minute encounter or if a patient simply feels like suing me. This factory-like job reminds me of the jobs I had working in restaurants as a teenager, but now I have a lot more responsibility. I still have $20,000 in debt and no children even. My actual salaried wage when I was working in my last job worked out to around $35/ hour. I did not go into Medicine to become rich. I drive a Honda, not a Lexus. I worked many, many hard hours to get to where I am. My surgical colleagues worked every other night for 5 to 7 years sometimes to get to where they are. They deserve a $500,000 salary, far more than a manager who pushes paper all day and has had only 2 years of extra schooling after an undergraduate degree to get to where they are. I am not asking for your pity or sympathy. I am asking for your respect and not to be accused of unethical intentions. I am leaving the practice of General Medicine now primarily because of the lack of autonomy in my professional practice. I simply cannot stand the fact that I am not allowed to sit with the patients and give them the time they need for the best care. It is heart-breaking for me since I have put so much of my life into this ideal of being “The Doctor.” Younger physicians and medical students see what is happening in Primary Care and they are smarter. They will not be joining General Medicine in its current form. If they are already in medical school, they will choose those specialties that offer a better lifestyle and ability to pay off loans and have security for the future. I don’t blame them. I implore anyone who is reading this to try to understand the training a doctor actually goes through. I had no doctors in my family, so I did not know what it is like. There are many very hard jobs out there. I know that. It takes more grueling training time to become a practicing physician than many other professions, however. Please don’t forget that when you are writing about doctors’ intentions. If I were a “crook,” I would have taken an easier route.

]]> By: Jonathan Blaze http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18928 Jonathan Blaze Mon, 08 Jun 2009 23:00:19 +0000 http://www.onpointradio.org/?p=14419#comment-18928 It is the corrupt medical industry who is responsible for these shortages: http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm They manipulate the supply of doctors, creating shortages so they can keep financially raping their patients. The medical industry is a scam, and doctors are nothing but crooks who send patients into bankruptcy while buying more vacation homes and Lexus SUVs. Do no harm? Think again. It is the corrupt medical industry who is responsible for these shortages:
http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm
They manipulate the supply of doctors, creating shortages so they can keep financially raping their patients.
The medical industry is a scam, and doctors are nothing but crooks who send patients into bankruptcy while buying more vacation homes and Lexus SUVs.
Do no harm? Think again.

]]> By: Ellen Dibble http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18875 Ellen Dibble Sun, 07 Jun 2009 16:03:46 +0000 http://www.onpointradio.org/?p=14419#comment-18875 I just heard Newt Gingrich on Face the Nation saying that a national public health insurance option would drive the insurers out of business. What on earth? Even with Medicare, there is Medigap. And there will always be noncovered "essentials," like glasses, dental care. This show came to mind, and questions about profit/nonprofit and issues "the people" need to address, hopefully with some informed insurance people (do they "hole up" in lobbies in DC?). The issue is how to ease the specialized costs (non basic, non-emergency, non childcare), especially the outrageously costly newest developments, under the aegis of private insurers (oh, they are there anyway for now), while taking those aspects we consider rights (we offer emergency care to everyone anyway) and making sure there is a government option that doesn't get carried away with profit potentials. If I want genetic coverage, or special reproductive services, or coverage for preventable diseases, or for problems that nonmedical care would tend to (diet and exercise come to mind), then I need a medical-gap plan. And if I want that medical gap plan to also provide the basic services, I can opt out of the government plan for a tax rebate of X amount. The idea that a cure is available and my plan doesn't cover it forgets that 20 years ago, that cure wasn't available at all. Now insurance will fork over a lot of money that yields a great deal of profit (both to the insurer and the provider; this show certainly details that), while there is no motive to get information out (and privacy laws that make useful information sharing, certainly among patients, unlikely) on less costly cures. A for-profit insurer wouldn't zero in on many efficiencies without non-profit competition, I think. But a non-profit option I think would have no business covering a lot of medical miracles people want. Is Viagra vital, a must-provide, but not crutches for someone with a broken leg so he/she can get to work? Is extending life (liver transplants come to mind) a national right, while other (less dramatic) care that enables more productive quality of life less so? You can live another two years, but those you do live will be with a ball and chain of this or that condition? Insurance options should let us choose. Nowadays, if you are paying twice as much for insurance as you are for rent, you probably fight for that Viagra. You probably say that for this price, I want the moon. Where do the private insurers pick up, where does the national right to care stop? I just heard Newt Gingrich on Face the Nation saying that a national public health insurance option would drive the insurers out of business. What on earth? Even with Medicare, there is Medigap. And there will always be noncovered “essentials,” like glasses, dental care. This show came to mind, and questions about profit/nonprofit and issues “the people” need to address, hopefully with some informed insurance people (do they “hole up” in lobbies in DC?).
The issue is how to ease the specialized costs (non basic, non-emergency, non childcare), especially the outrageously costly newest developments, under the aegis of private insurers (oh, they are there anyway for now), while taking those aspects we consider rights (we offer emergency care to everyone anyway) and making sure there is a government option that doesn’t get carried away with profit potentials.
If I want genetic coverage, or special reproductive services, or coverage for preventable diseases, or for problems that nonmedical care would tend to (diet and exercise come to mind), then I need a medical-gap plan. And if I want that medical gap plan to also provide the basic services, I can opt out of the government plan for a tax rebate of X amount. The idea that a cure is available and my plan doesn’t cover it forgets that 20 years ago, that cure wasn’t available at all.
Now insurance will fork over a lot of money that yields a great deal of profit (both to the insurer and the provider; this show certainly details that), while there is no motive to get information out (and privacy laws that make useful information sharing, certainly among patients, unlikely) on less costly cures.
A for-profit insurer wouldn’t zero in on many efficiencies without non-profit competition, I think. But a non-profit option I think would have no business covering a lot of medical miracles people want. Is Viagra vital, a must-provide, but not crutches for someone with a broken leg so he/she can get to work? Is extending life (liver transplants come to mind) a national right, while other (less dramatic) care that enables more productive quality of life less so? You can live another two years, but those you do live will be with a ball and chain of this or that condition?
Insurance options should let us choose.
Nowadays, if you are paying twice as much for insurance as you are for rent, you probably fight for that Viagra. You probably say that for this price, I want the moon.
Where do the private insurers pick up, where does the national right to care stop?

]]> By: Health Care. (united health care, universal health care) » Blog Archive » Following The Cost Conundrum: The Road To McAllen, TX, Through The Pages Of Health Affairs http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18865 Health Care. (united health care, universal health care) » Blog Archive » Following The Cost Conundrum: The Road To McAllen, TX, Through The Pages Of Health Affairs Sun, 07 Jun 2009 04:00:40 +0000 http://www.onpointradio.org/?p=14419#comment-18865 [...] more from Gawande, he was interviewed last night on “On Point” with Tom Ashbrook. Copyright © 2009 Health Affairs Blog. This Feed is for personal [...] [...] more from Gawande, he was interviewed last night on “On Point” with Tom Ashbrook. Copyright © 2009 Health Affairs Blog. This Feed is for personal [...]

]]> By: Putney Swope http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18829 Putney Swope Fri, 05 Jun 2009 20:14:32 +0000 http://www.onpointradio.org/?p=14419#comment-18829 It's wonderful that some of the people posting here will use the worse examples of National Health Care such as Spain's or Canada. How about we look at Switzerland, Netherlands, France and Germany or Taiwan for that matter to get a better idea of how to redesign our failing health care market. We do not have a system, we have a market and that is the problem it's run by for profit insurance companies and pharmaceutical companies. Lets also not leave out the lawyers in this mess. I'm not against having private insurance companies, I just think they need to be regulated and costs need to be controlled as they do in Switzerland which I think would be a good model for the US. It’s wonderful that some of the people posting here will use the worse examples of National Health Care such as Spain’s or Canada.

How about we look at Switzerland, Netherlands, France and Germany or Taiwan for that matter to get a better idea of how to redesign our failing health care market. We do not have a system, we have a market and that is the problem it’s run by for profit insurance companies and pharmaceutical companies. Lets also not leave out the lawyers in this mess.

I’m not against having private insurance companies, I just think they need to be regulated and costs need to be controlled as they do in Switzerland which I think would be a good model for the US.

]]> By: Putney Swope http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18827 Putney Swope Fri, 05 Jun 2009 20:04:03 +0000 http://www.onpointradio.org/?p=14419#comment-18827 <i>"Start Health Savings Accounts where patients pay a meaningful percentage of their bills and get to keep a small percentage of the money that’s left over each year. Patients need to have more “skin in the game.”</i> Really? more stake in the game you say? I think that the fact that about 60% of people filing for bankruptcy in the past year did so due to medical bills. I don't know "Primare Care Physician" about you but how much more of a stake do want us civilians to have here? “Start Health Savings Accounts where patients pay a meaningful percentage of their bills and get to keep a small percentage of the money that’s left over each year. Patients need to have more “skin in the game.”

Really? more stake in the game you say? I think that the fact that about 60% of people filing for bankruptcy in the past year did so due to medical bills. I don’t know “Primare Care Physician” about you but how much more of a stake do want us civilians to have here?

]]> By: david http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18822 david Fri, 05 Jun 2009 19:02:19 +0000 http://www.onpointradio.org/?p=14419#comment-18822 Richard C. - Medicare is being destroyed by the seniors that use it...look at those silly "scooters"..do you really think the taxpayers should buy grandma a scooter? or just pay for major medical care...I watched my parents use medicare like there was no limit...I lived in japan for 12 years..traveled throughout Asia...Japan has both private and public medical care...but YOU HAVE TO BUY INSURANCE..and they have people that TRACK YOU DOWN IF YOU DON'T PAY...as witnessed by a recent high level gov. offical who was not paying...China has public but it's bare bones..you have to tip the doctor if you want care...otherwise you BUY MEDICAL INSURANCE or go to a PRIVATE CLINC. One good country was Thailand..they have very good public hosptials...but still have a private medical insurance market too...so for the USA a combination of both would be best...BUT YOU HAVE TO PAY...nothing is free...and Medicare needs to cut out the fat and just pay the major medical bills..forget the scooters... Richard C. – Medicare is being destroyed by the seniors that use it…look at those silly “scooters”..do you really think the taxpayers should buy grandma a scooter? or just pay for major medical care…I watched my parents use medicare like there was no limit…I lived in japan for 12 years..traveled throughout Asia…Japan has both private and public medical care…but YOU HAVE TO BUY INSURANCE..and they have people that TRACK YOU DOWN IF YOU DON’T PAY…as witnessed by a recent high level gov. offical who was not paying…China has public but it’s bare bones..you have to tip the doctor if you want care…otherwise you BUY MEDICAL INSURANCE or go to a PRIVATE CLINC. One good country was Thailand..they have very good public hosptials…but still have a private medical insurance market too…so for the USA a combination of both would be best…BUT YOU HAVE TO PAY…nothing is free…and Medicare needs to cut out the fat and just pay the major medical bills..forget the scooters…

]]> By: Marc http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18783 Marc Fri, 05 Jun 2009 15:26:44 +0000 http://www.onpointradio.org/?p=14419#comment-18783 We have a system where the providers (docs) control both the supply and the demand. So, they tell a patient what services they need and then supply it (or get a cut from the supplier). And one group of payers, insurers, challenge these services from the outside and at their own peril (i.e. lawsuits). This system is not even close to running health care as a business. However, given politics, how the cost of health care is making business noncompetitive, and other factors, I can’t see us moving towards any form of capitalism for health care. Some form of national health care is probably required. But it’s scary to think of politicians, who are indebted to lobbyists, having even more influence than they have today. We could have anticipated the current problems by looking at where the money was coming from. Can’t we anticipate future problems by looking at who pays those who will be put in charge of this? We have a system where the providers (docs) control both the supply and the demand. So, they tell a patient what services they need and then supply it (or get a cut from the supplier). And one group of payers, insurers, challenge these services from the outside and at their own peril (i.e. lawsuits).

This system is not even close to running health care as a business. However, given politics, how the cost of health care is making business noncompetitive, and other factors, I can’t see us moving towards any form of capitalism for health care.

Some form of national health care is probably required. But it’s scary to think of politicians, who are indebted to lobbyists, having even more influence than they have today. We could have anticipated the current problems by looking at where the money was coming from. Can’t we anticipate future problems by looking at who pays those who will be put in charge of this?

]]> By: Rick Evans http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18753 Rick Evans Fri, 05 Jun 2009 12:57:05 +0000 http://www.onpointradio.org/?p=14419#comment-18753 @Richard C., I agree with many of your observations. However, comparing the U.S. to China, India or Indonesia is an apples to oranges comparison. A valid statistical sample is drawn from economically similar populations. The bar graph in Exhibit 1 http://www.kff.org/insurance/snapshot/chcm010307oth.cfm is the right comparison to make. While Canada's population is a fraction of ours the population of the OECD population exceeds ours. Finally, Gawande is comparing behaviors of physicians and not patient populations. During the show he points to another town in Texas with a similar population with much lower costs but very good care. @Richard C.,
I agree with many of your observations. However, comparing the U.S. to China, India or Indonesia is an apples to oranges comparison. A valid statistical sample is drawn from economically similar populations.

The bar graph in Exhibit 1 http://www.kff.org/insurance/snapshot/chcm010307oth.cfm
is the right comparison to make.

While Canada’s population is a fraction of ours the population of the OECD population exceeds ours.

Finally, Gawande is comparing behaviors of physicians and not patient populations. During the show he points to another town in Texas with a similar population with much lower costs but very good care.

]]> By: Chukwuma Onyeije http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-2#comment-18671 Chukwuma Onyeije Fri, 05 Jun 2009 01:11:28 +0000 http://www.onpointradio.org/?p=14419#comment-18671 This is a very informative and sobering assessment. It is also critical to a proper understanding of the nature of our health care crisis. The issue is not necessarily physician greed but rather built in incentives and modes of practice which facilitate overutilization. The other problem is changes in the nature of medical school education... This is a very informative and sobering assessment. It is also critical to a proper understanding of the nature of our health care crisis. The issue is not necessarily physician greed but rather built in incentives and modes of practice which facilitate overutilization.

The other problem is changes in the nature of medical school education…

]]> By: Alex http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-1#comment-18670 Alex Fri, 05 Jun 2009 01:02:04 +0000 http://www.onpointradio.org/?p=14419#comment-18670 I live in the US, and I work in the medical field. My sister has been living in Spain for over 8 years and I am horrified to see the care they have in their socialized system. Some examples she has experienced are as follows, just to name a few: 1) She was admitted for observation over the weekend while suspected of having an ectopic pregnancy (this can be an emergency), without having an ultrasound. The plan was waiting for it to rupture to send her to surgery because there was nobody to do an ultrasound because it was friday 3 PM and all radiologists were already gone for the weekend. In the US she would have had an ultrasound and the question answered in 1 hour. Of course, if docs cannot get sued in a socialized system, why would they care providing a fast and accurate diagnosis? 2) She has a daugther with rheumatoid arthritis and had to wait 6 months to have an MRI in the only hospital that was available to do it in a young kid. She flew to the US and had the MRI done next day. Note that she is instructed and educated and had struggle with the system; imagine what would happen to an noneducated, poor patient..... 3) She lives in a town with a population of about 100,000, 30 minutes from Madrid; there is no emergency room or surgical facility!!! If she has an emergency or urgent consult, they have to go first to a "general doctor" in local "offices" that do not have emergency, x-ray or laboratory facilities. These are usually crowded, doctors are usually not well prepared and not motivated, and if anything "medium tech" (such as an appendicitis) would be needed they are transferred to the general hospital downtown where they are treated in a very "impersonal" way. Of course this is cheaper than American Medicine, but is also poor quality of care. Is this what we want? Let's not be idealists. Motivation is everything in life. If docs are not motivated (they are not well paid and cannot get sued) they would not care as much as they should. I could go on and on for a while, but my conclusion is that we cannot get good and cheap at the same time. Another thought is that we, Americans, have a different mentality than Canadians and Spanish. We are more demanding. We expect faster and better service. If we don't get it we complain, we sue, etc. Forget about complaining in a socialized system. And get ready to wait............. It's easy to claim all the theoretical benefits of socialized medicine when we are enjoying the real benefits of the best medicine in the world that we have in the US. Everybody talks about the health care crisis, but over 70% of patients that have private insurance are happy with it. Uninsured patients are not denied emergency treatment in any hospital. Many counties have indigent funds that provide coverage for nonemergency services. I'm sure none of us would go to Spain, Sweden or Canada to have a cardiac surgery, but thousands come every year to the US to have surgeries and other procedures. I propose to all who claim for a socialized system to travel to any of these socialized medicine countries to have medical services so you will realize what you are willing to loose here in America. I live in the US, and I work in the medical field. My sister has been living in Spain for over 8 years and I am horrified to see the care they have in their socialized system. Some examples she has experienced are as follows, just to name a few:
1) She was admitted for observation over the weekend while suspected of having an ectopic pregnancy (this can be an emergency), without having an ultrasound. The plan was waiting for it to rupture to send her to surgery because there was nobody to do an ultrasound because it was friday 3 PM and all radiologists were already gone for the weekend. In the US she would have had an ultrasound and the question answered in 1 hour. Of course, if docs cannot get sued in a socialized system, why would they care providing a fast and accurate diagnosis?
2) She has a daugther with rheumatoid arthritis and had to wait 6 months to have an MRI in the only hospital that was available to do it in a young kid. She flew to the US and had the MRI done next day. Note that she is instructed and educated and had struggle with the system; imagine what would happen to an noneducated, poor patient…..
3) She lives in a town with a population of about 100,000, 30 minutes from Madrid; there is no emergency room or surgical facility!!! If she has an emergency or urgent consult, they have to go first to a “general doctor” in local “offices” that do not have emergency, x-ray or laboratory facilities. These are usually crowded, doctors are usually not well prepared and not motivated, and if anything “medium tech” (such as an appendicitis) would be needed they are transferred to the general hospital downtown where they are treated in a very “impersonal” way.

Of course this is cheaper than American Medicine, but is also poor quality of care. Is this what we want?

Let’s not be idealists. Motivation is everything in life. If docs are not motivated (they are not well paid and cannot get sued) they would not care as much as they should.

I could go on and on for a while, but my conclusion is that we cannot get good and cheap at the same time.

Another thought is that we, Americans, have a different mentality than Canadians and Spanish. We are more demanding. We expect faster and better service. If we don’t get it we complain, we sue, etc. Forget about complaining in a socialized system. And get ready to wait………….

It’s easy to claim all the theoretical benefits of socialized medicine when we are enjoying the real benefits of the best medicine in the world that we have in the US. Everybody talks about the health care crisis, but over 70% of patients that have private insurance are happy with it. Uninsured patients are not denied emergency treatment in any hospital. Many counties have indigent funds that provide coverage for nonemergency services.

I’m sure none of us would go to Spain, Sweden or Canada to have a cardiac surgery, but thousands come every year to the US to have surgeries and other procedures.

I propose to all who claim for a socialized system to travel to any of these socialized medicine countries to have medical services so you will realize what you are willing to loose here in America.

]]> By: Richard C. http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-1#comment-18660 Richard C. Thu, 04 Jun 2009 22:57:14 +0000 http://www.onpointradio.org/?p=14419#comment-18660 David says people should be forced to buy insurance because “Too many people are using a service but don’t want to pay for it.” Here’s a clue: If you don’t have insurance you pay MORE than what the insurance would pay on your behalf, even if you ask for and get a “self-pay” discount. I took a quick look at Dr. Gawande’s column in New Yorker, hoping to find a chart or table to support his statistics. Nada. Frankly, problems in health care notwithstanding, his thesis sounds like an example from “200% of Nothing” or “How to Lie with Statistics.” Let me restate it: Per capita Medicare costs in McAllen ($15K/yr) are twice the (overall) national average of $7.5K/yr. OK. Does anyone not expect Medicare costs to be above the average? Remember that Medicare is paying to treat us geezers, who, unfortunately, seem to be susceptible to a bunch of diseases that are rare in young whipper-snappers. Let’s see a chart of the Medicare cost averages from a variety of cities. What’re the one-sigma values? Is it a broad flat curve or narrow band where McAllen’s $15K would be out at six-sigma? His Mayo example is probably a red herring: Mayo is a global health resource, not a simple community medical center. Actually, it isn’t clear what Gawande’s $6.5K means there. Is that for Medicare beneficiaries in Rochester? The average annual bill for a Mayo patient? The cooperative team medical care sounds nice, though. HMOs: Over time I’ve heard a lot of bitching about HMOs. I had coverage (employer paid) through an HMO for several years and thought it was the best care I’d ever had under any of the plans the company had contracted. BTW: If anyone has info on how the countries most similar in size to the U.S. -- China, India and Indonesia – do their universal health care, please post it. Remember, California alone has a greater population than Canada. David says people should be forced to buy insurance because “Too many people are using a service but don’t want to pay for it.” Here’s a clue: If you don’t have insurance you pay MORE than what the insurance would pay on your behalf, even if you ask for and get a “self-pay” discount.

I took a quick look at Dr. Gawande’s column in New Yorker, hoping to find a chart or table to support his statistics. Nada. Frankly, problems in health care notwithstanding, his thesis sounds like an example from “200% of Nothing” or “How to Lie with Statistics.” Let me restate it: Per capita Medicare costs in McAllen ($15K/yr) are twice the (overall) national average of $7.5K/yr. OK. Does anyone not expect Medicare costs to be above the average? Remember that Medicare is paying to treat us geezers, who, unfortunately, seem to be susceptible to a bunch of diseases that are rare in young whipper-snappers. Let’s see a chart of the Medicare cost averages from a variety of cities. What’re the one-sigma values? Is it a broad flat curve or narrow band where McAllen’s $15K would be out at six-sigma? His Mayo example is probably a red herring: Mayo is a global health resource, not a simple community medical center. Actually, it isn’t clear what Gawande’s $6.5K means there. Is that for Medicare beneficiaries in Rochester? The average annual bill for a Mayo patient? The cooperative team medical care sounds nice, though.

HMOs: Over time I’ve heard a lot of bitching about HMOs. I had coverage (employer paid) through an HMO for several years and thought it was the best care I’d ever had under any of the plans the company had contracted.

BTW: If anyone has info on how the countries most similar in size to the U.S. — China, India and Indonesia – do their universal health care, please post it. Remember, California alone has a greater population than Canada.

]]> By: kent http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-1#comment-18654 kent Thu, 04 Jun 2009 20:21:30 +0000 http://www.onpointradio.org/?p=14419#comment-18654 As a primary care physician, I truly doubt that the vast majority of physicians are running up our health care costs in this country. Our out of control costs have 4 major contributors: the pharmacy industry and the insurance industry are obvious culprits. But technology also plays a role (just because we "can" do a test/procedure, doesn't mean we "should" do a test/procedure). And patients are the other component, whether that be in their lack of healthy lifestyles which contribute greatly to disease processes or their expectations for "more" health care. The fact that over 50% of health care dollars are spent in the last year of life neccesitates us to start making some decisions, again about what "should be done" as opposed to what "can be done". We need to ask what is the cost and what will be gained. Our health care system also needs to change to invest/compensate primary care for prevention and early disease management, rather than trying to play catch up with much more expensive/intensive specialist care late in the disease process. Until these issues are addressed by health care leaders and congress, little change will be possible to rein in current expenditures. As a primary care physician, I truly doubt that the vast majority of physicians are running up our health care costs in this country. Our out of control costs have 4 major contributors: the pharmacy industry and the insurance industry are obvious culprits. But technology also plays a role (just because we “can” do a test/procedure, doesn’t mean we “should” do a test/procedure). And patients are the other component, whether that be in their lack of healthy lifestyles which contribute greatly to disease processes or their expectations for “more” health care. The fact that over 50% of health care dollars are spent in the last year of life neccesitates us to start making some decisions, again about what “should be done” as opposed to what “can be done”. We need to ask what is the cost and what will be gained. Our health care system also needs to change to invest/compensate primary care for prevention and early disease management, rather than trying to play catch up with much more expensive/intensive specialist care late in the disease process. Until these issues are addressed by health care leaders and congress, little change will be possible to rein in current expenditures.

]]> By: Elva http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-1#comment-18652 Elva Thu, 04 Jun 2009 19:49:00 +0000 http://www.onpointradio.org/?p=14419#comment-18652 Reading that article on the high medical costs here in the Rio Grande Valley is not surprising. I moved back home 5 years ago and it really caught us by surprise. It is true that most people here are uneducated and poor. These people will sit at the doctors office all day waiting to see the doctor even if they have appts. They don't complain even when they are mistreated by the staff. The staff are mostly untrained people who have no training and little respect for the elderly. I have found out that you have to make some decisions about your health problems even if the doctor says otherwise. For most of these people, it would be difficult to get a second opinion because of lack of money or like me, insurance will not cover for second opinions. The fees are so expensive that you either save up for that procedure or not do it at all. In this bad economic times, sometimes that is the only option. It is time for healthcare to be revamped. However, to say that all the doctors are money hugry is not fair. I am blessed with a good doctor here in the Rio Grande Valley. He is a good listener and keeps his appts with his patients. He also tries to find the problem of your health concern w/o going thru all this expensive tests. When he does have to do that, he tries to help you find a dr. who will take care of the problem w/o too much hoopla. I think even he is finding that to be a harder thing to find. Reading that article on the high medical costs here in the Rio Grande Valley is not surprising. I moved back home 5 years ago and it really caught us by surprise. It is true that most people here are uneducated and poor. These people will sit at the doctors office all day waiting to see the doctor even if they have appts. They don’t complain even when they are mistreated by the staff. The staff are mostly untrained people who have no training and little respect for the elderly. I have found out that you have to make some decisions about your health problems even if the doctor says otherwise. For most of these people, it would be difficult to get a second opinion because of lack of money or like me, insurance will not cover for second opinions.
The fees are so expensive that you
either save up for that procedure or not do it at all. In this bad economic times, sometimes that is the only option. It is time for healthcare to be revamped. However, to say that all the doctors are money hugry is not fair. I am blessed with a good doctor here in the Rio Grande Valley. He is a good listener and keeps his appts with his patients. He also tries to find
the problem of your health concern w/o going thru all this expensive
tests. When he does have to do that, he tries to help you find a dr. who will take care of the problem w/o too much hoopla. I think even he is finding that to be
a harder thing to find.

]]> By: Health Affairs Blog http://www.onpointradio.org/2009/06/costly-care-in-a-texas-town/comment-page-1#comment-18649 Health Affairs Blog Thu, 04 Jun 2009 18:12:30 +0000 http://www.onpointradio.org/?p=14419#comment-18649 [...] more from Gawande, he was interviewed last night on “On Point” with Tom [...] [...] more from Gawande, he was interviewed last night on “On Point” with Tom [...]

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