February 14th, 2007 by Dr. Val Jones in Medblogger Shout Outs, Opinion
Tags: Finance, Hospitals, Medicare, Technology
3 Comments »
In my last blog post, I unwittingly evoked vehemence on the part of those pro/con a single payer model for healthcare. And so in this post I’d like to offer some more food for thought (while attempting to dodge the high velocity tomatoes):
First of all, Dr. Reece summarizes things nicely, suggesting that this debate is not entirely resolvable:
Incompatible Mindsets
• If your mindset is that government’s moral duty is to redistribute resources to protect the health of all, and that health is directly related to the extent of health system coverage, you think and receive information in a certain way. You generally attribute superior health statistics of other nations to universal coverage, even if these other nations have more homogeneous, smaller populations, and different cultures.
• If your mindset is that private markets provide the best care for most of the people most of the time, provide better access to high technologies, give more health care choices to citizens, distribute resources more efficiently and that the health of the people is more related to cultural behaviors and a nation’s heterogeneous population, you receive information in completely different way.
The Unending Argument
The power and efficiency of government vis-à-vis the power and efficiency of markets is a never-ending argument – an argument unlikely to change mindsets. To progressives, it’s a moral argument: to conservatives, it’s an exercise in reality. You can marshal persuasive arguments on both sides, without convincing either side who is right.
An economics blogger explains why extending Medicare benefits to all would not succeed:
The dirty little secret behind Medicare is that it works only because it does not cover every American. Part of the reason for this is that Medicare’s payment structure is designed to pay doctors and hospitals in such a way as to limit total spending, rather than to ensure they can break even. Clearly, they have to do better than break even to stay in business, and the people running Medicare know that. Medicare depends on the fact that there are lots of non-Medicare patients out there who (through their private insurance) can pay enough to keep the doctors and hospitals in business. This is called “cost shifting.”
Whether pro/con single payer system, I think that we nearly all can agree on one thing: price transparency is morally right. It’s hard to fix a system if you don’t really know where the money is coming from or going to. I think it would be nice to have people on both sides of the debate work together for that common goal first. Would you agree?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 7th, 2007 by Dr. Val Jones in Medblogger Shout Outs
Tags: Finance, Hospitals
4 Comments »
Well, this conversation from the blogosphere gets my blood boiling, I can tell you! In a recent blog post about the ugly under belly of hospitals, I discussed how administrator salaries decrease hospital resources. Dr. Stanley Feld’s excellent blog post digs even deeper:
Paul Levy CEO of Beth Israel Hospital writes a blog called “Running a Hospital”. He has tried to justify his salary after the Boston Globe published his salary of over 1 million dollars per year…
Remember hospitals such as Beth Israel Hospital in Boston are tax exempt community hospitals because they have this community obligation. These tax subsides and others tax subsides are opaque to the public. However, the public pays for these subsides. They contribute to the hospitals bottom line and Mr. Levy’s bonus.
Linda Halderman M.D. wrote an essay entitled “How Much is Your Doctor Worth?”. It is also worth reading. The subtitle should be, “How Much is Your Doctor paid?” The answer after the long essay is $59.50 for a complicated office visit. [If Levy were a clinician,] he would only have to see 168,067 patients in one year or 744 patients a day to generate a gross revenue of $1,000,000 before expenses.
What is more valuable to the healthcare system? A CEO’s salary based on revenue generated incentives and fund raising or good quality medical care?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 26th, 2007 by Dr. Val Jones in Medblogger Shout Outs
Tags: Complementary And Alternative Medicine, News, Pharmaceuticals, Research
4 Comments »
Wow, this was one of the best rants I’ve heard in a while (thanks to Kevin MD for linking to this article in his blog) – looks as if this writer is neither friend to homeopathy nor big pharma:
“Some homeopaths [say] that their cures are not amenable to scientific proof. That’s fine, if you want to call the multimillion dollar industry what it is: faith healing…
Homeopathy rests on three unproven tenets: First, ‘Like treats like.’ Because arsenic causes shortness of breath, for example, homeopaths prescribe its ‘spirit’ to treat diseases such as asthma. Second, the arsenic or other active ingredient is diluted in water and then that dilution is diluted again and so on, dozens of times, guaranteeing—for better and worse—that even if the dose has no therapeutic value, it does no harm. And third, the potion is shaken vigorously so that it retains a ‘memory’ of the allegedly curative ingredient, a spirit-like essence that revives the body’s ‘vital force.’
So what about the fact that some homeopathic patients get better? Part of the effect comes from the ritual of consultation with a practitioner who treats the patient like a person rather than a body part on an assembly line. And just taking anything can help; the placebo effect is real. In gold-standard, double-blind studies, placebos presented as possible cures sometimes rival pharmaceuticals for effectiveness, or beat taking nothing at all.
Nor are the effects simply psychological. When volunteers took a placebo that they were told contained painkillers, they experienced relief, while researchers watching PET scans of the subjects’ brains tracked increased levels of the body’s own pain-relieving endorphins. In other studies, research subjects given placebos instead of antidepressants also showed chemical changes in their brains. FDA data for six top antidepressants showed that 80 percent of their effect was duplicated in placebo control groups.
Which brings us to the patient’s dilemma: Have faith in 19th century magic or rely on a pharmaceutical industry that suppresses negative outcomes (including death), promotes drugs for nonexistent diseases, repackages old drugs in new bottles to circumvent patent expirations, bribes doctors with perks and cash and hires ghost writers to author favorable studies? Given the hype, toxicity, and expense of many drugs and Big Pharma’s snake-oil tactics, the side effects of water (laced with “memory”) start looking pretty damn good. If your condition is relatively minor, self-limiting or untreatable, you may be a lot better off drinking homeopathy’s Kool-Aid-less Kool-Aid.”
Ouch. What do you think of Mr. Allen’s remarks?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 12th, 2007 by Dr. Val Jones in Medblogger Shout Outs
Tags: Health Insurance, Health Policy
1 Comment »
Dr. Richard Reece’s latest blog post lists “12 health care predictions for 2007” – I looked into his crystal ball and was quite intrigued. Here are some highlights (see his blog for the full transcript):
- The home care market will boom
- Obesity will eclipse smoking as the #1 public health issue in America
- Web based patient education will become extremely popular
- High deductible health plans (powered by health savings accounts) will dramatically expand their reach
- Employee wellness and prevention programs will bloom…
What other trends do you think he missed? Do you disagree with any of his predictions?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
