The Great Health Care Plan still doesn't exist. Oh, there's sound bites by 'people' like Max Baucus who said with a presumably straight face that a tax on employer funded health plans would be a boon to society, as it would force the companies in question to offer policies that cover substantially less, and thus stem the gross overuse of medical services in the US.
Um---OK. Gotta go,Max. Got a date with reality.
I was growling through some stats on the MEPS website. No connection to the Coneheads. It's the Medical Expenditure Panel Survey arm of the Agency for Healthcare Research and Quality portion of the Department of Health and Human Services branch of the Federal Government. It's most recent data is 2006. It does things like sending (self-administered)questionnaires to diabetics between the ages of 18 and 65 to find out what percentage of them had a foot exam that year.
That's not unimportant. Au contraire. Foot infections in diabetics are a mess and we spend a bazillion dollars on them every year.
But aside from the people at MEPS sending their data to AHRQ at HHS, you know what happens to this valuable data?
Nada. Nothing. Zip. There is no way, at least from the blogosphere, to find out if this data is ever used to actually help people. It's just like that large ball tossed up to the top of the Centrifugal Bumble-Puppy tower with people standing around waiting to see which hole it'll shoot out of, and hoping they don't get hurt.
So when people start throwing data at you about who's going to get what in our New Health Care System, duck.
Monday, September 14, 2009
Sunday, September 6, 2009
Paranoia
Dr. Arthur M. Feldman wrote an excellent article in the "Outlook" section of The Washington Post today entitled "10 Things I Hate About Health Care Reform." It was well thought out and clearly written.
His section on tort reform, however, I felt missed two important points on the amount lawsuits add to the overall cost of health care.
He correctly mentions the cost of defensive medicine. A survey published in NEJM last year showed that in Massachusetts, 23% of tests ordered by doctors were done not because the MD or DO thought they were necesary, but because they wanted to have all the ammo they could of they got sued.
He mentions the phenomenon of physicans moving to states that already have caps on pain and suffering awards leaving some states over doctored and some under doctored.
But there are two other aspects of tort reform that need to be empahsized:
1) Insurance companies make more and more money every time malpractice premiums go up. Im Massachusetts, an Obstetrician or Neurosurgeon's YEARLY malpractice premium starts at around $250,000.00. So you have to make a quarter of a million just to open the doors. Then you can start paying the office overhead. So, insurance compaines being the ones that run health care, both private and public, have zero incentive to back tort reform.
2) Without retreat into self-pity,it can be said honestly that being a physician is Very Hard Work. It requires the nicest sense of judgement applied to a vast storehouse of knowledge tempered by the experiencce to know when to inervene and when to refrain. The intrinsic drive to do it well is its only safeguard against mediocrity.
If you apply the above standard every day of your working life while knowing that a lawyer seeking only money, not justice, can drag you into court and paint you as a negligent uncaring bastard, it dulls your edge. More burnout. More defensive medicine.
As a doctor you have to document (in an easily readible form, usually with words of no more that two syllables)to multiple unconnected federal agencies that you are meeting the standards of 'good medicine' established by bean counting bureaucrats.
Then, on top of this, some jamoke who solicits people to file lawsuits via ads on TV, municipal busses and phone books can take over your life for years while a frivilous suit is adjudicated. In most cases, this means that motions (read: billable hours)fly back and forth until the su-er decides his input in work is liable to exceed the probable award, or the su-ee decides that the suit lacks merit, but they've already spent, say 80 grand, to defend against a probable 70 grand award: the 'suit' is settled.
As long as there is a system in place that allows insurance companies to make huge amounts of money on malpractice insurance and provides lawyers the opportunity to tap into that huge pile of cash (both prosecution and defense), there will be no tort reform.
So: Outlaw advertising by lawyers. As lawyers make the laws, this may not happen.
But if a judge were able to lable a suit as fivolous, and force the prosecution to pay the defense's costs, the phone book guys would be much more circumspect about filing suits. And the amount of energy a physician now spends on paranoia (and the defensive medicine costs it generates) could be put back into looking after the best interests of their patients.
The best doctors have medicine as a vocation, not a job. Let's try to get our legal colleagues up to the same standard.
His section on tort reform, however, I felt missed two important points on the amount lawsuits add to the overall cost of health care.
He correctly mentions the cost of defensive medicine. A survey published in NEJM last year showed that in Massachusetts, 23% of tests ordered by doctors were done not because the MD or DO thought they were necesary, but because they wanted to have all the ammo they could of they got sued.
He mentions the phenomenon of physicans moving to states that already have caps on pain and suffering awards leaving some states over doctored and some under doctored.
But there are two other aspects of tort reform that need to be empahsized:
1) Insurance companies make more and more money every time malpractice premiums go up. Im Massachusetts, an Obstetrician or Neurosurgeon's YEARLY malpractice premium starts at around $250,000.00. So you have to make a quarter of a million just to open the doors. Then you can start paying the office overhead. So, insurance compaines being the ones that run health care, both private and public, have zero incentive to back tort reform.
2) Without retreat into self-pity,it can be said honestly that being a physician is Very Hard Work. It requires the nicest sense of judgement applied to a vast storehouse of knowledge tempered by the experiencce to know when to inervene and when to refrain. The intrinsic drive to do it well is its only safeguard against mediocrity.
If you apply the above standard every day of your working life while knowing that a lawyer seeking only money, not justice, can drag you into court and paint you as a negligent uncaring bastard, it dulls your edge. More burnout. More defensive medicine.
As a doctor you have to document (in an easily readible form, usually with words of no more that two syllables)to multiple unconnected federal agencies that you are meeting the standards of 'good medicine' established by bean counting bureaucrats.
Then, on top of this, some jamoke who solicits people to file lawsuits via ads on TV, municipal busses and phone books can take over your life for years while a frivilous suit is adjudicated. In most cases, this means that motions (read: billable hours)fly back and forth until the su-er decides his input in work is liable to exceed the probable award, or the su-ee decides that the suit lacks merit, but they've already spent, say 80 grand, to defend against a probable 70 grand award: the 'suit' is settled.
As long as there is a system in place that allows insurance companies to make huge amounts of money on malpractice insurance and provides lawyers the opportunity to tap into that huge pile of cash (both prosecution and defense), there will be no tort reform.
So: Outlaw advertising by lawyers. As lawyers make the laws, this may not happen.
But if a judge were able to lable a suit as fivolous, and force the prosecution to pay the defense's costs, the phone book guys would be much more circumspect about filing suits. And the amount of energy a physician now spends on paranoia (and the defensive medicine costs it generates) could be put back into looking after the best interests of their patients.
The best doctors have medicine as a vocation, not a job. Let's try to get our legal colleagues up to the same standard.
Wednesday, September 2, 2009
Headache
So, I tried to write about how the US finances itself, but I got such a horrible headache, I gave it up. The Federal Government is an incomprehensibly complicated behemoth. I get better at navigating the Federal websites, but they are still so disconnected functionally that you wind up with no idea of how the structure is organized, let alone how it works.
I went to Muckety.com, a fascinating website that displalys organizational maps of all manner of businesses and governmental structures. It took me four tries to get Muckety to recognize a link to its own section outlining the genreal structure of Our Govenment. I still couldn't get it to map it out. Anybody has better luck, let me know.
This exercise in mental flagellation began as an attempt to figure out how the government would fund health care. The medicare trust was pirated years ago to be replaced with a bunch of congressional promissory notes. That Bridge to Nowhere could have been your grandmother's artifical hip, but it was not to be.
So, foolishly, I started with the Treasury web site, dove into the Bureau of Debt Management site, and got suckered into reading the minutes of the August meeting of the Treasury Borrowing Advisory Committee. Members? CEO's of Goldman Sachs, JP MorganChase, Pimco, BlackRock, Moore Capital Investment and so on. (BlackRock, if you're interested, is in the process of buying the Capital Investment Division Of Barclay Capital LLC for 6.6 billion cash and 38 million shares [19.9%] of Barclay's. The will rename themselves no doubt. But I digress).
Not knowing anything about Moore Capital Investment, I Muckety'd again. I suggest you try it. It starts out as a four-link map, one of which is the Mutual Funds Association. I Muckety'd that. That (much more complex) map had a link to the top 100 members of this association. The screen blossomed into a labrynth of companies. Like who? Oh, Goldman Sachs, JP MorganChase, Pimco.... Now I know how Mickey felt when he kept trying to chop up all those brooms.
Most, if not all, of these plutocrats run hedge funds. So the guys who advise the government on how to structure its debt are the very same knuckleheads (Very Rich Knuckleheads)that just screwed everybody and his brother out of houses, retirement funds, and, in the end, health care.
Migranous. Hemicranial.
The only comfort I can draw from this chalkboard screeching nail bed stabbing exercise, is that maybe--just maybe--the whole freaking thing is so incestuous that the plots of the few to rob the many may be too cumbersome to really organize, and that this last money meltdown was just as much by chance as that butterfly in Tokyo that flapped its wings and made it rain in New York. Maybe.
I went to Muckety.com, a fascinating website that displalys organizational maps of all manner of businesses and governmental structures. It took me four tries to get Muckety to recognize a link to its own section outlining the genreal structure of Our Govenment. I still couldn't get it to map it out. Anybody has better luck, let me know.
This exercise in mental flagellation began as an attempt to figure out how the government would fund health care. The medicare trust was pirated years ago to be replaced with a bunch of congressional promissory notes. That Bridge to Nowhere could have been your grandmother's artifical hip, but it was not to be.
So, foolishly, I started with the Treasury web site, dove into the Bureau of Debt Management site, and got suckered into reading the minutes of the August meeting of the Treasury Borrowing Advisory Committee. Members? CEO's of Goldman Sachs, JP MorganChase, Pimco, BlackRock, Moore Capital Investment and so on. (BlackRock, if you're interested, is in the process of buying the Capital Investment Division Of Barclay Capital LLC for 6.6 billion cash and 38 million shares [19.9%] of Barclay's. The will rename themselves no doubt. But I digress).
Not knowing anything about Moore Capital Investment, I Muckety'd again. I suggest you try it. It starts out as a four-link map, one of which is the Mutual Funds Association. I Muckety'd that. That (much more complex) map had a link to the top 100 members of this association. The screen blossomed into a labrynth of companies. Like who? Oh, Goldman Sachs, JP MorganChase, Pimco.... Now I know how Mickey felt when he kept trying to chop up all those brooms.
Most, if not all, of these plutocrats run hedge funds. So the guys who advise the government on how to structure its debt are the very same knuckleheads (Very Rich Knuckleheads)that just screwed everybody and his brother out of houses, retirement funds, and, in the end, health care.
Migranous. Hemicranial.
The only comfort I can draw from this chalkboard screeching nail bed stabbing exercise, is that maybe--just maybe--the whole freaking thing is so incestuous that the plots of the few to rob the many may be too cumbersome to really organize, and that this last money meltdown was just as much by chance as that butterfly in Tokyo that flapped its wings and made it rain in New York. Maybe.
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