Kevin, M.D. - Medical Weblog

This is depressing, but incredibly predictable. The statistics that make the papers and are used by politicians are invariably the most extreme and scary ones, and their validity makes little difference. I read a study by a guy who added up the "costs to society" of the pet problems that various advocacy groups claim when trying to get politicians to make people do things, and he came up with well over the amount of money that was in circulation. Remember how many people the CDC said died from obesity in their first and most widely used study? Remember when they adjusted that down by 90% and said that that adjustment had no bearing on the severity of the problem?

Statistics have become meaningless. 'Nuff said.
 

"Lies, Damned Lies, and Statistics" Mark Twain hit the nail on the head.
 

Josh, your ignorance on this subject is appalling, but by all means stick with your truthiness. The US has the best healthcare in the world. The expense of that care (2 trillion and counting) is not excessive. Any problems with the healthcare system are because of the lawyers. If it's not the lawyers fault then it's the government. If it's not the government's fault then it's the insurance companies. If it's not the insurance companies fault then it's the patients.

Statistics are so much less believable than talking points.
 

Elliot, I think I agree w/ you. I never said the cost was excessive. I do believe the best HC in the world is in America. Lawyers absolutely have complicated the industry. Third-party payers have thrown have buried us in paper-work and red-tape. The gov't screws up everything it touches.

I'd like to hear more from you, I really would.
 

"Statistics have become meaningless. 'Nuff said."

Apply this same remark to every statistical analysis used on this board to support the claim that malpractice is behind every problem in health care today.

BTW, just because a person HAS some type of insurance doesn't necessarily mean s/he has health care access. Access is the problem, and Kevin has done a great job drawing attention to the lack of primary care available to society's lower echelon.
 

Agreed. Access to primary care is what the vast majority of people need. Thats what I talk about over at my blog and my solution for it. If you made primary care more affordable, say on the order of a tank of gas, you wouldn't need insurance.
 

I don't have too much sympathy for the uninsured. Many of the uninsured I see in my ER have a 2 ppd cigarette habit, a cellphone and IPOD in their purse.

Priorities. Priorities.

I took care of an uninsured trauma patient who wrecked his 911. I am sure He will stiff me and the hospital for his bill.

No Sympathy.
 

Well, I know we have the best care anywhere even though I can't find a single public health statistic where we are #1 except number of doctors, cost, and hospital beds (and we seem relatively far down the list on some things like infant mortality and life expectancy). The cost isn't excessive even though we spend more per capita than any other country and exeed by 5% the amount of our GDP we devote to healthcare compared to our nearest competitor (GO USA). The lawyers; damn those lawyers; even though most studies put the cost at no more than 2%, I know that they just mess up the entire system with defensive medicine (I know it when I see it). The government can't run a health system even though we are the only first world country not to have universal care. The rest of them are doomed to failure even though surveys show that citizens of those countries like their healthcare better than we do.

Statistics don't mean anything when you have the truthiness.
 

Hey Elliott you left out some number 1's. We are number 1 in obesity, our country is the fattest in the world bar none. One Third of our population is obese. We are number 1 in inactivity- We have the lowest rates of activity and exercise in the world. We have the highest cigarette consumption in the world. Take these factors into account and the fact they we try to SAVE 26 week old babies and up while other countries count them as miscarraiges and I think we are doing remarkably well with all of our statistics. Americans are a bunch of fat and lazy slobs that care nothing for prevention only if they can get a bigger king sized superfries with their 64 oz cup of Coke and a quadruple Bacon Cardiac Cheeseburger. As the old adage goes you can't make chicken soup out of chicken poop.
I love the heathcare I have, I wouldn't trade what I have in the US for any country's "free" system in the world. Bottomline, if I was going to get sick there is absolutely nowhere I would rather be.
 

I agree with anon 5:01 above.

We also have a gazillion Hispanic illegal aliens whose cultural emphasis includes early and multiple pregnancies with minimal prenatal care and little or no primary care.

But yeah, insurance is way expensive even for high earners. Partly because our healthcare system is the best in the world.
 

Universality isn't the only issue. Affordability for the individual without the benefit of a company/federal health plan is also an impedence to comprehensive health care.
My wife and I have health 'issues' and we have to pay $925 for the two of us a month with a $7500 deductable (EACH). This year we have managed to pay out of pocket almost the full $26,000. I had the good fortune to have a sudden cardiac death. The good fortune part (besides surviving) was that I had it in Australia. With no insurance the entire affair (ambulance, ER, BlastBlastBlast, angiogram/plasty, stent, 4 days CCU, follow-up with cardiologist and all meds) cost $5290 U.S.
My wife then had her gall bladder out here (Idaho) which cost close to $7000. Go figger!
I guess I should have wished to have had the Big One here where I would have got my money's worth out of my insurance (my last one cost $100,000).
About that tank of gas. I wish I got that much per primary care visit. The only ones that pay me more are the folks without insurance. I have to gouge the hell out of them to make up for the lousy reimbusements from the Blues, Aetna, (etc.), Medicaid, and Medicare (Oh, especially Medicare).
I've read all the stats about the uninsured (or the lack thereof) in literature and books like 'The Cure' (try to get that HSA account with high risk Hx) but if you don't think these people exist come and visit my walk-in clinic any day of the week.
I'm originally from Canada and Ive lived and worked in New Zealand , Oz , and Britain. All of those systems have problems (ONE of the reasons I'm here, but not for the money, I made more there) and yes this is a great place to be if you are desparately ill, but we can and should do better. Big money in medicine carries too much political weight. Corporate hospitals, pharmaceuticals, medical suppliers, and CEOs of insurance companies making obscene amounts of money might have something to do with cost over-runs. We (physicians) have the ability to cause change. All we need is the will, and a spine.
 

Elliot, I think I agree w/ you.

Elliot's comment = irony
Josh's reply = EXTREME irony?

Or is it just sweet, guileless youth?

Either way, "Doctoring The Truth About The Uninsured" may well be a focused and accurate analysis of data usually presented to the public in broad strokes.

But it's still spun--oh, baby, is it SPUN! The details do nothing to prove that the problem is exaggerated, even just in terms of how much it costs hospitals.

Young people need health insurance, too! You don't have to be over 35 to get ripped up in a car crash or develop cancer or become suicidally depressed. In the first two instances, you'll probably get care, but it'll bankrupt you. In the third, well, you just might not. This stuff happens. A lot.

As for the other bit of "truth": What difference does it make that condition of being uninsured--like the condition of being homeless--is not static? The consequences are the same, whether the unlucky SOB who's hit by a bus today is the same SOB who was counted among the uninsured last month. Even if his COBRA check is in the mail, his friendly Third Party Administrator is unlikely to give a flying fark.
 

Very interesting post. Even if the problem of uninsured people isn't as great as some would say it is, it's still a pretty significant problem.
 

Josh, do you know what the Pacific Research Institute is and from whom it gets its funds. Is it possible that they are providing biased data? If people could just stop listening to rhetoric and knee jerking and actually take an honest look at their own situations and the situations around them, they might see through the BS of the PRI and other special interest groups. By the way, do you know what percentage of bankruptcies in the US are due to medical bills? Think before you post!
 

"You don't have to be over 35 to get ripped up in a car crash or develop cancer or become suicidally depressed."
There is a good chance that a person's medical insurance has a motor vehicle accident exclusion clause. Cancer will be covered, unless the insurance company considers the treatment "experimental". In most insurance policies there is less coverage for psychiatric illnesses than medical illness. There is often a limit on psychotherapy and inpatient psych hospital stays. Even with good medical insurance, a suicidally depressed young person might not get adequate psychiatric care.
Not everyone benefits from health insurance.
http://rebeldoctor.blogspot.com/2006/12/not-everyone-benefits-from-health.html
 

A mandatory health insurance plan like in MA or now in MD nationwide would force all those younger people that think they are immortal to sign up and thus expand the risk pool. The problem of the uninsured is not as bad as the media portrays it really is a matter of priories as a previous commenter stated. A high deductible low cost bear-bones HSA needs to be offered with these mandatory insurance plans, but of course the special interests will be busy at work trying to jam in coverage for chiropractic, massage, PT, acupuncture, etc.

Which country has the best healthcare? Where do all the super wealthy foreigners go for care? The US! Of course France and Germany do well too, but still the vast majority of foreign dignitaries come to the US for care.

People confuse the quality of a healthcare system and it’s doctors with the quality of the health of a nation. They are not the same. The quality of the health of a nation depends on far more factors other than the quality of the healthcare system such as: smoking, crack cocaine babies, obesity, murder rates, alcohol consumption, racial diversity, fast food, inactivity, etc.

Don’t let the politicians fool you.
 

Independent Urologist, You know what a big fan of you/your blog I am, but please don't underestimate me ;) I didn't get to where I am by being uninformed or naive. I know who the PRI is and I know about the study's author, Sally Pikes (a Canadian) and I take EVERYthing i read w/ a grain of salt. I'd challenge you to provide ANY source supporting either view of UHC that isn't biased. The 'fact' (yes i use that term loosely) is that their info is based on Census Data. What IF those #s are right, does that change you're opinion.

As for medical bankruptcy, I'm surprised that YOU would let yourself believe such a poor piece of 'research.' Especially, when you challenge my sources :). I'll make a post today about that paper, it is a classic example of a poorly written/researched paper FULL of statistical inaccuracies and academically dishonest conclusions.
I look fwd to reading your views on that post.


Terry: Are you suggesting that you shouldn't pay more for health insurance?!? You said yourself that you have health issues, so you're a higher risk of using more resources. Of course you should pay more. Just like car insurance, the safer drivers pay less, the riskier drivers pay more. Isn't that they way it should be?

"Health Ins is too Expensive" Is that b/c we have TOO MUCH insurance? Should we have ins for primary care? The classic car analogy is that you don't have ins for cas/oil/tires, why have ins for primary care? Well, b/c it costs too much, but thats b/c of the added overhead of ins. Do you see the vicious cycle? Cut out the middle man, pay your PCP cash at the time of services, which YES requires the PCPs to pass the savings on and charge on the order of $20-40 for the avg OV.

Thanks for all of your comments!
 

Josh
The reason for our high premiums are that we do not belong to a large pool of insured individuals as would be the case in a large company or the government. We are unable to spread the risks as would be done in those cases.
Why is it not possible for there to be an insurance pool for independently employed or small business employed individuals say in a region or district? This would in some way at least mean that the majority of individuals would be of a similar socioecomonic background. The Blues already do this sort of costing in their premiums.
Car insurances also do this for different areas. Also high risk drivers tend to be bad or careless drivers. High risk people aren't (necessarily) 'bad' people. I would have preferred a little chlorine in my gene pool and picked my rellies better.
In the socialized medicine countries you do not see the high risk individuals paying more in income tax to pay for their health care insurance. That's because the the 'Pool' is the nation's population.
Why was it that the cost for my treatment in Oz was so much less?
That's not a third world country. Their minimum wage is ~$15.oo/hour and taxes not much more than here. They have private health care insurance, as well as socialized, which is encouraged by the government to have, at about $600.oo/year. How much would a visitor from another country have paid here for the same treatment that I received in Oz? Now, I have worked in third world countries, and I lament the waiting lists in Canada (where there is no private health care; yet) and the rationing of services. The NHS in Britain is in terrible shape and I wouldn't want to work in that system either.
We absolutely have the best medicine available but not affordable and we use it to excess. To make a living nowadays the average primary care practice feels obligated to max labwork and procedures which inflates cost. Although I have to agree that the actual cost of malpractice insurance and legal fees is likely not much more than the quoted 2% I'd bet you dollars to doughnuts that the additional extra cost of unnecessary lab work, imaging procedures, and referrals to specialists just to do CYA medicine in order NOT to get sued would put it in the order of double digits.
Our system is good but that isn't to say that it can't be improved. No matter what the stats, should we be satisfied that there are ANY uninsured or underinsured in such a wealthy country.
 

Josh wrote: Terry: Are you suggesting that you shouldn't pay more for health insurance?!? You said yourself that you have health issues, so you're a higher risk of using more resources. Of course you should pay more. Just like car insurance, the safer drivers pay less, the riskier drivers pay more. Isn't that they way it should be?"

Here in New Jersey, the state strictly regulates the individual health insurance market, so that health insurance is specifically not like auto insurance. Everyone in the individual pool pays the same premiums, no matter their age or medical history. No one can be turned away from buying insurance, simply because an insurer considers them too 'risky'. A person's premiums do not go up if they've had a serious illness. The yearly rate increases are pegged to the average usage of medical care by all individuals in that insurer's plan.

Even with these regulations, if a person gets sick, they still will pay more per year, because of copays and coinsurances. One of the problems with the individual policies is that there is no 'stop loss', which are common with corporate group plans. Most of the latter have a dollar limit, beyond which the company pays for ~95% of a person's medical for that year. From what I remember, it's ususally something like $3000-5000.

Josh, you sound like you're young, and have never had a serious or chronic illness.
 

"even though surveys show that citizens of those countries like their healthcare better than we do"

Now there is damned lie! Look in any Canadian newspaper and just see if there isn't an article on about a daily basis about somebody having to go to the U.S. for care. Pity all those Mexicans/Latinos that forego their national health insurance to work here. And all those international patients that cross oceans to see me for their care, I really should refer them to a psychiatrist, they must be crazy!
 

If you want to exclude children eligible for Medicaid and CHIP from the rolls of the uninsured, then perhaps we better define "uninsured." As a practicing pediatrician, if they're eligible but not on the rolls, then they're uninsured as far as my bottom line is concerned. Actually, worse than uninsured, as far as coverage: since Medicaid can be 3-6 months retroactive, we can't collect on visits pending eligibility. And then, if the coverage doesn't come through, we have almost no chance of recovering the outstanding balance. Their uninsurance may be temporary, and in some cases may be related to lack of personal motivation, but bureaucratic hassles also play a role. Just because they're financially eligible and theoretically covered doesn't make it so. I would argue that the majority of adults are also eligible to be insured under private plans, but most can't afford it, or decide the expense dwarfs the risk that they'll actually need it. Does that make them any less "uninsured?"
 

Having Medicaid is worse than being uninsured in my book. We accept cash, check, or credit card but not Medicaid.
 

This post has been removed by a blog administrator.
 

"I would argue that the majority of adults are also eligible to be insured under private plans, but most can't afford it, or decide the expense dwarfs the risk that they'll actually need it. Does that make them any less "uninsured?""
Yes, it makes them less uninsured. Some adults make the decision that medical insurance is a bad financial decision for them. The responisible ones set aside money to cover medical bills and thus self-insure.
 

Amen!
 

"The responisible ones set aside money to cover medical bills and thus self-insure."

If they are responsible enough to be doing this then they should be smart enough to also get into a tax saving HSA. The MA and MD mandatory insurance programs are a step in the right direction.
 

Some of you are so out of touch with reality that is scares me to know that you believe these things you say.

To the person who doesn't even live in the US and yet thinks he understands our obesity issue you sound like a dumbass! Yes, some people certainly do overindulge in fast foods.

Anyone who thinks that is the real cause of obesity on a national scale is out of touch. I'm a home health care nurse, who sees everyday what contributes to obesity.

Do you have any idea of the vast number of people (Elderly and disabled)who NEVER eat or visit a fast food joint and yet they are obese? They also don't overeat. What they do is go to the grocery store (or send someone) once a month! Thats right, once a month! They buy all the right things, except the last 2.5 weeks of every month they no longer have any fresh fruits or vegeables. They run out of meat by about the beginning of the third week so they eat the last half of every month on things like spaghetti, noodles, potatoes, cheese, etc....All high calorie foods. They don't overeat they do however have to survive.

As for the person who things everyone sitting in his office has an ipod in her purse, you know thats not true just as well as i do. First of all that is just your opionated impression of something you have NO knowledge about. Do you require your patients to dump all contents of their purses out for you to inspect? If not, then you are only assuming and you know what they say about that, don't ya?
 

"Anyone who thinks that is the real cause of obesity on a national scale is out of touch. I'm a home health care nurse, who sees everyday what contributes to obesity."

I agree. The causes of obesity are multifactorial. Since you are a homehealth nurse, the primary causes of obesity in your patient population is probably a sedentary lifestyle and poor diet. A different example would be the rapidly expanding obesity epidemic in the pediatric population. Causes here again are numerous but primarily may be increased sedentary lifestyle in children at school (loss of recreational recess time) and home (video games and the internet), high soda consumption, poor diet (junk food), parents setting poor examples by being obese themselves...
 

I agree. I refer to "no child left behind" as "no child without a fat behind"
 

In the past 30 years, the costs of healthcare have soared in the United States. Due to rapidly escalating healthcare costs, Americans in ever increasing numbers have begun to search for alternatives that could reduce their personal out-of-pocket medical expenses. In the last few years, hundreds of thousands of Americans have chosen to become Medical Tourists.

Cost of medical and surgical procedures in Mexico is very low compared to what is paid in the United States. In most cases, the savings from their medical treatment can give people extra money for vacation. Indeed, a patient and his/her family can take a luxury vacation in a Mexican resort and pay for the trip with the savings they receive on getting their procedures in Mexico. Medical Tourism in the city of Guadalajara can certainly be a win-win proposition. While taking care of health needs at big discounts, shopping sprees, sight-seeing, cultural pursuits, and trips to nearby beaches and spas can all be arranged around a medical appointment schedule.

For more information contact www.surgicalcareinternational.com