1) SreyRam Kuy: “As the recent Democratic presidential debate in Austin, Texas, highlighted, the healthcare issues that top Americans’ minds are not dwindling doctors’ payments or loss of physician prestige. It is access to quality healthcare.”
My take: Dr. Kuy doesn’t get it. Physician payment is intertwined with access to healthcare. The public may have little sympathy for “rich” doctors facing decreased payments. However, any Medicare cuts will lead to decreased access, as physicians will stop accepting Medicare patients in response.
When the debate is re-framed as such, patients are forced to care about any threats to physician payment.
2) The “new generation” of physicians are opting for more work-life balance.
My take: As it should be. These days, new physicians view medicine more like a job than a calling. It is apparent that politicians ([cough]Pete Stark[cough]) and the public have decreasing respect for the profession. In addition, the constant siege by the lawyers is taking its toll, as malpractice woes are driving more doctors out of medicine altogether.
In such hostile times, why should doctors sacrifice more to the profession than they already have?
3) Ads are popping up urging the public to “demand a CT scan” for lung cancer screening.
My take: Want to curb health care costs? You put an immediate end to campaigns like this.
Imploring the general public to obtain evidence-bereft CT scans foolishly feeds in the “more medicine must be better medicine” myth.
It is especially shameful that the physicians behind the ad – radiologists, pulmonologists and thoracic surgeons – stand to benefit financially from the indiscriminate use lung cancer screening.
Related posts:
- Work-life balance
- Can this be the year Medicare changes its payment formula?
- Physician payment reform by capitation, will it work this time?
- CT scans and lung cancer screening
- Single-payer supporters, be careful what you wish for
- AMA victory on the road to permanent Medicare payment reform
- Motives behind CT screening
{ 13 comments }
“Ads are popping up urging the public to “demand a CT scan” for lung cancer screening.”
Some of these ads are from those who are likely to benefit from more CT scans – radiology labs (like the new one around here who sent around mail offering “specials” for these CT scans among other tests), equipment manufacturers. Somehow I find it hard to believe that these special interests will put healthcare costs ahead of their own pockets.
IMHO – what is needed is more information about tests’ risks, what is recommended what is not, why, etc. BTW – a couple of years ago I heard one of the most popular “TV doctors” – Dr Rosenfeld of Fox’s Sunday Housecall listing CT scan for lung cancer among “recommended tests”. Want to stop patients demanding TV tests – complain about erroneous information given by TV doctors, write to them, produce your own ads, etc. Provide more information in the media to counter-balance the endless stream of “the more testing the better” ads we hear on TV all the time. I know one doctor who “did something” about it – Dr. Gilbert H Welch who published “Should I be tested for cancer” book. More of this type of information is needed.
Why do we act surprised when businesses don’t reduce their own profits or patients limit their own cancer screening for the greater good?
They want this because someone else is paying the bill. The problem isn’t the CT scanners, it’s the distorted demand produced by our screwed up third party payer system.
If most patients had to pay for these tests out of their tax sheltered HSA account, they’d have much more interest in whether or not a test is worthwhile.
More information will not help. If information was a cure to dysfunctional self-care behavior, then there would be no obesity. Did obesity go down when they put nutritional information on food? Of course not! People do what they do because they want to. If they are in that minority who makes decisions based on objective data, they will seek and find the data now.
More regulation of the market will not help. What will help is the removal of the distortion of the market introduced by government subsidized third party payment–the collectivization of the the payment for a purely personal decision of purely personal benefit.
Some people would want the unneeded scan even if they are paying for their own healthcare–but then if they are paying, why would that be anyone elses concern or business?
Personal freedom couple with personal responsibility solves an aweful lot of social problems by removing them from “society” altogether.
“They want this because someone else is paying the bill. The problem isn’t the CT scanners, it’s the distorted demand produced by our screwed up third party payer system.”
The third party payer system has its effect. But the problem is – a patient has no way of knowing if a test is recommended or not or why. OK, let’s say you remove a third party system. But then a lot of care would be unaffordable for a lot of people. Sure with my 6 digit salary I could afford most of routine care at least as long as I have my job. But for a lot of people a $100-something or even $200-something visit to a specialist would be unaffordable. And if you take a recommended test, and try to explain to a patient his own chance of benefitting in absolute numbers, he or she may not
do it either. Because no matter how you slice it, 1/1000 chance of benefitting maybe 10 years from now is going to look small and not worth the money. Even a needed diagnostic test with a pretty high chance of benefitting someone e.g. 1/20, may look small to someone given the cost depending on how much the cost is to this person and maybe how stingy this person is. So what you’ll end up is a bunch of well-to-do people getting lots of useless tests and some people not getting necessary treatment.
Additionally, even if someone pays out of pocket it seems like a fraud to convince someone to take a CT scan they don’t need, especially if the chance one would be harmed by it is higher than any benefit the test might have. Even if the law doesn’t recognize it as such. Someone with modest means may spend his hard earned money for a test because he thinks it is life-saving, only to have to spend more for false positives and maybe even be harmed. All for one’s own money. Someone else may save for months to have the test.
It seems to me that ethically it is much worse for a medical group to promote an unneded, potentially harmful test than for a store trying to sell you useless junk. Most of us value our life, and most of us would pay a lot to preserve it. A store selling you useless toy doesn’t tell you you may die if you don’t buy it. A radiology lab selling its test tells us that. Why the law doesn’t consider it criminal is beyond me.
“as malpractice woes are driving more doctors out of medicine altogether.”
Kevin, how many doctors have been driven out of practicing by malpractice claims? And of those, how many actually committed malpractice resulting in a grievous injury to the patient? Does “your take” involve anything more than assumptions?
You may be right that the public has decreasing respect for the profession, but when you spend more time testing than talking to your patients because that’s what you get paid for, what do you expect? You guys keep agreeing to contracts that you don’t like, but then bitch about the inevitable result.
Perhaps “your take” ought to involve looking in the mirror and accepting some responsibility, instead of blaming everyone else for a situation physicians are not willing to take affirmative steps to change.
As for ads for more medicine, don’t complain about wanting more of the free market and then whine when the free market, which involves selling your services, starts doing its work. You illustrate your lack of free market background and implicit embrace of government/HMO style healthcare by saying “Want to curb health care costs” and then trying to eliminate those operating in the free market. Health care costs are not a societal issue in the free market, anymore than “architects costs” or “engineers’ costs”. They are specific, and if people or their insurers will pay for those services being advertised, what business is it of yours?
If you don’t think they’re legit and people don’t need them, take an ad out explaining it and saying why what you do is better.
Re work-life balance:
The demands and the stress level can be almost as bad (although in a different way) in the corporate gotta-wring-every-last-dime-so-the-shareholders-can-get-rich world.
We all need more balance. My perception is that across the board, many workers want this and need it, whether they are physicians or not.
We’ve had a spate in my hometown of physicians retiring in their mid50s. I don’t begrudge them one bit.
“OK, let’s say you remove a third party system. But then a lot of care would be unaffordable for a lot of people. Sure with my 6 digit salary I could afford most of routine care at least as long as I have my job. But for a lot of people a $100-something or even $200-something visit to a specialist would be unaffordable.”
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It would be easily affordable if the money previously used for health insurance was used to pay the $100-$200 physician fee instead. There should even be enough left over to pay for a truely catastrophic policy.
Right Rack. It is easy for people to forget that third party payment is, except for those on welfare medical aid (Medicaid), really just prepayment–the money is already being taken from the recipient and had been done so for a long time.
People of all economic classes above the very destitute pack into the casinos around here at about 120$ average loss per visit. They can and do spend that much cash all the time on what they want. If they had been socking their insurance premiums into an HSA since they first went to work, most people would need only the thinnest of major medical policies by middle age.
I have an HSA and high deductible plan. Right after getting it, one of my dependents got diagnoses with a chronic condition. Worse case scenario. No time to build up savings in the HSA and our expenditures now just pretty much match the deductible every year without the major medical policy kicking in and helping out.
But it is still better than regular insurance. Our deductible (which we end up paying every year) + premium = 75% of what a full coverage policy would cost us. So we are still ahead minmizing third party payment even with a chronic condition.
And we don’t hassle with claims, pre-approvals and all that crap.
@Anon at 3:32. Asking for a test after being convinced by advertising that it’ll save one’s live isn’t the same as “disfunctional behavior” like overeating. The people who read these ads and ask for tests honestly don’t understand why a test that can detect a cancer early may not do any good. Your collegues on TV, media, advocacy organization have done a great job convincing people that “earlier is always better” when it comes to cancer. Why do you think that providing some information to the contrary – the information most people don’t know – wouldn’t work. What have you ever done to counter-balance the misinformation “TV doctors” and these ads provide? How can you expect lay people after all these incessant promotion of tests to be able to tell the difference between recommended and non-recommended test? Is it that you are just trying to shift the blame from your collegues to insurance system and the patients? So instead of stealing money from insurance, the authors of these ads will be stealing money from individuals, and harm a fair number of them in process. It is still unethical. “If they pay out of their own pocket, let them do it” – sure let them harm themselves believing they are actually protecting themselves from the desease everyone fears without telling them anything. Great.
“If you don’t think they’re legit and people don’t need them, take an ad out explaining it and saying why what you do is better.”
It’s actually pretty cool idea. Why don’t you guys make a large ad “RISKS OF OVERTESTING” or “RISKS of LUNG CT scans” with about three major bullets underneath. I am sure you guys are smart enough to come up with an ad.
In terms of third party payer – you could also convince the insurers’ not to cover these procedures.
“It would be easily affordable if the money previously used for health insurance was used to pay the $100-$200 physician fee instead. There should even be enough left over to pay for a truely catastrophic policy.”
And what about prescription drugs so many over-50 people are taking – statins, blood pressure, etc. Then there are recommended screening tests which aren’t counted as “catastrophic” yet can add up if you factor in false positives. Plus the amounts that are charged those with insurance are significantly less than what is charged the uninsured ones. Insurers have a lot of negotiating power that individuals don’t have, at least group insurers do. Additionally you keep talking about insurance premiums, but you are forgetting the whole factor of risk sharing with group insurance.
“People of all economic classes above the very destitute pack into the casinos around here at about 120$ average loss per visit.”
Is it a doctor using his own anecdotal information? Ever heard “plural of anecdotes isnt’ data?” Do you have some statistics as to what percentage of poor/middle class people come to casinos? How often? What about those who don’t come to casinos?
I am not the same poster as above, but I say you are getting ready to fight a losing battle anonymous.
Pick your poison: cigarettes, gambling, cell phones, plasma tv’s, cable, pay per view, movie theaters, nice cars, Hawaii vacations, going out to eat, brand label clothing, huge houses, purses, iphones, ipods, etc. These are all things that we DO NOT need in life, but many people think they do need them in life.
Anyone who thinks that Americans can’t afford 200 bucks to go see a specialist is in denial. In fact, I would contend that the average american wastes thousands of dollars a year. It is amazing how many people I know who have gone on extravagant Hawaiian/Carribean vacations that will later claim that they can’t afford healthcare!
So, like I said. Pick your poison. And the argument of “I’ve worked hard and I deserve to reward myself” doesn’t hold water here.
“Plus the amounts that are charged those with insurance are significantly less than what is charged the uninsured ones. Insurers have a lot of negotiating power that individuals don’t have, at least group insurers do. Additionally you keep talking about insurance premiums, but you are forgetting the whole factor of risk sharing with group insurance.”
Anon, I agree that the higher $ paid by the uninsured is a problem; I believe that those who pay cash at the time of service should be given a discount. In my previous post I did mention catastrophic insurance, in which risk sharing takes place.
“Pick your poison”… have you actually tried doing a budget on under 48K income for a family of 4 which if I am not mistaken is a median household income? What about those below the median? And as I said the issue isn’t just a $200 dollars for a specialist visit, but the other expenses e.g. prescription drugs and tests that can add up to thousands. Yes, some of the people have luxuries like TVs, etc., but many of them are financing it not through extra money but through credit card debt. Ever seen the statistics on how many people carry balances? It’s more than half. So the fact that someone spends money on luxuries doesn’t mean this person has extra money; simply that this person is irresponsible.
Regardless, I am not convinced that saying “we don’t need to do anything about our collegues who promote services that can HARM more people than they can help (if they can indeed help anybody since no benefit has been shown) because it is not our problem, it is insurance problem” or “we don’t need to provide accurate information to balance these ads since information isn’t going to make a difference, anyway” is appropriate. Nor is comparing a patient demanding scan because he honestly believes his life depends on it to a smoker who doesn’t was to quit makes sense. These ads convince people that CT scans is something that is vital to their health. When some of the oncologists behind these tests may actually believe in them, when an MD and a professor (Rosenfeld) goes on TV and tells millions that they need to have this test how do you expect an average guy reading these ads to understand that this test may be more likely to harm them than to help them?
It awfully convenient to push all the responsibility on the insurers. This way you don’t need to do anything.
How about another ad. “4 out of 5 doctors recommend against chest CT scans for symptomless people because” in large letters followed by 3 or 4 main reasons (”they haven’t been shown to save lives”, “they can lead to invasive tests that have serious risks, “they can result in unnecessary treatment”, “the radiation from them can cause cancer”). You are smart people, I am sure you can come up with some great ads. And making up a pretty paper square with nice fonts can be easily done on a computer. Nor is posting the ads in some places cost money.
Anyone who picks their medical procedures al la carte from what they see in the media is an idiot anyway–and a lot are. If I were to fund any message to counter that it wouldn’t be message for message specific counter information—it would be to encourage people to have a PCP and discuss their healthcare needs with that person before going anywhere else. If a person hasn’t found a PCP that they trust more than some shill on TV, they are already screwed.
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