Comments on: Health care reform: The uncivil war dividing America

By: newsdoc

newsdoc — Thu, 03 Sep 2009 18:46:34 +0000

The final bill, whatever it is, will only be a skeleton. It seems long to the lay person at one thousand pages but the Medicare manuel is much larger and gets larger by the year, same with the Medicaid manuels. Check with your biller and that is only about billing.The best thing would be (and most likely will be) a panel of doctors and others will be appointed to determine the benefits. Please remember the present array of service is vast and so are the conditions and the types of physicians and types of clinics and exceptions and on and on. Try to get specific payment levels from insurance companies or their “rules”. They are just now being obligated to tell us what they pay for more than a few CPT codes. The new ICD 10 program has over 10,000 diagnosis codes. Change is coming one way or the other. Not choosing is choosing.
Politically it is now more important that the bill be less specific with ridiculous criticism like death panels being used to scuttle the whole thing.

By: Robert Ricketson

Robert Ricketson — Thu, 03 Sep 2009 11:37:11 +0000

I have not read the entire 1018 pages of HR 3200 yet but what I did discover in the first 32 pages was this. It appears that in Sections 123 and 124 there is a discussion regarding the Standards Benefits. It expressly states that the Standard Benefits package does not have to be decided until 18 months AFTER the Act has been passed. This is obviously a concern. Why would you endorse a product that does not present what it will cover? At this point, one can only assume. That is a dangerous position. And if the final package is unacceptable, what recourse is there? There needs to be some clarification to this before we offer a blanket endorsement.

By: radphys

radphys — Tue, 01 Sep 2009 14:41:08 +0000

DrMonte and Outrider:

I couldn’t agree more. The conflicts of interest are glaring. One of the best things that could happen to health care is for physicians to once again become practitioners of medicine rather than entrepreneurs.

By: Outrider

Outrider — Tue, 01 Sep 2009 12:34:46 +0000

DrMonte:

Thank you. I’m a DVM, not an MD, but members of my profession wrestle with the issue of recommending tests and treatments every day. The difference is that our clients pay out of pocket, so we have a clear motivation to openly discuss cost vs. potential benefit.

That has not been my experience with human medicine, unfortunately. But I don’t have a good answer for how MDs should police themselves, though becoming hospital employees on flat salaries might be one solution upon which the government may ultimately decide.

As for myself, as an occasional patient, I prefer less intervention. More is not always better. I suspect that I am in the majority here.

By: John Ryan

John Ryan — Tue, 01 Sep 2009 11:27:52 +0000

The issue that I bring up isn’t that there aren’t badly motivated doctors (there are, as Dr. Ladner describes), but that our President is implying that we are subject to the same motivations (follow the money) that the Paul Krugman NY Times article reveals is guiding the actions of our legislators.
The chilling feeling I get from these statements is that the next step will be rationing expensive care under the guise of curbing physicians evil nature.
I don’t share the common view that we physicians don’t police ourselves. After 25 years doing primary care, I know exactly who to refer my patients to, and who not to. In the hospital environment, it is much more difficult, since the medical staff system is under the thumb of administration and its lawyers. But if you are not on your hospital credentials committee, you should be. It is very evident and quite easy who gets passed, and who needs a “performance agreement”.

By: newsdoc

newsdoc — Tue, 01 Sep 2009 02:54:00 +0000

It will either be change that we help make or change will come. If no bill is passed Medicare is due go bankrupt in 2012, the SGR will continue to squeeze payment to doctors Small changes will never get tort reform since as an individual concept it won’t pass through Congress or indiviually. I hope that when the government must pick up the bill like VA clinics the option to sue (the government) will go. Insurance companies and lawyers have a long history of codependence.
The argument that no one has read the bill is false. There are at least 3 versions out there. They are different in the Senate than in the House. They will need to be made into one if passed and then riders will be attached. That is how it is for all bills. The health insurance industry is large so it is not surprising the bill is big but it is still puny next to the budget.
The socialism argument is false. If it is Medicare, I must charge within certain guidelines. For other entities I can charge what I like but what I am paid is determined by the company. I cannot even bargain with the insurance companies except as an individual which is like David bargaining with Goliath.
Finally it is going to be expensive no matter what we do. By extending coverage to all those young people who don’t buy it now and others that think it is too expensive or that they are too healthy the monies coming in (the pool which the insurance company wants) will increase. Then hopefully through a reduction in insurance companies overhead (CPT-10) and tort reform the monetary pain may be bearable.

By: drmonte

drmonte — Tue, 01 Sep 2009 02:11:13 +0000

I might not agree with some of the things politicians have said on YouTube, but I do think there is a need for doctors to put ourselves under the microscope.

I was trained in Anesthesiology with a fellowship in pain medicine. I was appalled at what I saw happening in the world of chronic pain with regard to unnecessary, expensive, and potentially harmful procedures being done with little scientific data to support many of the procedures. Patients with back pain would get a presumptive diagnosis that would then be “tested” by performing a series of injections under fluoroscopy. If the patient “got better” the diagnosis was “confirmed” by the treatment. If the patient didn’t get better a new diagnosis was assigned and it in turn was tested by a treatment of different injections. This could, and often did, go on for a very long time and was very profitable for the doctor. Patients rarely got long-term benefit.

I would get patients like this referred to my office for second opinions. I was always shocked that the insurance companies had paid for the treatment and that the patient had allowed it to happen. People trust us. That puts a big burden of responsibility on our shoulders.

When my own father herniated a lumbar disc I had to take him to four different spine surgeons in different cities before finding one who would agree to a simple microdiscectomy. The others wanted to perform procedures involving cages and fusions. My father was in and out of surgery in a day and fully recovered with no complications within a few months. That was four years ago and he remains in excellent condition. Yes, some patients would have needed the more extensive and more expensive fusion surgery – but my experience in pain medicine was that the threshold for picking the most invasive and most expensive treatment option is often set very low.

We have a lot of expensive surgical interventions that are helpful when applied to the “right” patients. However, for physicians to turn a blind eye to misbehavior among their own is a poor reflection on our profession and another reason health care reform will be difficult.

My experience in medicine is that it is not a good thing for physicians to be tempted between invasive expensive treatment options and noninvasive, less expensive options.

Part of health care reform should be doctors policing ourselves better. How do we do that?

Monte Ladner, M.D.

By: John Ryan

John Ryan — Tue, 01 Sep 2009 01:35:13 +0000

Dr. Weinberger, you make a good point, but distortions of the truth aren’t limited to bogus “death panels”. Our President has announced at “town hall meetings” (easily viewed on YouTube) that our profession chooses tonsillectomies for sore throats and amputates diabetic feet in order to maximize fees. If the lead policy-maker is so misinformed, what can we hope for?

By: drmonte

drmonte — Tue, 01 Sep 2009 00:59:47 +0000

Read Paul Krugman’s editorial in the NYTimes from today (August 31, 2009). The health insurance industry pours $1.4 million per day into lobbying our congress. That works out to around $2500.00 per congressman and senator per day!

Health care reform will never happen, at least not in a meaningful way.

What we really need is to convince the mainstream media to cover the real issues. The unbelievably stupid comments by politicians (mostly the Republicans, but some of the Democrats too) are irrelevant. I’d like to see the media really cover the efforts by industries who don’t want the status quo to change.

Most of the people screaming at town hall meetings are the very people who need health care reform that includes a public option. They have been so distracted by lies that they can’t understand they’re working against their own interests.

An interesting book along these lines is Thomas Frank’s “What’s the Matter with Kansas.”

Monte Ladner, M.D.

By: Dr. Mary Johnson

Dr. Mary Johnson — Mon, 31 Aug 2009 23:04:52 +0000

Perhaps if I believed those who wanted healthcare reform were genuine . . . and that reform was real reform, carefully planned and thought-out, mindful of the failures of the past, and fiscally responsible?

http://drjshousecalls.blogspot.com/2009/08/teddy-kennedys-historical-family.html

I don’t.