INdiana Systemic Thinking

February 17, 2008

One Reason Not to Socialize Medicine

Today, United Press International carried a report highlighting one of the reasons why socialized medicine may not be the way to go.  Long story short, when you put bureaucrats in charge of healthcare (not that they aren’t already in the U.S.), stupid things happen.

Specifically, The British National Health Service decided patients were waiting too long to see doctors at emergency rooms.  So, the Labour party instituted a policy where all patients had to be seen by physicians within four hours of being admitted an Emergency Room.  When hospital administrators could not meet the requirements of the policy, they just stopped admitting people to the emergency room.  According to the story;

…the delays not only pose a health risk to patients, but keep ambulances occupied and unable to answer emergency calls.

“This is evidence of shocking systematic failure in our emergency services,” Lamb said. “As well as thousands of patients being stuck in ambulances when they should be getting urgent treatment, there will be countless others left waiting longer for ambulances to arrive.”

The Mail said current figures show that last year alone, an estimated 43,576 people were forced to wait for more than an hour to enter a British emergency medical unit for treatment.

If you don’t believe me, check out the story for yourself.

February 11, 2008

Cheap Healthcare Website Destined to Fail

The South Bend Tribune has this Associated Press Story about a website that allows users to search for health related services in an attempt to find low cost providers.  The site is a good idea, but will fail.  Why, you ask?  Because the “medical business” is not like other businesses (this is also why “free market” approaches fail).  Not because doctors are greedy, or they don’t want to negotiate their prices (as they do everyday with insurance companies), but because the rule of law will not allow them to.  See every doctor has to follow rules.  Some are legislated, which is not what I’m writing about here, and some are contractual.  These contractual rules often contain “non-disclosure” clauses, which prohibit telling you why the the site will fail.  If a doctor wants the dollars from big insurance, he signs the contract, sign the contract, play by insurance’s rules, and don’t tell anyone what the rules are.  Unfortunately, this make doctors look bad, which they hate, but they cannot afford to not sign insurance contracts.  So, the site will fail, docs will look bad, and everyone goes back to the same old way of doing things.  Ask yourself who benefits from this failure of a free market system, and you will see where the problem lies.  Unfortunately, those who know can’t talk about it.

February 9, 2008

Indiana Doc Leads Healthcare for All Fight

The Indianapolis Star has this artcle about Dr. Rob Stone.  You may not agree with everything he says, but at least he’s out there trying to do something about the insurance problem.

Stone, an emergency room physician at Bloomington Hospital, has emerged as one of Indiana’s most outspoken advocates for making insurance accessible to all. He is co-founder and director of Hoosiers for a Commonsense Health Plan, which contends that the current system is too profit-driven, too inefficient, and leaves too many people without affordable access to health care.

One of Stone’s favorite targets is Indiana’s largest health-care insurance provider, Indianapolis-based WellPoint, a $61 billion health insurance giant that provides coverage to 35 million people in America.

“WellPoint epitomizes our system,” he said. “They’re it.”

Stone’s PowerPoint presentation lays out his case. A Medicare-type program for all is better than the current system, he says. Medicare is currently for the elderly.

One slide — with information attributed to the International Journal of Health Services in 2005 — shows Medicare overhead spending was 3.1 percent of its budget, compared with 26.5 percent for investor-owned Blue Cross and Blue Shield plans.

Another slide — with information from the Employer Health Benefits Annual Survey and Bureau of Labor Statistics — showed that from 2000 to 2006 health insurance premiums rose 87 percent while workers’ earnings rose 18 percent.

For its part, WellPoint sees having a competitive, free-market system as key to improving the quality of care and controlling costs.

“We believe a single-payer health-care system would hinder progress in these areas by eliminating competition and restricting patient choice and could require patients to endure long wait times for care while possibly reducing the quality of health care,” WellPoint spokesman Jim Kappel said in an e-mail.

In its recent earnings report, WellPoint touted that it lowered its administrative expenses to 14.5 percent of premium revenue in 2007 from 15.7 percent in 2006 even as it added 708,000 members.

The company also pointed to flaws in other nations’ health-care systems.

“In Canada, which has a single-payer system, the average wait between a general practitioner referral and a specialty consultation at times has been longer than 17 weeks.”

Stone stands by his position. He recalls a patient who refused to seek treatment for chest pains that turned out to be a heart attack. He finally sought treatment for a second attack, only because the first attack left him disabled — but now eligible for government coverage.

“Medicare works pretty well, and it’s been around for a long time, so why not pattern something after Medicare?”

February 6, 2008

Big Pharma Hates McCain: and that’s a bad thing why???

There are two ways of determining where a politician stands on healthcare; read their platform statements, and/or follow the money.  If you choose the first, read carefully.  The language is as carefully crafted as your insurance policy, probably because it was written by the same people.  For example, something like “I want to reduce healthcare costs by implementing money saving technology” (which is common to several candidates) translates to:  I want to save insurance companies money by forcing providers of all sizes to spend money on updating computers and software.  So, sometimes following the second path is better.  Look at where a candidate is getting their money.  If it is from insurance and pharmaceutical companies, chances are they hope to make money if the candidate wins.  How do these companies make money?  In the case of insurance, either from charging the consumer more, or getting the provider to take less.  In the case of pharmaceuticals, continued law allowing them to sell overpriced medication in the United States and placing restrictions on generics.

So, how does all this get us to McCain?  Well, the Wall Street Journal’s Health Blog has a good post on his relationship with the pharmaceutical industry.  According to the Blog,

McCain opposes Big Pharma on two hotly contested issues: the re-importation of drugs from countries where they cost less and giving Medicare the clout to negotiate drug prices directly. McCain has long stumped for re-importation to save money. And he voted against the expansion of Medicare to include a drug benefit because it didn’t allow direct price negotiations by the government and because the program covers too many people.

His health-care plan also calls for drug companies to reveal prices of their drugs and to develop a straightforward path for the creation of generic biologics, two other ideas that wouldn’t do much for the bottom line of the industry leaders.

So there is the rhetoric.  Now how does that match up with the dollars?  Surprisingly well.  Again, according to the WSJ Health Blog:

The Center for Responsive Politics reports that McCain has received $39,797 in donations from pharmaceutical manufacturers. That puts him behind Obama ($154,710), Clinton ($140,544), Mitt Romney ($103,825), Rudy Giuliani ($91,550) and even Chris Dodd ($68,200)

 If we turn contributions around and see who is giving to McCain, we find:

…The most generous group is the retired, with more than $5 million in donations. And who wants cheap drugs more than the retired? No. 2: Lawyers and law firms, which have given $2.5 million, according to the CRP. (No. 6 on the list are health professionals with $713,952 in contributions.)

So the numbers appear to match the rhetoric, when it comes to pharmaceuticals.  However, the Blogmeister took a look at McCain’s healthcare plan.  It is very nonspecific and difficult to tell what he wants to do overall.  It would be interesting to apply the same analysis as above to his overall healthcare plan.  Still, it seems McCain has popular support for at least half the healthcare problem.  I’d really like to know, in non legal language, what he wants to do about the other half,  insurance companies.

January 15, 2008

Goodbye Tony Soprano

Somethings ya just think are constants in life.  Then this appears in the Fort Wayne Journal Gazette and it makes you doubt if anything is sacred.  Makes one wonder what’s next…  a populist uprising against taxes… people demanding something be done with healthcare…  Oh wait, those are happening too.   Wow, if the people in this story can stand up to La Cosa Nostra, it makes you wonder what else can be accomplished if your organized and fed up enough.

PALERMO, Sicily – When it came down to business, Cosa Nostra could always count on fear.

No more. In a rebellion shaking the Sicilian Mafia to its centuries-old roots, businesses are joining forces in refusing to submit to demands for protection money called “pizzo.”

And they’re getting away with it, threatening to sap an already-weakened crime syndicate of one of its steadiest sources of revenue.

The Mafia has a history of bouncing back, but this time it is up against something new: a Web site where businessmen are finding safety in numbers to say no to the mob.

“This rebellion goes to the heart of the Mafia,” said Palermo prosecutor Maurizio De Lucia, who has investigated extortion cases for years. “If it works, we will have a great advantage in the fight against the Mafia.”

The businesses are openly defying the Mafia by signing on to a Web site called “Addiopizzo” (Goodbye Pizzo), which brings together businesses in the Sicilian capital that are resisting extortion.

There’s more to the story if you click the link above.

January 14, 2008

Big Insurance Caught Again

Filed under: insurance,Politics: Healthcare — kurtglmft @ 1:03 am
Tags: , , , , ,

Hmmm, sound anything like whats going on in Healthcare????

From the Fort Wayne Journal Gazette:

U.S. insurance companies systematically overcharge customers and underpay home and auto claims to pad their already-fat bottom lines, a consumer group said.

The Consumer Federation of America’s insurance director, J. Robert Hunter, said insurance companies have enjoyed robust profits and contained losses largely by “methodically overcharging consumers, cutting back on coverage, underpaying claims and getting taxpayers to pick up some of the tab for risks the insurers should cover.”

January 13, 2008

Inside SB 218: Health Payor Study

Hat tip to Blue Indiana for bringing SB 218 to the Blogmeister’s attention.  This bill, authored by Sen. Vi Simpson (D-Elletsville) would establish a commission to study different systems of health care payment and make recommentations to the Governor and General Assembly.

Apparently the bill is having some difficulty getting a hearing in the Senate Health and Provider Services Committtee.   Hoosiers for a Commonsense Health Plan, via Blue Indiana, are urging people to contact the Committee Chair, Sen. Patricia Miller (R-Indianapolis) and ask her to schedule the bill for a hearing.

December 22, 2007

Teen Dies Waiting for Insurance Decision

Okay, this doesn’t have anything to do with mental health and only peripherally with politics, but anyone who practices healthcare knows what a problem this is… and not just with this particular insurance company.

From the Fort Wayne Journal Gazette:

LOS ANGELES – The family of a 17-year-old girl who died hours after her health insurer reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday.

Nataline Sarkisyan died about 6 p.m. Thursday at the UCLA Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda.

Attorney Mark Geragos said he plans to ask the district attorney to press murder or manslaughter charges against Cigna HealthCare in the case. The insurer “maliciously killed her” because it did not want to bear the expense of her transplant and aftercare, Geragos said.

Nataline had been battling leukemia and received a bone marrow transplant from her brother. She developed a complication that caused her liver to fail.

Doctors at UCLA determined she needed a transplant and sent a letter to Cigna Corp.’s Cigna HealthCare on Dec. 11. The Philadelphia-based health insurance company denied payment for the transplant, saying the procedure was experimental and outside the scope of coverage.

The insurer reversed the decision Thursday as about 150 teenagers and nurses rallied outside its office.

But Nataline died hours later.

According to CNN/Money.com, Cigna made $1,115,000,000.00 last year.  For those who are numerically challenged, that is one billion, one hundred fifteen million dollars.

December 14, 2007

One Bright Spot in Healthcare

The Indianapolis Star is reporting this morning that malpractice rates for physicians and hospitals are falling due to a well funded state malpractice fund and recently enacted legislation.

Malpractice coverage costs thousands of dollars a year. Under the old rate system, physicians paid from $2,997 a year, for a lower-risk doctor such as a pediatrician handling only office visits, to $33,969 a year, for a doctor in a specialty such as obstetrics/gynecology. Under the new rate structure, those payments will range from $2,426 to $27,489.

You can read the whole article here

December 9, 2007

Marketing and Big Pharma

Last night I had finished all the posting work for the blog and decided to do some web surfing.  It dawned on me I hadn’t done much of that since installing the RSS feed software.  So there I went.

However, I was drawn to a memory I had earlier in the day when I was posting this about Eli Lilly hiring a firm to do “damage control” [my phrase] for the drug Zyprexia.  I remember the story quoted a Psychiatrist who ran a blog.  I decided to check it out. 

I don’t know about anyone else, but things tend to trend for me.  What I mean is certain topics come up in different situations a few times over a few days.  This was one of those occasions.  As I looked through Dr. Carlat’s blog I was struck by the number of unflattering posts about the marketing practices of the major pharmaceutical companies.  What was strange, in a Jungian synchronicity way, was I remembered reading a post on Dr. Mike Schatzlein’s blog (titled, Is This Thing On), about the same topic, but more related to physical medicine.  I wasn’t going to post about it, because it didn’t really have anything to do with mental health, but once I read Dr. Carlat’s article, I decided big-pharma’s marketing tactics were relevant to everyone in healthcare and systemically undermining the patients right to trust his/her physician, despite the area of practice, with making the best medical decision, based on the patients’ needs.

Indeed, in Dr. Schatzlein’s blog, he makes the point that by advertising directly to the consumer, big pharma is, in a sense, undermining the physician who, because they may not prescribe a specific drug, is not, in the patient’s view,  giving the patient the best care.  In fact, the opposite is probably more true, that not prescribing a heavily advertised drug will more than likely, cost the patient less, and is more tailored to their specific situation.  Dr. Schatzlein also mentions a well know heart researcher who is currently hawking the prescription drug Lipitor.  While this researcher did graduate from medical school, he has spent his entire life developing high risk artificial hearts that, while not really successful, garnered him a high degree of fame.  According to Schatzlein, this researcher, after medical school, never sought a license to practice medicine and went straight into research.  So we have this researcher who has never written a prescription, telling consumers this is the best drug for them.  In the Blogmeister’s opinion, it appears that after a life of research (he’s getting up there), this researcher is “selling out” to big pharma to pad his retirement account.

It is exactly this “selling out” to big pharma that Dr. Carlat addresses in an article he wrote for New York Magazine.  The Blogmeister was enthralled with this article which describes the insidious way a good Psychiatrist was turned into a pawn for the drug companies through lavish ego stroking and, of course, cash.  He outlines how his conscience eventually caught up with him and his search to reconcile how he may have misled other physicians and possibly hurt patients, with wanting to be an ethical Physician.

The point of all this is the public needs to trust their Physicians.  They need to know their Physician is prescribing what is best for the patient, despite what  a drug representative just bought them for lunch.  By the same token, patients need to realize, while sometimes the best drug for them is the one with the best marketing campaign, sometimes it is not.  The person to determine that difference is your unbiased Physician.

[Post-script:  As I was fininishing this post, my 10 year old Daughter looked over my shoulder.  She saw the word “Lipitor” and commented, “Oh, I’ve heard of that, it’s on T.V.]

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