Re: American values to blame for health care crisis

December 6, 2008

Doctors and patients (as consumers) should both be aware of the costs of healthcare. It’s so easy to ask for an unwarranted blood test and imaging procedure. Ask a physician the cost of ordering a Vitamin D assay, or a MMR panel, they probably will not know. Similarly, a patient is unlikely to know the costs of these tests as well.

It’s an overwhelming field, and it is unrealistic for both doctors and patients to know the costs of everything. But the prized aspect of the process is the doctor/patient relationship. If enough time is allowed to educate patients about the costs of medicine, this could be improved.

My suggestion, remove administrators who have no training in medicine or nursing from healthcare. Get rid of the lawyers who serve as CEOs on healthcare panels and hospital boards. Replace them with doctors or nurses, people who have had real-life experience with the patients. The former views patients (and healthcare) as numbers, statistics and quotas. The latter knows what it takes to serve on the battleground.

Subject: American values to blame for health care crisisTo: Date: Saturday, December 6, 2008, 7:15 AM

Posted on another list serve:

Public release date: 4-Dec-2008[ Print Article | E-mail Article | Close Window ]Contact: Elaine Schmidteschmidtmednet (DOT) ucla.eduUniversity of California - Los Angeles

UCLA expert blames American values for health-care crisis

Reforming the system will require strong medicine, tough choices

To heal our ailing health care system, we need to stop thinking like Americans. That's the message of two articles by UCLA's Dr. Marc Nuwer, a leading expert on national health care reform, published this week in Neurology, the journal of the American Academy of Neurology.

"Americans prize individual choice and resist limiting care," says Nuwer, a professor of clinical neurology at the Geffen School of Medicine at UCLA. "We believe that if doctors can treat very ill patients aggressively and keep every moment of people in the last stages of life under medical care, then they should. We choose to hold these values. Consequently, we choose to have a more expensive system than Europe or Canada."

Consider these statistics:

The United States boasts the world's most expensive health care system, yet only one-sixth of Americans are insured. Medical expenditures exceed $2 trillion annually, making health care the economy's largest sector, four times bigger than national defense.

By 2015, the U.S. government is projected to spend $4 trillion on health care, or 20 percent of the nation's gross domestic product.

An aging population will boost spending. Half of Medicare costs support very sick people in their last stages of life, and experts estimate that Medicare funds will be exhausted by 2018.

31 percent of U.S. health care funds go toward administration. "We push a lot of paper," Nuwer says. "We spend twice as much as Canada, which has a more streamlined health care system that demands doctors complete less paperwork."

10 percent of U.S. expenses are spent on "defensive medicine" — pricey tests ordered by doctors afraid of missing anything, however unlikely. "Doctors don't want to be accused in court of a delayed diagnosis, so they bend over backwards to find something — even if it's a rare possibility — in order to cover themselves," Nuwer says.

Reforming the U.S. health care system with the goal of providing universal, affordable, high-quality care will require rethinking our overall values and paying greater attention to care-related expenditures, according to Nuwer.

Part of the current problem, he says, is that doctors are oblivious to the price tags of options they're prescribing for patients. He recommends educating physicians about the costs of care, including imaging, blood tests and specific drugs.

"Does a fancy electric wheelchair cost $500 or $50,000?" Nuwer asks. "Most doctors have no clue. We need to give physicians feedback about the dollar signs behind their orders."

###

Nuwer's co-authors on both articles include Dr. G.L. Barkley (Henry Ford Hospital, Detroit); Dr. G.J. Esper (Emory University School of Medicine, Atlanta); Dr. P.D. Donofrio (Vanderbilt University School of Medicine, Nashville); Dr. J.P. Szaflarski (University of Cincinnati Academic Health Center); and Dr. T.R. Swift (Medical College of Georgia, Augusta).

UCLA is California's largest university, with an enrollment of nearly 38,000 undergraduate and graduate students. The UCLA College of Letters and Science and the university's 11 professional schools feature renowned faculty and offer more than 323 degree programs and majors. UCLA is a national and international leader in the breadth and quality of its academic, research, health care, cultural, continuing education and athletic programs. Four alumni and five faculty have been awarded the Nobel Prize. For more news, visit the UCLA Newsroom.

[ Print Article | E-mail Article | Close Window ]

December 6, 2008

again and as usual, we look for experts in one field to guide us

expertly in another. this only gets us into further trouble;

it delays our finding out the information we need to make

appropriate choices. at worst, we allow others with no expertise in

our field to determine the value of a thing, even an

intangible concept such as health, on other things unlike health,

which are often market based-- just tell me how this is going to cost

me-- what's my bottom line? thus, the provision of healthcare, and

even the concept of health itself, become commodities, to be bought,

sold and traded as some company's stock.

one's state of health, and the standards which promote good health and

support proper health surveillance and maintenance, are not driven by

dollars.

they are driven most fundamentally by common sense and outcomes--

wash your hands,prevent the spread of disease; don't smoke, prevent

emphysema, lung cancer; don't drink in excess, prevent drunk driving;

wear a seatbelt, prevent traffic deaths; and by research used to

develop appropriate standards.

sometimes even research is suspect because of the funding source, eg

drug companies, tobacco companies, car companies, the milk lobby, the

corn lobby, the sugar lobby, the beef lobby, the pork lobby, a

religious belief, anyone who has some interest in an outcome being

studied and/or an axe to grind.

so who can be trusted?

my concept of health is very simple: if you don't have it and

maintain it, you can't do a whole lot of anything else. an ounce of

prevention is now worth a lot more than a pound of cure these days.

it's true that one's earning power can be linked to one's health, so

can other things be linked to it, like education. does that mean that

health and education are merely commodities to be bought and sold?

of course not. if they were, we would not need doctors and educators.

to provide healthcare, we would only need accountants, insurance

companies, lawyers, stock brokers and advertisers to determine it's

worth, offer it without really doing so, punish people if they get it,

put it into a form to be bought and sold and threaten you if you don't

have it, all the while using doctors as the instruments of their terror.

insurance companies may come and go, and the stock market may go up

and down, nonetheless the concept of health and the provision of

healthcare by doctors remains constant; the value of that trusted

relationship only increases in times of economic hardship, but only if

we do not allow others to interfere in that relationship.

as doctors, let's engage our patients in promoting good health, let's

stick to evidence-based medicine, stay away from pretending to be

economists, and tell our patients like it is. we are experts in the

provision of health care. only together can we break free of others

gambling with our patients health and extorting money over it. only

then can we afford the doctor-patient relationships we hear proclaimed

yet failed to support.

LL

December 6, 2008

EBM will only be acceptable if it's an adequate defence in a mal-practice suit.

If it is, then lots of waste can be removed.

Ordering an MRI for a kid's headache without even examining the child

is a flagrant waste of resources.

> as doctors, let's engage our patients in promoting good health, let's

> stick to evidence-based medicine, stay away from pretending to be

> economists, and tell our patients like it is. we are experts in the

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

December 6, 2008

I am with ya, Larry!

Only until the fundamental relationship of the doctor-patient is once again held in some form of esteem will we start to see any true change on a national level. I suspect this " revolution " is still a long ways away, unfortunately.

Durango, CO

again and as usual, we look for experts in one field to guide usexpertly in another. this only gets us into further trouble;it delays our finding out the information we need to makeappropriate choices. at worst, we allow others with no expertise in

our field to determine the value of a thing, even anintangible concept such as health, on other things unlike health,which are often market based-- just tell me how this is going to costme-- what's my bottom line? thus, the provision of healthcare, and

even the concept of health itself, become commodities, to be bought,sold and traded as some company's stock. one's state of health, and the standards which promote good health andsupport proper health surveillance and maintenance, are not driven by

dollars. they are driven most fundamentally by common sense and outcomes-- wash your hands,prevent the spread of disease; don't smoke, preventemphysema, lung cancer; don't drink in excess, prevent drunk driving;

wear a seatbelt, prevent traffic deaths; and by research used todevelop appropriate standards. sometimes even research is suspect because of the funding source, egdrug companies, tobacco companies, car companies, the milk lobby, the

corn lobby, the sugar lobby, the beef lobby, the pork lobby, areligious belief, anyone who has some interest in an outcome beingstudied and/or an axe to grind. so who can be trusted?my concept of health is very simple: if you don't have it and

maintain it, you can't do a whole lot of anything else. an ounce ofprevention is now worth a lot more than a pound of cure these days. it's true that one's earning power can be linked to one's health, so

can other things be linked to it, like education. does that mean thathealth and education are merely commodities to be bought and sold?of course not. if they were, we would not need doctors and educators.to provide healthcare, we would only need accountants, insurance

companies, lawyers, stock brokers and advertisers to determine it'sworth, offer it without really doing so, punish people if they get it,put it into a form to be bought and sold and threaten you if you don't

have it, all the while using doctors as the instruments of their terror. insurance companies may come and go, and the stock market may go upand down, nonetheless the concept of health and the provision ofhealthcare by doctors remains constant; the value of that trusted

relationship only increases in times of economic hardship, but only ifwe do not allow others to interfere in that relationship.as doctors, let's engage our patients in promoting good health, let'sstick to evidence-based medicine, stay away from pretending to be

economists, and tell our patients like it is. we are experts in theprovision of health care. only together can we break free of othersgambling with our patients health and extorting money over it. onlythen can we afford the doctor-patient relationships we hear proclaimed

yet failed to support.LL

December 8, 2008

In Maine it has been required for a few years that you post or make easily available your most common fees.LAW..

Along those lines, how easy is it for patients to find out what WE charge for our services? At the urging of one of my patients, I recently posted a fee schedule (see attachment) of my most common services online on my web site. I think if we are to call for greater transparency in healthcare pricing/costs, then we have to be part of that transparency, too. Also, if every doctor were to post their prices for all to see, we would no longer have to worry about not being able to mention how much we charge for this or that for fear of being seen as " colluding " .

Seto, MDOutstanding. I try and try to find out what something will cost, but it takes so much time, and usually ends-up with no reliable answer.

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/

MD ph fax

December 17, 2008

I HAVE THE PATIENT CALL AROUND TO PHARMACIES AND CHECK FOR BEST PRICE. IF IT IS STILL TO EXPENSIVE, THEY CALL BACK. tHE PHARMACIST HAS ALMOST ALWAYS GIVEN THEM A LESS EXPENSIVE ALTERNATIVE. NO WORK FOR ME. PATIENT EMPOWERMENT.

SORRY ABOUT THE CAPS//

To: Sent: Saturday, December 6, 2008 10:21:33 AMSubject: Re: American values to blame for health care crisis

Outstanding. I try and try to find out what something will cost, but it takes so much time, and usually ends-up with no reliable answer. I have found a useful tool for price-checking drugs: ePocrates website includes a brief paragraph on Average Retail Price for every drug listed, even on the free on-line version I am nibbling in my office; rapidly accessible (although my computer skills are still rudimentary) ... Mostly, I learn by mistake: the patient calls back, 4 days after a visit, and tells me he couldn't afford that pill I prescribed, or that ointment, and can I please come-up with a cheaper alternative. That is a slow way to deal with a problem ... worse than the waste of my time, is the realization that we just gave 4 days of extra time, for that GNR to swim from the bladder to the kidney, off Levaquin. I discovered that the 25-OH-Vitamin- D assay costs ~ $125 (and that some insurance companies won't pay for it, even when I try to link it to

a good universal diagnosis like "fatigue"); I discovered that an I.C.D. cost a patient $240,000 ... (or, at least that was the starting point in negotiation between the hospital and the Blue Cross folks, on the E.O.B. the patient saw ... if he ever needed a defibrillation shock, that probably would have triggered a little charge, that day ! ...). Patients call in, and say, "I want you to order an M.R.I. for little ny, because he is having headaches" -- that $1,000 picture may be covered by the family's insurance (especially the H.M.O. covered-lives) , but they don't want to bring him to my office, to ask him about his daily (on school-days) math-class headaches, and to look in his eyes with my funduscope, because their co-pay for office visits went up to $30 this year ... Of course, it may take me (or my staff) longer to fill-out the forms and make the phone calls to get prior auth for the M.R.I., than it would to complete a visit with the

kiddo. The problem certainly does involve the attitudes of the average American patient, stimulated by the newest scare on television, the newest advertisement for bigger and better boner drugs, the billboards touting the swell instant care at the big city major medical center (just a short helicopter/limo ride from our small town). Somedays, I think about Canada ... -- Rian Mintek, M.D. -- Allegan, Michigan.