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2009-04-27 -Signs, Portents, and the Weather-

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Posted by GolfBravoUSMC 2009-04-27 10:31|| || Front Page|| [11132 views ] Top

#1 A double-edged sword. This is a problem as many primary-care doctors refuse to see Medicare and Medicaid patients because of the low reimbursement rates. Trying to find a doctor really burns people who have paid Medicare insurance for years only to be denied care until they need emergency help through the ER, then find they can't find a doc to do follow up. Even health professionals are exasperated. We now have quite a few H1B doctors named Mo to fill the slack. The words of the Glasgow docs, "Those who cure you will kill you", come to mind.

Posted by Thealing Borgia 122 2009-04-27 11:24|| 2009-04-27 11:24|| Front Page Top

#2 "We have to increase spending to save money."

Spoken like a Democrat.

More health care does not save money. Better health care does not save money.

Read that again: better health care does not save money, it costs money and it costs more money in the long-term.

If you doubt that, try this intellectual experiment (don't do this in real life) --

1. Stop making insulin.

2. Count the future dollars you save when all the brittle diabetics have died.

But of course, we don't do that. Instead we have insulin and a dozen other expensive medicines. We have dialysis and renal transplants. We have heart surgery. Retinal surgery. Endocrinologists. Home blood glucose meters. We have a big, big chunk of our health care system dedicated to the care of people with diabetes.

That's as it should be. But it all costs money, and the better you do at it, the more it's going to cost, because the diabetics will live longer. As they do, they consume more health care dollars.

That's why Dr. Grover at the AAMC is dead-wrong. We will never save money. We'll spend it, and if we do so intelligently, people will live longer and better.

Posted by Steve White 2009-04-27 11:26|| 2009-04-27 11:26|| Front Page Top

#3 The only real solution is to increase the pool of Doctors, nurses, ect. and there is no way to do that that doesn't cost money (recruiting, training, pay sound familiar?). And treating them like a Private entering basic training or overworking them will NOT encourage them to stay in the field. Nor will the increasing need for liability insurance to fight off the lawyers.

Posted by tipover 2009-04-27 11:45|| 2009-04-27 11:45|| Front Page Top

#4 Dear Mr. White, re: #2.....

You say "But of course, we don't do that."

Check that headline again, okay? Maybe we don't do that NOW, but, you want to bet your house that it's not in the cards?

Posted by AlanC 2009-04-27 11:52|| 2009-04-27 11:52|| Front Page Top

#5 And treating them like a Private entering basic training...

Now that you mention that..if my memory serves me right we are witnessing another 'power' game. IIRC back when the baby boomers hit the demographic climb is when doctors started to see real income increases as demand out paced supply. About the same time, another major social event, the Vietnam commitment showed DoD it too had a serious doctor shortage. DoD budgeted, built and equipped a DoD medical college but was told by the ~~Guild~~ national medical accreditation board that it would not give graduates accreditation. Seems they viewed the potential flood of doctors that the college would start to generate would undermine their now lucrative earning power. Remember they set the limits on how many students that a particular education/hospital program can generate. Of course this is the same time the Donks were starting to exploit the anti-war movement for power. The two naturally allied to kill the program.

This is not a question of pure capitalism vs socialism with the power of the ~~Guild~~ accreditation board to choke the number of graduates as they have for decades.

Throw in that today a registered nurse with a masters degree probably has a greater body of medical knowledge than what we called a doctor eighty years ago. Maybe we need to evaluate exactly what real skill and knowledge is needed to accomplish what tasks before we simply accept
"facts" in the argument of shortages and needs.

Posted by Procopius2k 2009-04-27 12:08|| 2009-04-27 12:08|| Front Page Top

#6 Doesn't malpractice insurance have an influence? Perhaps some type of Tort reform would help to lower the cost to the doctor.

Posted by bman 2009-04-27 12:20|| 2009-04-27 12:20|| Front Page Top

#7 New doctors typically owe more than $140,000 in loans when they graduate.

Difficult to pay off school loans and lawyer up for tort lawsuits fights to the tune of $200-250k per year. Shakespear was correct about the lawyers.....what was it, nearly 500 years ago?

Posted by Besoeker 2009-04-27 12:24|| 2009-04-27 12:24|| Front Page Top

#8 One part of this that we don't talk about much is how we strip the third world of good doctors for our own system.

I call it imperialism. A century ago we took the raw resources from the third world, now we take their smart people.

Young doctors in Pakistan, India, Ethiopia, etc. come to our country to train (usually in third tier programs), and decide that life is better in Newark than in Peshawar (no, reeeallly?) So they stay and work as doctors here rather than return to their home countries.

Think about that: to pull that off they have to be pretty-darned smart. They need to learn English well enough to pass the entrance exam to their med schools (almost all the instruction in every third world medical school is in English). Then they have to improve their English well enough to pass the visa exam. They have to be good enough at their studies to pass the USMLE exams to come to the U.S. Then they have to perform well enough in the residency programs to graduate in good standing. They almost certainly have come on an H-1, J or equivalent visa, so now they have to find a way to stay here, usually by taking a position in a community that qualifies for a waiver -- e.g., Newark, Detroit, all the garden spots in our country.

I have a fair amount of respect for them: there's no way I could have learned Urdu or Pashto well enough to learn medicine in those languages, no way I would learn those languages well enough to use them in daily life, and no way I could have adapted to life in Peshawar, Tehran or Addis Adaba.

We could expand our medical schools by 5 to 10% over the next ten years, but you can't move too quickly, as it takes time to gear up the instruction and clinical opportunities. That expansion would cut into the need for foreign MDs, but it costs a lot more since right now, of course, the foreign countries are bearing a substantial amount of the cost.

Again, imperialism.

Posted by Steve White 2009-04-27 12:26|| 2009-04-27 12:26|| Front Page Top

#9 ....and no way I could have adapted to life in Peshawar, Tehran or Addis Adaba.

No adaptation worries Dr. White, they're all coming to a community near YOU!

Posted by Besoeker 2009-04-27 12:28|| 2009-04-27 12:28|| Front Page Top

#10 I have to wonder how much the way in which so many western-trained Arab engineers and doctors end up in Islamist terrorist groups or political organizations isn't just a sorting algorithm. The ones who are disposed to adjust to modern/Western values tend to *stay* in the countries they trained in, while the ones who can't handle the cultural milieu go home and make trouble wholesale.

Posted by Mitch H.">Mitch H. 2009-04-27 12:55|| http://blogfonte.blogspot.com/]">[http://blogfonte.blogspot.com/] 2009-04-27 12:55|| Front Page Top

#11 Haha, stealing the world's most talented people by offering them an unlimited platform for growth is the entire story of America.

"Imperialism" would be taking doctors by force; we just make such a kick-ass country that everyone wants to live here voluntarily.

Posted by gromky 2009-04-27 13:51|| 2009-04-27 13:51|| Front Page Top

#12 Well said, gromky.

Posted by Nimble Spemble 2009-04-27 13:54|| 2009-04-27 13:54|| Front Page Top

#13 A good point, gromky, we do entice them. Of course when they come here they've signed a statement saying they're going to go back. Then they don't.

Posted by Steve White 2009-04-27 16:57|| 2009-04-27 16:57|| Front Page Top

#14 Yep, It rather obvious here in Brownistan that you Yanks* need Tort law reform more than you need government rationed treatment!

* No offence meant.

Posted by Bright Pebbles 2009-04-27 17:26|| 2009-04-27 17:26|| Front Page Top

#15 none taken. With that rub-in V1agra, a lot less of us will be "Yanks" anyway

Posted by Frank G">Frank G 2009-04-27 18:44|| 2009-04-27 18:44|| Front Page Top

#16 The medical profession itself is very, very slowly morphing into something that reflects the realities of the nation today. At the turn of the last century doctors were driving ambulances. When I was a tad they were driving to your house in Cadillacs, making house calls. I think that ran you $10, and if you came to the office it was $5.

Medical insurance distorted that pay-as-you go cost structure. Rather than paying by the visit, you're now paying by the procedure -- there's a whole book of them with 5-digit codes, each with a Medicare-approved payment. So opening your mouth and saying "aaaah" now gets reimbursed at $12.50 and you bending over for the fickle finger makes the doctor $18.75. But the patient doesn't have to worry about it because the insurance company's paying, right?

On top of which, naturally, the docs support a fair-sized chunk of the legal profession, and now we're anticipating supporing the politicians, party hacks, and their relatives and hangers on, all dipping their beaks into that 8.5 percent of the economy. (That figure's probably out of date, since the last I looked it up was about 10 years ago.)

Patients seldom actually see doctors anymore. Their time's too precious because they've got to churn out procedures in enough density to cover the overhead of the office, the staff, the insurance, the affiliations, and the continuing education. There used to be a nurse sitting in the doc's office, greeting patients and occasionally assisting the doc as he was setting Little Johnny's broken arm there in the office prior to driving him (in the Cadillac) to the hospital if he didn't have the stuff to produce the cast himself in his GP office. The nurse is gone, replaced by a 19-year old with a student loan for her year's course in medical office administration. Registered nurses never touch bedpans anymore, LPNs are a dying breed, and the stinky work is done by medical techs who're actually glorified EMTs.

The GPs of my youth are now replaced by internal medicine practices, and increasingly we're seen by nurse practitioners, PAs, or even paramedics.

I have no idea what the medical profession is going to look like 50 years from now. I suspect it's not going to be pretty and I'm positive it's going to be a lot more complicated than it is today.

Posted by Fred 2009-04-27 19:50|| 2009-04-27 19:50|| Front Page Top

#17 Years ago I read an estimate that all the money paid to all US physicians on an annual basis is dwarfed by the money it takes to process all the medical/healthcare paperwork in this country.

Posted by Anguper Hupomosing9418 2009-04-27 21:41|| 2009-04-27 21:41|| Front Page Top

#18 We have known for more than 50 years that fairly simple computer programs are much better at medical diagnosis than doctors. This is because we know that people are naturally poor at solving complex problems.

Give someone a problem to solve and they hypothesize and then test their hypothesis. If the test disproves the hypothesis then they move on to the next hypothesis. Until the test(s) 'confirm' the current hypothesis (ie diagnosis).

This is both an inefficient(wasteful) and error prone - none of the untested hypotheses are tested - way of solving problems.

A much better way to solve diagnosis type problems is to start with a large number of hypotheses and then work through eliminatory tests, most eliminatory test first.

It's almost impossible to teach people to do this with a large number of hypotheses, despite people claiming they can.

Computer programs can do this easily and with much greater sophistication than I have described.

The big impediment to the use of such programs is doctors have fought tooth and nail against them, and to maintain their provider monopolies. Not least because it makes most of their training mostly a waste of time.

The other problem is no one has figured how to make money off them. Curing patients isn't a very profitable business.

Posted by Phil_B 2009-04-27 23:19|| 2009-04-27 23:19|| Front Page Top

23:34 OldSpook
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22:59 Skidmark
22:59 Fred
22:29 Glising Pelosi4893
22:29 Besoeker
22:22 Seafarious
22:21 Procopius2k
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22:11 JosephMendiola
22:06 trailing wife
21:58 JosephMendiola
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21:47 Anguper Hupomosing9418
21:44 JosephMendiola
21:43 Shieldwolf
21:41 Anguper Hupomosing9418
21:39 Nimble Spemble
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21:37 JosephMendiola
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21:34 JosephMendiola