Senate Finance Committee rejects public options (NY Times)

Now there's a shock:

http://www.nytimes.com/2009/09/30/health/policy/30health.html?hp

The exchange between Iowa's Charles Grassley and Senator Chuck Schumer (NY) borders on the comical:



Schumer: “I just want to know what you think of Medicare, which is a much more government-run program.”

Grassley: “I think that Medicare is part of the social fabric of America just like Social Security is. To say that I support it is not to say that it’s the best system that it could be.” 

Schumer: “But it is a government-run plan.”

Grassley: “It’s not easy to undo a Medicare plan without also hurting a lot of private initiatives that are coupled with it.” 

Schumer: “You are supportive of Medicare. I just don’t understand the difference. That’s a government-run plan and the main knock you have made on Senator Rockefeller’s amendment, and I am sure on mine, is that it’s government-run.”

Well, it would be comical if they were discussing a topic that was unimportant to the future of the country. Unfortunately, this is not the case. Now the only hope for the "public option" is with the full Senate. if that fails, the House bill presently includes the public option. If that and the Senate bills both pass, a House-Senate Conference Committee will then have to reconcile differences in language.

Katie Couric expounds on unnecessary MRIs and CT Scans

The CBS Evening News tonight had a piece on how many high tech diagnostic procedures are performed in the US annually (~$100B) and how, about a third of them were completely unnecessary. The one good point in the segment was that some physicians are lazily relying on these technological short cuts, rather than practicing good diagnostic medicine. The latter of which, of course, takes longer and provides less income. And the CBS News piece did state that patients were clamoring for these high tech solutions and it was hard for doctors to resist their patients' requests.

But the segment totally ignored the main reason for the increase in CAT Scans and MRIs: malpractice suits. If a patients comes in and complains of persistent headaches, unfortunately, these days the first thing that the physician thinks of is, "If I don't order every test under the sun and it it turns out that the patient has a brain tumor, the patient and/or the patient's family will sue the pants off me." In states like NY, which are saturated to the gills with trial lawyers (including its completely incompetent, lawyer-laden Legislature), there are presently no liability limits for pain and suffering . But that's old news and the Obama "plan" that's on the table, will do nothing about reducing medical malpractice costs. The US Senate "plan" does however, begin ratcheting down the number high tech diagnostic procedures that patients can have, unless they want to pay the costs for "unnecessary" MRIs and CAT Scans out of pocket. The next time a patient twists his or her knee when skiing and they can't have an MRI, they will know what it feels like to live under the Canadian health care system.

But there was a certain degree of irony, because of the commercials that followed the segment. They were all for pharmaceuticals. But then, the CBS Evening News mostly has commercials for non-generic prescription drugs. Why these drug companies spend billions of dollars on these commercials is beyond me, since most health insurance plans require physicians to prescribe generic equivalents. Further, these pharmaceutical TV commercial campaigns add substantially to US health care costs. But we all know that US health care is a growth industry. It shouldn't be, but it is.

Want to save $18 billion in US health care costs?

The solution is to reduce salt in our diets. Excess salt consumption is a major factor in hypertensive disease. Hypertension and associated diseases also are a major factor in reducing the quality of life in the elderly.

What do physicians think about health care reform?

The NEJM did a poll, summarized here. A sizable majority of doctors who were polled, favor a public-private mix of health insurance. But why is that a shock? Medicare is a public system. So's Medicaid, the armed forces health care and the VA. And many states now offer low cost health insurance for people who are not poor enough for Medicaid, but not well off enough  such that they can afford  a single policy version of private insurance. Take for example Healthy NY and allied programs. The Examiner has a nice summary of Healthy NY with links.

Is A.M.A. Support for Health Reform a Bad Sign? (NY Times)

John Tierney, the libertarian that writes the science columns for the NY Times apparently now is worried about the AMA and why they support health care reform.

I'd quote something that Tierney stated in the article, but all he does is quote other sources that cite that 1) there is a "medical cartel" that limits the number of new physicians that graduate medical schools in the US each year and 2) that US doctors make too much money and this is a much more of a burden on the health care system than more commonly cited causes, like malpractice insurance, insurance company overhead and pharmaceutical costs.

Tierney's viewpoint on health care and the AMA, is consistent with his misinformed views on climate change and other scientific issues, about which he is supposed to be knowledgeable. At least he's consistently wrong. You have to give him credit for that.

Uncontrolled growth of the US health care sector is a good thing?

1993 Nobel Prize Winner in Economics, Robert Fogel, writing in the Journal of the American Enterprise Institute says it is not necessary to control US health care costs. According to Fogel:

"There is no need to suppress the demand for healthcare. Expenditures on healthcare are driven by demand, which is spurred by income and by advances in biotechnology that make health interventions increasingly effective."

Fogel goes on to say that increasing US health care costs are a part of a very long-term trend and are not necessarily a bad thing:

"The main factor is that the long-term income elasticity of the demand for healthcare is 1.6—for every 1 percent increase in a family’s income, the family wants to increase its expenditures on healthcare by 1.6 percent. This is not a new trend. Between 1875 and 1995, the share of family income spent on food, clothing, and shelter declined from 87 percent to just 30 percent, despite the fact that we eat more food, own more clothes, and have better and larger homes today than we had in 1875. All of this has been made possible by the growth in the productivity of traditional commodities. In the last quarter of the 19th century, it took 1,700 hours of labor to purchase the annual food supply for a family. Today it requires just 260 hours, and it is likely that by 2040, a family’s food supply will be purchased with about 160 hours of labor."

Michael Pollan on Health Care Costs

You are what you eat:

Big Food vs. Big Insurance (NY Times)

Literally, overeating and obesity contribute greatly to US health care costs, as does smoking, alcohol, illegal drug use and other risky behaviors. Want to pay less for health care? As Austin Powers said, "Now, behave!"

Obama and Malpractice Reform

As much as I feel that Fox News is not that fair and balanced, I do agree with the main points in today's article.

And then you also have Jim Angle's "angle" on Obama's "profit motive" comments.

I'm afraid that Obama's speech has not really advanced the cause of sensible health care reform even a few centimeters.

Op-Ed Piece Troy Record, Troy, NY

Thank you to the Troy Record for publishing a version of my idea for US health care reform, which you can read in the column on the right.