Comments on: Rundown 8/25

By: David Correia

David Correia — Wed, 26 Aug 2009 04:06:52 +0000

One of the key issues that has been failed to be addressed is the very existence of health insurance and the behavior that it generates by the producers of goods and services of health care; physicians, hospitals, drug & equipment manufacturers, as well as ancillary providers. These producers are incentivised to charge as much as possible as their reimbursement is usually based upon some set of percent of charge based system. As charges increase the baseline reimbursement schedules increase overtime and we continue to get these exhorbitant increases in medical inflation year over year.

Increasing the number of insured will continue have a perverse effect in that it will reward this behavior and continue to drive up overall cost inflation. Increasing the number of insured must be coupled with new payment methodologies that reduce the overall rate and even reverse the rate of medical inflation.

Additionally, many of the companies involved in the health delivery system are publically traded and must meet Wall Street expectations of profit growth or disappoint their investor community. Ten Percent profit growth year over year is their driving mantra. These companies are acting in the best interests of their investors and shareholders, not in the interests of the nation or general public at large. This is not to condemn their current behavior, but just a commentary on their position. To believe that they will act any different than they currently act is folly.

So if we are serious about reform of health care we must address the underlying issues of the organization and funding of the health care delivery system as this issue is not simply about increasing the number of insured.

By: wbur.org » News » Krugman, On Why Reappointing Bernanke Was The Right Move

Tue, 25 Aug 2009 21:34:19 +0000

[...] an excerpt of Robin Young’s conversation with Paul Krugman on “Here & Now”. Click here to listen to the full interview. Filed under: Economy · Obama Have something to say? Please stay on topic, be [...]

By: Peter

Peter — Tue, 25 Aug 2009 18:58:59 +0000

“The Market” cannot solve healthcare’s problems because it has been the cause of them. Normal free-market economics don’t prevail here: instead of a neat buyer-seller relationship in which competition improves efficiency and lowers prices we have a complex four-way relationship between hospitals, doctors, patients and insurers that breeds inefficiency and raises costs.

Despite the ads you may see on your local TV stations, hospitals don’t really compete for patients; they compete for doctors, who then bring in the patients. But what doctors want isn’t lean efficiency. They want more and/or better services (there had better be enough MRI machines so I don’t have to wait 48 hours for results); they want the hospital to operate according to THEIR schedule, not to an efficient schedule (I don’t want to operate in the afternoon or, if I do want to operate late in the day, I don’t care that it’s after most of the staff have finished for the day and a team will have to stay late on overtime); and they want to be pandered to.

My own field is cardiac surgery. My present employer is one of the smaller programs in the area and our workload is about six cases a week. Yet this is conducted in two separate locations because the doctors who prefer each location refuse to be relocated to the other. One location has one dedicated OR and the other has two but each has an extra complete set of special equipment (at about $400,000 a set) just in case of an emergency while the others are being used. That is a total theoretical capacity of five rooms, and our team has to have enough people to be able to staff them all at once! The net result is that our clinical activity is about one third of the national average and we struggle each year to complete enough cases to meet the minimum requirement for re-certification.

An earlier job was in the largest city in a rural area. There are two hospitals in town, serving a pool of doctors who mostly work in both. Each hospital maintained enough theoretical capacity that they could almost take over the entire market in many specialties. Those doctors constantly blackmailed the hospitals into granting their wishes with the threat of taking all their patients to the competition. Four dedicated ORs for 550 cases per annum. Colleagues in the UK perform almost four times as many cases in the same space!

Don’t even get me started on the scams. Cardiologists who perform heart-caths in their offices but must transfer patients who need angioplasty and stents to the hospital. They are needlessly subjecting those patients to two procedures instead of one, and siphoning off income from the hospitals (where it could at least be used to offset the costs of treating the uninsured, which the doctors won’t do in their office!). Anesthesiologists who have a colleague place their IV lines before a case, because then they can charge for an extra person. Surgeons who have a partner scrub in for a short period during a case so they can bill for an assistant surgeon.

And you wonder why US healthcare costs so much more than it does anywhere else.

By: John LaGrange

John LaGrange — Tue, 25 Aug 2009 18:45:41 +0000

It was so nice to here a reasoned discussion of health care reform. Where I live the radio stations, other than NPR, broadcast only right wing attacks on health care reform and disseminate the the kind of blatant miss-information that Paul Krugman discussed. I have a lot of experience with the health care and insurance industry, and have found the insurance companies to be only an obstacle to obtaining health care, they add nothing to the system. Please continue to provide programing on this issue.

By: Ken

Ken — Tue, 25 Aug 2009 18:41:22 +0000

P. Krugman is on the crazy train in an alternative universe. The noble prize is a fig leaf for a socialist, for example Krugman and Gore.

By: Michelle Bland

Michelle Bland — Tue, 25 Aug 2009 17:48:29 +0000

I am curious about the “unnecessary testing and procedures” I keep hearing about. The decision for testing should be between my doctor and myself. Now my insurance company must “approve” all medical decisions before they will pay for them. As if they know better? I have had difficulty getting an emergency appendectomy approved, as they wanted me to wait 24 hours to see if I improved? Luckily my surgeon proceeded with the procedure trusting his medical judgment and not the insurance. The pathology later proved he was correct. My concern is, will these proposed changes make it even harder to get procedures approved? Why can’t the decision for my health care be between my doctor and myself?

By: Jill Ryan

Jill Ryan — Tue, 25 Aug 2009 17:47:08 +0000

Hello Heather,

Thanks for your interest, our audio is posted on the website after 2pm, hope you get a chance to listen to the autism segment. Also, we do not do show transcripts, sorry for the inconvenience.

-Jill Ryan, Here & Now

By: Heather

Heather — Tue, 25 Aug 2009 17:44:33 +0000

Hi Robin,
Love your show! I was unable to tune in today for your segment on adult autism. This is a very important topic that has not been addressed at all!

Do you have a transcript of it or can you send me the hospital name or information about the program? I really appreciate it!

Thanks in advance,
Heather

By: Carole Johnson

Carole Johnson — Tue, 25 Aug 2009 17:20:09 +0000

I can’t seem to tell if you have a link to what NPR refers to as Music Interludes….the musical bumpers between stories. There is one that you played around 12:33 EST and I am going crazy trying to remember the name of the song. This sounded like a guitar version. Can you give me the title and artist. Thanks….

By: Roy Schreiber

Roy Schreiber — Tue, 25 Aug 2009 16:42:09 +0000

Paul Krugman’s comments about the medical insurance industry are right on target. Their financial interests and my medical needs often do not coincide. They are profit making businesses or so-called “non-profits” in which the employees salaries depend upon how much money they make from those they insure. Our health requires people involved in all aspects of medicine who to put our health first. I must say I have never understood the moral difference between a robber sticking a gun in my ribs and saying, “Your money or your life,” and finding myself in a hospital bed where the medical industry is saying the same thing.