Healthcare reform

[Rex Kickass]

Because frivilous malpractice claims are actually only a small part of the problem in health care. It exists, its worth addressing, but by itself it isn't something where we fix it and all is well.

 

That's sorta my point. It's the one thing that we consistently hear from politicians who are opposed to a public option as the lynch pin of lowering health care costs... even though it affects costs much less than people think.

[Y2HH]

That's sorta my point. It's the one thing that we consistently hear from politicians who are opposed to a public option as the lynch pin of lowering health care costs... even though it affects costs much less than people think.

 

I think the bottom line is that everyone is in agreement something needs to be done -- I just think it needs to be an option where the Government isn't in control of this new "insurance company", it would become a monopoly (regardless of what they say, it would), that I have no interest in dealing with.

 

Cutting costs is one thing, via the proper measures, but handing control of this to an entity that can dictate pricing across the board, which essentially would cause a mass exodus of talented/trained people from that industry isn't the way to go about it. Some of you don't seem to care, probably because you've never been seriously ill, but I'd prefer an experienced/educated physician working on me/my family in times such as this who is properly compensated instead of someone that can care less because they would have made more money doing something easier that required far less education and dedication.

 

In short, yes, money talks. I wouldn't be doing what I do right now if I wasn't paid what I'm paid, neither will doctors, nurses, pharmacists, etc, to think they will is again -- dreaming.

[NorthSideSox72]

I don't think we need to look at cutting Doctor salaries - I think we need to look closer at having doctors do less of the medical work. This is already a trend underway, of course. But I think a lot of things we currently go to "the doctor" for - regular checkups, immunizations, many basic treatments - can be handled well by medical professionals who are not doctors and whose time is cheaper.

 

[lostfan]

I don't think we need to look at cutting Doctor salaries - I think we need to look closer at having doctors do less of the medical work. This is already a trend underway, of course. But I think a lot of things we currently go to "the doctor" for - regular checkups, immunizations, many basic treatments - can be handled well by medical professionals who are not doctors and whose time is cheaper.

I think a lot of nurses would agree with this.

[Y2HH]

I don't think we need to look at cutting Doctor salaries - I think we need to look closer at having doctors do less of the medical work. This is already a trend underway, of course. But I think a lot of things we currently go to "the doctor" for - regular checkups, immunizations, many basic treatments - can be handled well by medical professionals who are not doctors and whose time is cheaper.

 

Agreed.

[kapkomet]

If you wanna match anecdote for anecdote, explain why McAllen, Texas is among the most expensive cities in the country for healthcare - and yet Texas has the very same malpractice reform that people who whine about malpractice reform want?

I'll type this slow so no one misses is. I-L-L-E-G-A-L-S. Boy, that was a hard answer.

[Cknolls]

I'm not sure who "they" is (and it's not Democrats or Republicans, but Republicans tend to be the one to push this specific point), but if "they" is the current administration, they've said they're willing to put limits on malpractice lawsuits into the reform package. Frankly it's a non-issue and I don't see why someone who'd want to overhaul healthcare would be deadset on not going ahead with it.

 

 

They are the strawmen Obama uses in every argument he makes for doing something. There are those.......There are many......There are some.....It is getting old, quick.

[lostfan]

They are the strawmen Obama uses in every argument he makes for doing something. There are those.......There are many......There are some.....It is getting old, quick.

What?

[Rex Kickass]

I'll type this slow so no one misses is. I-L-L-E-G-A-L-S. Boy, that was a hard answer.

 

Then why does El Paso have half the cost per patient?

 

http://www.newyorker.com/reporting/2009/06...fa_fact_gawande

 

In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average....

 

El Paso County, eight hundred miles up the border, has essentially the same demographics. Both counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006 Medicare expenditures (our best approximation of over-all spending patterns) in El Paso were $7,504 per enrollee—half as much as in McAllen.

[Y2HH]

Then why does El Paso have half the cost per patient?

 

http://www.newyorker.com/reporting/2009/06...fa_fact_gawande

 

A paragraph later than the one you quoted explains why.

Edited June 16, 2009 by Y2HH

[Rex Kickass]

A paragraph later than the one you quoted explains why.

 

Until you get to the next page:

 

And yet there’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average.

 

Nor does the care given in McAllen stand out for its quality. Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.

[Y2HH]

Until you get to the next page:

 

Note he says "no evidence" on treatments, but the fact that the updated tech, building, tools, etc, costs more is the answer why, even if the writer doesn't want to admit it. It's easy to read between the lines here, the updated technologies obviously offer more and cost more, the say otherwise is insane. And it's possible because they're running a bunch of unnecessary tests -- or a plethora of other reasons, none of which the article actually uncovers...it just leaves it up to assumption.

Edited June 16, 2009 by Y2HH

[lostfan]

Note he says "no evidence" on treatments, but the fact that the updated tech, building, tools, etc, costs more is the answer why, even if the writer doesn't want to admit it. And it's possible because they're running a bunch of unnecessary tests -- or a plethora of other reasons, none of which the article actually uncovers...it just leaves it up to assumption.

Really? You're killing me man.

 

edit for your edit: The author also says treatments AND technologies and says they're no different than the rest of the country. How are you coming to these conclusions?

 

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

 

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

 

“Practically to zero,” the cardiologist admitted.

 

“Come on,” the general surgeon finally said. “We all know these arguments are bulls***. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

 

The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ”

Edited June 16, 2009 by lostfan

[Balta1701]

I'll type this slow so no one misses is. I-L-L-E-G-A-L-S. Boy, that was a hard answer.

Why bother? Nearly 1 million Californians go to Mexico for medical care every year. We don't need to bring them here for that, we're already going there.

[Y2HH]

Really? You're killing me man.

 

edit for your edit: The author also says treatments AND technologies and says they're no different than the rest of the country. How are you coming to these conclusions?

 

So because the author says it, it must be 1000000% true? What's his agenda, does he have one on either side? Is there something we aren't being told about that specific treatment center -- for example, does that more expensive hospital tend to treat higher risk patients or patients with sicknesses that cannot be treated elsewhere, there is just a lot being left out...and like I said, it's all being left up to our assumptions.

 

You see, I question things, even if I read them on the internet, it's easy to make opinions look like fact by tossing around official titles or themes when writing these papers. Sure, some of it could be from over testing and abuse of the system -- isn't that part of the reform to put a stop to this? But I'm sure there will be many more things that can be done aside from just that.

[lostfan]

So because the author says it, it must be 1000000% true? What's his agenda, does he have one on either side? Is there something we aren't being told about that specific treatment center -- for example, does that more expensive hospital tend to treat higher risk patients or patients with sicknesses that cannot be treated elsewhere, there is just a lot being left out...and like I said, it's all being left up to our assumptions.

 

You see, I question things, even if I read them on the internet, it's easy to make opinions look like fact by tossing around official titles or themes when writing these papers. Sure, some of it could be from over testing and abuse of the system -- isn't that part of the reform to put a stop to this? But I'm sure there will be many more things that can be done aside from just that.

How do I know that when I step outside leaving my job today I won't be struck by lightning?

 

I'm not accepting what the article Rex posted says as gospel (in fact, believe it or not, I'm more on your side than you think), it's that it's kind of hard to actually talk about what's in the article if you keep citing things from/about it that are incontrovertibly false. Source evaluation for academic purposes is one thing, but at some point you have to take a professional journalist's opinion at some level of face value, enough to be used as a reliable source. Otherwise WTF is the point of talking about anything at all? It's not like he cited a Huffington Post blogger or one of Nate Silver's 538 blog opinions.

 

Edit: for the record the person who wrote that article is a Harvard-educated surgeon

Edited June 16, 2009 by lostfan

[Y2HH]

How do I know that when I step outside leaving my job today I won't be struck by lightning?

 

I'm not accepting what the article Rex posted says as gospel (in fact, believe it or not, I'm more on your side than you think), it's that it's kind of hard to actually talk about what's in the article if you keep citing things from/about it that are incontrovertibly false. Source evaluation for academic purposes is one thing, but at some point you have to take a professional journalist's opinion at some level of face value, enough to be used as a reliable source. Otherwise WTF is the point of talking about anything at all? It's not like he cited a Huffington Post blogger or one of Nate Silver's 538 blog opinions.

 

While I agree -- I've lost just about all trust I've ever had for the media over the past few years, as nobody is reporting facts anymore, not even journalists, but spin and opinion that sway things in their own agendas favor. It's sad that it's come to this...but it has. I'm skeptical on everything I read these days, no matter who writes it, because this isn't just commonplace now, but accepted.

 

I'd love to believe articles like this, but with missing data -- and very important data -- it's impossible to agree. Like I said, I'd like to see the types of patients they treat, did he compare data to only similar patients, or did he say -- take a terminal cancer patient (because they happen to only be treated at hospital a) and compare it to a different sort of patient (because they don't even treat terminal cancer patients in El Paso), for example? It leaves important details like that out -- therefore I'm skeptical of the 2x the cost number he's throwing around while saying everything is the exact same, from technology to 'treatment' without ever saying what sort of treatment.

Edited June 16, 2009 by Y2HH

[Balta1701]

I'd love to believe articles like this, but with missing data -- and very important data -- it's impossible to agree. Like I said, I'd like to see the types of patients they treat, did he compare data to only similar patients, or did he say -- take a terminal cancer patient (because they happen to only be treated at hospital a) and compare it to a different sort of patient (because they don't even treat terminal cancer patients in El Paso), for example? It leaves important details like that out -- therefore I'm skeptical of the 2x the cost number he's throwing around while saying everything is the exact same, from technology to 'treatment'.

That's why he analyzed the data in the way that he did; he went to 2 towns in similar areas with very similar demographic makeups in terms of race, age, economic state, etc.

[Rex Kickass]

Note he says "no evidence" on treatments, but the fact that the updated tech, building, tools, etc, costs more is the answer why, even if the writer doesn't want to admit it. It's easy to read between the lines here, the updated technologies obviously offer more and cost more, the say otherwise is insane. And it's possible because they're running a bunch of unnecessary tests -- or a plethora of other reasons, none of which the article actually uncovers...it just leaves it up to assumption.

 

Let's review.

 

El Paso and McAllen are roughly equal when it comes to demographics, including non-English speakers, and illegal immigrants.

They offer roughly the same services, and have tort reform legislation in place.

 

So straw man #1: Blood sucking Lawyers - not an issue.

Straw Man #2: Illegal "They took our jooobbbssss" immigrants - not an issue.

 

McAllen ranks below El Paso in quality of service across the board. Yet charges twice as much to Medicare.

 

Is it a lack of regulation keeping costs reasonable in McAllen? Is it that El Paso just hasn't caught up in charging as much? Or should health care just be this expensive?

[Y2HH]

That's why he analyzed the data in the way that he did; he went to 2 towns in similar areas with very similar demographic makeups in terms of race, age, economic state, etc.

 

Similar people, demographics, races, ages and economic states have nothing to do with treatment types.

 

It's cheaper to treat a person with a headache than a brain tumor.

 

My question is/was, does the El Paso hospital treat the EXACT same types of patients? It's very rare that every hospital treats every type of patient in the same manner with the same expertise. See Mercy vs Northwestern, etc...this is no different as far as I'm concerned.

 

I'm skeptical, at best, that both of those hospitals have the EXACT same doctors performing the exact same treatments -- which is the only valid comparison I would know of. But if hospital A is paying their more experienced surgeons 5x more than hospital B, to say their treatments are absolutely equal without giving any data on the types of people performing them is a shady way of reporting it, IMO, and it comes across as an opinion, rather than fact based on comparison.

[Y2HH]

McAllen ranks below El Paso in quality of service across the board. Yet charges twice as much to Medicare.

 

It was my understanding he says they were equal -- no better/no worse -- yet I still know nothing about the people performing this care. To say everything, from doctors, to nurses, to technology is absolutely equal is impossible as far as I'm concerned, at least, unless you're writing a paper and want to send a message.

 

If everything is absolutely equal -- of even slightly worse in some cases -- yet they're charging 2x more, it should be pretty easy to bring them up on charges on allegedly attempting to defraud the medicare/medicaid system, right? So why aren't they?

Edited June 16, 2009 by Y2HH

[Balta1701]

Is it a lack of regulation keeping costs reasonable in McAllen? Is it that El Paso just hasn't caught up in charging as much? Or should health care just be this expensive?

We can also throw out this specific case study and look at a larger data pool. Dartmouth college has for years published studies using a calculated index for the performance of health care between states and compared that data to the amount spent on health care by specific states. Here is what the data look like for basically every year:

 

 

Basically, there really is no current correlation in this country between the quality of care given and the amount spent on it, in either the private or public health care markets.

Here are some detailed responses, including several links to full studies, regarding the "Utillization" argument that HH is trying to make that somehow there's a demographic difference that is important.

[lostfan]

While I agree -- I've lost just about all trust I've ever had for the media over the past few years, as nobody is reporting facts anymore, not even journalists, but spin and opinion that sway things in their own agendas favor. It's sad that it's come to this...but it has. I'm skeptical on everything I read these days, no matter who writes it, because this isn't just commonplace now, but accepted.

 

I'd love to believe articles like this, but with missing data -- and very important data -- it's impossible to agree. Like I said, I'd like to see the types of patients they treat, did he compare data to only similar patients, or did he say -- take a terminal cancer patient (because they happen to only be treated at hospital a) and compare it to a different sort of patient (because they don't even treat terminal cancer patients in El Paso), for example? It leaves important details like that out -- therefore I'm skeptical of the 2x the cost number he's throwing around while saying everything is the exact same, from technology to 'treatment' without ever saying what sort of treatment.

I admit I didn't read all 8 pages of that article since I'm at work, but the way it was written was pretty comprehensive, I'd even say scientific, factoring out variables and such. Obviously this writer had at least some agenda, but that doesn't disqualify the validity of anything that was said in and of itself.

 

Also - he makes another example about another location having much lower costs, but high technology and new equipment so that shoots down the suggestion that this is what makes McAllen's high.

Edited June 16, 2009 by lostfan

[mr_genius]

Similar people, demographics, races, ages and economic states have nothing to do with treatment types.

 

It's cheaper to treat a person with a headache than a brain tumor.

 

My question is/was, does the El Paso hospital treat the EXACT same types of patients? It's very rare that every hospital treats every type of patient in the same manner with the same expertise. See Mercy vs Northwestern, etc...this is no different as far as I'm concerned.

 

I'm skeptical, at best, that both of those hospitals have the EXACT same doctors performing the exact same treatments -- which is the only valid comparison I would know of. But if hospital A is paying their more experienced surgeons 5x more than hospital B, to say their treatments are absolutely equal without giving any data on the types of people performing them is a shady way of reporting it, IMO, and it comes across as an opinion, rather than fact based on comparison.

 

his evidence ignores so many variables. as a data and statistical expert, i must say that some of the 'data' arguments i'm seeing here are very weak.

Edited June 16, 2009 by mr_genius

[Y2HH]

We can also throw out this specific case study and look at a larger data pool. Dartmouth college has for years published studies using a calculated index for the performance of health care between states and compared that data to the amount spent on health care by specific states. Here is what the data look like for basically every year:

 

 

Basically, there really is no current correlation in this country between the quality of care given and the amount spent on it, in either the private or public health care markets.

Here are some detailed responses, including several links to full studies, regarding the "Utillization" argument that HH is trying to make that somehow there's a demographic difference that is important.

 

I will have to read this.