New Client Denied Health Coverage...

[89Hen]

I can assure you it's not just me doing the cherry-picking. The primary care community as a whole are noting this issues, as are leaders in both family/internal medicine who've been asked to explain to national media why costs are increasing.

I think Cap'n hits a very good point as well--but it's not just the fast-food advertising. Pharmaceutical industrial spending is off the charts, and the costs of medication are through the roof without a means to curtail it.

My personal belief is that physicians are ordering more tests, placing patients on needless medications at an alarmingly high rate because of the evolution of "C-Y-A Medicine." To me, Obama failed because his legislation didn't curtail litigation and lawsuits. Obviously, egregious errors need to be punished...but docs are getting sued at such a ridiculous rate, I was schooled by attendings who told me "You're not a good doctor unless you've been sued!" It's comical (and sad) that it's even EXPECTED anymore...but you still feel like ish when it's your name on the subpoena despite having performed standard practice and then some.

Oh, to the person who claimed that doctors stand to make a buck by ordering more tests...I can assure you I don't see a dime for doing so. As an added bonus, I invite you to take on my medical school loans for a year. While that may be entirely true of some professions, most doctors would tell you they'd take hitting the lottery in a heartbeat. Most physicians are comfortable, but nowhere near as wealthy as you'd think.

Which part of the chart doesn't look like it's going steadily up?

[89Hen]

Oh, to the person who claimed that doctors stand to make a buck by ordering more tests...I can assure you I don't see a dime for doing so. As an added bonus, I invite you to take on my medical school loans for a year. While that may be entirely true of some professions, most doctors would tell you they'd take hitting the lottery in a heartbeat. Most physicians are comfortable, but nowhere near as wealthy as you'd think.

Wait, you're a doctor? Hmmm.

[Cap'n Cat]

What I meant earlier, 00, about deifying doctors is the notion that we've given to them God-like, life-saving powers and that has meant a considerable cashing in on their part. Not necessarily "wrong", just a fact. Physicians in many (most) other countires do not enjoy the country club lifestyles we've provided them here.

And, I do think they lobby hard to protect their standing through the AMA and other organizations. Again, not necessarily "wrong", just sayin'.

[00bluehen]

No part. It all looks that way...but...It's going up by the steady rate of 3 months per year nowadays. The slope is flattening, and that is a smaller increase per year than what we saw in the 70s and 80s.

Contrast that "steady increase" with the slope increase of the GDP percentage graph. There's an overall decline (or, if you prefer, stagnation) in the slope of the increase when you contrast it with the increase in dollars.

For an irrelevant argument, you're sure debating this point hard, 89

[00bluehen]

Wait, you're a doctor? Hmmm.

I'm arguing AGAINST my profession's exorbitant use of tests, but saying that there are reasons behind it that weren't appropriately addressed by the administration.

[89Hen]

No part. It all looks that way...but...It's going up by the steady rate of 3 months per year nowadays. The slope is flattening, and that is a smaller increase per year than what we saw in the 70s and 80s.

Contrast that "steady increase" with the slope increase of the GDP percentage graph. There's an overall decline (or, if you prefer, stagnation) in the slope of the increase when you contrast it with the increase in dollars.

For an irrelevant argument, you're sure debating this point hard, 89

An irrelevant arguement? It has everything to do with this discussion. The claim is we spend too much for little return on life expectancy. I and others have shown that there is more benefit to health care spending than just life expectancy, then you show a chart that is CLEARLY showing that life expectancy is rising yet you claim it's flat.

[Ursus A. Horribilis]

Wait, you're a doctor? Hmmm.

I'm arguing AGAINST my profession's exorbitant use of tests, but saying that there are reasons behind it that weren't appropriately addressed by the administration.

You may have missed some of the previous discussions but tort reform and the need for the myriad of tests to protect the Dr. has been well hashed over.

What are the other things since you seem to be looking for someone to drag it out of you?

[00bluehen]

What I meant earlier, 00, about deifying doctors is the notion that we've given to them God-like, life-saving powers and that has meant a considerable cashing in on their part. Not necessarily "wrong", just a fact. Physicians in many (most) other countires do not enjoy the country club lifestyles we've provided them here.

Just be careful not to lump all physicians into that, Cap'n. The AMA (which I do not belong to out of principle, by the way) does indeed tend to side with the more "glamourous" specialties (surgical and medical, especially cardiology...)

I come to work every day wishing I wasn't viewed with that "God-like, life-saving" mentality. My patients have faith in me that I'll do right by them and do my best to ease their suffering/improve their situation as it stands. Truth is, despite our advances, death still wins 100% of the time. People have a hard time understanding that when their/their loved one's time is up. They like to sue because of this misunderstanding.

[Ursus A. Horribilis]

No part. It all looks that way...but...It's going up by the steady rate of 3 months per year nowadays. The slope is flattening, and that is a smaller increase per year than what we saw in the 70s and 80s.

Contrast that "steady increase" with the slope increase of the GDP percentage graph. There's an overall decline (or, if you prefer, stagnation) in the slope of the increase when you contrast it with the increase in dollars.

For an irrelevant argument, you're sure debating this point hard, 89

An irrelevant arguement? It has everything to do with this discussion. The claim is we spend too much for little return on life expectancy. I and others have shown that there is more benefit to health care spending than just life expectancy, then you show a chart that is CLEARLY showing that life expectancy is rising yet you claim it's flat.

At some point we have to reach the diminishing returns aspect of life expectancy anyway don't we? Maybe we're getting close as far as the average life expectancy is concerned. No matter what you do we are gonna wear out at some point.

[AZGrizFan]

Obama failed because his legislation didn't curtail litigation and lawsuits. Obviously, egregious errors need to be punished...but docs are getting sued at such a ridiculous rate, I was schooled by attendings who told me "You're not a good doctor unless you've been sued!" It's comical (and sad) that it's even EXPECTED anymore...but you still feel like ish when it's your name on the subpoena despite having performed standard practice and then some.

DING DING DING!!!

Ladies and Gentlemen, we HAVE a WINNER!!

[00bluehen]

An irrelevant arguement? It has everything to do with this discussion. The claim is we spend too much for little return on life expectancy. I and others have shown that there is more benefit to health care spending than just life expectancy, then you show a chart that is CLEARLY showing that life expectancy is rising yet you claim it's flat.

You initially claimed my statement was irrelevant. Now you're the one driving hardest to the hoop.

I'm not claiming the curve is flat. We're not doing a good enough job at what we need to be doing in this field, and physicians aren't helping themselves to get better at it. Not only that, but we're not getting help in the form of tort reform from the governmental level to ease our reliance on overtesting/pverspending.

Sorry I missed the earlier stuff, Ursus. New to the board once GoHens shut down in the summer. Apologies for rehashing old agruments.

[Cap'n Cat]

What I meant earlier, 00, about deifying doctors is the notion that we've given to them God-like, life-saving powers and that has meant a considerable cashing in on their part. Not necessarily "wrong", just a fact. Physicians in many (most) other countires do not enjoy the country club lifestyles we've provided them here.

Just be careful not to lump all physicians into that, Cap'n. The AMA (which I do not belong to out of principle, by the way) does indeed tend to side with the more "glamourous" specialties (surgical and medical, especially cardiology...)

I come to work every day wishing I wasn't viewed with that "God-like, life-saving" mentality. My patients have faith in me that I'll do right by them and do my best to ease their suffering/improve their situation as it stands. Truth is, despite our advances, death still wins 100% of the time. People have a hard time understanding that when their/their loved one's time is up. They like to sue because of this misunderstanding.

Good points. I agree.

[mebison]

More enumerated points from mebison:

1) Spine/back surgery is relatively new compared to hip and knee, so the field may get to one of those "obviously worth it" states eventually. There have been massive set-backs in hip replacements since they were first used, before they got to the "last for 30 years" stage.

2) Patients who are unhappy with their care are somewhat of an unreliable barometer (albeit certainly worth considering, still). For that lady with the septic hip, or the back patients who curse out their doctor for doing anything at all, they only know how they ended up. They don't know how things would have turned out if nothing had been done. The lady with the hip fracture may have ended up ripping out a femoral artery and needing emergency surgery, which could have still resulted in a septic hip. And if the back patients were willing to have the surgery (ultimately their decision), they must not have been feeling great before hand. Of course, doctors do make bad calls sometimes, as everyone (except NDSU fans) does.

3) Value - I'm finding myself conflicted about what to say about the attention paid to value in the hospital setting. On one hand, I've always been annoyed that medical devices are always evaluated and compared in terms of outcomes, but rarely is the cost even mentioned, or included in the comparison. On the other hand, one of the cornerstones of getting any new procedure approval and popularized is to prove its efficacy versus whatever was there before, including cost-effectiveness, particularly to get insurers to reimburse for it. This is a huge deal in the spine right now (for fusion vs. total disc replacement). And I know that doctors routinely prescribe generic drugs because they are cheaper, and I know of many cases where doctors would prefer not to continue treatment and are pushed to do so by the patients.

4) End of life costs are a major deal. I've seen that 25% of medicare costs are incurred in the last year of life. I think there is a cultural divide in attitudes towards death between countries that contributes to some of the disparity.

[Cap'n Cat]

Obama failed because his legislation didn't curtail litigation and lawsuits. Obviously, egregious errors need to be punished...but docs are getting sued at such a ridiculous rate, I was schooled by attendings who told me "You're not a good doctor unless you've been sued!" It's comical (and sad) that it's even EXPECTED anymore...but you still feel like ish when it's your name on the subpoena despite having performed standard practice and then some.

DING DING DING!!!

Ladies and Gentlemen, we HAVE a WINNER!!

Hey, again, another thing in which Cap'n Cat finds himself in a circle jerk with Conks. Agreed.

Talk about "God-like" doctors, look at lawyers (generaliztion understood, IT and JoltinJoe).

[mebison]

Man, you all got about 2 pages in while I was typing my dissertation of a post...I can't keep up

[Cap'n Cat]

Man, you all got about 2 pages in while I was typing my dissertation of a post...I can't keep up

Still beats the sh*t outta Bisonville, though, don't it? The IQ level here is dramatically higher.

[mebison]

Man, you all got about 2 pages in while I was typing my dissertation of a post...I can't keep up

Still beats the sh*t outta Bisonville, though, don't it? The IQ level here is dramatically higher.

Good Cap'n, I think its highest where-ever you aren't.

[Ursus A. Horribilis]

Man, you all got about 2 pages in while I was typing my dissertation of a post...I can't keep up

Quick hitters in several different posts get ya around quicker meb, I had to learn that early on myself.

[mebison]

Thanks

[mebison]

for

[mebison]

the

[mebison]

advice!

[Ursus A. Horribilis]

See. Nobody beat ya on that series.

[JohnStOnge]

It amazes me that people think that insurance companies should be required to do business with them. More of the entitlement mentality.

[BDKJMU]

I can't say for certain that it's Obama's fault, but what IS his fault is not living up to his pledge to effectively communicate what was in the new legislation - there will always be some people who never get it, but most people should if it has been explained properly. There are a lot of incumbents right now studying the plan they voted on to find out what's in it.

How the f are you going to explain a 2,000 page bill to people? The size of the bill alone ensures it will be a failure.