The Final Minority Report

Because Even Minorities Oppose Liberalism & Statism

The Doctor’s Perspective on Universal Healthcare

Why is no one talking about health care reform from the doctor’s perspective?

When Doctors Opt Out
By MARC SIEGEL

Here’s something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn’t automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I’ve had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider — who they liked — abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn’t take it. I realized a few years ago that it wasn’t worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state’s largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.

The dropout rate is less at major medical centers such as New York University’s Langone Medical Center where I work, or Mount Sinai Medical Center, because larger physician networks have more leverage when choosing health plans. Still, I am frequently hamstrung as I try to find a good surgeon or specialist to refer one of my patients to.

Overall, 11% of the doctors at NYU Langone don’t participate in at least two insurance plans — Aetna or Blue Cross, for instance — so I end up not being able to refer my patients to some of our top specialists. This problem, in addition to the mass of paperwork and diminishing reimbursements, is enough of a reason for me to consider dropping out as well.

Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we’re promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.

I wouldn’t want to be a patient when that happens.

Dr. Siegel, an internist and associate professor of medicine at the NYU Langone Medical Center, is a Fox News medical contributor.

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04/18/2009 Posted by | Health Care | | Leave a comment

UK Pregnant Woman Dies in Toilet B/c Med Staff Unavailable

The joys of socialized medicine!

“A woman died in labour in a hospital lavatory after her induction was delayed because of a lack of specialist staff, an inquest was told yesterday.”

I wonder if a private hospital who could be sued for medical malpractice would have had staff-on-hand to deal with this type of situation as opposed to a government-owned hospital where the only remedies are non-equitable (i.e., no tort or medical liability)?

04/18/2009 Posted by | Health Care | | Leave a comment

New Dem Health Care Plan

Oh crap

Democratic blogger Ezra Klein appears to be positioning Dem health care reforms as a way to cut costs, on the grounds that a reformed system will be able to make “hard choices” and “rational” coverage decisions, by which Klein seems to mean “not providing” treatments that are unproven or too expensive–when “a person’s life, or health, is not worth the price.” Matthew Yglesias’ recent post seems to be saying the same thing, though clarity isn’t its strong suit. (He must have left it on Journolist.)

Isn’t it an epic mistake to try to sell Democratic health care reform on this basis? Possible sales pitch: “Our plan will deny you unnecessary treatments!” Or maybe just “Republicans say ‘yes.’ Democrats say ‘no’!” Is that really why the middle class will sign on to a revolutionary multi-trillion dollar shift in spending–so the government can decide their life or health “is not worth the price”? I mean, how could it lose?

The “rational,” cost-cutting, “hard-choices” pitch isn’t just awful marketing–I don’t even think it’s accurate. Put it this way: I’m for universal health care in large part precisely because I think the government will be less tough-minded and cost-conscious when it comes to the inevitable rationing of care than for-profit insurance companies will be. Take Arnold Kling’s example of a young patient with cancer, where “the best hope is a treatment that costs $100,000 and offers a chance of success of 1 in 200.” No “rational bureaucracy” would spend $20 million to save a life, Kling argues. I doubt any private insurance company is going to write a policy that spends $20 million to save a life. But I think the government–faced with demands from patient groups and disease lobbies and treatment providers and Oprah and run, ultimately, by politicians as terrified of being held responsible for denying treatment as they are quick to pander to the public’s sentimental bias toward life–is less likely to be “rational” than the private sector.

That is to say, the government’s more likely to pay for the treatment (assuming a doctor recommends it). So it’s government for me.

Now, I understand that President Obama has chosen to sell his health care plan in the current budget as a way to control costs. How else to even colorably bill it as a policy response to the immediate economic crisis? That it won’t control costs seemed, initially, to be merely disingenuous–and what’s a little deception if that’s what it takes to get a good universal health care law passed? But on second thought, Obama’s strategy isn’t just disingenuous. In the not-so-long run it’s ineffective, a political loser.

Didn’t universal health coverage gain traction during the anti-HMO era, when voters began to see private-sector cost-cutting bureaucrats override the decisions of doctors to provide drugs and treatments to their patients? The evil HMOs tried to kick new mothers out of the hospital after a day! Politicians responded with laws mandating treatment, with a “patients’ bill of rights,” etc. But now, through a heroic, concerted effort at self-congratulatory Obamaist groupthink, the Dems are about to cast the government in the cost-cutting, treatment denying role and put themselves on the side of the heartless bureaucratic bean counters.

More broadly, haven’t liberals historically prospered when they promised and delivered more for the average American (more Social Security, health security, prosperity, clean air) in exchange for increased spending? Why not try the same with health care? Give pandering a chance.

04/17/2009 Posted by | Health Care | | Leave a comment

Why Health Care Reform is Hard

Here is why reforming health care will be difficult:

Peter Orszag offers a can-do outlook on controlling health care costs.

The bottom line is that health care reform must be deficit neutral in the short run and deficit reducing in the long term. We have to have scoreable savings in the short term to finance additional benefits or coverage. But we must do more than that. We have to move aggressively to change the rules of the game so that we slow the growth in long term costs. Many of these things may not have substantial short-term savings, but over the long term will contribute to more efficient arrangements in the health sector.

I think he makes it sound way too easy to control health care spending. Let me give a semi-anecdote.

My oldest daughter is in her mid-twenties. She has a friend the same age who was stricken with cancer last year. She was treated with chemotherapy, Initially, the doctors thought this had worked, but now the cancer is back. My guess is that her prospects at this point are rather frightening.

That ends the anecdote. What follows is my imagination.

Imagine it were my daughter. What would be my attitude? I imagine that I would be walking into the oncologist saying, “Look. There has to be something you can try. I don’t know whether it’s bone marrow transplants or stem cells or some clinical trial somewhere. But we can’t just sit here and watch her die. Either you give us something that has a chance of working, or we’ll find another oncologist who will.”

Next, imagine that the best hope is a treatment that costs $100,000 and offers a chance of success of 1 in 200. Would I want her to get that treatment? Absolutely.

But look at the issue from a rational, bureaucratic perspective. You have to treat 200 patients at a cost of $100,000 each in order to save one life, for a cost per life saved of $20 million. Is that what a rational bureaucracy would do?

A rational bureaucracy would not even tell the family about this treatment option. But I think that in the American culture regarding medicine, I would find out about it.

This semi-anecdote says nothing about free-market medicine vs. government health care. In my mind, free-market medicine is more likely to result in the treatment being attempted, but that is not necessarily an argument for or against free-market medicine.

My point is that I would be a lot less “can-do” than Peter Orszag in promising to rein in health care spending. I think that our cultural attitudes about medical services are such that attempts to bring rational cost-effectiveness to the system may not be so easy to implement.

04/15/2009 Posted by | Health Care | | 1 Comment

British Health Care – Continuing Series

Listening to our allies when it comes to socialized health care makes me happy for what we have in America

04/07/2009 Posted by | Health Care | | Leave a comment

Over 3 Years, 9 Patients Made 2,700 ER Visits Costing $33 Million

Guess who’s paying for these visits? YOU – THE TAXPAYER!
Don’t think this is just isolated to Austin.

AUSTIN, Texas – Just nine people accounted for nearly 2,700 of the emergency room visits in the Austin area during the past six years at a cost of $3 million to taxpayers and others, according to a report. The patients went to hospital emergency rooms 2,678 times from 2003 through 2008, said the report from the nonprofit Integrated Care Collaboration, a group of health care providers who care for low-income and uninsured patients.

“What we’re really trying to do is find out who’s using our emergency rooms … and find solutions,” said Ann Kitchen, executive director of the group, which presented the report last week to the Travis County Healthcare District board.

The average emergency room visit costs $1,000. Hospitals and taxpayers paid the bill through government programs such as Medicare and Medicaid, Kitchen said.

Eight of the nine patients have drug abuse problems, seven were diagnosed with mental health issues and three were homeless. Five are women whose average age is 40, and four are men whose average age is 50, the report said, the Austin American-Statesman reported Wednesday.

“It’s a pretty significant issue,” said Dr. Christopher Ziebell, chief of the emergency department at University Medical Center at Brackenridge, which has the busiest ERs in the area.

Solutions include referring some frequent users to mental health programs or primary care doctors for future care, Ziebell said.

“They have a variety of complaints,” he said. With mental illness, “a lot of anxiety manifests as chest pain.”

04/03/2009 Posted by | Health Care | | Leave a comment

Denying Medicine to Cancer Patients B/C of Rationing in UK

Socialized medicine in the UK: Skip to minute 5:00

03/31/2009 Posted by | Free Market Economics, Health Care | , | Leave a comment

English Health System in America?

An English conservative on whether nationalizing health care in America:

HANNITY: And Mr. Hannan, he joins us tonight from London.

Mr. Hannan, thank you for being with us. I got to — do you realize how your message is resonating loudly and clearly in American tonight and how inspired people are by your words?

HANNAN: And you say the nicest things. Listen, I’m happy to come on this show anytime you want me. I’m pretty perplexed by the whole thing. I’m trying to think of, if you could come up with the most boring phrase to enter into a Google search engine, and I thought, speech to the European parliament, so I am completely bowled over by what you said.

HANNITY: Yes, well — look, go over every line. We now are adding, by the year 2019, we’re going to have nearly $900 billions just on interest on the debt with what Obama is spending. He’s spending more than every president from George Washington to George W. Bush in terms of the debt he’s accumulated here.

And as you point out, you can’t spend your way out of recession, borrow your way out of debt. Do you think the world is making a mistake and that we’re really all collectively going to suffer these consequences?

HANNAN: We’re all collectively going to suffer the consequences. I mean it’s not our mistake. The mistake is being made by a small number of political leaders and the small number of their advisers. You know it’s a common sense that when you’re in debt, you spend less. Now anybody except a politician can see that. Anyone can see that in their private life.

You’ve run up too big a debt, you’ve run up too big a mortgage which you try and sort it out, because if you’re either a banker or a politician, you have a different take on these things. Because, of course, it isn’t your money.

You know, that great phrase of Milton Friedman. There’s only two kinds of money in this world, it’s your money and it’s my money, in a way. We’re very careful about the second of those. But of course, for politicians, it’s all your money.

HANNITY: Yes. Anybody but a politician can see that. I think that’s going to go down as one of the all-time classics. Unfortunately, it’s true. You know, one of the things, Mr. Hannan, that we’re debating in America, Barack Obama wants to lay down $634 billions for nationalized health care.

Well, we’ve had nationalized health care in Great Britain, and we’ve had it in France, and we’ve had a single payer in Canada. My question to you is, based on what you said, I would like you to explain to the American people if this is a good idea through this prism.

I read in The Daily Mail last week that the — the your health system, the NHS, literally has a group of people that decided, government bureaucrats, that they were going to give drugs to women with breast cancer and a certain rare form of stomach cancer. The rationing body is what they call it.

Is it a good idea for the U.S. to invest in nationalized health care?

HANNAN: Now, first of all, it’s important that you understand that that’s a true story, and it’s a typical story. It’s not in the newspapers because it’s unusual. We have a rationing body that’s called, the National Institute for Clinical Excellence. It’s known as NICE, N-I-C-E, which, coincidentally, there was an adult novel by C.S. Lewis in the 1940s where the NICE was this kind of Satanic conspiracy.

And in terms of them, align affects, you can sort of see the connection. I mean it’s a terrible thing to put anyone in this situation, any bureaucrat in this situation, of having to make those life and death decisions because they are literally life and death decisions.

HANNITY: So you…

HANNAN: The worse thing is for you as the recipient of health care because you’ve got no control over what you get. There’s no contractual relationship between you and the suppliers, so, you know, if they treat you today or next week or six weeks from now, where it’s too late because your condition has already deteriorated.

HANNITY: So your advice.

HANNAN: … there’s nothing you can do about it. You are expected to queue up with a smile and be grateful for what you have. And it is — it’s the last survivor of the kind of socialist post-war conspiracy. Sorry, socialist post war –- yes, I’m tired. It’s midnight. Socialist post-war consensus…

HANNITY: All right, let me ask you.

HANNAN: … in the U.K.

HANNITY: So your advice to America is to stay away from socialized health care. I think you’re very clear on that. Let me ask you what.

HANNAN: If you — listen, if you get nothing else from what I’m saying this evening, please do not make that mistake. If there are any congressman watching this who think, yes, it might be a bit fair, yes, it’d be a bit sort of cozy, you know, I promise you, it is worse for doctors. It’s worse for patients. It’s worse for taxpayers.

HANNITY: Let me ask you one last quick question here if I can, because, you know, a lot of Europe supported Barack Obama heading into this election. They were — you supported Barack Obama heading into this election. That’s why I found your comments fascinating.

Now, the United States of America — I think it’s embarrassing to get lectured by leaders of France, the European Union, president of Czech Republic, president by China, the communist Chinese, on how to run a better economy.

What has happened in terms of the faith and hope and trust and confidence that Europe once had in the president?

HANNAN: Yes, you know, I — first of all, I think I can trump your story. We have done all of the things that you’ve done wrong. We’ve borrowed more. We’ve spent more. We’ve increased the deficit and we pretended that there’s some clever plan about it. But we’ve done something that you haven’t done yet, which is, we’ve gone for the Zimbabwe option. We started just printing more money.

And I actually saw a newspaper in Zimbabwe saying, you know, the poor old Brits. Look at the mess they are in. You know, that having to do this.

HANNITY: Yes. I think you did.

HANNAN: We may have even got the excuse that we have of — so we are pitied by Mugabe’s Zimbabwe, which I think trumps even your communist.

(CROSSTALK)

HANNITY: I’ve got to run.

HANNAN: What made your country great, what made your people strong and prosperous and free.

HANNITY: Capitalism.

HANNAN: … that it was small government right from the beginning, right from the declaration of independence. There was a distrust of the concentration of power and a confidence in the freedom of the individual. And you know, people will always make better decisions for themselves than administrators will make for them.

And if — when you lose that, if you Europeanize yourselves, and under the illusion that it’s kind of, you know, a bit Hitler and a bit miser and you know, you make yourselves more popular in the world, you will throw away what may people actually respect you, not the least because I understand that it was something…

HANNITY: Daniel, I hope and I pray, and I mean this, that our politicians are listening to you tonight. Thank you for what you said. I hope you’ll come back on the program. We appreciate your being with us.

HANNAN: Pleasure to be here, Sean. Thank you.

HANNITY: All right. Thank you. Very inspiring.

03/28/2009 Posted by | Health Care | | Leave a comment

Saying No To Obama-Care (Where Democrat Hacks Get First Dibs)

Another argument against nationalizing health care under the government-run tent

Video Here:

03/27/2009 Posted by | Health Care | | Leave a comment