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June 25, 2007

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LAK

Well, as you know in England, you can pay for private rooms, specialists etc. And as you know, there are no mega health and insurance corporations reaping massive profits off of the health care industry in those others countries. Have you been to the Frist museum in Nashville? It is very very nice. There is a reason Bill Frist is a republican.

All other things being equal, and I realzie they're not, you at least have those profits being invested back into the system or being used to bring down costs. And you don't have this bizzare and perverse incentive structure for doctors to perform useless procedures covered by insurance that have high profit margins. C-section anyone?

And of course, I'd love to discuss the profit margins of big pharma too, and the influence they have over doctors who prescirbe drugs, (Neurontin anyone? How much did Pfizer settle that whistleblower case for?)not to mention the handout they got from the republicans in the prescripition drug joke the Bush administration passed.

And then there is the misallocation of resources that directly follows from a lack of regulation of the healthcare insustry comined with the unjust distribution of wealth in our society. The number of cosmetic surgeons and dermatogolists there are should shock anyone's conscience given how many people can't even get the most basic care. What kind of country are we where we allow some rich woman to get 4 face lifts and periodic botox injections while other women can't even get basic prenatal care?

Can't wait to see sicko.

Frederick Hamilton

LAK,

Much good and bad about the American health care system. Interestingly 89% of those WITH health insurance feel they are well cared for. The 40 million without health insurance is the real problem.

As to cosmetic surgery, England and Canada have a large contingent of plastic surgeons and as in America (where insurance or Medicare or Medicaid won't pay for cosmetic procedures) NHS won't pay either. Plastic surgery is a bad example to use to show problems with either system. No sane gov't or insurance co would pay for Botox or a face lift or tummy tuck or whatever. The rich in England, Canada and America get their plastic surgery outside of the "system".

Most physicians make very little compared to the work load put out with respect to their educational investment. The old plumber joke that I used to be a doctor.

If you think healthcare is expensive now, as Milton Freidman would say, just wait until it is "free".

One of the answers to a better health care system seems counter intuitive but is true, have patients responsible for a portion of their health care expenses.

To easy to blame greed for all the ills of the system. This terrible system has produced some remarkable drugs and doctors.

At least physicians still rate higher on the respect scale than politicians or lawyers. That takes some of the sting out of the avarice and greed screed.

The reviews of Michael Moore's film by even liberals are not favorable. Moore apparently also is wanting for any answers other than to make it "free". No free lunches. The Univ of Chicago Noble Prize economists know that. If it is of no cost to the patients, you'll be queing up for years for an elective surgery, just like Canada and England. And Cuba, the point of Moore's pic is a medical basket case. Most doctors and clinics in Cuba have no medicines, dressings or diagnostic testing ability. A real "sicko" of a system.

But no problems in the workers paradise south of Florida. What a wonderful free country with no jailed dissidents, complainers or political prisoners. Paradise medically and culturally. Sicko indeed.

FrankMCook

I hope when you do write more on this topic you will look into the effects of the health care system on the tort system. I am more and more convinced that broader health care coverage should reduce the need to resort to the legal system to recoup medical expenses. It is a topic that deserves serious academic study.

jimbino

I think a lot of the irritations in healthcare could be eliminated by banning price discrimination, by requiring posting of prices per CPT code (procedure) a la Medicare, and by requiring unbundling of services, as was done to break up the ATT monopoly pricing a few decades ago.

Then a rational person would stay uninsured, shop around for medical care, secure in the knowledge that he enjoyed MFN pricing, gained a 3% discount for paying by check instead of credit card and a 35% discount for relieving the physician from having to maintain a staff to process insurance and medicare/medicaid paperwork, and from suffering delayed or denied payment for his services as is common when dealing with insurance or the government payer.

It is these considerations that have driven thoughtful Americans to take dental and medical vacations to countries like Mexico, Brazil and Thailand that know how to treat patients fairly, if not like kings and queens.

LAK

That physicians rate higher on the respect sacle than lawyers does nothing for the greed screed. It usually isn't the physicians making out like bandits Frederick. It is the shareholders and executives of major health care corporations. It is the busienss school grads who decide how best to structure their premium/deductible schedule and the majority owners of Health South etc. It is the executives who fly around in private jets because they help run highly profitable health insurance companies. You know that. Doctors are mostly high priced wage earners these days whose labor does more to line the pockest of executives and shareholders than anyone else.

The Dude

Being from Birmingham, let me say that the Health South example is a little off base. The problem there was corporate corruption (non-unique to health care), not bad service or high rates for the mostly sports-injury-related health services. Scrushy did not screw patients, rather he screwed investors, and inflated his corporate earnings to the tune of billions of dollars. Corporate corruption certainly sucks; but that argument lies outside of/above health care. The strongest relationship it has to the current discussion is a very top-down application: you'd have to argue that corporations are more corrupt than governments. I think people in power are (or become) corrupt, and thus I prefer the checks and balances that exist in a capitalist state, rather than in a state where power is centralized in government (e.g., a state with no checks and balances). Although it isn't for his most heinous crime, Scrushy currently faces sentencing, with the recommended sentence being 25 years, along with former Democratic Alabama Gov. Don Siegelman (I believe a proponent of national health care himself) for bribery.

I think Saul, as usual, is correct when he says that the problem is inefficient allocation of resources, not the existence of insurers. The administrative state we live in creates notable inefficiencies for health care, many of which relate to tort law. Epstein would say, let patients contract away their legal rights to recover after getting hurt in hospitals, and watch health care prices plummet. Works for me. Hospitals would still have keen incentives for being safe-- reputation for safety would mean a lot more in the market place than it does now if there were no threat of massive tort recovery after negligent care. Then again, this pre-Lochner idea is so far from a reality in our society, it is sadly silly to discuss.

LAK

Actually, it is the perfect example. Health South is a perfect example of the result of underregulated free enterprise. Not only did they commit massive fraud on shareholders by lying about their earings to the tune of $1.5 billion, they then tried to cover it up by committing medicare fraud. Sweet. They had a fleet of 11 private jets. The CEO sold $75million in stock in one day before the accounting scandel was outed. But that isn't even the point. The very fact that so much of its revenue flowed into the hands of majority sharehodlers and insiders is the issue.

Now then we can move on to HCA, the company run by Bill Frist's family. They settled with the governemnet for $1.6 billion for commmitting years of medicare fraud, which likely didn't even come close to covering the actual amount of fraud they committed. Who was paying? oh yea, the public. But instead of public money going to helath care for those who need it, it went into the pockets of the Frist family, who did build a very nice museum in Nashville as a gesture of goodwill.

The very act of profiting off of healtcare is the issue. It is wrong. It changes the very nature of helath care, it changes who gets paid for what. It changes the incentives in health care.

Look at it from a legal persepctive. Corporations only duties are to their shareholders. Of course private corporations are going to try to maximize their profit, which isn't necessarily consistent with the healthcare needs of the public. It sets up these incredible incentievs to profit over providing good health care for the public. It results in profitable procedures happening too frequently, it results in massive medicare fraud for profitable drugs. There are reasons that drug companies have become so huge and profitable. Have you seen the number of drug cases out there where drug companies actively market the "spread" bewteen the price paid for the drug by medicare and the price actually paid by the healthcare provider? It is sicko. It has turned useless drugs into $2billion a year sellers. All to line the pockets of insiders at privatized health care providers.

It is one of our country's great shames. And that is to say nothing of the millions of people cut out of health care entirely becasue they are unprofitable customers. Sometimes basic decency should come before greed. There is not a chance that the inefficiees of a governemnt run healthcare system are larger than the amount of money taken by private interests out of the healthcare system for greed.

The Dude

Well, your buddy Scrushy is going to jail for 7 years LAK. But your response basically just makes the argument that corporate corruption is bad; how you make that unique to health care is unclear from your argument, except that you say that health care providers should not have any incentive in terms of making a profit? I am unclear how you expect this to work. Should health care be provided for free? Who should pay for it? Who should decide how to allocate resources within the new "free" health care structure? I think we are quickly going down the road of a capitalist vs. socialist argument, and that does not hold much interest for me.

LAK

No, my argument is that corporate corruption is an inevitable result of privatised health care, but my main problem is thatmoney is taken out of the system at all for profit and corporate excess. It wasn't fraud for healthsouth to have 11 private jets for its executives. It wan't fraud for executives and insiders to reap millions and millions of dollars in dividends. And my other point is that when profit is your motive public health isn't. There are reasons why so many C-sections are performed these days, and why so many people don't have health insurance at all. It has nothing to do with corruption. It has everything to do with profit as your end for providing health care.

Yes, healthcare should be provided for "free." Who should pay for it? The people in the form of taxes. Very well paid salaried professionals in the governement whose duties are to the general public and not corporate shareholders should make the decisions about coverage and costs.

hell just the profits recoverd form big Pharma could fund a large portion of public health care, and pharmceuticals might even be develped with the public good in mind rather than profit. Hopefully there will be more focus on discovering drugs for pressing health needs, not erectile dysfunction and the next round of psychatric lifestyle drugs that keep people from hating themselves so much. I'm all for antidepressants for people who actually need them, not for 7 out of the 8 people who take them who really don't. Though sedating the soul of the bourgeoise does have its efficiencies for maintaining the status quo.

"Hate your corporate law job working for the man for 80 hours a week? You don't need to quit and do something meaningful with your life! Just take this pill and all the sadness and anxiety will disappear!"

curtisstrong

Alright, there are some serious issues in this country that need to be addressed, but in this case, I really think it's about as horny as you can guess (more so even than immigration, I believe).

First, health care in this country is expensive, full of confusion (those health care plans) and uncertainty (whether or not you'll get it paid for), and also, in the end, not always worth the money. Private insurance has run wild the last couple of decades, and the trend has been to cut, cut, cut.

Yet, we have the problem of the economy and the tremendous impact that a socialist overhaul of the system would have. I agree with LAK when he implies that the stockholder's wives shouldn't be getting 500 facelifts and who knows what else, while Julie-in-the-ghetto has to work at Wal-mart for 2 years before she can even get a basic form of health insurance. Even so, we're talking about Billions (Trillions?) of dollars every year that our economy would have to make up somewhere else. That's not always the easiest thing to do. A major overhaul like that is going to be difficult, to say the least.

Perhaps Jimbino has an idea there about putting pricing up on some type of McDonald's style "medical menu," and letting people shop around, but I really think that the basic issue here is security. People want to feel like they're being taken care of and that they won't be spending Christmas around a fire in a barrel, simply because they got cancer, or were hit my some drunk driver.

My tentative recommendations for now are to hit back at the system. Let's start looking for medical care in places like India, where money can be saved, a vacation can be enjoyed, and the medical care (but do your research beforehand), is mostly the same as you would get in Uncle Sam's whorehouse hospitals.

If universal overhauls need to be made, (and after having lived in Spain where the medical care is free, I hope that there is a way to do it!), let's get it going, but beware of the economic pitfalls that may be lurking in the dark corners.

curtisstrong

Let's not forget to mention also that Julie-in-the-ghetto is still going to be (most likely) unable to pay the deductible for a major medical situation due to these great deductibles that some slick came up with a while back.

If a deductible is even $1,000, I'll tell you what, there are people who can't pay it. Imagine $2500 or $5000 that some of these plans have. Even WITH health insurance, it's a big smash to the pocketbook, and in a lot of cases, still not feasible.

Let's get her taken care of first.

Gymno

I am also uninterested in the federal socialist debate.

Why not have a debate about State socialism?

What is to stop an individual State from mandating a State ran health care insurance?

This system could be paid for by a State income tax or other funding mechanisms already in place. The goal would be to provided basic and preventative health care to all of its citizens for no or very low cost. The State could buy larger amounts of pharmaceuticals and negotiate a discount. It could have State ran hospitals as well as privately ran hospitals.

Insurance companies could still profit by providing additional coverage for things like elective surgery, or out-of-state specialist.

Doctors still have a choice of working for themselves or working for the State.

People would have at least some basic health care available not matter their economic situation.

It has always bothered me that when something is broken on a national basis, that the people do not exercise their power to influence public policy locally. Then if it works well we can implement it on a national level. If it fails then it will be reformed (in a land where people care about the political process).

Lets change the policy at the state level first before we have a national panacea.

We still must do something, and at least Sicko whether you cared for it or not has got people talking about alternatives to the very broken status quo.

Jeffrey Dach MD

Saul, thanks for an interesting review of Sicko.

What is the real solution, if Michael Moore’s government sponsored universal health care is not the answer?

The crux of the "SICKO" documentary is the disconnect between our expectations and the reality of health care. We are expecting compassionate care from another human being, and instead we get a faceless corporation. The person behind the desk or window is an agent of a health care corporation, which is not a human being, whose primary goal is to increase corporate profit.

This is America, and corporate profit is good, the profit motive forming the basis America’s greatness. Right?

The basic problem is that a corporation is not a human being. Therein lies the fallacy of replacing a corporation with a government agency, neither of which is a human being, when what we really want is a human being to deliver compassionate health care, and assist in serious health care decisions.

Review of "SICKO", by Jeffrey Dach MD
http://jeffreydach.com/2007/07/08/sicko--michael-moore-and-the-crisis-in-health-care-by-jeffrey-dach-md.aspx

Jeffrey Dach MD http://www.drdach.com/


Nic Cruickshank

some change or variation is necessary but government run may not be the best way. We end up paying for non elective surgeries here in Canada as well, and in certain cases where it is completely necessary. Diabetics in Canada need to pay for their own needles and portions of medication. Something should be done, but try something original since every method in existance has drawbacks that are serious to segments of society. It would be a lot nicer if the debate was about making health care work and not aping systems that currently run as opposite to the individuals interest as your system is already. All I can say from personal experience is don't mimic Canada because we are not doing that well.

Rev. Bob Richardson

"Siegelman Procecuted/Sentenced By The New Elite Group That evolved From The GOP"

The conviction of Siegelman and Scrushy is a joke, "A guy walks in, gives a contribution, and gets an appointment? Until Congress reforms this, this is the system we live under. They are criminalizing this contribution. What was the alleged crime? Richard Scrushy, wealthy owner of HealthSouth was appointed to a hospital board. A quid pro quo for a donation to the campaign for a state education lottery is the supposed bribe.

The bribery charge on which he was convicted did not involve pocketing money personally, but a rich business executive who put $500,000 into a campaign fund for a state lottery to support education. Prosecutors said Siegelman, named the executive to a state board, though the executive had held the same position under three previous governors. Remember that this happen in 1999 years before the HealthSouth scandal.

Why is this utterly ridiculous? Well besides the damning fact that 3 governors had already appointed him to the board, a wealthy hospital owner like Scrushy would always be appointed to a hospital board in any state for bringing jobs and money into the state. He didn't have to give anyone a dime to get that position. That alone was sufficient to earn him the respect of any governor. There was absolutely no need for any quid pro quo to get onto the board.

Repeatedly the prosecutors claimed that Siegelman "lined his pockets" and claimed that he was the "nexus of a pay to play" system. The problem with this is that no evidence of personal benefit to Siegelman was ever offered.

The prosecutors attempted to draft a RICO racketeering case against Gov. Siegelman. It is the worst drafted RICO that I’ve ever seen. Even Professor G. Robert Blakey, a former prosecutor and now a law professor who advised Congress in enacting the RICO called the entire case against Siegelman a "garbage can" and "a joke."

Fed. Judge Fuller ruled that his decision was influenced by a determination that both Siegelman and Scrushy had failed to take responsibility for their crimes. The fact that no crime ever took place is the reason for not taking responsibility for it.

Why were Rove, the Department of Justice, and Bob Riley so concerned about Scrushy's donation to the Siegelman’s Alabama education lottery campaign? They believe that the state lottery in Alabama would have an impact on the Republican laundered cash flow from the Indian casinos.

McCain is the senate chairman over Indian Affairs who “has not” been protecting the Indians. Lobbyists have for years used scare tactics on the Indians making them think that if they didn’t pay for their services and make donations to designated groups that they would lose their gambling licenses. Many of Bob Riley’s past affiliates (Trent Lott, John Lundy, Toby Roth, Dan Gans, Dax Swatek, and Twinkle Andress) are now working as Lobbyist for directly for the Mississippi Indians. Recently convicted lobbyist Michael Scanlon also started his career working for Riley.

This case is the distorted idea of Karl Rove to use federal prosecutors to win elections, destroy prominent Democrats and damage the Democrats' donor base in Alabama.

An elite group has evolved that is holding top state and federal offices. They are using the name of the GOP to control government elections, courts and receive and direct monies much of which are associated with government contracts. Karl Rove has been a major organizer in this movement; however, I don’t feel that he is the head of it. I do feel that it’s root go back to President Nixon.

It's a disgrace to us Americans that President Bush allows Karl Rove (a political analysis) to use the resources and powers of the Attorney General. Nearly everyone agrees that the appointment of Gonzales was a ploy to get the Latinos votes and a front for Rove.

Curious

Why, in the discourse regarding health care reform, do commentators rarely discuss the fact that insurance companies are exempted from national anti-trust laws and are instead regulated by the states? Does this exemption matter? Should we care? Would more competition in the insurance industry alleviate some of our healthcare problems?

cigar cutter xikar

A full body x-ray scan is an effective method of maintaining a high level of security

Dr. Buttmunch

I'm a primary care Doc. I wish they WOULD socialize it. It is not only more humane but patients would get better care. I take care of uninsured at a community health clinic. I cannot refer them to orhopedists or dermatologists so it is a false safety net. The HMOs really are Evil. Ive seen it first hand. We punish people for working b/c they cannot have medicaid even if they are burger flippers. it's insane

Joan A. Conway

I recently heard horror story about a man who had not reached retirement age for his social security benefits, and his corporation went bankrupt leaving him with that weasel of an insurance company in the interim. He had developed edema in his feet and legs and doctors don't know the cause of his aliment at the Free Health Clinic. His application for his retirment benefits awaits approval for his disability, if he is lucky to get it. He sold herbal products, drugs, food,and cosmetics in a health store for years.

I believe this American male has been given a raw deal, in spite of the Free Health Clinics concerns and its care.

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