Bioethics, medical finance, Medicare, public policy

>Varied and deep rooted (cost of health care)

>I’d just add a few observations to the New York Times editorial (free registration required) on the cost of health care in the US.

I’m a big proponent of making patients responsible for more of their health care costs. Health Savings Accounts, long term care insurance, and even deductibles are good ideas. I would also add that the vast majority of the people on Medicaid and public assistance could do some sort of public service work in payment for their health care. (Medicare, disability, and veteran’s health care has been paid for already.)

I especially like the idea that primary care should be emphasized. How about *paying* doctors to do it instead of ensuring that we lose money for every Medicaid and Medicare patient we see?

And they don’t mention some of the problems that I see:

1. Over the counter medicines that probably aren’t needed in the first place and don’t do what they are believed to do. Did anyone notice that the baby cold medicines are not useful and no longer standard of care? And please don’t get me started on homeopathy – I’ll irritate a couple of million of my readers if I go on about the useless idea that a substance diluted millions of times in water can’t do anything.

2. Botox, cosmetic surgery, and beauty treatments – Do these services, when provided by a physician go into that giant number?

3. The hidden costs of school-based health care and the need for “notes” from doctors for school and work. I doubt that many people are aware of how much of Medicaid money is spent on “mainstreaming” and on learning disabilities in our school systems. I’m sure that few would understand the pressures that doctors face to provide the testing, medications, and follow up required to get mom back to work after the baby is too sick for daycare or school, for the note for the Tuesday patient who says they had food poisoning on Monday, or for the demand from a school or from the parents to get the 7 year old tested for a learning disability for all sorts of reasons.

4. Salaries and perks for insurance big wigs that could pay for the healthcare system of a couple of nations. United Healthcare, which threatens to swallow up every insurance company in the nation, has paid at least $120 Million dollars to its CEO for at least 10 years.

5. I don’t want it to go away — but — Medicare pays for quite a bit of the research and medical education in the country. We need to see this research and the doctors, medicines and treatments that come from these funds as the valuable commodity they are and quit dinging “health care costs” for it.

About bnuckols

Conservative Christian Family Doctor, promoting conservative news and views. (Hot Air under the right wing!)


4 thoughts on “>Varied and deep rooted (cost of health care)

  1. >"And please don't get me started on homeopathy – I'll irritate a couple of million of my readers if I go on about the useless idea that a substance diluted millions of times in water can't do anything."I didn't understand that sentence. Is there an extra negative in there? It almost looks like you are endorsing homeopathy by calling it a "useless idea" that homeopathic medicines "can't" do anything, which sounds like you are saying that they _can_ do something?If you meant to say that they are really useless, I'll be cheering loudly, that's for sure.My parents aren't into homeopathy, but they have been bilked of lots of money by people selling "naturopathic treatments" of various sorts, and I just wish I could give some of those people five minutes alone in a room with a large, angry dog.

    Posted by Lydia McGrew | November 28, 2007, 12:06 am
  2. >You got me on my grammar – it's a useless idea that can't do anything.I argue that if a treatment works, someone would have figured out a way to commercialize it. I love measurements and tests. I warn patients that the strength of generics is supposed to be within certain parameters, comparable to the brand names, and so for things like vitamins, they shouldn't let anyone talk them into spending a lot of money. What's surprising is how many of my patients sell those awfully expensive vitamins to their friends and relative.s

    Posted by | November 28, 2007, 6:13 am
  3. >"What's surprising is how many of my patients sell those awfully expensive vitamins to their friends and relatives."Isn't the placebo effect wonderful? I know lots of people who buy and sell that kind of stuff. Here's the deal: Nobody ever says, "Okay, this is a combination of vitamin E, vitamin D, and vitamin C, such-and-such mgs. of each, and it'll be great for your health." If they said that, somebody might go out and just buy a giant generic bottle of each of those vitamins, and that would be the end of Reliv or whatever the business is. No, they give the product a name, like "Reliv," and then act like the health drinks, vitamin bars, and what-not just have this combination of vitamins and herbs that is so amazing and specific that you couldn't possibly get the same effects in any other way. They collect testimonials from people, not saying, "I took generic vitamin C every day, and I had a lot fewer colds," but instead saying, "My son had severe learning disabilities, and I started giving him Reliv every day, and now he's reading at grade level." Stuff like that. And people think, "Well, if these people are telling the truth, then it must be wonderful stuff," and they buy it at a price they can ill afford and become in their turn distributors. They have no concept of double-blind testing, control groups, the placebo effect, the post hoc fallacy, the way that the effects of nature or other things can be attributed to what you are taking, and on and on.

    Posted by Lydia McGrew | November 28, 2007, 2:39 pm
  4. >In clinical trials for one of the oral antihistamines, 40% of the control group actually said that they would take the placebo again because it worked so well. Fortunately, the actual antihistamine worked even better. But was the efficacy x – 40% or x?

    Posted by | November 29, 2007, 5:19 am

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