The costs of health care

Why is health care so expensive and so unsatisfying? Just ask anyone who visits a hospital or a doctor and you will get the message. Ask anyone who has to pay for their health insurance and then copay for medications or visits. What are the root causes of this? DocBrain has been a physician for 36 years and can shed some longitudinal light on this. Here are some of the lies that drive health care in the wrong direction.

1. Doctors and hospitals are not looking out for your best interest. Gone are the days of Ben Casey, Marcus Welby, and Dr. Kildare. Doctors are portrayed as egotistical, self-centered, avaricious and uncaring. Hospitals are portrayed as disorganized, uncaring, and cold places. Yet, in all my years of practice, this has been the extreme exception and not the rule. As Larsen has pointed out in his cartoons, God has peppered the earth with a few jerks and they appear in every place, but for the most part, those who have chosen to be in health care do it out of a desire to help people.
2. Doctors and hospitals must be regulated. This is one of the centerpieces of modern medical management and has NEVER been proven to be the best method. The cost of all the regulations is enormous, creates friction in the health care system, and detracts from your care as a patient. When a child is "taught to the test" in order to do well on a standardized test, that child might not really be learning the subject matter. Similarly, when a doctor "treats to the reimbursement and lawyer" they are focusing on the chart and not on you. Yet, this is exactly what the doctor must do now to avoid culpability in legal action and to be paid for services rendered. If a doctor sits with you and helps you deal with a personal problem that you would not like written in a medical record, well, she will not get paid. However, if you come to your doctor about a headache and that doctor documents your response to questions about your skin and bowel movements, well, that will improve reimbursement. Doctors and hospitals need information, techniques and strategies to improve safety and delivery. We need data, not bludgeoning. We need systems for improved patient management and flow, not regulations.
3. Malpractice lawsuits help improve medical care for all of us. This is completely false and, if anything, can worsen care. True physician and hospital errors are almost always settled prior to court. Cases that go to court may be contraversial and the decision of the court can alter the practice of medicine adversely. The court decision that vaginal delivery is the main cause of mental retardation and cerebral palsy led to increased c-sections, with increased morbidity and mortality for women. And yet, the data then and now continues to show that MR and CP are rarely due to delivery, being due to intrauterine damage. The association of silicon breast implants with autoimmune disease led to bankrupting a company, many people losing their jobs, and many women after mastectomy suffering unneeded disfigurement. Study after study proved the safety of the implants, which have only now begun to be reintroduced into the medical arena. There are many other examples.
4. Big pharma is out to get all your money. Big pharma is actually out there to find agents that reduce suffering, disability, and cure disease. They may put a positive spin on their products, but that is their job. Physicians and pharmacists see what really happens and can act accordingly. Again, what we need in data and information, not regulation. FDA approval may be based upon hundreds of subjects trying a medicine. It then gets released and thousands take it. We need central data about evolving side effects, efficacy, and benefits. What we get is regulation and friction. Thanks to the government and managed care.
5. Doctors are well paid. This is no longer true. If your child is finishing high school and is looking for something to do, more financial success with less work and less regulation is available in many arenas. This will eventually lead to less competition for medical school places and lower quality physicians. It will also lead to physicians forming large, impersonal groups in an attempt to reduce unit costs, a trend which is becoming the norm. You will not have the one-to-one relationship of the past. You will be a number.
6. More to follow...also, feel free to add any observations of your own...

DocBrain is anti-ebcot, among other things!

We are an enlightening society. It is no longer acceptable to be racist or to have religious prejudice. But it must be acknowledged that many prejudices are based on something else, which transcends any one religious or racial group. DocBrain believes that the main problem is that we are lacking the proper words in our vocabulary to describe what we really dislike and so default to stereotypes which are insulting and erroneous, to say the least. So, DocBrain has come up with some new words which should have no social baggage and should enable us to be free to say what we really don't like. It goes without saying that these words apply to anyone of any race, religion, citizenship or national origin who meets the criteria.

Vam = Violent adolescent male
Yumwow = young unmarried multiparous woman on welfare
Hamow = healthy adult male on welfare
Ebcot = employed but cheating on taxes
Dodo = drugged out drop out

So, really, we walk down the streets of our town, afraid of the vams who travel alone or in packs. Our hard earned income goes to pay yumwows, who, while trying to live out their youth, fail to provide properly for their brood of children, often with disastrous results. Meanwhile, hamows and dodos give nothing back to society and ebcots get an undeserving free ride.

Whether you believe that any of these people are responsible for the lives they live or society has let them down or left them behind, DocBrain can't help but find something unappealing about each of them. Users and losers, all. DocBrain thinks it is our duty as a society to do all we can to have less of each of these types of people.

The Pittsburgh Post Gazette

We get this newspaper for only one reason: our dog likes to bring in the paper in the AM for a dog biscuit treat. I would have dumped this paper years ago but for this one redeeming quality. As our poor dog is getting up in years, I do look forward to dropping this paper like the piece of trash it is. I rarely look at it anymore, but on Sunday, my wife asked me to read a letter to the editor. This AM, much to my regret, I glanced at the front page for the first time in months. This is not the paper to read if you are trying to keep a normal blood pressure!

Let's see how you view some of the Post Gazette's dealing with "the news".

According to the Post Gazette, Hamas is an organization that runs after school programs. Yes, this is how Hamas was described in a front page article several years ago. When I spoke to the editor, he stated that he had no control over what the news wires sent him and had to publish it as is or not at all. Apparently, they could not or would not add anything anywhere in the paper to distance themselves from this distortion of the true nature of this organization.

Today, a front page, above the fold, article referred to Donna Moonda, the calculating murderess of her husband Dr. Moonda, merely as a widow. The article was blatantly biased in favor of sparing Mrs. Moonda from the death penalty. While I also am opposed to the death penalty, I found the adjective "widow" inappropriate, insulting, and callous, to say the least. The writer might as well have described Mrs. Moonda as a blonde, prior health care worker, high school graduate or any other appellation that has no bearing at all upon the reason she was highlighted on the front page. While an overzealous writer could be excused for going over the top to express her biases, an editor has the duty to be truthful (that is RELEVENTLY truthful, for any editor who doesn't know ethics). Mrs. Mooda should have been labelled a murderess, as the true reason she is a widow is that she arranged for her husband's execution.

A letter to the editor on Sunday proclaimed that the University of Pittsburgh had spent thousands of dollars to influence the mayor of Pittsburgh in a way that would be favorable to the university. Why wasn't this covered as news on the front page? Why was the only "coverage" a letter to the editor from a distressed reader?

This newspaper is an embarassment and an insult to the great city of Pittsburgh!

I want my $$$!!!

http://www.ibx.com/news_events/press_releases/2007/03_28_Highmark_and_IBC_Agree_t.html

DocBrain has had it!! DocBrain provides health care services within Pennsylvania and is paid very little for the work he does. DocBrain is a patient in Pennsylvania and pays a high premium for his healthcare. DocBrain also pays taxes to the state. The insurance companies are rolling in money. There is something very wrong with this picture.

DocBrain gets little for his efforts, pays large amounts in taxes and pays large amounts for health insurance. The insurance companies, in bed with the state government, keep massive (billions) of dollars in "reserve", have enough money to give a bribe of hundreds of millions to the state "to help the uninsured" to get approval for mergers, advertise at football stadiums, buy buildings, donate MY money that I would rather donate myself.

If you are a Pennsylvanian who earns a living, you are being ripped off! Even if you believe that your doctors and hospitals are being paid enough, you should demand financial responsibility from your health care insurer to either give you more services or to return some of your money to you. You have overpaid for your health care. They are squandering your money on buildings, advertising, "charitable contributions", influence buying, and even giving it to pay for health care for the uninsured. This is not capitalism, as entry into the insurance industry is regulated.

If you live in Pennsylvania and this doesn't make you angry, tell me why.

What makes us Americans?

DocBrain recently read a critique of America as a disorganized society with a distorted system of rewards and punishments. If this is true, how did we get this way and what can we do about it?

As Americans, we struggle with two basic concepts:

• The concept of freedom ("life, liberty, and the pursuit of happiness")
• The concept of responsibility for others ("establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty...")

DocBrain believes that freedom can only be real if the limits of principle and practicality are accepted. Freedom that challenges either usually ends in disaster. Similarly, whatever you do to help your fellow citizens can only be judged in its outcome.

One of the main problems with the US is that, as social citizens, we tend to do what we perceive is the right thing without any attempt to measure the outcome. This leads to the conclusion that something is good if it makes you feel good. In failing to either define what we expect as a good outcome and to measure that effect, we fall short of what we could actually be.

People settle into one of two camps: freedom or responsibility. Unlike freedom, the administration of responsibility requires new laws. We do not measure or optimize objective benefit. Responsibility gets a bad name as it restricts freedom and never delivers on its promise, always demanding more from us. Freedom, while a good concept, seems harsh and disconnected from others.

Defining success, measuring for it, and optimizing the path to it could lead us to that perfect balance between freedom and responsibility. And that should make anyone feel good.

You're not the boss of me

If I were king...

• All criticism would be constructive; destructive and pointless criticism would be a punishable offense.
• Freedom would trump equality
• Rules and laws would be few but rigorously enforced
• Any changes would be followed for their impact, and the changes would be modified (or scrapped) to optimize their impact.
• Malice would be a punishable offense.
• Taking of something belonging to another without their free consent would be punishable under the law (this includes wealth, land, life, dignity, feeling of safety and comfort).
• Self serving vices would be allowed as long as they did not impact others. If you have amassed enough wealth, for example, and want to be lazy, OK. But, don't expect others to support your laziness.
• All crimes would be dealt with as learning experiences: once a person has felt regret, demonstrated remorse and has made restitution, they would be able to return to society.
• Lifelong learning would be the duty of every one.
• Trying to make the world a better place would be the prime directive.
• Charity to others would be encouraged as the prime way to help those in need, with "pay it forward" as the expected response to the receipt of charity.
• The above rules would apply to those within my kingdom and only for my subjects. Those who entered my kingdom legally would have to abide by my rules. Those who entered illegally would be forced to swear allegience to me or be returned to their native land.
• My laws might be harsh to some (if you need something expensive and cannot afford it and if no one is willing to help you through charity, you might be out of luck).