Info on the Socialization of medicine

[iamtravis]

I'm trying to get some information about the issue of socialized healthcare. I want to try and make an unbiased judgement on the subject and if you guys could post some pro/con articles, that would be greatly appreciated.

Also, in regards to this topic coming up in interviews how is the "healthcare is not a right" outlook recieved? I understand that this is an extremist viewpoint, but at the same time we do live in america and are a free society. I can see what kind of argument is made for socializing medicine and health-care, but this concept inherently goes against the everything that american has traditionally stood for. There is a movement from the land of opportunity to the land of i-haven't-been-able-to-make-something-of-myself-so-i-should-be-given-something.

In a free society there will always be class structure. The differentiating factor of a free society from other politcal structures is that free society doesn't fix a person in any one class. I think it is a shame that not everyone can receive healthcare and i wish there was a a way to prevent it, just as i wish there was a way to prevent any type of misfortune. At the same time, however, unless we are going to resort to a communistic society, there is no way to allow for a "something for nothing" standpoint.

My qualms with socialized healthcare are obviously not with the moral ideology underlying it. I really do think, however, that we should worry ourselves with the degratory effects that can come as a result of socialization in general, regardless of specifically applying in the case of medicine.

Most of the times socialization affects the general quality of that which is socialized. In the case of medicine, i truly believe that if you allow everyone free healthcare, the benefactors will end up the ones who get shafted the most, and ironically no one will care. The working middle class will shoulder the burden of supplying the funding through more extensive taxing and the likes. The poor uninsured will get healthcare, but everyone will still not be happy. Those that were getting adequate healthcare will soon receive less than adequate attention. Those that were unable to get it will still also get less than adequate attention. In the end, there is a general decrease in quality throughout the system with the slight increase for a few not even being adequate enough to meet the demands that initially triggered the need for change.

Healthcare, along with everything else in a free society, is the reward of hard work and efforts. Just as there is hunger shortages, and homeless, there will always be those that can't afford adequate healthcare. For one, I cannot justify having my own healthcare reduced to in order to provide for essentially ineffective healthcare of someone else. If you disagree with this, then you disagree with free society because the ability to choose has been revoked.

I agree that having poor uninsured is a shame. I agree that something needs to be done because the current state of affairs in medicine is nothing to be desired; however, everything i have read about universal healthcare seems to show that it is an ineffective method of reform.

I made this post to give my opinion on a topic that I have some interest in. I also made this post because I am open minded to hear arguments pro-universal healthcare. I am sure there are issues out there that I have not touched on or have been given thorough information about. I would like to hear other's thoughts on this so I can make a more informed decision on the matter. Again, this is not meant to flame anyone or anything and if this turns out to be the case, i'll delete the thread. I am simply interested in what sdn has to say about this topic and there is no wrong or right answer because even the brightest minds in the world can't agree on anything yet.

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[lessismoe]

I haven't personally come to a conclusion about this issue, but here are some factors you may want to consider as you think about this:

1. Lack of (relatively inexpensive) preventive care for the poor can result in (relatively expensive) remedial care later on, again burdening the working middle class.

2. Public health-- will delaying care for the poor (as is the current case, if you've visited an ER anytime lately) be the catalyst for the next wave of infectious diseases?

I've heard arguments that not ALL aspects of health care should be socialized, and that only basic and preventive care should be provided for all.

 

[iamtravis]

Originally posted by lessismoe

I've heard arguments that not ALL aspects of health care should be socialized, and that only basic and preventive care should be provided for all.

See, now that seems like a more realistic solution. I think something along those lines is more likely to have a positive effect rather than socializing all aspects of healthcare.

 

[elias514]

The myths associated with health care in the U.S.:

 

[iamtravis]

these are exactly the things that i'm talking about. all excellent suggestions, but is there anyway that you guys can give some links to where i might find out the answers to these questions?

 

[greggth]

Originally posted by iamtravis
...
Healthcare, along with everything else in a free society, is the reward of hard work and efforts. Just as there is hunger shortages, and homeless, there will always be those that can't afford adequate healthcare. For one, I cannot justify having my own healthcare reduced to in order to provide for essentially ineffective healthcare of someone else. If you disagree with this, then you disagree with free society because the ability to choose has been revoked.


The way you state your position makes it sound as though you have not thought it through thoroughly.

One of the basic tenets of our current system of medical ethics is that people who cannot afford to pay should not be denied care in life-threatening situations.

Do you believe that an accident victim who comes into an emergency room with no identifying information, and therefore with no proof of the ability to pay, should be denied care? What if that person has identifying information and you know that he will not be able to afford life-saving treatment?

If you are an Ayn Rand enthusiast, you should say it. At least you should be able to cite some philosophers, writers, or politicians who hold the same opinion as you do.

Here is an AMA statement on it:

http://www.ama-assn.org/ama/pub/category/8538.html

E-9.065 Caring for the Poor.

Each physician has an obligation to share in providing care to the indigent. The measure of what constitutes an appropriate contribution may vary with circumstances such as community characteristics, geographic location, the nature of the physician?s practice and specialty, and other conditions. All physicians should work to ensure that the needs of the poor in their communities are met. Caring for the poor should be a regular part of the physician?s practice schedule.

In the poorest communities, it may not be possible to meet the needs of the indigent for physicians? services by relying solely on local physicians. The local physicians should be able to turn for assistance to their colleagues in prosperous communities, particularly those in close proximity.

Physicians are meeting their obligation, and are encouraged to continue to do so, in a number of ways such as seeing indigent patients in their offices at no cost or at reduced cost, serving at freestanding or hospital clinics that treat the poor, and participating in government programs that provide health care to the poor. Physicians can also volunteer their services at weekend clinics for the poor and at shelters for battered women or the homeless.

In addition to meeting their obligation to care for the indigent, physicians can devote their energy, knowledge, and prestige to designing and lobbying at all levels for better programs to provide care for the poor. (I, VII) Issued June 1994 based on the report "Caring for the Poor," adopted December 1992 (JAMA. 1993; 269: 2533-2537).

 

[elias514]

The myths associated with health care in the U.S.:

Myth #1 (The Alpha Myth): America has the best health care system in the world.

Fact: The World Health Organization in 2000 ranked the U.S. 37th in terms of overall quality of health care.

Fact: With respect to life expectancy and infant mortality rate, both of which are standard indicators of overall quality of health care delivery, the United States ranks near the bottom among industrialized nations.

Myth #2: The American health care delivery system is not broken, because everyone, regardless of insurance, has access to care in emergency rooms.

Although, it is true that anyone can get health care in an emergency room, the use of emergency rooms for primary care needs (colds, flu, stomach problems, etc.) is a serious problem. Emergency rooms are far more expensive than a visit to a family doc. The ER physician, since he/she does not know the patient and does not have the patients medical records, is obliged to practice defensive medicine, lest the physician be sued for some medical oversight. This translates into a slough of unnecessary and oft expensive tests. Furthermore, there is no continuity of care in an ER setting.

Myth #3: The free market will solve the problems associated with the health care system in the U.S.

Market-driven health care has been an abject failure in the U.S. It has produced an astronomical number of uninsured and underinsured people--43 million and approximately 40 million, respectively. With the advent of managed care, the ability of individuals to choose their health care provider has actually diminished and continues to do so (n.b., the free market approach, in order to be successful, requires the assumption of choice to be valid). An inexcusable amount of money is diverted to administrative costs, such as paperwork and marketing, in the US (25-50%), with the result that less and less money is available for actual patient care.

Myth #4: Private is always better than public.

Fact: The overhead cost of Medicare is around 3%. Contrast this figure with the overhead costs associated with private insurance companies; their overhead ranges from 9% to 30%. The inflated overhead of private insurance companies stems from higher administrative costs, esp. the exorbitant salaries of CEOs these days, and marketing.

When profit margin assumes a higher priority than quality of patient care, as is more often the case than not in corporate health care, the patient loses. Plain and simple. Health care and corporate profit should be mutually exclusive terms.

Myth #5: Universal coverage translates into a financial albatross; in other words, we cannot afford universal coverage.

Fact: Every other industrialized country has managed to provide universal health coverage, and pay LESS for health care as a percentage of GDP. Moreover, these nations achieve better health outcomes than the U.S.

What so many people fail to realize is that national health insurance involves far less administrative hassles. The paperwork is streamlined, such that there is a universal health insurance form, not the countless different forms in existence today. The savings from paperwork alone are considerable; one scholar estimated a savings of $200 billion annually. In addition, a national health insurance plan would enable to the federal government to impose cost control measures on the pharmaceutical industry, which means that drugs would be cheaper in the U.S. This form of cost control, of course, would greatly reduce the cost of health care in the U.S.

Myth #6: The reason why drugs are so costly in the U.S. is research and development.

Fact: The profit margins of pharmaceutical companies are around 19 percent. Contrast this figure with the median for Fortune 500 companies--i.e., 5 percent.

Fact: Europe churns out just as many new drugs as the U.S. each year.

Fact: Pharmaceutical companies spend $8000-12000 per physician in their effort to market drugs.

The real reason why drugs are so expensive in the U.S. is that the pharmaceutical companies spend a fortune on marketing each year.

 

[lessismoe]

Fact: Pharmaceutical companies spend $8000-12000 per physician in their effort to market drugs.

The real reason why drugs are so expensive in the U.S. is that the pharmaceutical companies spend a fortune on marketing each year.


THIS is a good point for discussion on this board. What do y'all think about pharmaceutical companies and their marketing tactics? What do you think you'll do when you're a doc and a rep comes into your office with Prozac logo golf clubs (exaggeration)?

I remember seeing some news story about how patient advocates in the US are p!ssed off that we pay taxes to the government, the government gives money to these pharmaceutical companies through NIH or tax breaks, and then the companies sell their new drugs to us at higher prices than they sell them to other countries.

In the thread of privatizing healthcare, do y'all think we should de-privatize pharmaceutical companies/regulate drug profits since we are already subsidizing their R&R costs?

 

[greggth]

From Public Citizen's Health Reserach Group. (Public Citizen was founded by Ralph Nader).
http://www.citizen.org/hrg/
http://www.citizen.org/publications/release.cfm?ID=6770

April 26, 2001

David Leach, MD
Executive Director
Accreditation Council for Graduate Medical Education
1515 North State Street Suite 2000
Chicago, IL 60610-4322

Dear Dr. Leach,

A survey of 117 residents at University of California at San Francisco (UCSF) teaching hospitals (105/117 residents or 90% responded) found that many considered expensive drug industry promotional items such as a free educational trip (43%) or luggage (15%) to be appropriate. A larger proportion, 86%, considered a free dinner lecture sponsored by a drug company to be appropriate. Even among those residents who did not consider such items to be appropriate, many said they had accepted or would accept them if they were offered. Although only 39% of these doctors stated that industry promotions influenced their own prescribing, 84% thought that it did have an effect on the prescribing of other physicians. There was an appalling lack of education of these physicians about the ethics of physician-drug industry interactions with 86% stating they had little or no such education in medical school and 94% having had little or none in their residency programs. Nonetheless, approximately two-thirds thought that rules on interactions between industry representatives and residents and faculty were appropriate. The study was done by Drs. Michael Steinman, Michael Shlipak and Stephen McPhee of the Division of General Internal Medicine, Department of Medicine, University of California, San Francisco and San Francisco Veterans Affairs Medical Center and appears in the May, 2001 issue of the American Journal of Medicine (embargoed until 5 PM, April 26, 2001). Those surveyed were residents in the UCSF Department of Medicine, working in four hospitals (UCSF Medical Center, San Francisco VA medical Center, San Francisco General Hospital Medical Center, and UCSF Medical Center at Mt. Zion).

Public Citizen's Health Research Group concludes that this study confirms previous concerns about the scope of the pharmaceutical industry's largesse towards residents at this early and vulnerable phase of their careers as doctors-prescribers. The clear documentation of the massive denial of influence on the residents themselves flies in the face of a growing number of studies documenting the influence of such promotional activities on doctors? prescribing practices. The widespread absence of educational programs on the ethics of such interactions in the large number of medical schools from which these residents must have come mandates the inclusion of such evidence-based education---including a review of published studies documenting the drug industry?s influence on doctors---in medical school curricula as well as residency training. In addition, it is urgent that teaching hospitals adopt policies to restrict the contact between drug industry representatives and medical students, residents and faculty. A previous study of family medicine residency programs found that in those programs with restrictions on such contacts there were fewer gifts to residents and less perceived benefit of drug industry promotional information.[1] Other studies have documented the influence of the pharmaceutical industry on doctors? requests for specific drugs to be added to hospital formularies[2] and on physicians? own prescribing practices.[3]

We are writing to the Accreditation Council for Graduate Medical Education (ACGME) because your organization accredits residency training programs to ask that you require much more education of residents concerning these issues and that you also urge widespread adoption of a model set of restrictions---based on the more stringent of those now in effect---to limit, if not eliminate, pharmaceutical industry contact with residents. We are also writing to the Association of American Medical Colleges to urge that they incorporate much more education about these issues into medical student education and similarly promote model, stringent restrictions on pharmaceutical industry/resident interactions. We would be glad to meet with you to discuss these issues.

Sincerely,

Sidney M. Wolfe, MD
Director

Peter Lurie, MD, MPH
Deputy Director
Public Citizen?s Health Research Group

[1] Brotzman GL, Mark DH. The effect on resident attitudes of regulatory policies regarding pharmaceutical representative activities. J Gen Intern Med. 1993 Mar; 8(3):130-4.

[2] Chren MM, Landefeld CS. Physicians' behavior and their interactions with drug companies. A controlled study of physicians who requested additions to a hospital drug formulary. JAMA. 1994 Mar 2; 271(9): 684-9.

[3] Orlowski JP, Wateska L. The effects of pharmaceutical firm enticements on physician prescribing patterns. There's no such thing as a free lunch. Chest. 1992 Jul;102(1):270-3.

 

[viking]

Remember... The US spends the most on healthcare, but also does the most research and development. Why? The two sector are linked; whereas, in other countries they are exogenous from one another. R&D is expensive. If a pharmaceutical company thinks someone will pay for a drug (i.e. insurance co.), then they will develop it. Hence, more insurance will be demanded as well. If the insurance company gets less money (b/c government monopsonistic buying power as in Canada) then they will not do the research. Everyone wants drugs, but everyone wants better drugs. There is a trade off, often ignored in the fashionable arguments about the topics.

 

[viking]

medicare coverage of drugs will drive price down, because considerable monopsony power gained

 

[viking]

socialized medicine is bad for doctors from an incentive, moral, and psychological standpoint. but good for an idealist b/c helping improving access could be viewed as a "public good". i would rather be acting like a good samaritan, then fufilling a formula of treatment set out by a govt.; when you're part of the system you lose the you of you and get disillusioned I think

 

[greggth]

Another article from Public Citizen
http://www.worstpills.org/public/sample.cfm

Update on the Illegal Promotion of Gabapentin (NEURONTIN)

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In the May 2002 issue of Worst Pills, Best Pills News, we wrote about gabapentin (NEURONTIN), a drug approved by the Food and Drug Administration (FDA) for treating seizures, a somewhat limited potential market, that was illegally transformed into a ?blockbuster? drug with sales approaching $1.5 billion in 2001. The metamorphosis was accomplished by fabricating a number of uses for the drug that are not FDA approved. These included bipolar disorder, attention deficient disorder, and migraine. The use of a drug that is not approved by the FDA is referred to as an ?off-label? use.

The May article was based on New York Times reporting and documents from the U. S. District Court for the District of Massachusetts. This court recently released new documents that for the first time gave the public an inside picture of the lengths to which a pharmaceutical company will go to sell a drug even when there is no evidence that it is safe or effective for the uses being promoted.

This article is based on allegations made in recently released court documents.

Gabapentin was originally produced by Parke-Davis, which was acquired by Pfizer, Inc, of New York in 2000. The only FDA approved use for gabapentin at that time was as an add-on treatment for epilepsy. This is a very limited market with little upward potential for sales. The new court documents allege that Parke-Davis knew that pain management, psychiatric disorders, anxiety and depression were immense markets which, if tapped, could yield enormous profits from sales of gabapentin.

The Decision to Promote Gabapentin for Unapproved Uses

Documents revealed that after an extensive economic analysis, senior officials at Parke-Davis determined that it was not sufficiently profitable for Parke-Davis to obtain FDA approval for gabapentin?s alternative uses mentioned above by doing the types of studies necessary for approval. Instead, company officials developed a strategy that would allow Parke-Davis to avoid the costs of proving gabapentin?s safety and effectiveness for these other uses, while allowing the company to enter the lucrative off-label markets.

Taking advantage of a loophole in the FDA?s off-label marketing rules, Parke-Davis decided to employ a ?publication strategy? that would allow it to promote gabapentin by the massive distribution of publications supposedly written by independent researchers who purportedly described the scientific evaluation of gabapentin. Another advantage of this strategy, from the company?s perspective, was that it could be done immediately. There was no need to wait for the results of scientifically conducted clinical trials to determine if gabapentin was actually effective in the treatment of these conditions and submit them to the FDA for approval.

Payment to Doctors to Increase Gabapentin Prescriptions

The company?s ?publication strategy? required doctors to perform the work normally performed by the company?s sales force in order to promote gabapentin. This necessitated that Parke-Davis make tens of thousands of payments to the doctors who would act as a surrogate sales force as well as to the practicing physicians who would receive the message. In other words, adoption of the ?publication strategy? required the company to pay physicians to either recommend the prescription of gabapentin or to order gabapentin, in violation of the federal anti-kickback regulations, according to the newly released court documents.

A description of the various programs Parke-Davis used to make these payments to physicians follows.

Consultants? Meetings
A common trick used by Parke-Davis to funnel illegal payments to doctors to encourage them to prescribe gabapentin off-label was through ?consultants?? meetings. Under this front, Parke-Davis invited doctors to dinners or conferences and paid them to hear presentations about off-label uses of the drug. Under the guise that these doctors were acting as consultants, Parke-Davis sometimes, but not always, had the doctors sign bogus consulting agreements. At these meetings, the company would give these doctors lengthy presentations relating to gabapentin, particularly regarding off-label usage. Presentations would be made by Parke-Davis employees or physician speakers hired by the company for the purpose of promoting gabapentin, and questions relating to the use of gabapentin would be solicited and answered. At some conferences, the sponsoring organization or Parke-Davis intentionally posed questions to the speakers about off-label use to insure that the doctors were exposed to such information.

Parke-Davis would routinely analyze whether the consultants? meetings were successful in getting doctors to change their prescription writing practices. At some meetings, the so-called consultants were asked directly if they would write more gabapentin prescriptions as a result of the meeting. This question would have been irrelevant if the actual purpose of the meeting was to receive the consultants? advice. Parke-Davis also routinely tracked consultants? gabapentin prescription writing practices after these meetings. Parke-Davis actually analyzed whether the doctors they had paid had in fact written more gabapentin prescriptions after the meeting, using market data purchased from third parties.

Medical Education Seminars
The court documents revealed another platform used by the company to pay kickbacks to doctors to hear off-label promotion of gabapentin. These were programs billed as Continuing Medical Education (CME) seminars. These conferences and seminars were set up to appear to qualify for an exception to the FDA?s off-label marketing restrictions which permits doctors to learn about off-label uses of drugs at independent seminars. Such seminars, however, must be truly independent of the drug companies. The companies may make ?unrestricted grants? for the purpose of a seminar, but may not be involved in formulating the content of the presentations, picking the speakers or selecting who attends the seminars. Parke-Davis retained third party companies to present seminars while in fact retaining control of virtually every aspect of these events. The seminar companies obtained Parke-Davis? approval for all content presented at the seminars. Parke-Davis also paid all expenses, including all the seminar companies? fees.

The company designed and approved the seminars, hand-picked the speakers, approved the seminar presentations, previewed (in most cases) the contents of the seminars prior to a presentation, selected the attendees based on their ability and willingness to prescribe high quantities of gabapentin, evaluated the presentations to make sure Parke-Davis? ?message? was appropriately
delivered, black-listed presenters whose presentations were not sufficiently pro-gabapentin, and monitored the prescribing patterns of the physicians who attended.

Grants and Studies
Parke-Davis also made outright payments, in the form of grants, to reward demonstrated gabapentin advocates. Company sales managers identified key doctors who actively prescribed gabapentin or programs which were willing to host gabapentin speakers and encouraged such persons or programs to obtain ?educational grants? from the company. Parke-Davis? sales people informed leading gabapentin subscribers that significant advocacy for gabapentin would result in the payment of large grants. These studies did not involve significant work for the physicians. Often they required little more than collating and writing up office notes or records. Parke-Davis frequently hired technical writers to write the articles for which the ?authors? had been given grants.

Payments to ?Authors? of Ghost-Written Articles
Another method of paying off doctors for backing gabapentin was to pay honoraria for the use of their names on scientific articles intended for publication in various neurology and psychiatry journals, but actually ghost-written by technical writers hired by Parke-Davis, which retained control of all such articles. In 1996 Parke-Davis paid for at least 20 such articles, most of which dealt with off-label use of gabapentin, and were placed according to the company?s ?publication strategy.? Naturally, Parke-Davis paid all expenses in connection with these articles.

Once Parke-Davis and the technical writers conceived the articles, the company and its outside firms attempted to find recognized gabapentin prescribers whose names could be used as the authors of these articles. In some cases, drafts of the articles were completed even before an ?author? agreed to place his or her name on the article. This even occurred in connection with case histories that purported to describe the ?author?s? personal treatment of actual patients. The ?authors? were paid an honorarium of $1,000 to lend their names to these articles, and also were able to claim publication credit on their professional resumes.

Speakers? Bureau
Parke-Davis also formed a Speakers? Bureau, another tactic to make large and numerous payments to doctors who recommended gabapentin at teleconferences, dinner meetings, consultants meetings, educational seminars, and other events. These speakers repeatedly gave short presentations relating to gabapentin for which they were paid anywhere from $250 to $3,000. Some speakers received tens of thousands of dollars annually in exchange for recommending to fellow physicians that gabapentin be prescribed, particularly for off-label uses. Speakers who most zealously advocated gabapentin were hired most frequently for speaking events, regardless of the fact that many of these events were billed as independent medical education seminars where objective information was supposed to be delivered.
.... (rest of article on website)

 

[jlee9531]

the rank of 37 is in part due to the fact that the WHO judge with a eurocentric version of healthcare in mind.

it is just an arbitrary ranking.

tho i would love to have some form of healthcare to provide for all but i dont want to sacrifice having arguably the best group of doctors in the world, state of the art medical technologies and not wait in line for special procedures when and where they are needed.

our system most definitely has flaws but we can do things to eventually correct these things.

or at least under a single payer system....as long as they dont take control of the delivery of health care then that could be an option as well.

im outs...

 

[hobs]

with regard to the question of is healthcare a right or a privelege----

i think that's kind of an artificial way to look at it, and not particularly productive. rights do not always translate into things being free or being cared for by the government. for example, just because we have a right to bear arms doesn't mean that the government should hand out guns if a person wants them. government should not interfere with a person's efforts to exercise such a right, but it should not be overly concerned with the facilitation, especially financial, of a person's excercising of a right (consider, for example, the prohibition against giving religious institutions $). consequently, i don't think health care is an inherent right in a person's life.

the question may rather be framed as to whether or not health care constitutes the basic needs of a person---with food, shelter, utilities, clothing. i think this is more reasonable, and more to the point when considering the function of health care.

the united states should have a socialized healthcare system, and i think it makes us look backward and barbarian that we are the only industrialized nation without such a program.

problem is that too many people are making too much money off of the system as it is. what pharmaceutical company wants comprehensive preventive services for chronic disease when it can keep people on insulin, beta blockers, or whatever for the duration of their lives? greed rules, and it goes much deeper than the health care system.

 

[winstonm]

This is perhaps the first thread of this kind which does not contain some kind of crazy stereotype of Canadian health care.

Calling our system "socialized" is a bit of a stretch. Health care is publicly funded but in most cases, privately delivered. Physicians are independent agents. You can pretty much see any damn physician you want here, unlike being resticted to a pool as with most HMOs. Someone on this site once wrote that Canadian neurosurgeons make $50K--yeah right. In Ontario, the maximum the physician can bill the provincial insurance system is about $455K before the gov't starts reducing payments (for ex. if the fee is $200, the doc might actually get 66% of that).

A study was done a few months ago which showed the amount of money the States would save in admin coss if it adopted a single-payer system like ours. I don't see that happening until there is some serious campaign finance reform that prevents Big Pharma and the insurance companies from throwing dough at candidates. It was, afterall, Prudential that was instrumental in defeating the first major movement for a national health service there many decades ago.

I don't know how the tax situation works in the US, but would it not be the case that many of the tens of millions of people with no/little coverage pay taxes that in turn fund research which results in therapies that they don't get access to? How just is that?

As for the previous comment about primary care vs expensive curative treatments later, think about the coming wave of diabetes that will surely hit the people who don't get regular check-ups, don't discover the signs early and thus are not able to start management techniques while they have a chance.

The US is funny because you can arguably get the absolute best care in the absolute best facilities anywhere, or get nothing at all. It's amazing to think how much stronget the country would be if everyone was guaranteed at least primary care, if not more.

 

[greggth]

Originally posted by winstonm
A study was done a few months ago which showed the amount of money the States would save in admin coss if it adopted a single-payer system like ours. I don't see that happening until there is some serious campaign finance reform that prevents Big Pharma and the insurance companies from throwing dough at candidates. It was, afterall, Prudential that was instrumental in defeating the first major movement for a national health service there many decades ago.

The US Congress is about to approve a bill to try to reduce prescription drugs costs for senior citizens on Medicare. This bill will give 14 billion dollars to HMOs and insurance companies, and 80 billion dollars to employers (mostly private companies, I think). And yet the same bill keeps it illegal to buy prescription drugs in Canada that were manufactured in the US (they are cheaper in Canada). Why is that? What happened to free trade, NAFTA? Don't we want people to be able to trade freely across international borders? Apparently not when the profits of pharmaceutical companies are threatened.

And there is no guarantee that the costs of prescription drugs will be kept down for any length of time. One analyst, Dean Baker, said that even with this law, average prescription drug costs for senior citizens will double by the year 2013.

 

[topherius]

And yet the same bill keeps it illegal to buy prescription drugs in Canada that were manufactured in the US (they are cheaper in Canada). Why is that?

didn't you listen to the FDA? apparently when the drugs are exposed to canadian air, they become dangerous for consumption.

in all seriousness, the medicare bill is a load of crap, purportedly designed to help seniors but mostly just providing giant kickbacks to the insurance industry. i particularly like the part where it bars medicare administrators from negotiating with pharm companies to lower prices on drugs.

I don't know how the tax situation works in the US, but would it not be the case that many of the tens of millions of people with no/little coverage pay taxes that in turn fund research which results in therapies that they don't get access to?

um, yup. do the math. 44 million in the u.s. have no insurance. 34 million below the poverty line and thus pay no taxes ==> ~ 10 million who pay taxes but have no insurance.

my $.02: the market has shown, in innumberable areas (e.g.: the environment, the insurance industry, and yes, pharm) that it can't regulate itself. and why should it? its only goal is to make profits. it's driven by people trying to make money. it has to be regulated. if that means, in the area of healthcare, a single-payer system, then so be it. in a perfect world, such a system would also rein in malpractice insurance, and between that and the overhead costs that (as someone noted) a centralized system would eliminate, really, docs and other health professionals shouldn't take that much of a hit anyway.

not to go off on a rant, but i think those of us in relatively good personal positions often forget ourselves. if we move to a single payer system, maybe we as doctors will be making less, but we will still be way better off than most of the patients we're serving. i'm not supporting a society built on equality of condition, but i'm just saying, let's get some perspective here.

 

[thackl]

It's already socialized......... that's why my son's 30 min visit to the ER and 2 stitches in the lip cost us $875. Those who can afford it pay way to much while others pay nothing...


This is just a rant and I'm not being very serious, but $875??? I just paid for minor procedures on 5 other kids too.

 

[potuhusky]

The goal should not be socialized medicine, but rather socialized insurance. The single payer system is our only realistic hope for a balanced delivery of universal access, cost containment, and quality assurance.

1) Countries who have this system spend 5% of their GDP as compared to the US who spends 15% on an ineffective system. So cost should not be a realistic issue.

2) Yes this system would invoke the dreaded wait time for elective procedures but this is more of an cultural issue. In a "now" culture, we lose sight of the value of time in the healing process. There is a reason why these "elective" procedures require this wait. If there was a clinically siginificant reason for a procedure to be expedited, then there are measures to ensure it.

3) Countries who have this system have a much higher approval rating for their respective national health insurance then we do with ours.

4) The majority of US citizens have a seriously misconstrued view of the overall effectivness of its health care system. Most think it is the best the world. This is at best naive, at worse arrogant, and a few doses of denial in between.

For a great in depth review of the US's ailling health care system, I sugges the following book. "Health Care in America: Can our Ailling System be Healed?" by John P. Geyman 2003. It is expensive, $52, but well worth owning. The library should carry it.

 

[greggth]

The United States has a much larger population than any of the countries commonly cited as health-care "success stories".

 

[topherius]

(responding to thackl)

no, our system is not socialized...and that's why you paid so much for a minor procedure! that's exactly the result of having a system that is at once non-socialized and dedicated to providing urgent care to all. because there is an inadequate government subsidy, the bulk of the costs falls on those with insurance/those who can pay. in a socialized system, everyone would pay the same for the same procedures, or (if it were a tiered socialized system, which makes sense) they could pay more if they wanted better care. but the baseline, inexpensive care available to everyone would be completely adequate--which is what would make it different from the status quo.

and as far as the u.s. being larger...i'm not sure what this has to do with anything. sure, it means the mechanics of a single-payer system would have to be different than for a tiny country. but otherwise, i don't see what difference that makes. we have more people to take care of, but we also have a lot more money to spend on such a system (or at least we would if we had some common sense...)

 

[thackl]

Originally posted by topherius
(responding to thackl)

no, our system is not socialized...and that's why you paid so much for a minor procedure! that's exactly the result of having a system that is at once non-socialized and dedicated to providing urgent care to all. because there is an inadequate government subsidy, the bulk of the costs falls on those with insurance/those who can pay. in a socialized system, everyone would pay the same for the same procedures, or (if it were a tiered socialized system, which makes sense) they could pay more if they wanted better care. but the baseline, inexpensive care available to everyone would be completely adequate--which is what would make it different from the status quo.

I know, I'm just bitching about the $875. Pretty sad

 

[topherius]

yeah, that's true. my roommate was in a wreck and they gave him a cat scan at the er and then billed him for $2000. yikes! i definitely sympathize.

 

[ornis4]

I love Ayn Rand and all, and even wrote a research paper on The Fountainhead in high school, but c'mon...if you follow some of philosophies and ideals presented therein, you probably should not be involved with medicine/healthcare:

"I came here to say that I do not recognize anyone's right to one minute of my life... It had to be said. The world is perishing from an orgy of self-sacrificing." --Howard Roark, The Fountainhead

This isn't exactly the embodiment of our medical philosophy, is it? Personally I think this whole issue is ridiculous. Medical care should not be a privelage, and is one thing I believe should be socialized, completely outside of our free ideals. I'm obviously not pushing free nose jobs for the world, but in terms of primary care and emergency, it should be all access.

It's a chain reaction, really...if we allowed for some primary care rights for the underprivelaged, it could prevent the overwhelming number of them that flood ER's all the time by keeping them healthy, rather than simply keeping them from the brink of death when they get there, only to send them right back out into the world. We consider ourselves on the forefront of the ways and ideas of the world, yet many other nations are making our health care system look archaic. Who knows what will happen...we all know it's about the $$$, especially in congress, where something like this would have to be initiated by them.

Oh well, just my 2 cents....just think of the people on Thanksgiving who, in addition to being underprivelaged, can't even find the medicine they need for a simple ailment.

 

[greggth]

3 points:

1. I am just starting to read "Severed Trust" (2000) by George Lundberg (former JAMA editor, fired, allegedly for political reasons, after 17 years). In the book, he seems to be arguing that insurance should cover the entire cost of preventative care and care for catastrophic injuries and illnesses. But other services, including outpatient care by the primary care physician and specialists, should be paid for by patient out of his own pocket.

Lundberg writes that one of the big problems with all-encompassing insurance plans that pay for everything, is that they encourage patients to run to the doctor for every little thing that bothers them, although many of these problems are self-limiting (that is, they will resolve on their own, without help from any physicians). In his ideal system, patients would be deterred from such behavior, because they would have to pay for these visits themselves. Insurance would cover scientifically-tested preventive measures, as well as really serious problems. He says a similar system is used in Singapore and seems to work well.

2. There is a thing called "defensive medicine," when a doctor does medically unnecessary tests in order to protect himself or his institution from the slim chance that he fails to detect a problem, resulting in a lawsuit. I wonder how much defensive medicine adds to the cost of medical care.

3. At the same time, under the current system, patients must be allowed to sue doctors who hurt them. I don't know much about it, but it seems to me that when economic damages are awarded for loss of wages, an executive who makes $200,000 a year will be entitled to 10 times more of an award than someone who makes $20,000 a year. Is that fair? If I recall correctly, they used that type of system to give awards to people who lost family members at the World Trade Center.

 

[felipe5]

Originally posted by lessismoe
Fact: Pharmaceutical companies spend $8000-12000 per physician in their effort to market drugs.

The real reason why drugs are so expensive in the U.S. is that the pharmaceutical companies spend a fortune on marketing each year.


THIS is a good point for discussion on this board. What do y'all think about pharmaceutical companies and their marketing tactics? What do you think you'll do when you're a doc and a rep comes into your office with Prozac logo golf clubs (exaggeration)?

No my friend, your golf club example shouldn't be considered an exaggeration. I've seen instances like it before........i shadowed a general surgeon for a year who was constantly hounded by extremely goodlooking drug-reps (seriously drop dead gorgeous women).........he was an avid hunter, and one time, they brought him a rifle bag with a drug logo on it. I mean COME ON!!!!!!!!!

I believe that the ridiculous amount of money that pharmaceutical companies spend on marketing directly affects our health care system in many ways.

First off, a day doesn't go by where I don't flip through a 3 page ad or some crazy commercial of some drug. Granted, I think these companies need to advertise, but when is it too much?

One problem that arises from such intense advertising is that the target population is only given one side of the story........the patient may not realize that there may be other treatments available, some that may possibly benefit the patient more so than the med. One example that totally fits this point is the damn Prozac (Ithink its prozac) commercial, in which a depressed bouncy ball is draggin along, due to "a chemical imbalance" within his cute little body-head. After taking the anti-depressant, he's as happy and social as a ball with no body can be.

So, it looks like the quick fix lies with popping a pill. Anti-depressants are prescribed for a plethora of psychological disorders, including panic disorders, major depressive disorder, and post traumatic syndrome, to name a few. Yet, in some of these disorders, other treatments, such as specific kinds of therapy (e.g. cognitive behavioral therapy), have much higher recovery rates, lower relapse rates, etc. Yes, some of the treatments/therapies may be more expensive in the short-term (but if you do the math, not inn the long term), but the fact remains that patients aren?t aware of other options)??seriously, how many people know about CBT versus prozac?

So, I am not denying the fact that meds sometimes ARE the treament of choice??. This issue also affects the physician in many ways as well??..in my prozac/CBT example, some physicians outside of the realm of psychiatry maybe unaware on not-too-familiar with a alternative treatment may be blinded by these gorgeous drug-reps and cool gifts. Also, this intense advertising could raise people?s expectations of the efficacy of the drug. What could possibly stem from that??
high expectations---->frustration---->negative affect on the doctor patient relationship.

Any other opinions on this topic? I think its an incredibly interesting one.

 

[Elysium]

I think more physicians would be in support of a socialized health care system if the following things were true:

1) Comparable reimbursments to today's current system (unlike Medicare which pays about 50% of the cost of the procedure) so that physician incomes could remain consistant (OR severly reduce the debt of student loans)

2) Insure that buracracy would not rule the system (as is the case in Medicare and HMOs), so that doctors would not have to constantly be battling the govt. over pt. treatment options

3) Insure the development of good and effective drugs by pharm companies.


There are certainly example of BAD socialized medicine programs (e.g. the NHS). I think any citizen of the UK on this board could elaborate on the major inadequacies of that system...

Just my .02