Medicynic

This article from Reuters puts out system in perspective:

“Americans are the least satisfied with their health care system, while the Dutch system is rated the best, according to new research.

Polls about health care in 10 developed countries by Harris Interactive revealed a range of opinions about what works and what doesn’t.

In the United States a third of Americans believe their system needs to be completely overhauled, while a further 50 percent feel that fundamental changes need to be made.

“Given that all countries other than the U.S. have universal health care systems in place, this may invite questions on why the U.S. remains the only wealthy, industrialized country without such a system,” Harris president George Terhanian told Reuters.”

“The U.S. model, widely criticized on its combination of private insurance and publicly-funded programs, spends more on health care than any other nation worldwide but ranks low on overall quality of care, according to the World Health Organization (WHO).”

The health plans offered by Obama and McCain do not answer the questions raised by this polling.  Neither mandate universal health coverage nor attack the lack of value in health care in the U.S.  Our costs are double those elsewhere and our outcomes worse.  Is this the American way?

McCain’s so called plan actually does away with the employer mandate so fewer people will likely be insured.  His tax rebate scheme will not cover insurance costs and further his plan allow insurers to deny insurance to the sick and other high risk groups.  He would, hard as it is to believe, make things worse than they are.

Obama’s plan is better but still allows the waste and duplication of multiple insurers administrative costs–which amount to about 30% of health care spending.  Medicare spend under 10% on administration.

Nice feature on NPR regarding the United Kingdom’s approach to expensive medications. There are trade-offs–toxicity, expenses, limited efficacy.

You don’t find such openness in the U.S. where unrealistic expectations, incomplete information, irrational use of funds and conflicts of interest drive utilization.

I came across a letter in the June 26th N.Y. Review of Books from Gayle Greene regarding a dispute in the 50’s and 60’s about the safety of x-raying pregnant mothers. Today a defense of this practice would be viewed as ludicrous but read the letter, and also the book The Woman Who Knew Too Much: Alice Stewart and the Secrets of Radiation to learn more.

From the NY Review of Books:

“I interviewed Doll while writing about Stewart, the physician and epidemiologist who discovered that the practice of X-raying pregnant women, which was common in the Forties and Fifties, doubled the chance of a childhood cancer. Doll and Stewart moved in the same Oxbridge circles, sat on the same committees and editorial boards. Both started out as physicians, then moved into epidemiology after the war, each making major discoveries in the Fifties that helped shape epidemiology so it came to include cancer as well as infectious diseases. But after Stewart went public with the dangers of radiation, she plummeted to obscurity, while Doll, credited with discovering the link between lung cancer and smoking, rocketed to fame and a knighthood.”

“Immediately after Stewart published her findings, Doll launched a study to prove her wrong. For nearly two decades, he succeeded in keeping her findings from being accepted, thereby allowing fetal X-raying to continue”

“After his death it came out that Doll was receiving payment from Monsanto (quite a lot) all the while he was doing the studies that cleared vinyl chloride of an association with liver cancer. I’d have thought that would have laid to rest this overblown veneration. But no, Horton defends him, suggesting that he may simply have been “naive.” I can tell you, whatever else he was, he was not naive.”

Not much has changed as indicated in today’s (June 8,2008) NY Times report on professors of pediatrics receiving unreported income from drug companies.

“In 2000, for instance, Dr. Biederman received a grant from the National Institutes of Health to study in children Strattera, an Eli Lilly drug for attention deficit disorder. Dr. Biederman reported to Harvard that he received less than $10,000 from Lilly that year, but the company told Mr. Grassley that it paid Dr. Biederman more than $14,000 in 2000, Mr. Grassley’s letter stated.”

“At the time, Harvard forbade professors from conducting clinical trials if they received payments over $10,000 from the company whose product was being studied, and federal rules required such conflicts to be managed.”

This is the tip of the iceberg of unreported relationships between physicians, researchers, and institutions and the medical industrial complex.

Powered by Zoundry

Medicare drug costs, deductibles (read that as the infamous doughnut holes) are increasing at multiples of the inflation rate and the insurance for Medicare part D are increasing at multiples of the inflation rate.

In the political campaign we talk of strategies to provide universal health care but have heard few if any suggestions to control costs. We continue to pay whatever the providers charge (providers=practitioners, institutions, insurers, equipment manufacturers and pharmaceutical manufacturers). Where cost containment implemented it is almost always at the patient/practitioner/institution level.

That’s not bad but it has proven ineffective. We continue to have hospitals with wide variability of costs between one location and another; physicians overusing technology–doing tests and providing treatments that do not change decisions or outcomes; and pharmaceuticals that alone cost more than the average and mean incomes/year of individuals.

This is a system from hell and unless we are willing to attack costs beyond cutting provider reimbursement we will continue to pay twice what the rest of the world pay for care and continue to have mediocre results.

Powered by Zoundry