Category Archives: Medical

More Health Insurance is Not the Answer!

Health care “reformers” keep talking about getting us more health insurance. Then they talk about cutting costs. This is contradictory nonsense.

Insurance, whether private or a government Ponzi scheme like Medicare, means third parties pay the bills. When someone else pays, costs always go up.

Imagine if you had grocery insurance. You wouldn’t care how much food cost. Why shop around? If someone else were paying 80 percent, you’d buy the most expensive cuts of meat. Prices would skyrocket.

That’s what health insurance does to medical care. Patients rarely even ask what anything costs. Doctors often don’t know. Often nobody even gives a damn. Patients rarely ask, “Is that MRI really necessary? Is there a cheaper place?” We consume without thinking.

By contrast, in areas of medicine where most patients pay their own way, service gets better, while prices fall.

Take plastic surgery and Lasik eye surgery: Because patients shop around and compare prices, doctors work hard to win their business. They often give customers their cell-phone numbers. Service keeps increasing, but prices don’t. “In every other field of medicine, the price is going up faster than consumer prices in general,” says John Goodman of the National Center for Policy Analysis. “But the price of Lasik surgery, on average, has gone down by 30 percent.”

This shouldn’t be a surprise. What holds costs down is patients acting like consumers, looking out for themselves in a competitive market. Providers fight to win business by keeping costs down and quality up.

Yet politicians keep telling us the solution is more insurance. And they mean insurance not just for catastrophic diseases that could bankrupt us but also for routine treatments.

The politicians are so oblivious to reality that they are on course to make things worse. Obama would force every business to either give workers health insurance or pay a fine into the public system. Why is that something we should want employers to do? Premiums come out of our salaries, but insurers are accountable to our bosses, not to us.

Why not just have a free market where people can buy whatever kind of health insurance they want? Competition would then bring prices down.

Obama and his Senate allies would limit competition by requiring insurers to cover everyone for the same “fair” price. No “cherry picking,” the president says. No charging healthy people less.

They call this “community rating,” and it sounds fair. No more cruel “discrimination” against people who have a preexisting condition, obese people or smokers. But such simple-minded one-size-fits-all rules take from insurance companies their best price-dampening tool: Risk-based pricing encourages people to take better care of themselves, just as car-insurance companies reward good drivers. With one-size pricing your car-insurance company must give the town drunk the same deal it gives you.

Insane, but the health-insurance industry is playing along. Insurers say that if government forces everyone to have insurance, they will accept all customers regardless of preexisting illnesses.

They also offered to stop charging higher premiums to sick people. They’re even giving up on gender differences.

Sen. John Kerry huffed, “The disparity between women and men in the individual insurance market is just plain wrong, and it has to change.” The president of the industry trade group, Karen M. Ignagni, agreed that disparities “should be eliminated.”

Give me a break.

Women pay more than men for health insurance for good reason. Despite being healthier than men, they incur higher costs because they go to doctors more often, and they take more medicine. Kerry is pandering. I don’t recall him demanding that men be protected from higher life-insurance and auto-insurance premiums.

“Community rating” hides the cost of health care. It’s as destructive as ordering fire insurance companies to charge identical premiums for wood frame and stone houses. Universal health insurance with “no discrimination” pricing will make health care costs rise even faster.

When politicians interfere with free markets, unintended consequences harm everyone, except the companies that lobby hard enough to protect themselves.

Is it too much to expect our rulers to understand this?

John Stossel @ Reason Online

End of Life Care – Bankrupting America

It makes no sense to spend the kind of money we do at the last few months of a person’s life when we cannot afford reasonable health care when it can the greatest difference in the quality of life. Stats show us that 10% of the people use 75% of the healthcare dollars in America. A large portion of that is end of life treatments (futile) for elderly people wiht multiple co-morbidities that only extend life by a few weeks or months.

In a world where we all wrote personal checks for our health care, I’d be entirely on board with this. If someone with a terminal illness thinks the best possible use of their accumulated wealth is to blow it on a longshot chance of eking out a few more painful days or weeks in an ICU—and the evidence suggests that aggressive end-of-life intervention often doesn’t even get you that—then that’s their choice. I hope that’s not my own reaction when the time comes. A lot of what passes for indomitable where-there’s-life-there’s-hope optimism in American culture is a not-terribly-convincing attempt to camouflage our failure to come to terms with our own mortality. I hope I’ve made my peace well enough not to insist on every desperate gesture of denial science has to offer. Even if it’s a question of genuinely adding a few extra weeks or months to a long life well-lived, I hope I have enough other worthy uses for whatever money I’ve saved that I don’t empty the accounts buying every last available minute. But hey, death is scary. Maybe I’ll feel differently when the time comes; I certainly won’t second-guess anyone who wants to make a different choice.

Except, that’s not actually how our existing healthcare system works. In the real world, the decision to do throw the kitchen sink at every ailment is either funded by the government, or by private insurance. A fair amount of the time, it will be made not by the actual patient, but by family members for whom “do whatever it takes” is a low-cost salve for the guilt of never actually visiting grandma at the home. The insurers are substantially constrained in the range of treatments they need to cover, which gives doctors little enough incentive to control costs or limit tests or treatments themselves. (My impression is that this is partly a function of an increase in the increasingly cozy relationships between referring doctors and testing facilities.) These “choices” are not free. They are not a noble reflection of the infinite preciousness of life. These socialized costs—and they’re effectively “socialized” whether it’s the government or private insurers picking up the tab—raise premium costs, make it more expensive to employ people, push some people out of coverage entirely, and otherwise divert scarce resources from things that might actually help somebody.  The notion that this perverse result is somehow required by “medical ethics” is simply grotesque.

This is pretty clearly unsustainable. The more medical technology advances, the greater the number of expensive longshots, the more hours and minutes we can lease back from oblivion at ever greater cost. Over the long term, we can decide that any probability of any added increment of lifespan for people in medical care trumps evey other possible private and public good, or we can ration. That rationing can be by individuals weighing the costs and benefits relative to their resources, or it can be by governments—whether directly or by regulation of insurers and providers. Between those options, I’ll leave it to the wonks.  But please, if you’re going to claim an unlimited right to make other people subsidize the understandable impulse for denial and wishful thinking, at least let’s not pretend that it’s somehow a matter of protecting “individual choice.”

From the New York Times Health Blog article – At the End of Life, Denial Comes at a Price

An empty hospital bed.

Like the rest of us, doctors struggle to talk about dying. These conversations with patients occur haltingly, awkwardly and often not at all. But a study published recently in the Archives of Internal Medicine suggests just how costly that silence may be, both in health care dollars and in patients’ suffering.

A team of investigators, led by researchers at the Dana-Farber Cancer Institute in Boston, interviewed 603 patients with advanced cancer. They asked the patients, who had about six months left to live, whether their doctors had discussed their wishes for end-of-life care. The majority — 69 percent — said those conversations had not taken place. And in the last week of life, those patients who had talked with their doctors wound up with medical bills that were on average 36 percent lower — $1,876 compared to $2,917 — than those of patients who did not have end-of-life conversations with their doctors.

Why such a big difference? Dr. Holly Prigerson, a professor of psychiatry at Harvard Medical School and an author of the study, explained that the patients who never talked about their end-of-life wishes were more likely to be resuscitated, intubated or put in intensive care — or all of the above. Patients who had had those conversations generally opted for comfort, or palliative, care at home or in a hospice at much lower cost.

But wouldn’t aggressive, more expensive care at least offer dying patients a bit more time at the end of life? Not according to this study. The patients not only did not live longer overall, but based on reports from family members and other caregivers, they also suffered more physical distress in the end.  

These correlations may not prove a cause-and-effect relationship between end-of-life conversations and outcomes. Still, Dr. Prigerson said, “The study suggests that as costs go up, the misery and suffering index also goes up.”

Why should doctors be so reluctant to talk about dying when patients are terminally ill? Dr. Susan Dale Block, chair of the department of psychosocial oncology and palliative care at the Dana-Farber Cancer Institute, noted that oncologists don’t want to appear to be giving up on patients by discussing plans for dying. At the same time, family members and loved ones worry that such conversations might upset an already vulnerable patient. And patients themselves often feel their role is to be heroic and to soldier on, against the odds, with yet another treatment or intervention. By Maggie Jones

Julian Sanchez – http://bit.ly/JZzM

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British Rationing of Healthcare- US Future Under Obamacare?

N.I.C.E-National Institute for Health and Clinical Excellence. England Ration care board.

-In march banned Lapatinib and Sutent that prolong the life of those with certain forms of breast and stomach cancer.
Comment from the Public Health director “there is a limited pot of money”.-That’s ration care!

-2007 Board restricted access to 2 drugs for macular degeneration(blindness). When certain people got it, they only got it in one eye. Chief Executive on NICE “When treatments are very expensive, we have to use them for the most benefit to certain patients.”

-Alzheimers-limited the use of drugs(Aricept) that could help. MD’s argued vociferously that this is the most effect way to slow it down. NICE ruled it cost 2 much.

Other NICE rulings include the rejection of Kineret, a drug for rheumatoid arthritis; Avonex, which reduces the relapse rate in patients with multiple sclerosis; and lenalidomide, which fights multiple myeloma. Private U.S. insurers often cover all, or at least portions, of the cost of many of these NICE-denied drugs.

NICE has also produced guidance that restrains certain surgical operations and treatments. NICE has restrictions on fertility treatments, as well as on procedures for back pain, including surgeries and steroid injections. The U.K. has recently been absorbed by the cases of several young women who developed cervical cancer after being denied pap smears by a related health authority, the Cervical Screening Programme, which in order to reduce government health-care spending has refused the screens to women under age 25.

The NICE board even has a mathematical formula for doing so, based on a “quality adjusted life year.” Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care.
http://online.wsj.com/article/SB124692973435303415.html

Private U.S. insurers often cover all, or at least portions, of the cost of many of these NICE-denied drugs.

Homeopathy – Quack Cures

http://www.news.com.au/adelaidenow/story/0,22606,25724962-5006301,00.html

HOMEOPATHY does not work and homeopathic remedies should not be sold alongside other treatments, one of the world’s most prominent thinkers says.

Simon Singh, a best-selling author and Emmy-nominated documentary filmmaker, will be in Adelaide soon for the Festival of Ideas.

He will discuss his latest book, Trick or Treatment? Alternative Medicine on Trial.

He said it was “disgraceful” homeopathic remedies were on chemists’ shelves.

“I just think that’s absolutely disgraceful. I have no qualms in saying that,” he said.

“(For) the homeopathic remedies, some of the herbal remedies, there’s just no evidence, no convincing evidence at all these things really work.

“I think it’s doing a disservice to the customer to just put them there as though they’re just like any other treatment.”

Homeopathy uses animal, mineral or vegetable sources in water. The “medicines” are highly diluted, sometimes to the point where the original substance is undetectable. Practitioners believe the water holds the “memory” of the original substance.

Homeopathy

The Australian Association of Professional Homeopaths claims homeopathy can treat “most diseases, health complaints or conditions” and says it is rejected by orthodox medicine because of a “conceptual and scientific clash”.

Alternative therapies have been under the spotlight since a Parliamentary inquiry into practitioners promising cures for cancer.

The report warned the main danger of many therapies was that patients could give up their conventional treatment.

21quack