This just in. A doctor who works at an academic hospital in Texas reports that he recently received a letter from the CEO of the hospital congratulating him for the high number of MRI scans he ordered during the prior month. He had never seen such a letter before, and wasn’t in the habit of ordering MRIs on patients unless they were medically indicated. In this case, it was coincidental that he had ordered so many that month.
Citizens of the United States: Do you know what this means? It means that the profit motive in healthcare delivery no longer hides behind a veil of professionalism and respect for patients. It is now openly accepted, even in academic centers, that patients are viewed as nothing more than walking ATMs. At least in Texas.
He goes on to tell about how the new dean hired a firm to come in and teach the administration and doctors how to maximize their use of revenue producing services and minimize those that don’t. Specialists were encouraged to take on new patients just long enough to run a slug of expensive tests and quickly discharge the patients back to their primary care doctors as soon as they had extracted as much revenue as they could. I don’t know if there are kickbacks for ordering tests, but it wouldn’t surprise me.
After twenty years of practicing medicine in the U.S., I now live and practice in Canada. I don’t miss the American system in the least. In Canada, healthcare is considered a moral enterprise. Even so, doctors earn as much or more than their counterparts in the United States. MRI machines are purchased by the Ministry of Health, paid for through tax revenues, and are used as needed with no charge to patients.
Many Americans may find it sad that no profits are to be made off an MRI machine in Canada, or unconscionable that their tax dollar might be going toward someone else’s MRI. Personally, I view both as doing the right thing. No conflict of interest for doctors, fewer unnecessary tests ordered, no concerns that patients won’t get the test, and so on. The same applies to doctor visits, other tests, surgeries, chemotherapy, hospitalizations, and most drugs for those qualified by age or infirmity.
None of this is new, just a reminder. Obama’s reform may be a step in the right direction, but for-profit healthcare is a runaway train in the U.S. and will require more drastic changes than Obama’s to slow it down. Read Atul Gawande’s fine article in the New Yorker to get the whole picture.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Tuesday, August 17, 2010
Monday, April 26, 2010
God willing, you know!
So I just watched Ann Curry on NBC interviewing a minister who attributed his surviving yesterday’s massive tornado in Mississippi, to ‘The Lord this and The Lord that…His only comment about those that were killed in the storm was that The Lord still loves them blah blah blah…
I have been extremely fortunate. I've never had to suffer through the tragedy of losing a loved one in a tornado or a plane crash. I have a hard time, however, imagining anything more offensive than hearing from a survivor that 'God was watching over me’. I understand the ‘why me?’ question, but attributing one’s survival to God's selective protection is tantamount to blaming the dead for causing their own deaths.
It is the height of misguided indoctrination and arrogance for a person to believe that he or she could be individually selected to live through a natural or humanitarian disaster. Delusional ideation—that’s the medical term. Being selected to live implies that those who died were not merely ignored by God, they were selected by God NOT to live. It couldn’t be negligence or oversight, right? Since God is omniscient and all-powerful, right? It must be that God hand-picked half the airplane's passengers to die a scorched painful death. And to think that people go to churches, synagogues, and mosques to worship this God? Something is amiss here.
This all-seeing God must also have had little interest in watching over the events that led to the tornado or plane crash in the first place: the weather, how much fuel was in the tanks to burst into flames, the pilot's skill (you've seen priests bless pilot's hands, surgeon's hands, and the like). Apparently God was too busy protecting that minister, or that small group of passengers in rows 21 to 29 who survived the crash, to pay attention to other details.
Similarly, God must have had it in for six million Jews in World War II, but was fine with protecting the Nazi German murderers who lived out their natural lives after the war. They moved to the United States and were protected for their anti-communist stances. God Bless America, you know. "Ohhh, that's different", Christians say. "Nazi Germany was an example of free will and self determination—God-given, like Adam and Eve, the serpent, the apple. They’ll get theirs in the end, sort of thing."
How about the brave crew of the space shuttle Challenger, or the 200,000-plus who died in the Tsunami of 2004? God must have decided it was their time to die—fathers, mothers, kids, everyone. The millions murdered by Pol Pot and Stalin?—God must have been just fine with those two charming fellows practicing free will, since both had the luxury of living out their natural lives. God willing, you know. That’s the popular phrase these days. How about the passengers of Pan American flight 103 over Lockerbie, Scotland? They must have been really bad or really good for God to have selected them for early admission to the afterlife. Meanwhile, the perpetrators who planted the bomb still walk today, no doubt because God ordained it. And so on.
If there were something that should shatter the whole concept of faith, and bring into serious question the entire notion of an overseeing, all-protecting higher being, it would be any one of the atrocities above, or any of thousands of similar disasters over the millennia where innocent people were dashed against the rocks of misfortune or eviscerated by the swords of their fellow man.
Sadly, the concept of 'God watching over me' will not likely disappear any time soon. No matter how uncivilized or unsubstantiated, once beliefs are labeled as faith-based, the rest of society becomes reluctant to challenge or reject them.
Journalists, on the other hand, and their editors and producers should at least recognize how irresponsible it is to broadcast or publish comments from survivors who claim to have been 'saved by God'. The implications of blame for the victims and the added insult to victim’s families are totally unjustifiable.
I have been extremely fortunate. I've never had to suffer through the tragedy of losing a loved one in a tornado or a plane crash. I have a hard time, however, imagining anything more offensive than hearing from a survivor that 'God was watching over me’. I understand the ‘why me?’ question, but attributing one’s survival to God's selective protection is tantamount to blaming the dead for causing their own deaths.
It is the height of misguided indoctrination and arrogance for a person to believe that he or she could be individually selected to live through a natural or humanitarian disaster. Delusional ideation—that’s the medical term. Being selected to live implies that those who died were not merely ignored by God, they were selected by God NOT to live. It couldn’t be negligence or oversight, right? Since God is omniscient and all-powerful, right? It must be that God hand-picked half the airplane's passengers to die a scorched painful death. And to think that people go to churches, synagogues, and mosques to worship this God? Something is amiss here.
This all-seeing God must also have had little interest in watching over the events that led to the tornado or plane crash in the first place: the weather, how much fuel was in the tanks to burst into flames, the pilot's skill (you've seen priests bless pilot's hands, surgeon's hands, and the like). Apparently God was too busy protecting that minister, or that small group of passengers in rows 21 to 29 who survived the crash, to pay attention to other details.
Similarly, God must have had it in for six million Jews in World War II, but was fine with protecting the Nazi German murderers who lived out their natural lives after the war. They moved to the United States and were protected for their anti-communist stances. God Bless America, you know. "Ohhh, that's different", Christians say. "Nazi Germany was an example of free will and self determination—God-given, like Adam and Eve, the serpent, the apple. They’ll get theirs in the end, sort of thing."
How about the brave crew of the space shuttle Challenger, or the 200,000-plus who died in the Tsunami of 2004? God must have decided it was their time to die—fathers, mothers, kids, everyone. The millions murdered by Pol Pot and Stalin?—God must have been just fine with those two charming fellows practicing free will, since both had the luxury of living out their natural lives. God willing, you know. That’s the popular phrase these days. How about the passengers of Pan American flight 103 over Lockerbie, Scotland? They must have been really bad or really good for God to have selected them for early admission to the afterlife. Meanwhile, the perpetrators who planted the bomb still walk today, no doubt because God ordained it. And so on.
If there were something that should shatter the whole concept of faith, and bring into serious question the entire notion of an overseeing, all-protecting higher being, it would be any one of the atrocities above, or any of thousands of similar disasters over the millennia where innocent people were dashed against the rocks of misfortune or eviscerated by the swords of their fellow man.
Sadly, the concept of 'God watching over me' will not likely disappear any time soon. No matter how uncivilized or unsubstantiated, once beliefs are labeled as faith-based, the rest of society becomes reluctant to challenge or reject them.
Journalists, on the other hand, and their editors and producers should at least recognize how irresponsible it is to broadcast or publish comments from survivors who claim to have been 'saved by God'. The implications of blame for the victims and the added insult to victim’s families are totally unjustifiable.
Friday, February 19, 2010
In corporations we trust: health reform in America
by James Channing Shaw
I have practiced medicine in Canada and the United States. I know both systems well. My mother-in-law recently spent 12 hours in the emergency room of an academic New York City hospital. She had suffered a small stroke. She received excellent care, I.V. fluids, an MRI, and close observation over night. I asked approximately 20 of my American friends what they thought the cost of her ER visit might have been. Assuming I was searching for a high number, they guessed between $3000 and $9000. The actual bill: $19,800.
A little more than a year ago, my stepfather-in-law underwent abdominal surgery, an emergency second surgery, spent two weeks in intensive care and two months of rehab in hospital. The total bill for his three months of first rate inpatient care: $25 (for the television in his room). The difference: he lived in Canada.
Well-informed Americans continue to be confused about health care reform. Even the most highly educated have fear that reform will reduce what they get now. Institutions that oppose reform have been remarkably effective in instilling fear of change, of systems like Canada. Clarification and understanding are sorely needed if change is to occur. While no one knows precisely what reform will look like, everyone should at least know the principles that drive the current U.S. system.
1. Most health care in the U.S. is all business. Americans seem to view medical care not as a societal priority similar to, say, police and fire protection, but as a commodity. Insurance companies have a responsibility to their stock holders, not patients, doctors, or hospitals. It is good business for them to reject applicants with pre-existing illnesses. The system is analogous to fire departments that charge for putting out your fire, or don’t come at all if you have had a previous fire.
2. For-profit medicine does not translate to best medicine. The U.S., while having by far the most expensive per-capita health care in the world, ranks 37th internationally overall, 14th in preventable deaths, and 24th in life expectancy. Over-treatment is routinely practiced by doctors as a source of revenue production. While any health system is susceptible to abuses, the American structure enables such ethically corrupt practices through its acceptance of entrepreneurialism in medicine. Most countries that fund health care out of tax revenues try to restrict entrepreneurial ventures in medical services.
3. American insurance companies usually limit the dollar amount they cover. Catastrophic illness, for all but the most affluent, still results in bankruptcy. In 2007, over 60 per cent of bankruptcies in the U.S. were medical, either from medical debt or loss of income from illness.
4. For-profit health care generates enormous administrative costs that could otherwise be spent on the delivery of care. Picture a large hospital with thousands of patients, each with different insurance red tape, versus one standardized plan for billing. Administrative costs are factored into the fee schedules and passed along to patients in the form of premiums or exclusions. Stock holders win, patients lose.
The rest of the world does it differently and, according to most sources, better than the United States, for less cost. The two main questions are whether Americans wish to provide health care insurance for everyone, analogous to police and fire protection, and whether they think for-profit insurance companies can be trusted to broker such a service. Republicans put their trust with corporate insurance companies, the same ones that have exercised their power to derail reform. Republicans in Congress have given a clear signal that they care more about corporate America than health care for Americans.
Surprisingly, many Americans who would be best served by health reform, and are in most need of it, continue to go along with the distorted arguments and anti-reform rhetoric from conservatives. That was true in Saskatchewan in the 1960s when a public system was first introduced and insurance companies were, by decree, eliminated from the government insurance plan. The new system was so successful and popular that it later was implemented throughout Canada.
If Americans who oppose reform could get over their aversion to centralized insurance funded by taxes, and embrace health care as a moral enterprise instead of a business venture, the United States could begin the process of improving overall quality of care, and at the same time start to reduce its per capita health care costs.
James Channing Shaw is an American physician currently at the University of Toronto.
I have practiced medicine in Canada and the United States. I know both systems well. My mother-in-law recently spent 12 hours in the emergency room of an academic New York City hospital. She had suffered a small stroke. She received excellent care, I.V. fluids, an MRI, and close observation over night. I asked approximately 20 of my American friends what they thought the cost of her ER visit might have been. Assuming I was searching for a high number, they guessed between $3000 and $9000. The actual bill: $19,800.
A little more than a year ago, my stepfather-in-law underwent abdominal surgery, an emergency second surgery, spent two weeks in intensive care and two months of rehab in hospital. The total bill for his three months of first rate inpatient care: $25 (for the television in his room). The difference: he lived in Canada.
Well-informed Americans continue to be confused about health care reform. Even the most highly educated have fear that reform will reduce what they get now. Institutions that oppose reform have been remarkably effective in instilling fear of change, of systems like Canada. Clarification and understanding are sorely needed if change is to occur. While no one knows precisely what reform will look like, everyone should at least know the principles that drive the current U.S. system.
1. Most health care in the U.S. is all business. Americans seem to view medical care not as a societal priority similar to, say, police and fire protection, but as a commodity. Insurance companies have a responsibility to their stock holders, not patients, doctors, or hospitals. It is good business for them to reject applicants with pre-existing illnesses. The system is analogous to fire departments that charge for putting out your fire, or don’t come at all if you have had a previous fire.
2. For-profit medicine does not translate to best medicine. The U.S., while having by far the most expensive per-capita health care in the world, ranks 37th internationally overall, 14th in preventable deaths, and 24th in life expectancy. Over-treatment is routinely practiced by doctors as a source of revenue production. While any health system is susceptible to abuses, the American structure enables such ethically corrupt practices through its acceptance of entrepreneurialism in medicine. Most countries that fund health care out of tax revenues try to restrict entrepreneurial ventures in medical services.
3. American insurance companies usually limit the dollar amount they cover. Catastrophic illness, for all but the most affluent, still results in bankruptcy. In 2007, over 60 per cent of bankruptcies in the U.S. were medical, either from medical debt or loss of income from illness.
4. For-profit health care generates enormous administrative costs that could otherwise be spent on the delivery of care. Picture a large hospital with thousands of patients, each with different insurance red tape, versus one standardized plan for billing. Administrative costs are factored into the fee schedules and passed along to patients in the form of premiums or exclusions. Stock holders win, patients lose.
The rest of the world does it differently and, according to most sources, better than the United States, for less cost. The two main questions are whether Americans wish to provide health care insurance for everyone, analogous to police and fire protection, and whether they think for-profit insurance companies can be trusted to broker such a service. Republicans put their trust with corporate insurance companies, the same ones that have exercised their power to derail reform. Republicans in Congress have given a clear signal that they care more about corporate America than health care for Americans.
Surprisingly, many Americans who would be best served by health reform, and are in most need of it, continue to go along with the distorted arguments and anti-reform rhetoric from conservatives. That was true in Saskatchewan in the 1960s when a public system was first introduced and insurance companies were, by decree, eliminated from the government insurance plan. The new system was so successful and popular that it later was implemented throughout Canada.
If Americans who oppose reform could get over their aversion to centralized insurance funded by taxes, and embrace health care as a moral enterprise instead of a business venture, the United States could begin the process of improving overall quality of care, and at the same time start to reduce its per capita health care costs.
James Channing Shaw is an American physician currently at the University of Toronto.
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