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Politics as Ususal

POLITICS. We have a tacit understanding to exclude politics from the blog, but current events are pushing the borders.  It’s not our fault, other forces are on the move. At the border last year was the Iraqi civilian body count issue precipitated by articles in The Lancet. That’s when politics intrudes into medical research and literature.

Other borders are matters of licensure, and of permitted and rejected methods and materials, encoded into licensure, food and drug laws, and a myriad of administrative edicts and court decisions.  One can’t escape the politics of those, especially when Congress and states start to control as commercial entities, areas that historically belong in culture: professional behavior codes, codes of traditional relationships between physicians and patients, for instance. These are under further pressures of conformity and legal sanctions enforced by the power of central government.

Steve  Salerno (web site: www.journalismpro.com, blog: www.shamblog.com), author of the WSJ article on “CAM” and the NCCAM last December that precipitated the Chopra, and Co. responses, brought to attention a recent House hearing at which Congr. Riley (D, Ohio) queried Sec. Sibelius whether she was aware of “mindful meditation” as a cost-saving method that should be included in any federal health plan.

Here we go again. Ten to 15 years ago it was Sen. Harkin legislating research and practice from halls of Congress resulting in the Office of Alternative Medicine and NCCAM. That legislation resulted in financed medical school courses, multiple more lectures and demonstrations, and now med school divisions with endowed chairs, scores to hundreds of employed associates, and with little to no scientific feedback or oversight.

The sectarians are on the move again to be included in a prospective national health insurance scheme. The politics is inevitable, not because of us, but because of the economic push by sectarians.  Here in Northern California we saw two acupuncture articles – one in the SF Chronicle, the other in a hospital and practice journal – within 2 weeks of each other. Content was no different from the puff pieces in the 1990s.

I wrote both authors and editors, asking if the articles were generated by the authors or by “someone else”. I got one response (the hospital journal author) stating the reporter thought it up herself.  I then asked to speak to her by phone and got no response.

And from the SF Chronicle came no response at all. I’ll be working on it the next few weeks.

The first bit of good news (in my view) came through an LA Times article yesterday that Ted`Kennedy had removed from his version of the bill, the federally funded choice option.  A few words about that. Many observe a federally run health insurance option as the camel’s nose under the tent, the end to private medicine in the US, and the takeover of medicine by government. The prediction was, that like Medicare and Social Security, the cost could not be funded by a set-aside funding mechanism, but that the inevitable cost over-runs would be financed by – of course, federal taxes and deficit spending, increasing the national debt. The federal plan would be cheaper and unfair competition.  The Feds would never increase the premiums to cover the cost of a federally sponsored plan because it could not be competitive, and would break its own financial setup – just like the rest of federally funded undertaking. The costs would probably be greater than privately run plans or else care would have to be rationed more than would happen on the private side. Nevah hoppen, GI.

Besides, legislated general medical care would be open to being amended at first or later to include your “mindful meditation” fees that advocates and sectarian are sure to request. Then start adding and multiplying from acupuncture and chiropractic on down.

So removal of the federally funded option was good news indeed – if it remains out. There is no assurance it won’t reappear. If people want insurance to cover such electives and personal and philosophical fulfillments, be my guest. Just allow them to pay for it themselves, and not take my taxes to pay for it like the NCCAM has.

I was asked by a prominent physician with entrée to the Administration for my view of an ideal “reform plan.”  I stated the above and then some; mainly that the feds have no business expanding their role. Bug out. Leave “reforms” to the states and individual choices. Why?  Once the feds approve for payment sectarian and implausible methods, extracting them for payment is harder than “pulling teeth.” Once the camel’s nose…

WHAT’S A REFORM? As for reforms, look at history. Our medical system works well for most people, and I’d say, better than in most countries, no matter what the critics and malcontents say.  I’ve worked both privately, in the armed forces, a university hospital, in safety net county hospitals.  They all work as a system despite their separate subsystems. And the most efficient and cheapest is the private system, and it’s the freest. .

The present private insurance system can be reformed. It began in the late 1930s-40s, tied to employment because large firms though it a good idea to keep good employees by including medical insurance as fringe benefit. There was no other reason. A good idea, but with unforeseen consequences. It introduced the third party, the problem of systematic abuse (in addition to two-party abuse) and the concept of approved and disapproved methods  – a generally good idea, but… Medical insurance also should bug out of employment agreements, and be completely portable (another suggestion.)

The second development was the takeover of medicine by the business community (The Business Roundtable) in the 1970s-80s. Medical professional organizations just rolled over and had tummies scratched by the false offers from business, HMOs, and organized insurance to guarantee income.  It was a disgrace at the time. Many of us complained but so many bought into the “system” promises as did state legislators, that we lost our choices, and professional freedom.  A bad idea with bad consequences. It was the genesis of the 10 minute visit, lack of listening, and the host of modern criticisms.

Any reform must keep medical care as a primary relationship between patient and professional (physician and nurse, dietician, etc.) because that is the human nature of the matter, and anything interfering with it will be dysfunctional, and not correctible, period. Quality review has to be limited to opinions of other – peer and expert – opinions. Government plans inevitably encode pseudoscientific methods and practitioners because the plans are not insulated from politics and economic pressures.

Private insurance would be functional and affordable with co-pays, and only partial outpatient coverage, and with insurance mainly for expensive disasters. Expensive drugs can be made more available through economics if the market could be freer to operate. “Safety net” clinics and hospitals would still exist. That which does not respond adequately to the market we can still work on without discharging the entire US medical system. Or even a single payer – my idea of another nightmare.

As for the concept of the system being in crisis, I dealt with this previously. It’s a conjured myth; hyped by people who want a say in controlling the present status.  The word crisis goes back as far as the 1950s. That is no crisis. We have a correctable situation, but not a crisis. There is no epidemic of deaths due to lack of insurance coverage.  And no need for a takeover of medicine by a central government.

Posted in: Health Fraud, Politics and Regulation, Science and the Media

Leave a Comment (25) ↓

25 thoughts on “Politics as Ususal

  1. Mark Crislip says:

    Don’t we have a humor tag?

  2. David Gorski says:

    Wally, you might be interested in a series written by a friend of mine, Mark Hoofnagle. He looks at what health care is like in several countries with various universal care plans. You’ll find that it’s not as simple as you make it out to be. Believe it or not, some of these countries have government and private systems that exist side-by-side perfectly happily and profitably:

    1. Are Patients in Universal Healthcare Countries Less Satisfied?
    2. What is the cause of excess costs in US healthcare?
    3. What’s health care like in Australia?
    4. What is healthcare like in the Netherlands?
    5. What is healthcare like in Germany?
    6. What is health care like in France?
    7. What is health care like in the UK, Canada and New Zealand?
    8. The Obama Plan – Part I

    Quite frankly, I learned some stuff from these posts that I hadn’t known, and these posts present arguments against your contention that the U.S. health care system is “better than in most countries, no matter what the critics and malcontents say.” If people who castigate our current system for being bloated, inefficient, and inequitable are “malcontents,” then I guess I must be a malcontent.

    I’ve said it before, and I’ll say it again. We already have government-run health care in the U.S. It’s here; our system is not a free market and has not been one ever since I first entered medicine back in the 1980s. The government in essence sets what physicians and hospitals can charge for any procedure through Medicare reimbursement rates, and the third party payers use that as a baseline to negotiate their rates of reimbursement with hospitals. Indeed, we have the worst of both worlds. We have a government run system that exists without providing the the one benefit that, whatever its faults and shortcomings, a government run system should be able to claim over a private system: universal coverage. I’d also be interested if you have evidence or examples of systems where the free market has been allowed to work its magic. Do those systems do a better job than what we have now? Do they do a better job than in nations with universal health coverage? In other words, where’s the data? And, to be fair, that goes both ways. Where’s the data to support these various systems? Mark tries to present some of it in some detail, including statistics and studies. Are his statistics and studies (or the conclusions they make) wrong? If so, I’d like to see the evidence to counter them.

    In any case, I used to think as you do, more or less. Indeed, I thought a lot like you until maybe the early 2000s. However, the longer I see the dysfunction in the system the less I am able to defend it. At least, I can no longer dismiss the problems as being the complaints of “malcontents.” I’m sure that practicing in one of the most economically depressed (if not the most economically depressed) region of the nation probabably limns the problems in our health care system for me really well. I’m totally with you when it comes to trying to keep the CAM advocates from hijacking health care reform, but I’m no longer so sure that a single payer plan would be the disaster you paint it and your arguments aren’t exactly convincing me. Things have gotten so bad that I no longer fear even single payer. Sure, I’m not sure it would be the best solution, but I can no longer dismiss it out of hand, as you do.

  3. daedalus2u says:

    The “system” might not be in crisis, but many individuals in the system and not in the system are in crisis, or are just one health problem away from a crisis.

    I have to disagree that private for-profit health insurance can be made cost effective and that a federal program could never compete with private health insurance. If there was a level playing field, a federal program would win hands down. The federal program doesn’t need to produce a profit for its shareholders. A private for-profit corporation must.

    The reason US health care is so expensive is exactly because of private health insurance. Private health insurance administrative costs are high because they are trying to avoid “high risk” participants. If you let the private insurance companies skim off the healthy 20-somethings and dump all the 50+ individuals onto the government, of course the government program won’t be able to “compete”.

    Look at the salaries of the health insurance executives.

    http://www.huffingtonpost.com/bob-cesca/the-health-insurance-mafi_b_214098.html

    What creative and/or innovative business practices are those executives responsible for that makes them worth tens of millions per year?

    I agree with Dr Gorski, we have the worst of both worlds, the inefficiencies of government run by lobbiests, and the rapaciousness of unchecked greed to pay for those lobbiests.

    Health care is something that can consume infinite resources and not deliver good health. A profit motive is a poor way to run a system where the costs and benefits are unknown and mostly opaque to the user and provider. Insurance plans are complex for a reason, because complex plans are difficult to evaluate so people spend more than they would spend if they knew what they were actually buying. Asymmetric information in a transaction highly favors the one who controls the information.

    Insurance is the wrong economic model to supply most health care. Insurance is an inefficient way to fund known and predictable expenses. The insurance provider simply adds administrative costs, and profit to those expenses.

  4. luthierstone says:

    If the private system works then why are there 45 million Americans who lack insurance? While there are certainly people in any system who fall through the cracks, can’t we do better than 1 in 6?

    What is it that’s holding the private system back?

  5. Bookman says:

    It’s funny, up here in Canada where health insurance is publicly run, alternative medicine has to be covered by the private insurers. If you have private extended health insurance you can get acupuncture, chiropractic, and all manner of faith-based procedures covered. The taxpayers refuse to foot the bill on that nonsense. As someone with private health insurance with my employer, I kind of resent the fact that the premiums deducted from my paycheck have to support my colleague’s fondness for quackery. Ah, the “freedom” of private insurance is grand.

    It’s terrible up here having everyone covered by health insurance. We miss all that stress, all those illness-related personal bankruptcies, all that driving around looking for an emergency room that will take you in to treat your coronary…

    As an American I know the U.S. system well, and I really don’t miss it one bit. The Canadian system needs improving, but it’s generally fair and of excellent quality, and as I say, you don’t have to make the choice of making either your rent or your health insurance payment this month.

  6. onegoodmove says:

    Our medical system works well for most people, and I’d say, better than in most countries, no matter what the critics and malcontents say.

    This blog is science based? Let’s see some evidence for your unsubstantiated claim. Taking off your blinders and removing your fingers from your ears will improve your chances of success.

  7. Mark Crislip says:

    Todays Grand Rounds was by our former Governor, Dr. John Kitzhaber.

    He gave an eloquent talk on health care reform based on history, evidence and an understanding of medical reality that reflects my last 20 years in private practice medicine.

    He refutes all the assertions in Dr. Sampsoms post.

    I lack the facility with the data to recapitulate his lecture; Dr. Kitzhaber’s website is

    http://wecandobetter.org/

    I hope Dr Kitzhaber represents the future, otherwise we are toast

  8. Citizen Deux says:

    So the WCDB organization, supported by The Foundation for Medical Excellence and chaired by Oregon insurance executives is to be considered neutral?

    Certainly an insurance firm can seek substantive improvements, however, it would seem that the ultimate test of the system would be the end user’s satisfaction.

  9. David Gorski says:

    It’s funny, up here in Canada where health insurance is publicly run, alternative medicine has to be covered by the private insurers. If you have private extended health insurance you can get acupuncture, chiropractic, and all manner of faith-based procedures covered. The taxpayers refuse to foot the bill on that nonsense.

    Actually, that’s a very good point. More and more private insurers are starting to cover woo, as was documented earlier this week by the AP as part of its excellent series on CAM. The reason, I suspect, is that insurance companies are businesses. Although they are hired by employers and are thus more responsive to them than to those whom their insurance actually covers, if enough of their potential customer base wants woo, this desire will eventually make itself felt through by insurance companies through employers and through how many choose various plans offered by their employers. In that case, woo sells, and insurance companies may feel compelled to offer it in order to avoid losing customers to other insurance companies that do offer it. Also, it’s usually fairly cheap, and it gives the illusion of doing something.

    In other words, Wally’s argument that a private system is so much more resistant to the infiltration of quackery than a government-run system is not particularly convincing. Both systems can be prone to the infiltration of woo, just for different reasons. For government plans, it’s politics; for private plans it’s customer demand.

  10. merickson says:

    I haven’t read this blog for quite a while, but I thought I was on Opinion-Based Politics (=99% of the web), not SBM. I’ll have to read Dr. Sampson’s other posts, but this certainly doesn’t do him credit.

    Overall coherence was completely lacking. You start by talking about CAM, which is both science and politics-based, but as soon as you admittedly leave the former (“in my view … many observe…the prediction was” et al.), your subject is the public plan option of the health care reform bill. After a few paragraphs of conjoining the financing of CAM treatments and a federally sponsored public plan, you completely leave SBM and go off the cliff with unsupported claims about health care reforms.

    “There is no epidemic of deaths due to lack of insurance coverage.” Do I have to point out the many ways to ridicule this sentence?

    I wholehearted agree with Dr. Gorski and daedalus2u, but have no idea what Dr. Crislip meant with his humor tag comment. Was it weak sarcasm?

  11. Mandos says:

    As someone who has lived under a single-payer system in Canada for most of my life, and for the past few years, an employer-based private insurance system in the USA, I would take the single-payer system hands-down—with no copays, or user fees, and no additional insurance required, and no “safety net” clinics.

    The US system is needlessly expensive, cumbersome, and pointless, and reform will not come by redoing the existing plans. It is also deeply immoral.

    The basic problem of health care funding is that some people need it more than others, and it bears no relationship (or an inverse one) to their ability to pay. There is a reason why employer-based insurance is cheaper than individual plans—the healthy are subsidizing the unhealthy. And that’s as it should be. People should not fear the financial impact of visiting the doctor, and there are people who even at $25 copays would choose substandard care to put food on the table.

    The US system *invites* many of the arguments made for CAM. My employer has decided to change insurance providers. My doctor does not take the new plan. I have to choose a new doctor. The hassle this involves, and the end of a comfortable doctor-patient relationship, invites the belief and perception that medicine neglects the human factor.

    In Canada, I had the same family doctor for decades, starting from when I was a child. My parents’ changes in employment did not affect this, and they still go to the same doctor. Only that doctor’s probably impending retirement will change this relationship.

    We need to sweep the private insurers of the table. There is no reason why there should be a middleman acquiring profits from the system between doctors and patients, when it’s been shown that government-run insurance systems work just as well.

  12. Mandos says:

    As for quackery, my current health insurance contains considerable support for CAM, if I ever wanted to get poked by needles. My Canadian insurance never did. The medical clinic I usually go to has a CAM center. I had always thought of CAM as a conceit for people with money to blow when I lived in Canada. The political pressure to keep the costs down while maximizing coverage in Canada tends to make provinicial goverments balk and funding CAM.

    I fear that this article sounds like a mask on an ideological claim. Which is perfectly fair—health care delivery is a matter of ideology and moral philosophy in part—but we should have *that* discussion, not an inaccurate portrayal of prejudices surrounding government health care delivery.

  13. Charon says:

    Wallace Sampson retired in 1997, and retired from private practice in 1991. This may explain why he doesn’t have the pain of HMO paperwork etched into his mind.

    (I’m not a doctor, but my dad was up until retirement a couple years ago. In private practice, he had to do all the paperwork himself. He was a fierce advocate of a national health care system when it was proposed by Clinton in 1993, when HMOs were starting to get going, and my recollection is that insurance companies just got worse since then.)

  14. psychability says:

    A topic appropriate to this blog, particularly as the US revamps health care, is if and how to administer practice standards and guidelines. Politics and profit motives continue to impact care in the single payer system in which I practice. As long as I keep to certain ethical standards, e.g. safety and informed consent, I am free to offer scientific information and treatment or non-SBM. As I review many clinician records, I am distressed to see the amount of CAM that is practiced by physicians and paid for by the public system (although the system may not be aware of what is being paid for). This will become more problematic as physicians graduate from programs with academic CAM departments.

    How can this be addressed in whatever new system the US develops?

  15. daedalus2u says:

    To address psychability’s question by a method that I am familiar with (I am an engineer, not a health care provider). There is a book that describes the generation and evolution of the ASME Boiler Code. I think there are multiple good examples in this of how stakeholders with competing interests can agree on standards that work and by doing so address the needs of the many.

    http://catalog.asme.org/books/PrintBook/Code_Authorized_History.cfm

    In the late 19th century, the number of deaths from boiler explosions sometimes exceeded 500 per year (yes, per year). There were a number of horrific steam ship disasters where the boiler exploded and the ship burned to the water line, killing virtually everyone aboard (the worse disaster was over 1,100 deaths). These were tolerated as a cost of doing business because a steam engine was the only source of mechanical work remote from water power.

    It was a consortium of stake-holders, users of steam boilers, manufacturers of steam boilers, academics, and most importantly the insurance companies that insured businesses that had steam boilers. There was some involvement of political agencies, usually via fire departments and fire inspectors, but I think the political involvement was less important than that of the insurance companies.

    Boilers are of trivial simplicity compared to physiology, but some of the arguments used against the Code are the same as are used against SBM today, that it infringes on the autonomy of individual practitioners, that small businesses will be put out of work. That it will make boilers too expensive. Ultimately it was the economics of insurance that drove it. If a boiler wasn’t built according to Code, no one would insure it. With no insurance on the boiler, the building couldn’t be insured, and without insurance the building couldn’t be used as collateral. The cost of a boiler was small compared to the value of a building. The incremental cost to have a boiler built according to Code was very small compared to the cost of being unable to use the building as collateral.

    If we make the analogy of the SBM standard of care as analogous to built according to Code, and CAM as not built according to Code, then to use the lessons learned in the development and adoption of the ASME Boiler Code, we simply have to constrain the relationships between the various stake holders in health care to the analogous relationships between the stakeholders in the adoption of the Code.

    I think a way to do this might be to “ration” health care to only the SBM standard of care. That if you want CAM that has to be paid for out of pocket. I think that private health insurance will have a harder time rationalizing the “rationing” of health care if customers want CAM. The most economic method to supply health care is to supply woo that costs nothing and then use marketing to make people think it works. If the Federal Government has a single payer system, that system could (I think) more easily be limited to SBM standard of care because there are objective mechanisms for determining what that treatment is based on actual results.

    Requiring all health care providers to have malpractice insurance at a certain level as a condition of receiving payments from health insurance makes sense, if those health care providers are doing things that conceivably could require other health care providers to treat. If there is malpractice, the patient or the patient’s health insurance provider should not be stuck with the bill to fix it.

    If we can get “malpractice” to be defined (in this sense) as deviations from the SBM standard of care that cause harm, so that CAM providers who do stuff to their patients that require SBM standard of care methods to fix, and they can be billed for the cost to do so, CAM providers that do dangerous stuff will be uninsurable. Even if the malpractice insurance is no-fault (in a legal sense) and just covers the cost of SBM fixes, it will make CAM providers that do dangerous stuff uninsurable.

  16. The Blind Watchmaker says:

    daedalus2u,

    I like your reasoning.

  17. The Blind Watchmaker says:

    I put this comment on Mark Hoofnagle’s Denialism Blog post on the Obama Plan. Thought it would be relevant here.

    Just a thought.

    The so-called “demographics hypothesis” in economics holds that real inflation (the double-digit kind) that we saw in the 70′s may have been caused by the huge “Baby Boomer” generation all trying to enter the workforce. The economics at that time supported a relatively smaller workforce. As the Boomer Bubble moved through time (each year with a greater number of 20-somethings looking for jobs), the workforce and the economy had to adjust. This was correlated with double digit inflation in the general economy. According to the hypothesis, the general economy had to fund it’s own expansion with inflation to accommodate the huge numbers of new workers. Once the Boomers were “all in”, we saw tame, single digit inflation from the mid 80′s on up.

    Whether this is cause and effect, or a post-hoc correlation, I’m not sure.

    If there is something to this, then maybe what we saw in the general economy in the 70′s, we are now seeing in the “medical economy”. The same huge Boomer population is now entering its mid 60′s. They are utilizing the health care system more and more (just as they were all looking for more and more jobs in the 70′s as their population bubble moved through time).

    The “medical economy” has been expanding, both in terms of facilities and new technologies with which to provide care. This expansion may be funding itself with double-digit inflation in health care costs.

    If this is true, then it may be another decade or 2 before this Baby Boomer population bubble is “all in” (meaning that the health care infrastructure is big enough in scope to provide the care that is demanded by the population). At that point, we may very well see a dramatic slow-down in health care inflation. Since the so-called Generation X is smaller than the Baby Boomer Generation, the supply may actually be bigger than the demand. We could actually see deflation in health care dollars at that point.

    I do not know if this is the main driver of inflation in the general economy or in the health care economy. There is a correlation, though. There are many, many other variables at work, including abuses, greed, fraud, redundancy, and defensive practices. But I wonder just how much these add up to the unprecedented double digit inflation of health care costs that we are seeing.

    If the demographic hypothesis turns out to hold water, then we may not be able to legislate away the inflation until the Baby Boomer wave has wiggled its way into the system like a pig in a python.

    (By the way, I wouldn’t recomend using the demographics hypothesis for investing. According to guys like Harry Dent, the Dow should be somewhere between 25,000 and 40,000 by now. Just a little off.)

  18. Newcoaster says:

    Health Care in the hands of private, for profit companies will never have the best interests of your health in mind, only what creates profits for shareholders. When they pay out medical expenses, that is considered a loss. Administrative costs of private health care in the USA are triple what administrative costs are for government funded (not run) health programs in other modern nations, such as Canada, where I live and work as a physician.

    America has one of the best…AND ironically one of the worst health care systems in the world. It is certainly the most expensive, easily twice as pricey on a per capita basis as that in Canada, France, Germany and most of Europe and Japan. Unfortunately, 40 million of your ‘capita’ have no health coverage at all. It is a health care version of your economic state, with the elites who get everything wondering what the problem is. But for all the cost, health outcomes are no different, and in some categories, arguably worse, in particular with preventive medicine. ( no profit in that if you have narrow, short term thinking)

    In no modern wealthy nation…other than America…can a middle class person bankrupt themselves paying for a medical illness. In no modern wealthy democratic nation is the unfortunate unwell person blamed for his illness, and allowed to figure it out for himself. Among modern, wealthy, industrialized nations, America is unique in having the highest rates of teen pregnancy and abortion, the highest infant mortality rates, the highest rates of HIV and drug abuse.

    It is America’s shame that it doesn’t consider the health of its citizens as part of the Bill of Rights.

    Wallace, you should read “The Conscience of a Liberal” by Paul Krugman (2008 Nobel Prize winner for Economics) where he dissects the tired old movement conservative arguments you promote for the ideological smoke screen they are.

    I agree that if and when America does manage to fix its healthcare system that the issue of sCAM treatments being sanctioned is a huge problem. They sense a historic opportunity to get their foot in the door, and those of us…or rather those of you in America…who want to keep medicine rational and evidence based have some hard work to do to prevent that.

    But, the US health system is a failure for a significant proportion of your citizens, and a single payer system has been proven to be the most cost effective. There is no such thing as a perfect system, every form of socialized medicine has problems with cost containment, and access…but everybody has access.

  19. Newcoaster says:

    MANDOS SAID “The political pressure to keep the costs down while maximizing coverage in Canada tends to make provinicial goverments balk and funding CAM.”

    Unfortunately in British Columbia, we have a populist government. Liberal by name, but right wing, privatization, union busting conservatives by nature. The former Minister of Health…with no health training/work experience/education in the last few years has brought forward legislation
    -that the government health system now pays for acupuncture for poor people
    -allows midwives to use acupuncture for pain relief in labour
    -allows Naturopaths to prescribe medication and order laboratory tests.

    I regularly have patients come in for a note so their private insurer will pay for the chiropractice, acupuncture or whatever woo that they want, but it is my policy not to provide them with a note.

  20. Mandos says:

    Yeah, BC is always a strange political case. Canada’s California?

  21. wertys says:

    By way of what got Dr Sampson started, in the Pain Medicine field there is emerging solid data from the psychologists (most of whom I admit I cannot bear sitting through an entire presentation from) that a style of ‘mindfulness’ awareness, which is different from standard CBT can be quite helpful in helping chronic pain sufferers make positive adaptions to their situation, and our clinic is in the planning stages of starting up a ‘mindfulness group’ to help train our patients in the technique. We are also recruiting subjects for an RCT looking at mindfulness training for depression relapse prevention. Perhaps the politician quoted was not overstating the case a bit, but the idea of mindfulness training is not total woo at this stage, it does have a hard edge that can be studied. I have actually not yet seen a mindfulness study funded by NCCAM, but I might if I look harder I suppose.

  22. Lame-R says:

    There are pros and cons, strengths and weaknesses in every country’s healthcare setup. The proponents on both sides of the issue are adept at choosing the studies and statistics that best support their personal beliefs. Until each side is willing to give some ground, we’ll just keep at the incessant bickering.

    Since, as Gorski pointed, we already have heavy government involvement in healthcare, let’s just connect the dots and do it right. As another commenter pointed out by suggesting a public/private mix may be the ideal route, a good compromise would be for the government to fund a minimum standard of care for everyone, i.e. everybody gets a Toyota. For those that want a Cadillac, let them pay for it. Yes, we do spend a lot of money on MRI’s, proton therapy, fancy drugs, end-of-life heroics, etc.. Fact is, some people want it–well let them pay for it themselves. We’re prosperous enough that we can afford to ensure that everybody at least gets the basic care when and where they need it. And yes, our government can do a decent job delivering this care (not just paying for it), as evidenced by the VA system.

    That being said, the money’s gonna have to come from somewhere, and we already have a massive medical liability looming large like an iceberg. For starters, cap healthcare providers’ salaries; it is immoral to get rich off other people’s illnesses, and many specialties have plenty of room for some trimming. Reign in the costs of prescriptions through collective bargaining, generics, and patent reform. Cut back on admin costs and defensive medicine practices. And for good measure, just to make sure we’ve got all the doctors we need, increase subsidies to med schools and students. If we’re gonna treat this as a basic human right, then we need to move away from viewing it as a system in which to profit. The different members of the healthcare provider chain need to be re-structured as civil servants, not as wealth-creators.

  23. daedalus2u says:

    Wertys, mindfulness meditation is just another way of inducing the placebo effect which is the neurogenic production of nitric oxide. It will work like other methods of stress reduction which do the same thing.

  24. cloudskimmer says:

    Where is a reputable source for deciding on whether or not single-payer works? Some people are horrified by the Canadian system: long waiting times; you’ll die of cancer before you can have surgery! Other people claim that it works very well.

    Is there any support for President Obama’s claim that most people like their health care plan? It appears to me that the reason is that they haven’t had a major medical problem; it’s only then that they find that they can only see doctors affiliated with their plan, get a very limited number of physical therapy visits, and are faced with high copays. Or when you get sick when you are out of town–just try getting medical treatment for reasonable cost! If more people actually used their insurance for a meaningful illness, I think they’d be far less happy.

    And what can be done to correct the discrepancy in specialists? There are many plastic surgeons in my phone book (I live in a large metropolitan area), but no geriatric physicians, despite the fact that there is a large local population of elderly people. What’s up with doctors who want to do face lifts, botox injections and liposuction, but don’t want to get involved with people who have real medical problems?

  25. weing says:

    “What’s up with doctors who want to do face lifts, botox injections and liposuction, but don’t want to get involved with people who have real medical problems?”

    I guess, they have to make a living. Maybe they have kids in schools, mortgages, etc. Can’t really make those payments by taking care of geriatric patients. Don’t get me wrong, I am in primary care. But my non-geriatric patients are subsidizing my care of the elderly. I wouldn’t make overhead otherwise. The trick is to keep the number manageable. It’s getting more difficult to do as more of my patients enter the Medicare years.

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