Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
Mar -
A few more thoughts
31 Jul2009
TS, my colleague and co-author, argues that we have a free market. Balderdash! Physicians get paid per visit, regardless of their experience. Supply and demand does not work. We have negative incentives to spend enough time with patients – because spending more time costs us money. We have negative incentives to answer telephone calls or emails – time with no pay.
Patients think they like their insurance plan, because they are scared of the unknown. Survey physicians about the problems of insurance companies.
20 years ago I lost a favorite patient because I could no longer see patients with his insurance. The patient had no choice because his employer only offered one insurance plan.
Aaron asks me about the complexity of the bills. Aaron, read the >1000 pages and then tell me it is straightforward. The more clauses in a bill, the more opportunities to take provisions out of context.
Take the palliative care provision. I have read the language, and know the physician who worked with the Congressman on the language. This provision is pro-patient and pro-physician. Critics have lied about the language and made this a major focus for critiquing the bill.
What do we really need? First, we need some arrangement for universal coverage. I care for the uninsured. We provide care in the emergency department and the hospital, but that is not adequate. I discharge patients with inadequate followup. Too often I see those patients back in the hospital.
We need better access to outpatient physicians. Achieving this will require major changes to payment. Our payment system is irrational.
Unfortunately, we need malpractice reform – but the Democrats will not go there. If they really want health care reform they should compromise on this issue.
But we really need a bare bones program. Keep all the extra pet project out of the bill.
The status quo leads to increased costs, because it is easier to order tests than to talk and think. Talking and thinking take time, and that time is not rewarded by our current payment system.
We will probably get some form of health care reform, because the Democrats cannot afford to fail. We will likely get a watered down inadequate bill. And that is a shame.
Related posts:
- Some thoughts on health care reform
- Are the Democrats destroying health care reform?
- Obama’s speech
- Shame on the Republicans, shame on the Democrats
- Some early inclusions in the House bill
Related posts brought to you by Yet Another Related Posts Plugin.
- In: Medical Rants
7 Responses to A few more thoughts
missy
July 31st, 2009 at 8:01 am
Unfortunately, we need malpractice reform – but the Democrats will not go there. If they really want health care reform they should compromise on this issue.
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They won’t go there because they don’t want to bring sovereign immunity into the debate or acknowledge it in the bill.
http://content.healthaffairs.org/cgi/reprint/19/6/152.pdf
brian
July 31st, 2009 at 9:31 am
the name of the “insurance” reform bill is funny to me. the idea that this is going to improve patient choices… is funny. it will improve patient choices for those with no insurance now, but this will be at the cost of choices for everyone else that already has some coverage. interesting… more robin hood politics?
if we really want to give choices then:
1. raise taxes
2. slash 600 billion defense budget (therefore, stop subsidizing France’s and Canada’s healthcare system which they are very proud of but they have little to no defense budgets.)
3. Create a true universial healthcare core (civil service access to everyone.) Socialized incomes and socialized expenses.
4. allow for private healthcare and insurance to continue.
everyone gets a choice. doctors & Nurses can choose to be government employees with all the perks and its advantages or they can be private and paid what the free market will bear. Patients can have free or low cost care with it’s disadvantages or pay more and get better care.
but sadly…. this will never happen. after all…. healthcare is a right and bigolly we all must have equally mediocre healthcare.
still depressed about it.
Matt
July 31st, 2009 at 10:27 am
“Unfortunately, we need malpractice reform – but the Democrats will not go there. If they really want health care reform they should compromise on this issue.”
They won’t go there because it wouldn’t do any good – it’s a state law issue. Unless you want to go to single payer.
rjh
July 31st, 2009 at 11:38 am
Do be careful about reading regulatory bills. I’ve dealt with many misunderstandings before. Don’t read the bill to figure out whether it says what you want. Read the bill with the intention of finding a way to mis-use it or abuse it. The actual implementation will be by regulators who will interpret it in their context, with their understandings, according to their definition of terms. This can sometimes result in entirely the opposite of the intended result. An attempt to read it as a hostile actor can reveal a lot about potential misinterpretations.
This particular section I have not read, so I don’t know whether it is being mis-represented or not.
k
July 31st, 2009 at 11:29 pm
How can there be a free market when the system has gone to such lengths to hide the true costs of products and services? This includes hospitals, insurance company negotiated rates, etc.
The piecework payment system (RVRBS and CPT) need to go away. In a previous post, you discussed the difficulty of measuring quality. To me, quality is care that is consistent, physicians willing to work with me to solve problems, and keep me out of the hospital. Quality has nothing to do with hospitalcompare.gov or AHRQ, IMHO. Physicians know every pt is different, and sometimes evidence based medicine standards do not apply. I am ambivalent about my insurance plan – state high risk pool is outrageously expensive, but it’s all I can get. I would love to see community rating, guaranteed issue, and the like. I would also like to be able to choose whatever plan I desire, and I would like to get out of having to wield my ICD/CPT code-fu when I have to talk to the insurance company.
Insurance companies are evil b@stards – their sole functions are to delay and deny payment or treatment. Physicians should not have to waste so much time on the minutiae and administrivia. Streamline the system!
Everybody should have coverage – Medicare and Medicaid pts have problems finding physicians who will accept their insurance, and EMTALA should not be an unfunded mandate. Make uninsureds pay something – to the ED doc, at the very least.
Payment reforms need to be revised to attract more primary care/IM/peds physicians. Current E&M coding is a mess! I would also like to see some kind of malpractice reform, but it’s hard to fight the lawyer lobby.
Woodside Park Bob
August 1st, 2009 at 5:35 am
“Missy” misinterprets how sovereign immunity applies to malpractice cases. Under the Federal Tort Claims Act the federal government has chosen to waive sovereign immunity and is responsible for the acts of the physicians and other medical professionals it employs and, in effect, insures them for their malpractice. The only difference from the private sector is that the claims or suits are brought against the United States of America rather than the individual medical professional.
The above applies to all malpractice cases against federal medical professionals except claims brought by active duty military personnel. The Feres doctrine prevents claims by active duty military personnel treated by military doctors. A bill currently in Congress would eliminate this exemption. By the way, military dependents can sue the government for malpractice.
TMLutas
August 1st, 2009 at 7:56 am
Supply and demand do work,if given a chance. Look at medicine uncovered by most insurance and you’ll see a more free market system. You’ll also see a more responsive, pleasant, and effective system.
There is a need for a negotiator/advocate that the patient hires to ensure that care is appropriate and not quackery, CYA against lawsuits, or medically unnecessary. In the present system, we have an imperfect, unsustainable implementation. The present reform bills coming out of committee are worse, not better than the present system.
We need reform that is sustainable. No 1st world medical system is currently sustainable. All will go broke in the next 65 years (which is how the actuaries calculate such things). The type of reform on the table has been tried and accelerates the downward spiral, no thanks.