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AMA news NY Times Health Washington Post Health LA Times Health Medscape BBC Health News Healthier US.Gov No Free Lunch
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Mort Kondracke on health care and the presidential campaign Bush and Kerry, healthcare foes (warning - this link will give you the latest Kondracke column - thus if you are reading this in the future, you will have to search back through his columns to find this particular column).
The remainder of the article argues that Bush is worse because of the proposed NIH budgets. Disclaimer: I receive NIH funding and AHRQ funding. Wow, this is a really tough issue. I am reminded of the famous George Bernard Shaw quote (often attributed to Winston Churchill) - "We've already established what you are, ma'am. Now we're just haggling over the price.". We know that we cannot increase the NIH budget by 100%. Our challenge is to understand how much we should increase that budget. Supporting the NIH is akin to motherhood and apple pie. One can always stand on the high moral ground when criticizing the President's NIH proposal. The question becomes not the NIH budget per se, but the NIH budget in the greater context of the overall budget. I would love to see NIH increases and AHRQ increases. Our research group would have better funding odds. Our fellows would more likely have successful research careers. And even more important, our contributions (and the contributions of similar groups around the country) would improve our overall health status. Read the article and perhaps you can decide (just on this issue) whose approach would benefit the common good. I fear that I cannot tell. I often rant that each party has good and bad proposals related to health care. This article reinforces my beliefs. Posted byCongress is wrong 2 Cancer Drugs, No Comparative Data - this title is misleading, because the drugs are really anemia drugs, used both with cancer patients and with Chronic Kidney Disease patients.
We (physicians) have no way to choose between two similar drugs (and these drugs are just variants of each other) unless we have head-to-head comparisons. I have repeatedly ranted on this subject. For physicians to control pharmaceutical costs, we must do the right studies. The study which CMS wants is the right study. Congress should not prevent important medical research. I hope that we can overcome the pharmaceutical industries meddling so that we can do good comparative studies. Interestingly, the health insurance industry wants these studies. Thus, the Republicans have two major support groups at odds over this provision. I hope that Congress revisits this issue. Perhaps this article and more like it will help everyone understand the importance of doing this type of research. Posted byCosts and benefits This article does not explicitly address medical issues. However, I believe it does a nice job emphasizing the costs of any benefit. One can take these principles and apply them to malpractice suits, drug benefits, marijuana laws, and many other issues that we address regularly. Goodies cost us
No free lunch. Someone has to pay. Posted byIs the new Medicare bill flawed? Or how inconsistent our politicians are. This column documents the Democrats' inconsistency on Medicare. I am not implying that the Republicans are any better when it comes to the political process. Patient welfare will always remain secondary to political gain. Medicare hypocrisy
I hope you read that excerpt and the remainder of the article. The Medicare bill is flawed. Virtually every bill passed by Congress is flawed. We can always find and exploit the flaws. What we should (and apparently never will) do is to evaluate the pros and cons and weigh them to decide on whether a bill is worthwhile. I believe that on the whole (the forest view) this is a good bill. If I focus on trees, of course I see some that should be cut down. Posted byFrist on Democrats working to change the Medicare law Frist Expects Congress to Try to Expand Health Coverage
I worry that the politics of health care will undermine real progress. The Democrats do not seem to care whether this law helps some patients. They will not admit that having a drug benefit, even with some gaps, trumps having no drug benefit. They see any law purely for its political ramifications. But then the Republicans are no different here. Politics trumps the common good at all times. In years past, the Congress and Senate understood compromise. The two parties worked together to at least try to craft positive legislation. The Medicare bill is not perfect. But then neither am I, or you. Frist is right that we should watch what happens for a year or two prior to making more radical change (because this law is radical change). Posted byWhy John Edwards scares me! Yesterday I linked to Sydney Smith's piece on Edwards. One of my most frequent commentors - Bernie - had this to say:
Bernie and I often disagree - and we both give and take arguments well. I really have not problem with his character, rather his apparent philosophy scares me. Rangel has a great post on this - How Edwards and his ilk are destroying America Quoting from Rangel-
Obviously, physicians and lawyers view the world through different prisms. (Well maybe not all lawyers, but likely most trial lawyers). These prisms differ due to a fundamentally different motivation for our professions. Physicians have the patient's well being in mind as a first priority. We "adjudicate" information to try the best known therapy for our patient. We espouse evidence based medicine as our goal. New studies change our practice (the recent data on HRT represents a study which has caused a sea change). We often will consult a colleague if we believe that the colleague can add valuable insights into our patient's care. The job of the trial lawyer is to win the case for his/her client. Some lawyers take cases to change policy. But most cases are chosen for monetary benefit. The underlying principle is to win. There are exceptions to this generalization, however, it is not the lawyer's job to worry about the health care system. He/her will often put the client's interest above the greater good. That is the nature of the lawyer/client relationship and of trial law in this country. I believe that lawyers like John Edwards undermine our medical system. They can ignore data, science and greater good, and they do regularly. They are doing their job - and Edwards does that job well. I admire his skill, but I disdain what his cases do to our health care system. I do not blame him, but I do not want someone with his attitude about the law as my president. We need tort reform, and not just in medicine. With Edwards in power any hopes of reform would vanish. The court system, as used in this country, does not protect the public good. It does not evaluate the scientific evidence as scientists do. We need a change, and since Edwards represents the current sorry state of affairs, he scares me. Posted byAs predicted, we have not heard the last of the Medicare bill Despite New Law, the Fight Over Medicare Continues
Unless we elect a Democratic majority in the House and Senate, I doubt that they will get their wish. I would like to see some slack in negotiating drug prices. It sure works for the VA system. Posted byA plus for the Medicare bill Our legislative process has great flaws. The bills they construct make a camel look normal. Almost any observer can find flaws with any bill. Each bill contains something which makes great sense. Most of you know the expression - there must be a pony in here. Perhaps this is the pony. Rural Doctors Welcome Medicare Overhaul
These provisions have great importance. They are long needed and very welcome. Keep searching, there may be more ponies. Posted byThe Canadian approach to marijuana I agree with this editorial. O Canada, O cannabis The Medicare Bill This is a bill that everyone can (and will) criticize. If you are interested here are some links with selected quotes. 6 Democratic Candidates Attack Medicare Measure
The debate is interesting. The Democratic candidates have sided with Ted Kennedy in attacking the bill. The NY Times (not known as a conservative bastion) has endorsed the bill. AARP (which many consider pro Democrat generally) has endorsed the bill. Everyone dislikes something about this bill. This bill is clearly a compromise. So I leave you with two quotes about compromise:
NY Times endorses Republican Medicare plan Wow! Medicare for the Fiscally Healthy
Well said, and correct logic!!!
NY Times on the health insurance crisis
The NY Times takes the easy road - let big government provide a solution. As usual, those who favor big goverrment show little understanding of the crisis, they just want Congress to solve (put a bandaid on) the problem. Health care costs may or may not be escalating out of proportion. We must relate cost to value. We need to understand where the money goes. Health care costs increase for many reasons. Some costs increase because newer technology makes diagnosis more reliable. More reliable diagnoses allow us to better target therapies. Some costs increase because new medications allow us to improve quality of life or even quantity of life. Some costs increase because patients demand more care. Some costs increase because the cost of doing business increases: government regulations always cost money, malpractice insurance costs, higher salaries for employees (supply and demand for nursing staff). So the question we should ask as a society is what health care we want, and is it worth the money? Should we expect health care expenditures to increase or not? Can we develop more reasonable governmental regulations? Can we control liability costs? Solving the health insurance problem should require a careful analysis of all costs. We should better understand why health care costs increase every year. Unfortunately, I am skeptical that Congress will address this issue intelligently. They rarely show common sense when passing laws which have impact on health care. Why should we expect better now? Posted byThe stalled Medicare bill
Regular readers know that I favor health savings accounts. I would like to see a tighter linkage between the patient and health care cost decisions. While I have written often about this concept, Robert Prather - Insults Unpunished - has written even more often. For a feel for this issue check out - Health Care Costs Yet Again. I believe that the Washington Post has this issue wrong. In the meantime, I do not expect any compromise on these issues. We will go another year with politicians dancing their dance. And our single payor system for the elderly gets more unfair to both patients and physicians. Posted byFat as a political issue Political Debate Looms Over Obesity
Apparently, the obesity lawsuits captured political attention. As a libertarian, I believe that each individual must take responsibility for his/her own actions. Thus, I cannot support suing over obesity. The article seems balanced and presents both sides. Posted byWow!!! Congress considering a logical proposal Back from my beach hiatus, I browse the NY Times quickly and find! Congress Weighs Drug Comparisons
As expected, the pharmaceutical companies oppose this plan. Their rationale is incomprehensible.
Sometimes an idea makes great sense. This idea fits that category. Posted byWashington Post on Medicare
I agree with the Washington Post. I should not receive the same benefit as someone with little retirement income (I assume that my retirement savings will provide a better than average lifestyle). We should help the needy, but getting older does not necessarily imply neediness. Posted byWill we have a Medicare bill? I would guess not. The current bills are huge, technical and significantly different. It appears that House Republicans and Senate Democrats are digging in their heels. Compromise Seen as Harder to Find on Medicare Drugs
I would like to see a good bill. But my limited observation does not suggest that either side has a good bill. I believe that an error of commission would harm us more than an error of omission. We do not need a bad bill. We have enough of those already. Posted byTort reform unlikely I think the Democrats just get too much money from the trial lawyers. Short of Votes, Senate G.O.P. Still Pushes Malpractice Issue
So we have a national problem (admittedly worse in some states than others). We may have no acceptable solution. The politics are bothersome.
Posted by NY Times on prescription drug benefits
Some patients need a prescription drug benefit. We should take into consideration ability to pay. If not, any plan could have major financial implications on Medicare. Posted byPrather on prescription drug benefit Congress continues to work on providing a prescription drug benefit. We all want such a benefit, but many worry that we cannot really afford that benefit. As usual Robert Prather has weighed in - There Ain't No Such Thing As A Free Lunch (TANSTAAFL). Now I know that TANSTAAFL comes from a science fiction book, written by Robert Heinlein. It should become a widely used phrase.
Read his full entry and especially the comments. Prather speaks logically - this means he is unelectable - but I admire his reasoning. Posted byWorldwide AIDS funding approved We have followed this story closely for several months. This link summarizes the final bill - $15 Billion AIDS Plan Wins Final Approval in Congress Posted byThe politics of a Medicare drug benefit Congress and the President are now focusing on a Medicare drug benefit. We should all view this debate cautiously. Pharmaceutical costs have a major impact on the sick. Without a drug benefit, only the wealthy can afford our many medication advances. We all agree that we would like to provide a benefit to all Medicare beneficiaries, however, we also must consider the fiscal viability of any such plan. Herein lies the debate, which the NY Times outlines well - Bush Drug Proposal in Medicare Plan Faces a Stiff Battle.
I personally am conflicted over this issue. Sorting out the pros and cons is, at least for me, dizzying. I do understand both sides of this issue, and can make a strong case either way. I could also attack each position. The cost of prescription benefits will become staggering. How we pay for that benefit will, unfortunately, impact how we pay for the rest of health care. We should follow this debate and watch how the politics unfold. The process makes me uneasy. Posted byMore on Universal Health Care Found this link thanks to Jane Galt - Asymmetrical Information. Premium Blend: Why is it so difficult to provide universal health care?
I hope you read those paragraphs carefully. Shapiro has summarized the dilemma of health care costs beautifully!! He offers a modest solution, but admits that it is unlikely to work. As long as we have no connection between health care costs and personal expenditures, we likely will have no major health care reform. Economists cannot tell us how much health care we need . Rather, as a society we determine how much health care we want . Unfortunately, our desires have no relation to what we would spend. The current system has no balances. Universal health care would not improve that problem, it would only shift the locus of control. One need only look to Canada and Great Britain (amongst many) to understand the types of health care cost decisions made in a single payor system. Our health care insurance system is broken. Perhaps we could look at ways to improve that system, and in some way link behaviors with costs (e.g., smokers and the obese would pay higher insurance) and expenditures with graduated co-pays. Only when each individual starts to understand costs will market forces apply. Without the power of market forces, I suspect that we will be continuing this debate for many years. Posted byRead Jane Galt on Dean's health care proposals Like Jane Galt, I am working through my thoughts on the Democratic health care proposals. In the meantime, read these two posts from her site - HillaryCare, Part II. In this post, she challenges readers
So Jane instead gets an email example which proves her point. Wow. I just got this amazing response to my post on Dean's health care rhetoric: The response is heartwrenching and finishes with this quote
Posted by Sowell on universal health care I have been planning to rant about universal health care. As I have been thinking through this issue, I am attracted to this piece by Thomas Sowell. I will quote liberally, because the link is not permanent! "Universal health care"
While I often have problems with the insurance companies, I do not resent them making a profit. Rather I resent the tactics they use to make those profits.
While I will take issue with some of Sowell's arguments, he generally does understand. Our current system is flawed - a problem which I plan to address later this week. Meanwhile, please share your thoughts on this piece. Posted byGood news in DC House Adopts Global Plan of $15 Billion Against AIDS
Indeed it is!!! Posted by On politics and health care Now it become official. We (the medical blogger community) have been discussing the health care crisis for many months. Today the NY Times declares it so! Health Care Limps Up Political Ladder They (and the Democrats) rarely look at the true underpinnings of this crisis. We need solutions which diagnose the disease, not those which try to treat the symptoms. Posted byOn politics and health care Now it become official. We (the medical blogger community) have been discussing the health care crisis for many months. Today the NY Times declares it so! Health Care Limps Up Political Ladder They (and the Democrats) rarely look at the true underpinnings of this crisis. We need solutions which diagnose the disease, not those which try to treat the symptoms. Posted byThe stupid war - the war on drugs Consistent readers understand that I approach most issues from a libertarian viewpoint. You are entitled to great freedom, but the freedom of your fist ends at my nose. I argue, often without much success, that our war on drugs creates many more problems than it possibly prevents. While I understand the ravages of drugs on our youth and also many adults, the costs of the drug war (not monetary costs, but criminalization of large sectors of society, murders, robbery, etc.) far exceed the costs that would associate with decriminalization. As always, one must choose which costs are worse, costs of omission or costs of commission. We know the costs of the drug war. This commentary does an elegant job of summarizing the problem. The war on drugs
We need rationale in this discussion, but I fear we will only get emotion. Some drugs are deadly, but the drug trade itself is - I believe - more deadly. We need enlightenment here. I doubt that we will get that enlightenment. Posted byMedicare drug benefit - new ideas Medicare Drug Benefit Plan Is Proposed by 2 Democrats. I have previously ranted that we really cannot afford to provide a complete drug benefit for all Medicare aged patients. Finally, some Democrats agree.
This proposal has the advantage of making sense. We should strive to help those who clearly need governmental help. A $4,000 deductible makes more sense for those with adequate incomes. Posted byMoynihan This blog will remain 99% medicine. However, I must comment on Daniel Patrick Moynihan. I generally vote Republican. My political philosophy is best described as Libertarian domestically and neo-conservative internationally. (see Robert Prather to better understand this - Neocons Vs. Paleocons. Regardless of ones political inclinations, Daniel Patrick Moynihan should represent the ideal in politics. He based his stands on principle and intelligence. Even when one disagreed with him, one had to reconsider ones own position, because he was so damn smart. Read this outstanding tribute from George Will - A Beautiful Mind. Oh, but that we could have the Congress full of his like! Posted byMedicare relief - for this year Now official, we will receive a slight increase for each patient visit in 2003. Physicians win Medicare payment relief: With an increase secured for 2003, the AMA will focus on preventing a cut next year.
So this story will continue, but today's chapter has a decent ending. Posted by |