Comments on: Contact Us http://madashelldoctors.com Where the rubber gloves meet the road. Thu, 02 Feb 2012 23:14:51 +0000 http://wordpress.org/?v=2.9.1 hourly 1 By: Samuel Metz MD http://madashelldoctors.com/contact-us/comment-page-1/#comment-11499 Samuel Metz MD Sat, 24 Dec 2011 20:43:22 +0000 http://madashelldoctors.com/?page_id=413#comment-11499 Dear Sir from LaGrande, The Vermont Workers Center meetings were advertised in the Baker City Herald and LaGrande Observer to encourage attendance from the communities and to generate questions, both hard and otherwise. Had you attended, your questions may have been answered. Would you like to add your name to our mailing list so you won’t miss our next appearance? Your point about private clinic expenses is well taken. Perhaps the largest expense in any primary care clinic is the cost of collecting money from private insurance companies, roughly $80,000 per year per physician. Private insurance companies deny 30% of all first claims, and those of us who have run our own practice know that these claims are being denied not because we are trying to defraud the insurance company but because insurance companies stay in business by denying valid claims. With a single payer system, this administrative cost is converted to health care. Medicare costs are increasing. So are health care costs around the world. Medicare attempts to protect access to health care for seniors by considering new delivery and payment mechanisms. Private insurance companies compensate by raising premiums, cutting benefits, increasing co-pays and deductibles, excluding patients who need care, dropping healthy patients who get sick, denying payment to providers, and generally providing less care to fewer patients.. Neither is attractive, but Medicare is the better bargain. You are correct that not-for-profit private insurance companies are no less piratical than for-profits. Both generate a 40% loss of premium dollars to administration, roughly ten times that of Medicare and twenty times that of more efficient single payer systems. We need to eliminate all private insurance companies, for-profit or not, as the parasitical intermediaries between patients and physicians. We absolutely agree that familiarity with the strange and twisted economics of American health care is essential to understanding any reform proposal. Any seemingly simple and easy "solution" should be received with skepticism. Fortunately, single payer systems have demonstrated their ability to provide better care to more people for less money ever since the concept was invented in America eighty years ago. Single payer systems provide care to our armed forces, our veterans, and 26 million other Americans who get care via multi-employer health plans. Single payer financing is the American solution to America's health care problems. Samuel Metz MD Dear Sir from LaGrande,

The Vermont Workers Center meetings were advertised in the Baker City Herald and LaGrande Observer to encourage attendance from the communities and to generate questions, both hard and otherwise. Had you attended, your questions may have been answered. Would you like to add your name to our mailing list so you won’t miss our next appearance?

Your point about private clinic expenses is well taken. Perhaps the largest expense in any primary care clinic is the cost of collecting money from private insurance companies, roughly $80,000 per year per physician. Private insurance companies deny 30% of all first claims, and those of us who have run our own practice know that these claims are being denied not because we are trying to defraud the insurance company but because insurance companies stay in business by denying valid claims. With a single payer system, this administrative cost is converted to health care.

Medicare costs are increasing. So are health care costs around the world. Medicare attempts to protect access to health care for seniors by considering new delivery and payment mechanisms. Private insurance companies compensate by raising premiums, cutting benefits, increasing co-pays and deductibles, excluding patients who need care, dropping healthy patients who get sick, denying payment to providers, and generally providing less care to fewer patients.. Neither is attractive, but Medicare is the better bargain.

You are correct that not-for-profit private insurance companies are no less piratical than for-profits. Both generate a 40% loss of premium dollars to administration, roughly ten times that of Medicare and twenty times that of more efficient single payer systems. We need to eliminate all private insurance companies, for-profit or not, as the parasitical intermediaries between patients and physicians.

We absolutely agree that familiarity with the strange and twisted economics of American health care is essential to understanding any reform proposal. Any seemingly simple and easy “solution” should be received with skepticism. Fortunately, single payer systems have demonstrated their ability to provide better care to more people for less money ever since the concept was invented in America eighty years ago. Single payer systems provide care to our armed forces, our veterans, and 26 million other Americans who get care via multi-employer health plans.

Single payer financing is the American solution to America’s health care problems.

Samuel Metz MD

]]> By: Michael HuntingtonMD http://madashelldoctors.com/contact-us/comment-page-1/#comment-11498 Michael HuntingtonMD Sat, 24 Dec 2011 20:39:26 +0000 http://madashelldoctors.com/?page_id=413#comment-11498 Dear Rich from LaGrande, Thanks for your comment. For your one letter there are probably hundreds of people who feel the same way. The over-riding motivation for our two tours this year was to make sure Oregonians recognize that the US health care system (really a sick-care non-system) is causing unnecessary severe suffering here and around the nation and is collapsing under its own weight. We think there are ways to reverse this tragedy. First we must decide as a society that it’s in our best interests to keep each one of us as healthy as possible, that health care is a human right and public good, and from those concepts enact laws that do include everyone and control costs. All this would seem beyond achievable except that twenty two other nations have done it. True, they all face financial and ethical struggles, but they have figured out how to provide health care for all their people at about half the US cost per-capita, while our extravagant spending provides adequate care for only about half of our population. The medical bills you mention are way too high for a variety of reasons that are correctible. We currently finance our health care system by making sure we do lots of medical procedures at the highest reimbursement rate we can get by with. We depend on inflated reimbursements from CTs, MRIs, surgeries, and drugs to bring in enough revenue to keep our hospitals and clinics open, support the costs of those who cannot pay, and create generous to massive incomes for segments of our health care industry. The people who can’t pay for their care are you and me except that they have been excluded from healthcare because of cost and pre-existing conditions. It would be as though we financed our fire department by underfunding the fire-prevention unit and allowing other conditions that cause houses to catch fire. Then we would respond to calls from owners of the burning houses, ask the owner if he/she had paid the fire protection premium that month, if not, allow the fire to continue until serious damage had occurred, then expend much manpower, equipment, and water to douse the flaming ruins, then charge the owner thousands of dollars. The RVU system you mentioned is at the center of this dysfunctional health care “fire department”. The AMA owns the CPT coding system and makes $ millions on royalties from it. The secretive RUC Committee of the AMA is the determiner of RVU rates and is 85% specialist in membership. Procedures are rewarded “as the market will bear”. But of course this is not a free market; the providers control price and the demand. Primary Care is left behind and gets far less reimbursement for counseling patients in ways that would prevent illness and cost. Then of course our health care (non)-system pays for many unnecessary middlemen. Private health insurance is an investment business only tangentially related to health care. The motivation in this industry is to minimize costs so profits will be high. Therefore the people who might get sick are systematically excluded from coverage. Removal of this parasitic industry from health care would remove about 15% of the current costs. But it all gets back to what we want a health care system to do. If we want it to be an income stream for as many people as the system can fund, we will continue on our present course until the system collapses. If we view health care as a human right, a public good like fire and police protection and public education, water safety, road safety, we will all benefit as part of a much healthier society. Michael Huntington MD Dear Rich from LaGrande,

Thanks for your comment. For your one letter there are probably hundreds of people who feel the same way.

The over-riding motivation for our two tours this year was to make sure Oregonians recognize that the US health care system (really a sick-care non-system) is causing unnecessary severe suffering here and around the nation and is collapsing under its own weight. We think there are ways to reverse this tragedy. First we must decide as a society that it’s in our best interests to keep each one of us as healthy as possible, that health care is a human right and public good, and from those concepts enact laws that do include everyone and control costs. All this would seem beyond achievable except that twenty two other nations have done it. True, they all face financial and ethical struggles, but they have figured out how to provide health care for all their people at about half the US cost per-capita, while our extravagant spending provides adequate care for only about half of our population.

The medical bills you mention are way too high for a variety of reasons that are correctible. We currently finance our health care system by making sure we do lots of medical procedures at the highest reimbursement rate we can get by with. We depend on inflated reimbursements from CTs, MRIs, surgeries, and drugs to bring in enough revenue to keep our hospitals and clinics open, support the costs of those who cannot pay, and create generous to massive incomes for segments of our health care industry. The people who can’t pay for their care are you and me except that they have been excluded from healthcare because of cost and pre-existing conditions.

It would be as though we financed our fire department by underfunding the fire-prevention unit and allowing other conditions that cause houses to catch fire. Then we would respond to calls from owners of the burning houses, ask the owner if he/she had paid the fire protection premium that month, if not, allow the fire to continue until serious damage had occurred, then expend much manpower, equipment, and water to douse the flaming ruins, then charge the owner thousands of dollars.

The RVU system you mentioned is at the center of this dysfunctional health care “fire department”. The AMA owns the CPT coding system and makes $ millions on royalties from it. The secretive RUC Committee of the AMA is the determiner of RVU rates and is 85% specialist in membership. Procedures are rewarded “as the market will bear”. But of course this is not a free market; the providers control price and the demand. Primary Care is left behind and gets far less reimbursement for counseling patients in ways that would prevent illness and cost.

Then of course our health care (non)-system pays for many unnecessary middlemen. Private health insurance is an investment business only tangentially related to health care. The motivation in this industry is to minimize costs so profits will be high. Therefore the people who might get sick are systematically excluded from coverage. Removal of this parasitic industry from health care would remove about 15% of the current costs.

But it all gets back to what we want a health care system to do. If we want it to be an income stream for as many people as the system can fund, we will continue on our present course until the system collapses. If we view health care as a human right, a public good like fire and police protection and public education, water safety, road safety, we will all benefit as part of a much healthier society.

Michael Huntington MD

]]> By: Rich, former CMPE http://madashelldoctors.com/contact-us/comment-page-1/#comment-11124 Rich, former CMPE Tue, 20 Dec 2011 05:09:44 +0000 http://madashelldoctors.com/?page_id=413#comment-11124 Saw y'all were in Baker City Last week, never had any heads up. Maybe you didn't want anyone asking the hard questions again. Was there anyone present who has had to pay the bills in a healthcare organization and keep it running financially? Clinics don't run on rainbows and sunshine, after all. Have you ever figured out what the RVU rate would be in your proposed system? I asked last April in La Grande, never got an answer. Our Medicare taxes don't seem to be keeping solvent. I just watched a bunch of tripe online from MAHD, and the bottom line is "profits are bad". Looking to my left and right, the "non-profits" always had the highest paid folks, as they could roll that payroll into expenses, and buff up their reimbursement rates from government payers. MAHD Docs: do medicine, and come to the table to discuss reality when you get some economics ed....MHO Saw y’all were in Baker City Last week, never had any heads up. Maybe you didn’t want anyone asking the hard questions again. Was there anyone present who has had to pay the bills in a healthcare organization and keep it running financially? Clinics don’t run on rainbows and sunshine, after all. Have you ever figured out what the RVU rate would be in your proposed system? I asked last April in La Grande, never got an answer. Our Medicare taxes don’t seem to be keeping solvent. I just watched a bunch of tripe online from MAHD, and the bottom line is “profits are bad”. Looking to my left and right, the “non-profits” always had the highest paid folks, as they could roll that payroll into expenses, and buff up their reimbursement rates from government payers. MAHD Docs: do medicine, and come to the table to discuss reality when you get some economics ed….MHO

]]> By: Pat Griffin http://madashelldoctors.com/contact-us/comment-page-1/#comment-9127 Pat Griffin Wed, 02 Nov 2011 20:14:18 +0000 http://madashelldoctors.com/?page_id=413#comment-9127 Dear Health Professionals, Thank you for caring about (& working toward), a single payer plan! Can you give me a name of a good general practitioner or internal medicine doctor who accepts Medicare? My husband & I have a secondary insurance policy with Blue Shield/Cross, but are having a difficult time a doctor here in Portland. Pat Dear Health Professionals,

Thank you for caring about (& working toward), a single payer plan!

Can you give me a name of a good general practitioner or internal medicine doctor who accepts Medicare? My husband & I have a secondary insurance policy with Blue Shield/Cross, but are having a difficult time a doctor here in Portland. Pat

]]> By: Thomas Cox PhD RN http://madashelldoctors.com/contact-us/comment-page-1/#comment-8967 Thomas Cox PhD RN Thu, 27 Oct 2011 22:33:45 +0000 http://madashelldoctors.com/?page_id=413#comment-8967 In the summary for H.R.676 it says: "The Improved Medicare For All program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment..." It is clear from this that these folks do not understand risk, risk management through insurance, how insurance products are priced, how insurers manage claims, and the solvency requirements of legitimate, appropriately capitalized health insurers. I expect this from Republicans and conservatives, I certainly expect no more from Tea Party members, but it is really disappointing to see Democrats and liberals screw this up. As it turns out, after close to a decade doing insurance and reinsurance rate making, reserving, and expense reporting I think I have a glimmer about this stuff. Doesn't hurt that I am a psych social worker, psych nurse, mathematician, and statistician. The bottom line is that it does not matter how large the entity collecting premiums is - it matters who is actually managing the risks. If a legitimate national health insurer manages the insurance risks for the entire population, the risk management system will be the most efficient it can be. But, if the "National Health Insurer: functions like a managed care organization, collecting premiums, and transferring the insurance risk management role to physicians, nurse practitioners, hospitals, long term care facilities, and home health agencies, as the Prospective Payment Systems do and as the summary suggests 676 would extend, you will not alter the single most inefficient aspect of our current health care finance system: The inefficiencies introduced when health care providers serve as small, incredibly inefficient insurers for their patients. There is absolutely no advantage to have a "single payment receiver system" when the barriers to effective and efficient risk management remain unchanged or increase. I actually work on this a good deal - here are some recent publications: Cox, T. (2011). Standard Errors: Statistical Consequences of Health Care Provider Insurance Risk Assumption. In JSM Proceedings, Section on Health Policy Statistics. Alexandria, VA: American Statistical Association. In press. Cox, T. (2011). The Impact of Size on Success of Health Insurance Companies. Nurse Leader, 9(5): 38-41. Cox, T. (2011). Exposing the true risks of capitation financed healthcare. Journal of Healthcare Risk Management, 30: 34–41. Cox, T. (2010). Legal and Ethical Implications of Health Care Provider Insurance Risk Assumption. JONA’S Healthcare Law, Ethics, and Regulation, 12(4): 106-116. and I am putting together a series of Working Papers on risk, risk management through insurance, and health care reform. If, like me, you think that health care rationing is best done dispassionately and at a great distance from the face to face interactions between caregivers and patients, please do NOT support H.R. 676! What we need is a real national health insurer that achieves dramatic cost reductions through efficient risk management and appropriate utilization review. We do not need to continue compelling health care providers to slash patient benefits in order to remain solvent. In the summary for H.R.676 it says:

“The Improved Medicare For All program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment…”

It is clear from this that these folks do not understand risk, risk management through insurance, how insurance products are priced, how insurers manage claims, and the solvency requirements of legitimate, appropriately capitalized health insurers.

I expect this from Republicans and conservatives, I certainly expect no more from Tea Party members, but it is really disappointing to see Democrats and liberals screw this up.

As it turns out, after close to a decade doing insurance and reinsurance rate making, reserving, and expense reporting I think I have a glimmer about this stuff. Doesn’t hurt that I am a psych social worker, psych nurse, mathematician, and statistician.

The bottom line is that it does not matter how large the entity collecting premiums is – it matters who is actually managing the risks. If a legitimate national health insurer manages the insurance risks for the entire population, the risk management system will be the most efficient it can be.

But, if the “National Health Insurer: functions like a managed care organization, collecting premiums, and transferring the insurance risk management role to physicians, nurse practitioners, hospitals, long term care facilities, and home health agencies, as the Prospective Payment Systems do and as the summary suggests 676 would extend, you will not alter the single most inefficient aspect of our current health care finance system: The inefficiencies introduced when health care providers serve as small, incredibly inefficient insurers for their patients.

There is absolutely no advantage to have a “single payment receiver system” when the barriers to effective and efficient risk management remain unchanged or increase.

I actually work on this a good deal – here are some recent publications:

Cox, T. (2011). Standard Errors: Statistical Consequences of Health Care Provider Insurance Risk Assumption. In JSM Proceedings, Section on Health Policy Statistics. Alexandria, VA: American Statistical Association. In press.

Cox, T. (2011). The Impact of Size on Success of Health Insurance Companies. Nurse Leader, 9(5): 38-41.

Cox, T. (2011). Exposing the true risks of capitation financed healthcare. Journal of Healthcare Risk Management, 30: 34–41.

Cox, T. (2010). Legal and Ethical Implications of Health Care Provider Insurance Risk Assumption. JONA’S Healthcare Law, Ethics, and Regulation, 12(4): 106-116.

and I am putting together a series of Working Papers on risk, risk management through insurance, and health care reform.

If, like me, you think that health care rationing is best done dispassionately and at a great distance from the face to face interactions between caregivers and patients, please do NOT support H.R. 676!

What we need is a real national health insurer that achieves dramatic cost reductions through efficient risk management and appropriate utilization review. We do not need to continue compelling health care providers to slash patient benefits in order to remain solvent.

]]> By: TerryFlowers http://madashelldoctors.com/contact-us/comment-page-1/#comment-8614 TerryFlowers Fri, 14 Oct 2011 00:54:36 +0000 http://madashelldoctors.com/?page_id=413#comment-8614 https://wwws.whitehouse.gov/petitions#!/petition/replace-affordable-care-act-hr-676/GzrHpdWW Better than a public option is H.R. 676. This would reduce our nations overall healthcare costs AND provide healthcare for every man, woman and child...no exceptions...from the womb to the tomb. We need to eliminate the profit motive from the financing of healthcare. The public option would not do that. H.R. 676 would. Please log in and sign the petiition to Replace the Affordable Care Act with H.R. 676 https://wwws.whitehouse.gov/petitions#!/petition/replace-affordable-care-act-hr-676/GzrHpdWW

Better than a public option is H.R. 676. This would reduce our nations overall healthcare costs AND provide healthcare for every man, woman and child…no exceptions…from the womb to the tomb. We need to eliminate the profit motive from the financing of healthcare. The public option would not do that. H.R. 676 would. Please log in and sign the petiition to Replace the Affordable Care Act with H.R. 676

]]> By: bigbrotherbooter@comcast.net http://madashelldoctors.com/contact-us/comment-page-1/#comment-8486 bigbrotherbooter@comcast.net Sat, 08 Oct 2011 18:08:05 +0000 http://madashelldoctors.com/?page_id=413#comment-8486 I just created a petition on the whitehouse petition site to support and make into law the public option, that was removed from the recently passed healthcare bill. We need a whole bunch of signatures so we can create support for a public option. here is the link http://wh.gov/28R . Idealy it would be nice if we all picked a day were we can all sign the petition and get on www.congress.org to write our congressman and senators on the same day. Kind of a virtual march on washington. Just an idea. I just created a petition on the whitehouse petition site to support and make into law the public option, that was removed from the recently passed healthcare bill. We need a whole bunch of signatures so we can create support for a public option. here is the link http://wh.gov/28R . Idealy it would be nice if we all picked a day were we can all sign the petition and get on http://www.congress.org to write our congressman and senators on the same day. Kind of a virtual march on washington. Just an idea.

]]> By: admin http://madashelldoctors.com/contact-us/comment-page-1/#comment-8466 admin Sat, 08 Oct 2011 00:10:32 +0000 http://madashelldoctors.com/?page_id=413#comment-8466 Dr. Metz responds to Mr. Brazier, Thank you for listening critically to the NPR broadcast, “To the Point,” on October 3rd and specifically to my comments. I will do my best to respond. Data demonstrating our public health ranks near or at the bottom of industrialized countries come from multiple sources. They all concur regarding our dismal results. The sources (and links I found most useful) are listed below [1-6]. Correcting our health care statistics for smoking, obesity, traffic fatalities, race, and homicides makes no perceptible difference in our relative ranking [7]. Some of the criteria stand on their own without requiring correction for equally sick patients with comparable diseases. These include maternal mortality, foot amputations per 100,000 diabetics, and lives lost to treatable diseases. The clinical efficacy aspect to which you refer compares clinical outcomes for patients receiving treatment. This presumes citizens receive treatment. This is mostly true in other industrialized nations but unfortunately not in the US. A participant on the broadcast, Dr. Schoen, is co-author on one article documenting compromised access to health care in the US [8,9]. Compromised access, not provider ineptitude, is the principal factor responsible for our poor health [10,11]. Once Americans get through the door of a hospital or physician’s office, their care compares well to other countries. Unfortunately only relatively wealthy Americans have sufficient money to get through those doors. The 44% of Americans who do not receive health care in a timely manner or, in some cases, at all, make our overall statistics poor [9]. Some statistics show longer survival rates in the US for certain kinds of cancer. These conflict with other statistics, confounding the claim [12]. Additionally, similar mortality rates for these cancers suggest differences (if any) are attributable to earlier diagnosis rather than longer life expectancy [13,14]. You are correct that differences in the definition of “live birth” affects statistics on infant mortality and life expectancy at birth. Here is a statement from the OECD (italics in the original): “Some of the international variation in infant mortality rates is due to variations in registering practices of premature infants (whether they are reported as live births or not). In the United States, Canada and the Nordic countries, very premature babies (with relatively low odds of survival) are registered as live births, which increases mortality rates compared with other countries that do not register them as live births.” [15] Correcting for this different definition does not improve our rank. “The United States has … the highest infant mortality rate among the eight countries that report this metric similarly.” (Canada, Denmark, Finland, Iceland, Japan, Norway, Sweden, and the United States [16,17]). This is presented in a graph with data from the CIA, reference [17] Some contend American neonatologists make humanitarian (and usually futile) efforts to save premature or underweight neonates, efforts not made in other countries. If so, we expect a lower life expectancy at birth than these other countries. This is true. However, after these desperately ill neonates die young, we expect a rise in comparative life expectancy at ages five years and above. We do not see this. The relative life expectancy ranking of the US compared to other countries does not change at any age (until age 65, suggesting an effect of Medicare on health care access). This is presented in graph form at following reference: [18] You are not alone in suggesting our health care must be better than statistics indicate. Many Congressional leaders make similar statements [19-26]. As these members of Congress are in the top 10% income bracket, it is unlikely they have encountered the access failures plaguing Americans in lower income brackets. They also have political agendas served by publicizing their unsubstantiated beliefs. If you have additional studies that should be included, as your last paragraph suggests, please share the citations and I will include them in future discussions. References 1. Organization for Economic Cooperation and Development (OECD) www.oecd.org/health/healthataglance www.oecd.org/document/16/0,3746,en_2649_37407_2085200_1_1_1_37407,00.html www.oecd.org/health/healthdata www.oecd.org/health/healthataglance www.oecd.org/document/11/0,3343,en_2649_33929_16502667_1_1_1_1,00.html 2. Preker AS. The introduction of universal access to health care in the OECD: lessons for developing countries. In: Achieving Universal Coverage of Health Care. Nitagyarumphong ES, Mills A (editors). Ministry of public health, Bangkok, 1998, p.103 3. The Central Intelligence Agency (CIA). The World Factbook. www.cia.gov/library/publications/the-world-factbook 4. The World Health Organization (WHO) Selected indicators of health expenditure ratios, 1999–2003.World Health Report 2006. www.who.int/whr/2006/annex/06_annex2_en.pdf. www.who.int/whr/2006/annex/06_annex2_en.pdf www.who.int/research/en www.who.int/whr/2000/annex/en/index.html www.who.int/whr/2000/en/annex01_en.pdf www.who.int/whr/000en/report.htm 5. The Commonwealth Fund www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf www.globalhealthfacts.org/bytopic.jsp www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf Nolte E, McKee CM.. Measuring the health of nations: updating an earlier analysis. Health Affairs, Jan/Feb 2008, p. 71 Schoen C, Davis K, How SKH, Schoenbaum SC. US health system performance: A national scorecard. Health Affairs Web exclusive, November/December 2006; 25(6): w457-w475, 6. The Kaiser Family Foundation www.globalhealthfacts.org/bytopic.jsp 7. Muennig PA, Sherry A. Glied SA. What changes in survival rates tell us about US health care. Health Affairs 2010;29, no.11:2105-2113. doi: 10.1377/hlthaff.2010.0073 8. Schoen C, Doty MM, Robertson RH, Collins SR. Affordable Care Act reforms could reduce the number of underinsured US adults by 70 percent. Health Affairs, 2011;30, no.9:1762-1771. http://www.latimes.com/health/la-fi-health-insurance-20110908,0,343767.story 9. Consumer Reports Health Insurance Survey Reveals 1 in 4 People Insured But Not Adequately Covered, ConsumerReports.org, September 2007. September 12, 2007, www.consumerreports.org/cro/cu-press-room/pressroom/archive/2007/09/0709_eng0709ins.htm. 10. www.oecd.org/document/11/0,3343,en_2649_33929_16502667_1_1_1_1,00.html 11. Mark Pearson, Head Health Division, OECD, Written statement to Senate Special Committee on Aging, 30 September 2009. Disparities in health expenditures across OECD countries: Why does the United States spend so much more than other countries? www.oecdwash.org/PDFILES/Pearson_Testimony_30Sept2009.pdf 12. Paul Krugman. Cancer Survival. New York Times, March 24, 2011. krugman.blogs.nytimes.com/2011/03/24/cancer-survival 13. Aaron Carroll. Senator Johnson’s odd dislike of the PPACA. The Incidental Economist. March 23, 2011 theincidentaleconomist.com/wordpress/senator-johnsons-odd-dislike-of-the-ppaca 14. Aaron Carroll. Survival rates are not the same as mortality rates. The Incidental Economist August 31, 2010. theincidentaleconomist.com/wordpress/survival-rates-are-not-the-same-as-mortality-rates 15. OECD Health Data 2005. www.oecd.org/dataoecd/15/23/34970246.pdf 16. www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html 17. Congressional Research Service, Peterson CL, Burton, R. U.S. Health Care Spending: Comparison with Other OECD Countries. 9-17-2007 18. WHO, World Bank, UNESCO, CIA, individual country databases from 2008. www.worldlifeexpectancy.com 19. http://online.wsj.com/article/SB10001424052748704662604576202203050970010.html “We need to recognize that the finest health-care system in the world is at risk—and repeal ObamaCare before it's too late.” Sen. Ron Johnson (R-Wisc) 20. http://www.washingtonpost.com/wp-dyn/content/article/2010/02/25/AR2010022504325.html “I do believe we have the best health care system in the world.” Sen. John Barrasso (R-Wyo) 21. http://www.nytimes.com/2009/11/05/opinion/05kristof.html Sen. Richard Shelby (R-Ala). President Obama’s plans amount to “the first step in destroying the best health care system the world has ever known.” 22. http://www.mdmagazine.com/forum/general-medicine/45 Sen. Rand Paul (R-Ky) “The debate should start by acknowledging that we have the greatest health care in the world, and that 100% of people in the country have 100% access to emergency care. Those things are sort of lost on people when they talk about the uninsured. Everybody in our country can receive medical care.” 23. http://www.foxnews.com/politics/2009/07/21/gop-senator-steps-war-words-obama-health-care-reform/ Senate Minority Leader Mitch McConnell (R-Ky), "We do start with the notion, however, that we have the best health care in the world," 24. http://www.issues2000.org/2008/John_McCain_Health_Care.htm Sen. John McCain (R-Ariz) “The real question is: How are we going to keep health care costs down, because we have the highest quality of health care in the world in America today?” 25. http://www.ontheissues.org/2008/Fred_Thompson_Health_Care.htm former Senator Fred Thompson (R-Tenn) “Americans have the best healthcare in the world.” 26. http://www.minnpost.com/politicalagenda/2009/08/31/11231/rep_bachmann_thinks_us_health-care_system_is_best_in_the_world_but_the_statistics_say_otherwise Rep. Michele Bachmann (R-Minn) "Let's not destroy the greatest health care system the world has ever known." Dr. Metz responds to Mr. Brazier,

Thank you for listening critically to the NPR broadcast, “To the Point,” on October 3rd and specifically to my comments. I will do my best to respond.

Data demonstrating our public health ranks near or at the bottom of industrialized countries come from multiple sources. They all concur regarding our dismal results. The sources (and links I found most useful) are listed below [1-6].

Correcting our health care statistics for smoking, obesity, traffic fatalities, race, and homicides makes no perceptible difference in our relative ranking [7].

Some of the criteria stand on their own without requiring correction for equally sick patients with comparable diseases. These include maternal mortality, foot amputations per 100,000 diabetics, and lives lost to treatable diseases.

The clinical efficacy aspect to which you refer compares clinical outcomes for patients receiving treatment. This presumes citizens receive treatment. This is mostly true in other industrialized nations but unfortunately not in the US. A participant on the broadcast, Dr. Schoen, is co-author on one article documenting compromised access to health care in the US [8,9].

Compromised access, not provider ineptitude, is the principal factor responsible for our poor health [10,11]. Once Americans get through the door of a hospital or physician’s office, their care compares well to other countries. Unfortunately only relatively wealthy Americans have sufficient money to get through those doors. The 44% of Americans who do not receive health care in a timely manner or, in some cases, at all, make our overall statistics poor [9].

Some statistics show longer survival rates in the US for certain kinds of cancer. These conflict with other statistics, confounding the claim [12]. Additionally, similar mortality rates for these cancers suggest differences (if any) are attributable to earlier diagnosis rather than longer life expectancy [13,14].

You are correct that differences in the definition of “live birth” affects statistics on infant mortality and life expectancy at birth. Here is a statement from the OECD (italics in the original):

“Some of the international variation in infant mortality rates is due to variations in registering practices of premature infants (whether they are reported as live births or not). In the United States, Canada and the Nordic countries, very premature babies (with relatively low odds of survival) are registered as live births, which increases mortality rates compared with other countries that do not register them as live births.” [15]

Correcting for this different definition does not improve our rank. “The United States has … the highest infant mortality rate among the eight countries that report this metric similarly.” (Canada, Denmark, Finland, Iceland, Japan, Norway, Sweden, and the United States [16,17]).

This is presented in a graph with data from the CIA, reference [17]

Some contend American neonatologists make humanitarian (and usually futile) efforts to save premature or underweight neonates, efforts not made in other countries. If so, we expect a lower life expectancy at birth than these other countries. This is true. However, after these desperately ill neonates die young, we expect a rise in comparative life expectancy at ages five years and above. We do not see this. The relative life expectancy ranking of the US compared to other countries does not change at any age (until age 65, suggesting an effect of Medicare on health care access).

This is presented in graph form at following reference: [18]

You are not alone in suggesting our health care must be better than statistics indicate. Many Congressional leaders make similar statements [19-26]. As these members of Congress are in the top 10% income bracket, it is unlikely they have encountered the access failures plaguing Americans in lower income brackets. They also have political agendas served by publicizing their unsubstantiated beliefs.

If you have additional studies that should be included, as your last paragraph suggests, please share the citations and I will include them in future discussions.

References

1. Organization for Economic Cooperation and Development (OECD) http://www.oecd.org/health/healthataglance http://www.oecd.org/document/16/0,3746,en_2649_37407_2085200_1_1_1_37407,00.html http://www.oecd.org/health/healthdata http://www.oecd.org/health/healthataglance http://www.oecd.org/document/11/0,3343,en_2649_33929_16502667_1_1_1_1,00.html

2. Preker AS. The introduction of universal access to health care in the OECD: lessons for developing countries. In: Achieving Universal Coverage of Health Care. Nitagyarumphong ES, Mills A (editors). Ministry of public health, Bangkok, 1998, p.103

3. The Central Intelligence Agency (CIA). The World Factbook. http://www.cia.gov/library/publications/the-world-factbook

4. The World Health Organization (WHO)

Selected indicators of health expenditure ratios, 1999–2003.World Health Report 2006. http://www.who.int/whr/2006/annex/06_annex2_en.pdf. http://www.who.int/whr/2006/annex/06_annex2_en.pdf http://www.who.int/research/en http://www.who.int/whr/2000/annex/en/index.html http://www.who.int/whr/2000/en/annex01_en.pdf http://www.who.int/whr/000en/report.htm

5. The Commonwealth Fund http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf http://www.globalhealthfacts.org/bytopic.jsp http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf

Nolte E, McKee CM.. Measuring the health of nations: updating an earlier analysis. Health Affairs, Jan/Feb 2008, p. 71

Schoen C, Davis K, How SKH, Schoenbaum SC. US health system performance: A national scorecard. Health Affairs Web exclusive, November/December 2006; 25(6): w457-w475,

6. The Kaiser Family Foundation http://www.globalhealthfacts.org/bytopic.jsp

7. Muennig PA, Sherry A. Glied SA. What changes in survival rates tell us about US health care. Health Affairs 2010;29, no.11:2105-2113. doi: 10.1377/hlthaff.2010.0073

8. Schoen C, Doty MM, Robertson RH, Collins SR. Affordable Care Act reforms could reduce the number of underinsured US adults by 70 percent. Health Affairs, 2011;30, no.9:1762-1771. http://www.latimes.com/health/la-fi-health-insurance-20110908,0,343767.story

9. Consumer Reports Health Insurance Survey Reveals 1 in 4 People Insured But Not Adequately Covered, ConsumerReports.org, September 2007. September 12, 2007, http://www.consumerreports.org/cro/cu-press-room/pressroom/archive/2007/09/0709_eng0709ins.htm.

10. http://www.oecd.org/document/11/0,3343,en_2649_33929_16502667_1_1_1_1,00.html

11. Mark Pearson, Head Health Division, OECD, Written statement to Senate Special Committee on Aging, 30 September 2009. Disparities in health expenditures across OECD countries: Why does the United States spend so much more than other countries? http://www.oecdwash.org/PDFILES/Pearson_Testimony_30Sept2009.pdf

12. Paul Krugman. Cancer Survival. New York Times, March 24, 2011. krugman.blogs.nytimes.com/2011/03/24/cancer-survival

13. Aaron Carroll. Senator Johnson’s odd dislike of the PPACA. The Incidental Economist. March 23, 2011

theincidentaleconomist.com/wordpress/senator-johnsons-odd-dislike-of-the-ppaca

14. Aaron Carroll. Survival rates are not the same as mortality rates. The Incidental Economist August 31, 2010. theincidentaleconomist.com/wordpress/survival-rates-are-not-the-same-as-mortality-rates

15. OECD Health Data 2005. http://www.oecd.org/dataoecd/15/23/34970246.pdf

16. http://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

17. Congressional Research Service, Peterson CL, Burton, R. U.S. Health Care Spending: Comparison with Other OECD Countries. 9-17-2007

18. WHO, World Bank, UNESCO, CIA, individual country databases from 2008. http://www.worldlifeexpectancy.com

19. http://online.wsj.com/article/SB10001424052748704662604576202203050970010.html

“We need to recognize that the finest health-care system in the world is at risk—and repeal ObamaCare before it’s too late.” Sen. Ron Johnson (R-Wisc)

20. http://www.washingtonpost.com/wp-dyn/content/article/2010/02/25/AR2010022504325.html

“I do believe we have the best health care system in the world.” Sen. John Barrasso (R-Wyo)

21. http://www.nytimes.com/2009/11/05/opinion/05kristof.html

Sen. Richard Shelby (R-Ala). President Obama’s plans amount to “the first step in destroying the best health care system the world has ever known.”

22. http://www.mdmagazine.com/forum/general-medicine/45

Sen. Rand Paul (R-Ky) “The debate should start by acknowledging that we have the greatest health care in the world, and that 100% of people in the country have 100% access to emergency care. Those things are sort of lost on people when they talk about the uninsured. Everybody in our country can receive medical care.”

23. http://www.foxnews.com/politics/2009/07/21/gop-senator-steps-war-words-obama-health-care-reform/

Senate Minority Leader Mitch McConnell (R-Ky), “We do start with the notion, however, that we have the best health care in the world,”

24. http://www.issues2000.org/2008/John_McCain_Health_Care.htm

Sen. John McCain (R-Ariz) “The real question is: How are we going to keep health care costs down, because we have the highest quality of health care in the world in America today?”

25. http://www.ontheissues.org/2008/Fred_Thompson_Health_Care.htm

former Senator Fred Thompson (R-Tenn) “Americans have the best healthcare in the world.”

26. http://www.minnpost.com/politicalagenda/2009/08/31/11231/rep_bachmann_thinks_us_health-care_system_is_best_in_the_world_but_the_statistics_say_otherwise

Rep. Michele Bachmann (R-Minn) “Let’s not destroy the greatest health care system the world has ever known.”

]]> By: Jay Brazier http://madashelldoctors.com/contact-us/comment-page-1/#comment-8390 Jay Brazier Tue, 04 Oct 2011 03:01:45 +0000 http://madashelldoctors.com/?page_id=413#comment-8390 Greetings Dr. Metz: I listened with interest to your commentary on "To The Point This Morning." I was particularly intrigued by your claim that the health system in every country achieves better outcomes at lower costs than the system in the US. Is this based on studies that directly compare the costs and clinical efficacy of treating equally sick people with specific diseases? E.g. international comparisons of clinical efficacy. If so - please share them here on your site. If it is not based on studies that directly compare how effectively doctors and hospitals treat patients, then please share the data that you have based these claims upon. ' Life expectancy and infant mortality statistics, while commonly cited in support of such claims, are confounded by real factors (murders, accidents, risk-factor prevalence, etc) and registration artifacts (vastly different standard for determining what constitutes a live birth and recording it as such) that vary dramatically from one country to the next. Consequently - they are very unreliable indicators of clinical efficacy. If either constitutes the basis for your critiques of health system performance in the US, I hope that you will, at a minimum - acquaint yourself with the literature that outlines their limitations for this purpose. Best Regards, -Jay Brazier Greetings Dr. Metz:

I listened with interest to your commentary on “To The Point This Morning.” I was particularly intrigued by your claim that the health system in every country achieves better outcomes at lower costs than the system in the US.

Is this based on studies that directly compare the costs and clinical efficacy of treating equally sick people with specific diseases? E.g. international comparisons of clinical efficacy. If so –
please share them here on your site. If it is not based on studies that directly compare how effectively doctors and hospitals treat patients, then please share the data that you have based these claims upon. ‘

Life expectancy and infant mortality statistics, while commonly cited in support of such claims, are confounded by real factors (murders, accidents, risk-factor prevalence, etc) and registration artifacts (vastly different standard for determining what constitutes a live birth and recording it as such) that vary dramatically from one country to the next. Consequently – they are very unreliable indicators of clinical efficacy.

If either constitutes the basis for your critiques of health system performance in the US, I hope that you will, at a minimum – acquaint yourself with the literature that outlines their limitations for this purpose.

Best Regards,

-Jay Brazier

]]> By: Paul Hochfeld http://madashelldoctors.com/contact-us/comment-page-1/#comment-7422 Paul Hochfeld Tue, 06 Sep 2011 04:24:11 +0000 http://madashelldoctors.com/?page_id=413#comment-7422 The point of the first incident above is unclear. Dr. Chirls describes a failed business venture decades ago by a dozen physicians. It is not obvious how this incident relates to single payer health care today. His second incident states without documentation that single payer works only because wealthy patients go outside the system. As an example, he implies the Swiss health care system succeeds only because a famous private heart hospital was established there long ago. As Switzerland does not use a single payer system and is also the second most expensive country in the world for health care (the US remains in first place), the relevance of this incident to single payer remains unclear. The Department of Veterans Affairs health care system has evolved in the last 65 years, as have most systems. It is not clear how the third incident describing the actions of a single VA physician in 1950 relates to any current health care system, single payer or otherwise. His last point, that salaried physicians are second-rate, lazy, and bureaucratic, is not true. Salaried physicians at multi-specialty clinics provide care at many of America’s leading hospitals, including most academic medical centers. If Dr. Chirls has evidence these physicians provide worse care than fee-for-service physicians, he did not present it. Single payer systems in the US and around the world provide better care for less money to more people than American private insurance companies. Incidents from the past century presented by Dr. Chirls do not invalidate this present reality. Dr. Chirls comment begs the question: how can the US provide care to all citizens (as do all other industrialized countries) without increasing costs? As his comments indicate his doubts about single payer, he is welcome to propose his own solutions. My impression is Dr. Chirls endured some highly unpleasant business arrangements during his career in medicine and fears a single payer system will create more. It is imperative that health care planners understand the fears of clinicians like Dr. Chirls and work hard to assure them that their fears are unfounded. submitted by Dr. Samuel Metz, Dr. Paul Hochfeld and Dr. Mike Huntington The point of the first incident above is unclear. Dr. Chirls describes a failed business venture decades ago by a dozen physicians. It is not obvious how this incident relates to single payer health care today.

His second incident states without documentation that single payer works only because wealthy patients go outside the system. As an example, he implies the Swiss health care system succeeds only because a famous private heart hospital was established there long ago. As Switzerland does not use a single payer system and is also the second most expensive country in the world for health care (the US remains in first place), the relevance of this incident to single payer remains unclear.

The Department of Veterans Affairs health care system has evolved in the last 65 years, as have most systems. It is not clear how the third incident describing the actions of a single VA physician in 1950 relates to any current health care system, single payer or otherwise.

His last point, that salaried physicians are second-rate, lazy, and bureaucratic, is not true. Salaried physicians at multi-specialty clinics provide care at many of America’s leading hospitals, including most academic medical centers. If Dr. Chirls has evidence these physicians provide worse care than fee-for-service physicians, he did not present it.

Single payer systems in the US and around the world provide better care for less money to more people than American private insurance companies. Incidents from the past century presented by Dr. Chirls do not invalidate this present reality.

Dr. Chirls comment begs the question: how can the US provide care to all citizens (as do all other industrialized countries) without increasing costs? As his comments indicate his doubts about single payer, he is welcome to propose his own solutions.

My impression is Dr. Chirls endured some highly unpleasant business arrangements during his career in medicine and fears a single payer system will create more. It is imperative that health care planners understand the fears of clinicians like Dr. Chirls and work hard to assure them that their fears are unfounded.

submitted by Dr. Samuel Metz, Dr. Paul Hochfeld and Dr. Mike Huntington

]]>