Just a quick note before we start: Please stay on topic: the movie Money Driven Medicine, health care and health care reform. To see new comments, please hit refresh frequently, and to reply to comment, please hit the reply button under the comment. And as usual, please forgive my typos.

That being said: Welcome, Maggie and Rob to Firedoglake’s Movie Night and thanks for joining us.

Hello from Rob Johnson

I love that the fim is being used as part of the health care reform campaign that people can watch it online and that you have organizing tool on your website for people to hold viewing parties!

Health care reform is so important to millions of Americans–not only lower insurance costs, but also better care. Money Driven Medicine stresses the importance of patient involvement…hopefully we’ll see a growth in that if the current plan moves forward.

Thanks Lisa,

Yes, people are holding screenings in their homes, in universities . . .

And hopefully they’re contacting their representatives (and now senators!) about the need for a change.

Was this film aired on Bill Moyers this year? I know I watched all or part of it somewhere.

I have seen data from the World Health Organization that ranks US healthcare about 37th in quality. I have also seen OECD data from 2007 that puts per capita spending in the USA at more than twice the OECD(Developed Country) average. So there is a lot of work to do and we as voters have to keep the pressure on the money driven politics in order to escape from the trap of money driven medicine.

Yes a shortened version was on Bill Moyers

The film reveals what’s broken in our healthcare system.

I’m excited that the legislation under considration is addressing these problems.

The bills under are far from perfect but they represent an enormous step forward.

It is stunning to me that we have higher mortality rates thn other western democracies, yet we spend so much more on health care…why is that?

Rob is right–

When compared to other developed country’s our rankings are very low.

It’s important to realize that much of this has to do with poverty.

We tolerate much higher levels of poverty than other developed countires.

And in the U.S. poor people die 6 years sooner than more affluent citizens–access to healthcare is not our only health care problem.

Thanks. And thank you all for you great work on this film/issue. Am so disheartened right now.. I don’t think I can support one incumbent who voted for this in the House last weekend… ever again.

But you are right, we must keep working for something much better. That may include with the utmost importance.. ending money driven politics.

Re Congress:

During the month of November, the film’s distributors have been hand-delivering DVDs of the film to all Senators and Representatives.

I will let Maggie address that one. FRom the vantage point of an economist a simple answer emerges. Monopolies garner more than market rates for services. Lots of layers and middle men. But there is a deeper structure here and Maggie’s book really gets to that essence. Kenneth Arrow, Nobel PRize winning economist wrote in the early 1960s that economics doesn’t work right in healthcare. He was right

That is great to hear, it is a very good documentary on the Healthcare situation and what needs to be done.

The United States doesn’t really have better care than other Western democracies. It just has more care

Um. Decidedly NO. In the U.S. the rich get more treatments, not more care. The middle class and the poor can suck hind tit.

Poverty is one reason that the U.S. ranks so poorly in int’l health rankings.

The other factor is that we are the only country in the developed world that has chosen to make healthcare a largely unregulated for-profit enterprise.

A great many people in our healthcare industry are selling–and selling hard.

As a nation, we’re over-medicated. And too often, patients are exposed to unncessary and unproven tests and treatments.

When they undergo unncesary procedures they are, by definitoin, exposed to risk wtihout benefit.

It’s weird that Republicans are screaming that the government should run health care, yet they are fine having non-doctors run it…And hasnt the govtt been in healht care for a long time? My uncle through the VA in the late 1940s and early 50s worked on Navajo reservations treating the tribespeople, and also researching pulmonary diseases. The government was paying him…

THere is an old saying Be hopeful but not optimistic. Mitch Albom wrote a wonderful book about mortality recently and he tells a story of a Christian woman who called a retired Rabbi to help a dying woman and her husband. The couple were Christians. The woman was in a coma. Her husband acted like he wanted no part of the Rabbi. Then they prayed together. When the Rabbi left the nurse who made the call winked at him as he left. Albom’s comment was that the nurse had a lot of guts. The rabbi replied “Yeah and a lot of love” Love seems to me what gives us the guts to press against the odds and produce the miraculous. Not always. The odds are against us. But we cannot let people extinguish our love because they act ugly, greedy or corrupt.

dCAHNomics–

Exactly– the rich get more treatments, but too many of those treatments offer neither comfort nor cure.

They’re not getting more care.

Since I’ve been writing about U.S. medical economics since 1991, I’ll present the short version one more time, then bid a fond adieu.

The reason why the medical industry has market (or pricing) power is because of the knowledge gap between buyer & seller. Add to that, the customer is vulnerable (sick), meaning that the seller has even more economic power. I dubbed this the mafia of the intelligentsia, intelligentsia referring to the knowledge gap, mafia (rather than the inappropriately mild “cartel”) because of the vulnerability of the customer.

There’s this reply button at the bottom of each comment that will make the conversation flow much clearer.

The U.S. has exactly the medical industry that the market would create: lotsa treatments for the rich, nadda for the rest. It’s just taken many years for the true construct to be revealed for all to see.

In another documentary we recenlty discussed , Orgasm Inc., the filmmaker cited how as nation we consume so many Rx drugs compared ot the rest of the world. She linke dthat in part to Reagan allowing Rx drugs to be advertised on TV and radio (only the US and New Zealand permit this).

Goodness knows, I’ve lain awake at night wondering if I have restleg syndrome or if I am suffering form .

And then there’s the rebate program that was in place for Aricept and Procrit via oncologists…

Lisa–

You’re right.

More and more of today’s hospitals are run, not by health care professionals, but by MBAs.

And if anyone is “interfering” in the doctor/patient relattionship, it is the drug-makers, running ads telling you that you should tell your doctor what to prescribe.

As for the government– it has been running Medicare for a very long time.
And the vast majoriyt of Ameircans prefer Medicare to private insurers.

I do not think the Republican position coheres if one just uses logic. There is a lot of fear of government in their spirits. The ostensible services are things we all desire. They just see government as likely to take it off course. The right is romantic about markets and the left is romantic about government and we have discredited experts to rely upon when we do not know which way to go.

In fact fear is very important here. Fear leads to lack of faith in professionals. This notion that they will rip you off, as if economic motives govern absolutely everything down to the small change is a real fearful way to see the world. As a result business bureacrats are put in charge.

That is sick stuff Lisa. I know Doctors who are freaked out because they are really really pushed by their patients who want flomax ( so they can go fishing with the guys I guess). LIke the patient KNOWS from the ads.

Imagine a U.S. govt run medical program “administered” by the Rs? Surely no greater nightmare can be imagined, except perhaps a U.S. invasion of Afghantistan & Iraq.

eCahnomics-

Yes, in the health care market consumers have very little power to keep a lid on prices–or demand higher quality.

If I’m shopping for a thin-screen TV, I might decide that they’re still too expensive. I’ll wait until competitors come out with cheaper models.

But if I have cancer, I can’t wait for a cheaper cancer drug to come along.

And if you tell me that Hopsital X offers a bargain on mastectomies on Thursdays, I won’t be intersted. When people are serously ill, they are not looking for bargains. They are looking for the best. And they tend to believe that the best is the most expensive.

80 percent of our health care dollars are spent when we are seriously ill.
As you say, we’re not in a position to shop around as”savvy consumers. We’re sick, we may well be in pain, old and/or afraid.

Lack of knowledge about one’s health care does create fear. It’s important that patients are fully aware of the pros and cons of treatment, as well as the costs. And heaven knows if you get a hospital borne infection, you ‘ll be charged for them to cure it!

We have a food industry that does not nourish, a financial industry that does not spread and dampen risk and promote investment, a drug industry that uses universities and the government to do its R&D and then they do marketing, and a medical industry that does not do healthcare. Can somebody tell me how we can reboot this system. It is malfunctioning on a diet of free market fundamentalism

On nutrition see T. Colin Campbell’s book THE CHINA STUDY and especially part IV on the politics of food standards

Or How about financial reform designed by the derivatives dealers and too big to fail banks?? Back to healthcare sorry

Rob is right that Americans don’t like/trust “experts.”

But the truth is that when it comes to medical care, we need care based on medical evidence.

Only physicians, medical reserachers and healht care professionals are in a positoin to sift through the evidence and figure out which treatments are going to be most effective for which people.

This is why President Obama has funded a “comparative effectiveness panel” and the Institute of Medicine has appointed a panle made up of doctors and other professionals.

Oh yeah, so many disasters in the U.S., one loses track.

When my mom was sick I spent a lot of time doing the research I could to find out the side effects of the super antibiotic she was on, what all was going on. Luckily I knew a geriatric specialist so I could ask questions, and a cancer researcher so I could ask more questions about her other health problems later–but not everyone has those resources. Or is that suspicious of what they’re being told.

Back when Alex Gibney and I were walking around reading Tom Frank’s book ONE MARKET UNDER GOD we used to talk about how healthcare was the arena where free market logic would explode. The fundamental question was “Are you a consumer or are you a patient.” Comparison shopping on the way into the emergency room on a stretcher!!! No ambulance driver go to Harper Hospital not Grace I like the deal better there!!(I am from Detroit)

Then we met Maggie who put a lot of color onto the absurdity and made this the deeply informed film it became.

I don’t have any hope for the U.S. In the other rich economies, there is more sense of social contract. In the U.S. that is regarded as communism. so there is a fundamental dislike in the U.S. for any kind of commitment to one’s fellow humans.

Rob, I agree.

There is a belif out there that free market competiton can solve all problems.

The problem is that, by law, for-profit corporations must first serve the intersts of their shareholders. This is the law. They are expected to maxiumize revenues.

Unfortuantely, maximizing revenues and profits is not always in the best interest of their customers.

Particularly in the health care market, the conflict of interset is huge.

It pained me to lern form watching money driven medicine that med students are turning away form family practice/GP towards specialtie. We need those front line doctors, and they need sometimes more than 15 mins per patient. I s there some way to encourage more GPs?

I watched this documentary earlier today, it being available for free and all. The basic point it makes is quite valid: a great big chunk of the problem with the US health care system today is overtreatment. Our system seems to have a kind of schizophrenic quality: it undertreats the poor and lower middle class, then overtreats everybody when money is available.

But aside from the documentary, there’s a point Mrs. Mahar makes repeatedly on her blog that needs to be brought up here — that the public option is “Medicare Part E (for everyone).” I’ve written about that here and here. The sad truth is, there’s no way that anyone with even the barest clue about health policy could make that statement, much less make it five or more separate times, unless they were just lying. So that’s what I think Mrs. Mahar did: she lied about the public option being “Medicare Part E.”

My brother beat the system, and the immediate family collaborated. He was ill, didn’t know how much but prognosis didn’t seem good. So he signed papers that he would not be treated, and he wasn’t. He died of undiagnosed cause about a year after he was debilitated enough not to enjoy life (which he always did to the ultimate in prior years).

With the cost of education loans that is sadly understandable

A question for readers/viewers:

When you read what is being written about health care reform, what most concerns you? What worries you?

Since I’ve been on the case for so long, I can’t read anything on the subject of medical economics because teh stoopid, it just hurts too much.

Is there was an incentive program that if doctor worked as GPs x amount of their loan would be written off, more if they were in underserved areas?

Amen.

Long story short, had scratch on leg from a construction incident at my house. Became infected, which surprised the hell out of me; I had alcohol’d it, cleaned and changed band-aids; it was that small.

Have insurance, go to doctor, I say “remember I’m allergic to pennecillin and the other standard myelins out there. Surprised it’s infected. How about you test what bug it is?

Nope; get a scrip. 2 days later, still red hot and bigger are. Doc advises immediate visit, then ER, phone in admission.

I say to the intake crew, “Look, I’m allergic to penicillin and the standard myelins. How about you test what bug it is?” Nope, now a new IV drip. No improvement in 24 hours Primary refers specialist #1, for $200 bucks of 15 minute interview/exam, record reading, who refers specialist #2, with a $400 consult, who orders MRI! and says, “Hmm, patient claims allergic to pennicillin, etc. Test for bug.”

MRI over $2k, test for bug? $300. Huh, new meds.

But by this time, I had to have a PIC LINE! EDIT: BTW, it was an MRSA. They were all shocked that that particular bug was “in the wild” as I hadn’t been near a hospital, nor anyone with an MRSA.

It’s maddening, even when you know your record, and advocate your own care.

The current legislation would hike Medicare premiums for family docs by 5% to 10% (depending on where they are located) in 2013, plus offer bonuses to doctors who are offering better chronic disease management, more collaborative care (working with other docs) or better outcomes at a lower cost.

In addition, in 2010, Medicare has proposed raising fees for primary care docs by 4% and for nurse/practioners by 3%. At the same time, it would lower fees for cardiologists by 6%.

Congress has 60 days to oppose these changes. Otherwise they atomatically become law Jan. 1

This is the first in a series of changes in the Medicare fee schedule that we can
expect over the next 3 years.

The reform legislation makes it clear that a public insurance plan would incorporate Medicare’s reforms.

Agreed my Dad said no all he wanted was to die in his house with us and a nurse trying to take care of him still

where more than once she was left tied to the bed moaning and thrashing from a urinary track infection until I got there and raised hell

If had happened to my Dad Knives would be pulled.

Kelly–

I’m afraid this is a classic story.

We don’t pay doctors to listen to patients.
We pay them to do something.

So they ignore you–and do something.

The financial incentives are screwed up.

But –the good news– the legilsation would change financial incentives, paying docs and hospitals more, not for how much they do, but for how well they do it.

Preservation of the profit motive for non-healers; companies. That’s what worries me most.

For me it is that the protection of monopoly profits of pharma, insurers etc. will lead to very costly care of the uninsured. This will send deficit hawks into a frenzy and lead to cutbacks in service on medicare and loss of other social services. The Wall Street types are deficit hawks except when they need a bailout and then they take a vacation underwater while the dirty bailout deed is done.

That would be wonderful! We sent the ICU docs who helped us with our dear friend (RIP) a basket of muffins and wrote the director of the hospital a nice note. the care was awesome. They really were so helpful and caring and honest about the situation. And relieved at the choice that his wife made.

Thank you Lisa and Robert for this very important and timely chat. I haven’t had time to read all the comments. I apologize if these were already covered or are otherwise well known. Milwaukee Journal Sentinel has done an excellent series focusing on physicians at UW’s Medical school taking payments from manufacturer’s. From 7 Nov 2009:

Physicians’ disclosures to UW, journals inconsistent
At least 9 doctors’ links to industry did not match

Earlier this year, Minesh Mehta, a cancer specialist at the University of Wisconsin School of Medicine and Public Health, co-authored a medical article on TomoTherapy, a radiation therapy system developed by researchers at the university.

Any doctor reading the article would have thought Mehta was an unbiased researcher with no conflict of interest or financial stake in TomoTherapy Inc.

After all, the journal article said Mehta reported no potential conflicts of interest.

But documents obtained from the university tell a different story.

Those records show Mehta had told the university he would make more than $20,000 in 2008 working as a TomoTherapy consultant. He also owned stock options in the company.[...]

The link leads to more examples.

From 2007 Psychiatrists Top List in Drug Maker Gifts

WASHINGTON, June 26 — As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.

How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.

The number most likely represents a small fraction of drug makers’ total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.[...]

Yes, the reform legislation greatly increases loan forgiveness and scholarships for med students who go into primary care.

Research tells us that ned students coming from low-income homes are more likely to go into primary care. And they are more likely to want to go to practice in areas where they are most needed–inner-cities and poor rural areas.

In other words, they go back to the places where they grew up. And, because they understand the culture, they are in a good positon to really help.

But kids coming from low-income families are not likely to go to med school if that means taking on $200,000 in loans. They don’t have a family that can help them out if something goes wrong . . . And if you’re coming from a poorer family, $200,000 seems an unimaginable amount of money.

(I actually can’t imagine taking on $200,000 in debt unless I was buying a house.)

These scholarships and loan forgiveness programs will bring more people into primary care. We had programs like these in the 1970s, and they worked.

So much changed after Reagan was elected in 1980.

I can understand not wanting to respond; it’s much more convenient to ignore it when you’ve consistently told other people falsehoods and that gets pointed out.

However, for the record, Mrs. Mahar seems to have acknowledged the opposite of some of her later statements when she said, reviewing the Commonwealth study:

“…in many cases, the doctors who treat them would be paid less. As a result, patients who choose the public sector plan might well have a hard time finding physicians willing to take their insurance…The private plans would have the funds needed to pay providers more and create ‘integrated networks,’ overcoming some of the fragmentation that leads to errors in our health care system.Quite simply, they would be able to offer better care.”

Lisa, I was deeply moved by the story of your Mom. It sounded so similar to my Dad, who was miserable his last few years without cigarettes or alcohol. My Dad went to a lot of trouble to create a living will so he wouldn’t be kept alive. He told everyone. His cardiologist played a neat trick on him though. He never told my Dad that he had to wear a “no resuscitate,” medallion around his neck. Without that, the cardiologist knew the paramedics would have to revive him and put him on a ventilator. After my Dad’s fatal heart attack, he was brain dead, but those five days on the ventilator were a huge pay day for the cardiologist and the hospital.

BooRadley–

Thank you

The reform legislation would require doctors to publicly disclose all money that they receive from corporations.

(This is just one of the many aspects of the bills that the media never seems to talk about. There is much meat in this legislation. Flaws, yes,
but also meat).

As a financial jouralist at Barron’s, I never owned stock. If I did, I could find myself in a position where I was writing about a company I owned–or a competitor.

We were allowed to buy stock, but had to hold it long-term.

I believe that doctors should not be allowed to own stock or options in healthcare companies. There are many other stocks to own. They also can buy mutual funds. But the potential conflict of interest if they own indivdiual stocks is just too huge.

Maggie, thank you so much for your response and your excellent work. Please accept my apology for leaving you out of my initial comment. In my haste I didn’t fully read Lisa’s introduction.

NO WAY! That’s awful! I had medical powers for my mom and also for my aunt, DNRs etc.

My mom continued to smoke despite her cancer, but she stopped drinking once she had back surgery.

Kellly-

For-profit companies in the health care industry need to be tightly regulated–as they are in Europe.

In this country we recognize (or at least used to recognize) that gas & electric companies should be regulated because heat & light are necessities. We can’t let these companies gouge people and make heat and light unaffordable.

Healthcare also is a necessity. Which is why other countries regulate healthcare companies.

The good news: The House bill would require the Secretary of Health and Human Services to negoiate with drugmakers for discounts on drugs for Medicare patients. (This would almost certainly be exteneded to the public plan.)

In addition, a last minute amendment to the House bill would require that private insurers ask gov’t regulators for permission if they want to raise premiusm–and explain why the hike is needed. This would begin next year. (Reformers are afraid that insurers will begin hiking premiums next year, anticipating regulation in 2013.)

Might this be why Mexicans live longer than Whites despite our lack of healthcare coverage because we bring the Family to the Death bed? I’m not sayin Lisa don’t love her Mom but I’m a felon and with strong family ties I bet Mexicans show up more at hospital visits
Me and Pablo (my Bro) went to the hospital once Full length wool tench coats waiting in the waiting room to hear hear what what was going on the hospital kept us waiting so we stared telling stories about the police… not nice stories .
The guy next to us was a Cop we didn’t notice until or mom started making hand signs after about 5 minutes I caught on (hey I’m a guy we are not subtle) I told her I didn’t care sides I thought to myself me and the Bro were taller and out weighed him.
Plus what I did not realize till later was one of ours was down and we were pissed with waiting a fight would have made me feel good normally we would back down but not with our own in trouble Mexicans react to frustration physically.
Lisenting to Styx Pacheo brothers drums and base both from Chicago my grand Aunt was Pacheo Chicago never mind the spelling coincidence?
My Grand Aunt locked away with TB lost a husband and daughter.

I think it is fine to disagree vehemently with a commentator. Calling them a liar is very strong and ugly. You better be able to back up that she is not only wrong but knows better and is choosing to lie. Maggie is a deep and thorough student in this realm. If you are being ignored it is because you are not pursuing a difference over an issue you are engaging in a character smear. You know she is my friend and I will defend her against your conduct. Speak to the issue that infuriates you and present clearly your difference and we will gladly explore it with you.

Maggie in response to your question about concerns: Mine are that I be givn a right to choose the options and treatments; that some forms of alternative medicine (still ) be covered like accupuncture and chiropractic. I also want the right to hospice and palliative care. I think palliative care and pain management are a necessity.

And all contraception including vasectomies and tubal ligation should be covered by insurance once a person is over 30 and wants one. I think by then pretty much we’re clear if we want kids or not.

Sex assignment surgery and related treatments: cover it! Ditto abortions.

Uh..I visited my mom every other day at her house while she was on hospice care and before, and before that at her hospital and nursing home…My aunt I visited twice a week at her nursing home and gosh uh…your point is?

Thank you. YOu took the words right out of my typewriter, uh computer thingy

TB bone breast cancer my grand Aunt was suppose to live six months lived a few years would climb up the stairs like a lizard tough old lady my bro named hid daughter after her Lusisa Giant growing way faster than us throw back to my Dad six foot tall Mexicans not common in the great depression but all the anger of my Mom…I worry.

Things Come Undone–

We must tell patients that they have a right to decide how and where they want to die.

Hospitals should not be prisons. Yet once they have you in the “system”
too often it seems impossible to get out.

This is where palliative care is so important. Palliative care specialsts are trained to talk to seriously ill patients about their options– what treatments are available, benefits and risks. They level with the patient if he is dying. (Unless he makes it clear he doesn’t want to hear about death). They make sure that the patient isn’t in pain. (Pain control can be very difficult; palliative care specialists are trained in this areas.)

Most importantly, they draw out patients– asking them to talk about their greatest hopes and fears.

Some patietns are most afraid of pain. For others, living just 4 more months may be most important– because their daughter is scheduled to have their first grandchild then.

Patients must be allowed to make informed decisons–and for each individual, those decisions will be different.

Dr’s get scared about telling bad news I again am not saying you didn’t loved your mom but me and the Bro were making it perfectly clear to the nurses we would go after a Cop and trust me normally we are not that stupid.
We both been there.
Any bets the nurses told the doctors? Hispanics do live longer than Whites I’m throwing out an alternative theory besides race.

Late to comment, but a recent story highlights a new problem. If the patient does sound like they know what is wrong with them, and what might be the possible treatments, they might get from the doctor(as my wife did): “Why do you think you have that? Did you read it on the Internet?”. Then you have to defend why you know what is wrong with you. She’s had an injured shoulder, now frozen, for 11 weeks – with no treatment, because the medical professionals are first working on her broken clavicle (which, of course, means they are doing nothing, as that is the prescribed treatment). Now on to a second opinion – and we really feel we have to manage our own health care. We don’t have an advocate in any of the hospitals or clinics we’ve been to. The primary physician defends the specialist, the radiologist defers to the orthopaedic clinic, etc. And we just want her to get healthy. Maybe with some help from them.

It is inspirational to see doctors who care about patients’ rights and care. That was a high point for me Money Driven Medicine, seeing all the great doctors.

Agreed but before my dad got there well cooking food that was better for him I wish they told me. My Dad’s birthday party in August hot next day he had a minor stroke I wish now I turned the AC on I wished the dr’s gave us better education about how to home treat our folks.

One thing about this, is you have to plan to die. You really do, and hardly anybody does.

We’ve been going through this in my family, as there’s no imminent death, but my partner’s parents definitely need assisted living (in their ’80s) and they didn’t want to live with US! Bitches!

So we’ve had many conversations since Spring, about what this all means, and selling their house, and putting, literally everything in order.

So I guess my point is, eliminating surprise is a huge benefit, mostly emotionally really, even though the subject of talking about one’s end of days is very difficult. And I mean VERY.

As an early cancer researcher and now cancer patient I have more optimism and hope than most express here.

I base that on my faith in the power of the bedside to bind physicians and other caretakers to compassion and commitment to the welfare of their patients. I am grateful that my personal experiences as a patient are affirming. But I do not doubt the many disturbing experiences one hears every day.

Medical care not be a market phenomenon. It is either good enough or it is not. All deserve that, regardless of wealth and privilege.

But the pressures are great and I know the profession is suffering and I have no doubt quality is eroding.. Nicholas Kristoff has an excellent article addressing the status of care in the US with good numbers. http://www.nytimes.com/2009/11/05/opinion/05kristof.html?_r=1

In fact I wrote a diary on this topic not too long ago but it has scrolled off. A shorter version is on my Talking Stick News log http://talkingstick.gamountains.net/news

Please if you havent already, check out Money Driven Medicine online where you can watch it in full.

And make sure you check out PublicOptionPlease.com along with writing your senators about your health care concerns.

We need to take charge of our healht care on a personal and legislative level.

Mr. Johnson asks why I use such strong terms. The answer is that by calling the public option “Medicare Part E (for everyone),” the entire health policy debate has been flipped on its head. I don’t think that Mrs. Mahar doesn’t realize that. She must realize it if she has written a whole book on the health care system. It is like saying that the mouse is bigger than the elephant.

I suggest anyone interested read this and this. I have little idea what Mrs. Mahar’s motivations are for making these statements.

And also YES, make sure you have a living will and that you make your funeral arrangements in advance. healht care directives are vital. (and you dont want family to get bullied into a silly casket!)

Maggie and Rob, THANK YOU BOTH SO MUCH for making Money Driven Medicine and helping inform us as patients and as consumers. And thnak you for being here tonight for a great chat!

Did you guys just hear Rachel re: Stupack and C street? Freaking huge!

There are biases about African Americans not getting treated as well as Whites I’m exploring reverse discrimination a whole nest of Mexicans showing up in a hospital and not looking Nice might explain it after all our social class is the same.

I had a conversation last week with my doctor. I’m working on lowering my C-Reactive Protein number, the only lab tests that is not in the normal range. For the doctors in the house, my father died of congestive heart disease; my mother of diabetis, a high CrP number is a real warning. I had a weird blood pressure reading (81/61) at the dentist and wanted to talk about it. The reading was just either faulty equipment or not adjusted right.

As we talked about diet, I mentioned that I’ve been working on diet, because I have no intentions of taking a statin, because I believe that diet (I’m sensitive to arachidonic acid) and exercise will get me there. She said, that statins should be the last resort and that diet and exercise are the primary means of getting there. She said that too often in the medical field, if there is a problem the only solution presented was a drug. It is nice to have a good doctor.

What you say about information asymmetry is of course true, but if it were the only reason, European mortality rates would be the same as in the United States, which they aren’t. Take the asymmetry as a given, and then ask, what institutional form best mitigates the consequences. The very worst form is monopoly, which allows the sellers of services to price discriminate between the informed and uninformed. The best form is something like the British National Health Service or its equivalent in France, where the decisions are made by civil servants imbued with a sense of responsibility to patients. There is no ‘invisible hand’ that enforces that reponsibility, and there is no institutional reform that can create that invisible hand. That’s why the public option was always the only option. The other alternative is ruthless regulation, which makes the regulators the equivalent public servants.

This isn’t rocket science, but a lot of people would like to make you think it is.

You seem eager to drive us to your links rather than explaining yourself. And again, calling a guest a liar is not appropriate.

Next week we have THE TRIAL AND TRIUMPH OF HE KING OF POP, a doc about Michael Jackson. Plenty to discuss, as the hournalist was at the trial every day.

Lisa–

I agree that, under reform, basic comprehensive care should include
acupuncture and chiropracty.

I think this is likely..

It also should cover vasectomies, tubal ligation, etc.

Sex changes will be harder– though with reocmmendatoins by two psychiatrists, this should defintely be possible. (I’m not against sex changes, just saying that since this surgery is very, very expensive, we probably need to establish medical necessity: i.e. the patient is suffering because his body and mind are in conflict.)

Abortion, as we’ve seen this week, is the really hard one.

Pelosi knew, late last week, that if there was not an abortion amendement, there would be no bill.

She was dead set against the amendement, but basically had no choice.
So many poor woman don’t have access to good health care. On balance, it’s more important to get them the access to health care than to give that up while holding out for access to abortion.

The problem is that opposition to abortion is not simply a conservative born-again position. A great many Catholics– women as well as men– still oppose abortion. And many of those Catholics are Democrats.

I don’t think there is anything that Pelosi–or even Obama — could have done. I grew up in a Catholic family. People who are anti-abortion are absolute. They are like the NRA.

No one–including the president–could talk them into changing their positon. (No doubt you coudl pay some politiicans to change their position, but that wouldn’t change their constitutents. Cross their constituents on this issue and they would be voted out of office.

Abortion has no place in the health care reform bill. But there seems no way to keep it out.

By feeling is that we are going to have to deal with access to abortion in separate legislation. At some point, there has to be a show-down. But we don’t want to risk health care reform when going head-to-toe with conservatives on this one.

Ideally, in two years, or at worst, four years, we will have enough new blood in Congress to ease restrictions on abortion.

The only good news: today only 13% of all women use insurance to cover tbe cost of an abortion. Most pay out of pocket, and go to low-cost clinics where the average cost of abortion is under $600. This is still a large amount of money for poor women It can take time to scrape it together, which means they have the abortion later in their pregnancy. More suffering.

Thank you again all of you for a lively and informative movie night!

Kelly this is so important. I went through this with my father who was deteriorating after my mother died. The key is establishing trust early on so the process is connected. Getting started on the conversation is hard. Susan Piver wrote a great book on Hard Questions between Aging Parents and their Adult Children.

http://www.amazon.com/Questions-Adult-Children-Their-Parents/dp/1592400779/ref=ntt_at_ep_dpt_8

And we just want her to get healthy. Maybe with some help from them.

Keeping my Dad at risk for stroke in the AC thats the the kind of advice I’d have wanted:( I don’t blame anyone but the system.

It’s interesting that many informed people in the United States believe that single payer is a monopoly situation. But actually it’s the opposite: it’s a monopsony (not a word most people have ever heard, I think). I don’t really agree that there is a “best” form that resembles the NHS, though. It’s really very variable, but we do need to remove for-profit insurance and we do need to implement tight cost controls on providers.

I Pray you get better:) Hands on Screen

Hospice care can play a great role in these situations….help get the documents, provide home care, monitor pain. What the lies have put out about end of life &/or hospice has been unconscionable.

It’s the truth. If you can’t deal with it, I’m sorry.

The links are extended statements of mine. One of them is a response to Mrs. Mahar. They are quite relevant.

Take out Hispanic numbers on living longer once in America we live longer than Whites and we generally don’t have healthcare then compare that to Europe. Until our Family pressure on Dr’s and our tendency to let our dying live at home until they die is examined Europe and Japan live much longer than you folks.

Thanks so much. I am blessed to be free 2 years and counting and really don’t think much about it anymore. Blessings to you.

Really good Book Salon. Very informative and interesting. Thanks to both our guests and to you, Lisa

calling a guest a liar is not appropriate.

new rule? i thought we used to complain about the nyt telling krugman he wasn’t supposed to use the word.

the accusation is either justified or not. if justified then an accurate description is indeed appropriate.

Your welcome look at the SunRise and see Hope Feel the Thunder and feel Strength see a Buttercup or Violet like I used to pick for my Mom in the woods and realize someone cares:)

Selise she is asking for links thats fair at the Lake.

new rule? i thought we used to complain about the nyt telling krugman he wasn’t supposed to use the word.

Now then anyone calling you out on that if you had links…well I just wish I had been there to stand by my friend nobody fracks with my friends without proof while I’m around and If I ever fail at call me out.

Is this still a discussion about hc reform? Because here’s my big question. We know about the cost drivers being lack of efficiency, overuse, largely unregulated industry. We know there’s a lot of confusion regarind “how much” and “how many” would enroll in a public option. Why is the focus on health care financing reform, instead of health care reform. Why can’t we have a tightly regulated industry, there are a lot of things that can happen to drive down costs and improve quality. Why is the focus on financing the industry by mandating Average Joe purchase insurance?

Maggie:

Can you tell me who is eligible for Medicare E?

Thanks!

khin did include links at comment @40 and again comment @75. khin also wrote a diary here about the issue and his/her intention to bring it up. all i’m trying to say is that i don’t think it should be dismissed out of hand.

It’s hard to take anonymous accusations too seriously. I read the blog, who is “Khin”?

a commenter and diarist at fdl.

one of the blogosphere’s earliest values was that social signifiers, even gender do not matter. what matters is not traditional authority but the content of one’s posts.

The source matters. Anybody can put anything on a blog and tell you it’s fact. Credibility matters.

Lisa:

Maybe you can help me: Who is eligible for Medicare E?

Danke!

If you’re asking me, I have no idea. I didn’t know there was an offical “Medicare E” I thought it was a phrase that was coined to describe a possible public option. And I don’t know who’s eligible for any possible public option, either. I’m not sure anybody really knows.

In fact, I don’t think there’s any immediate answers to almost anything. The more I learn, the more I realize, this HC debate is going to rage for years, to the point I think most American’s are going to get sick to death of talking about HC long before we really transform the industry.

did you read the links provided? there are source links included that go directly to maggie’s blog. isn’t that the kind of credibility that ought to matter?

anyone, with an important name or not, can put anything on a blog and tell you it’s fact. that’s why it’s the content and sources that matter. if your problem is that you don’t know if khin isn’t important enough to respond to, that is your choice. but if would like to engage with the content of the critique then reading the source links is what i recommend.

Damm well Straight Selise!

I’m very familiar with Maggie’s blog, I’ve been a regular reader of hers for a couple of years now. I know she’s very credible. What I don’t know is who Khin is and why he/she is on a Maggie witch-hunt. There’s been a lot happening in the past 10 months regarding health care. Things have changed. This Khin person is picking and choosing Maggie’s statements, I recall at least one was as far back as February. That was a lifetime ago.

Perhaps because France and Japan and God knows how many other countries spend less on healthcare but insure everyone?

not a witch hunt, an actual documented critique. if you find that critique faulty in any way, i’d be very glad to know of it. but if your objection is only that you don’t know khin, that really doesn’t address the substance of the question.

If you have an argument with Selise address her.

Perhaps France and Japan and God knows how many others don’t have a corporate health care system run by the medical mafia. We do. Why do we have to finance this industry? Why can’t I take my kid to the doctor and pay the bill? Are we going to mandate homeless people buy homes? Are we going to mandate grocery insurance? My point is, why don’t we fix what’s broken instead of mandating all American’s keep the medical mafia in the lifestyle to which they’ve become accustomed? Did anybody read this Sunday’s NY Times? http://www.nytimes.com/2009/11/08/magazine/08Healthcare-t.html?_r=3

good question.

I don’t have an arguement with anybody. Khin’s the one with the arguement but she doesn’t have anybody to argue with.

but if your objection is only that you don’t know khin, that really doesn’t address the substance of the question.

You Handled it Selise no need for my help I always thought you were special :)

watertiger is upstairs!
Late Night: The Teabag Party Makes it Official, But Still Needs a Mascot

(((TCU)))

Uh because they live longer than us whites and spend less hey I’m ok with the present system I’m Mexican you keep on paying for health insurance and I’ll still live longer than you without paying .
I’m only in this fight because I think everyone should live as long as I do.

Selise your my friend that I am not there to back up my friend everytime hurts:( That my Friends don’t back you up when I trust you 99% of the time suggests I might have to talk to my friends and i don’t want to:(

no worries TCU. you are very kind, but no worries. be at peace my friend.

Getting started on the conversation is hard. Fear leads to lack of faith in professionals.