How The AMA Preserves The Status Quo In Medicine

from the throwing-up-barriers dept

In my initial posts on the power of professional organizations, like the AMA and the Bar, I laid out the general case for thinking of these organizations as labor unions as well as the some of the history of this thinking. As I acknowledged at the outset, none of this is particularly new, as people have been talking about these ideas for some time, including Milton Friedman. But for various reasons, this discussion is more timely than ever -- certainly more so than when Friedman was taking the issue up. In this post, I'm going to delve deeper into the AMA, explore what exactly the organization does, and explain why it's important that its power be addressed. First of all, it's generally agreed upon that the US economy is facing some sort of problem when it comes to healthcare. The magnitude of the problem is open to debate, but it's clear that costs are spiraling and access is dwindling. Those are, of course, closely related, since access wouldn't be dwindling if it weren't getting more expensive to provide it. Even if one doesn't accept that the problem is a full blown crisis, it should still be regarded as a market failure that healthcare services are growing less available. This is exactly the opposite of what typically happens across most industries, as the market, over time, will tend to produce more of a good at ever cheaper prices. Nobody with any experience in tech could fail to understand this phenomenon. The other reason why this is important now has to do with technology. The advance of medical technology is moving rapidly, and it has the potential displace disrupt traditional modes of healthcare delivery.

While it's certainly not the whole problem, doctors are an obvious place to look. At every step of the healthcare process, there's (typically) a doctor bill to be paid. And because of the high hurdle one needs to clear in order to get licensed as a doctor, there hasn't been a whole lot of price erosion over time, as there has for, say, IT workers. This is where the AMA comes in. Officially, the AMA has a number of noble goals that few people could find fault with. Chief among them, it claims it wants to preserve the high quality of the healthcare field for the betterment of the public. Of course, preserving the quality of healthcare involves keeping the barriers to entry to being a doctor as high as possible, which allows them to "keep the quacks out", while conveniently protecting Doctors' comfy profit margins. This is done through a number of means, as the AMA tends to side with any proposal that would obviate the role of non-doctors in the delivery of healthcare. The AMA has routinely pushed back against moves to make certain drugs available over the counter, for this would remove the doctor as a gatekeeper to medicine. It's also spread FUD about cheap, walk-in medical clinics that are staffed by nurses, as it claims that these clinics could undermine the important relationship between a patient and their doctor. That could be part of it; it could also be, as some doctors willingly admit, that walk-in clinics could force doctors to bring their prices down to compete. Other areas that the AMA has gotten involved in include inserting doctors into various phases of labwork and testing, and opposing licensing schemes that could foster the expansion of telemedicine. As it is, the patchwork of state-by-state licensing regimes serve as a legal hurdle to telemedicine, and the AMA seems to be pretty happy with the status quo. Historically, the AMA has also tried to limit immigrant doctors.

All of these actions point to a fairly consistent pattern, but still, most people can't accept that there's an alternative. The standard thinking goes that without adequate regulatory measures, the industry would quickly be overrun by quacks, imperiling patients everywhere. But there's a reason that most industries, even ones that are barely regulated, don't become lousy with quacks: quackery isn't good business. If you know that your local fruit stand consistently sells rotten plums, you won't go there. Things like word of mouth and the desire to keep one's brand strong force providers into line, or else they'll quickly find themselves out of the market. And seeing as people go out of their way to educate themselves on goods and services a lot less important than healthcare (hence the magazine Consumer Reports), we can only assume that people will take the same measures to learn about the doctors they go to -- actually, this isn't theoretical, as people already investigate doctors before going to them. Ultimately, the quack argument is just a straw man. The goal of letting more people engage in the practice of medicine isn't an endorsement of non-skilled professionals, but an acknowledgment that people could adequately perform certain healthcare functions without years and years of medical school (and enormous student loan debt to pay back). There's strong evidence that for common purposes, trained nurses can provide care that's equal to doctors in terms of outcome. What's more, it's easy to imagine many healthcare functions that could be delivered by trained technicians. How many years of training does it take to diagnose strep throat and provide an individual with antibiotics? How hard is it to test for a urinary tract infection? With technology, these tasks (will) become even easier, opening up roles for people with rudimentary vocational training. The common objection to this is that these technicians won't know what to do when there's something more serious going on. But then there'd be nothing stopping them from referring a patient to a doctor, in exactly the same way that an ordinary physician will refer a patient to a specialist when something is above their pay grade.

Not only are fears of quacks overrated, there are plenty of reasons to believe in the opposite scenario, that lowering the barriers to entry into the industry would make for a more robust marketplace that better serves patients. Cost is obviously the big one. With more parties competing to offer health services, cost will necessarily fall. By lowering costs, you also start to solve the availability problem, as insurance becomes more affordable. The other way a more competitive environment benefits customers is that providers compete on quality. It's a sure sign of an uncompetitive marketplace when a patient can assume that if they get to the doctors' office on time, they'll have to wait another 90 minutes to get in. In a more competitive scenario, not only would doctors want to avoid wasting their patients' time, but they'd be forced to invest more into their offices. The industry might even become more forthright about things like success rates, which is not something you hear much about today.

To be sure, competitiveness among healthcare providers is just one challenge among several that are facing the industry. The pharmaceutical industry has its own set of headaches. And there are broad public policy debates to be had surrounding care for seniors and other entitlement-related issues. But in light of glaring market failures, it would seem that the AMA, which obviously stands athwart market solutions, is on the wrong side of the problem.


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  1.  
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    reed, Jun 21st, 2007 @ 1:12pm

    Time for some reform!

    I have had the pleasure of watching Sicko and I must say it is an eye opener even if it is one sided.

    My wife spent a day in the hospital two weeks ago because she had been violently ill for over a week and needed desperately to be re-hydrated from continuous vomiting. We don't have health insurance and we are both full time students.

    The bills just keep coming in. The 6 hours of care in the hospital was over $3,600. The emergency doctor bill was over $800. She had some diagnostic test done and those rang in around $1000. The radiologist bill was over $400. We are still receiving bills and the total is almost $6,000 dollars for around 6 hours of care. Keep in mind this is about a third of my salary for a WHOLE YEAR.

    I shudder to think what would have happened even if we had insurance. Would they have denied treatment? Or later refused to pay?

    American health care has become a no-win situation and the recording of Nixon hearing how HMO's will cost more and offer less service is a sad commentary about out government's respect for the common people.

     

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    Sanguine Dream, Jun 21st, 2007 @ 1:34pm

    Cost

    I've noticed over the recent years that monthly premiums, dedutibles, and co-pay rates. I use Blue Cross Blue Shield and after this year's renewal every single one of my co-pay options has gone up at least $10. Yet the quality of care seems to be the same.

    And then throw in malpractice lawsuit winnings. Doctors and lawyers have been agruing for years over how much a patient should be able to win in a lawsuit. And do you think its for the sake of the patient? No. The doctors want give up as little as possible (less winnings for the patient = lower malpractice insurance rates = more money in the doctor's pocket) and the lawyers want the patients to win more so that their perentage of the winnings go up.

    Not to be the devil's advocate (and a little off topic) but I can somewhat understand how the cost of medication would rarely (if ever) go down. Any given medication requires a specific combination of specific ingredients. And unless a new cheaper in ingredient is found that can replace an existing one then the cost will always be about the same. Even if a new cheaper ingredient that produces the same effect if found then its back to the drawing board in the R&D section to make sure the new ingredient doesn't require altering the formula even further. The only way I could think of a medication getting cheaper is for the cost of the ingredients to drop but if you were selling valuable materials would you be tempted to lower your price?

     

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    Me, Jun 21st, 2007 @ 1:35pm

    Exactly

    And this is why my consulting biz has a scale of three rates:

    Doctors,Lawyers = $$$$$
    Anyone in the Insurance field = $$$$
    Everyone else = $

    Laugh all you like, but I am doing quite well for myself.

     

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    dataGuy, Jun 21st, 2007 @ 1:47pm

    Re: Cost

    I have no expertise in this area but I'm willing to bet that the cost of the ingredients is a very small percentage of the price of a given medicine. For the drugs marketed on TV, the cost of the marketing campaign is likely to be larger that the manufacturing costs. Not to mention that if the drug is given to you in a hospital they tack on a big charge for the "cost" of having a professional give you the drug, even it is an over the counter medication.

     

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    Overcast, Jun 21st, 2007 @ 1:59pm

    Of course...

    Ask yourself this too..

    If a cure for cancer did exist - would the American Cancer Society keep it to themselves?

    Of course - it's not about helping people, it's about money.

     

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    Eastside, Jun 21st, 2007 @ 2:09pm

    AMA

    One other thing to be aware of is that the AMA currently has a monopoly on CPT codes. These are the codes that physicians must use to get reimbursed and the AMA has them trademarked so everyone who wants to use them in software or organize them in a book has to pay a fee. This is why they are also pushing against the adoption of ICD-10 which is the system that the rest of the world is using, while we in the states are still saddled with ICD-9 and CPT codes, which the AMA makes money off of.

     

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    A. L. Flanagan, Jun 21st, 2007 @ 2:13pm

    One bit of disagreement

    I'm hugely in agreement with 90% of your post, but I feel I have to point out that, in fact, quackery can be very good business indeed. Look at all the things that were sold as "medicine" before regulation was imposed. Even today, there's huge business in "homeopathic" medicines and "male enhancement products" and similar garbage.

     

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    CJ, Jun 21st, 2007 @ 2:18pm

    Re: Overcast

    Of course they wouldn't keep it to themselves. You've just opened up a whole new market. Cancer wouldn't disappear from the earth, but to get cured you'd need to see your Doctor.

     

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    ehrichweiss, Jun 21st, 2007 @ 2:18pm

    I'll give you 3 ways...

    Fear...Uncertainty and Doubt.

    "It might be cancer"

    "It" might also be a benign cyst.


    "Always get medical attention if you have chest pains"

    That way when you are working out your chest muscles you don't have to think that it just might be that you strained a pectoral muscle or the like, nope it HAS to be cardiac arrest.

    "Your son has a fever, it might be meningitis."

    I'd laugh at that one if it hadn't been pulled on me and my wife. The quack, err, physician had no problem scaring the bejesus out of us but didn't feel the need to pay for the test when he guessed waaaaaay wrong.

    Let's not forget the flu shots that give you a cold for a year, weight loss pills approved to cause heart disease, and the overwhelming need for them to think they know more about your body than you do.

    You'd think I would be a mortal enemy to someone in the medical profession but oddly enough, about 1/2 of my in-laws are doctors, nurses, nurse practitioners, radiologists, etc.

     

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    Scheffy, Jun 21st, 2007 @ 2:25pm

    While I agree with parts of the article, I think it shows the main problem of directly relating the medical field to economics in that the patients and the care they receive are just "goods" to be bought and sold. On the surface they're related, but there's a major difference between getting a bad product off eBay or not having your car repaired the way it's supposed to be and getting shoddy health care from some "quack." In one case you might be pissed about getting the wrong product or that your A/C still doesn't work right, but in the other there's potential for some major life-long aftereffects of getting treatment from somebody that doesn't know what they're doing.
    The problem with the argument of free-market health care is that there have to be a few casualties before word gets around that some provider doesn't know what he/she is doing. Not that this doesn't happen with the system as it stands now, but I would think it would happen a whole lot more if you could walk out of your local community college with a 2-year degree in orthopaedics.
    At the same time I'm not agreeing with how things are currently done - I recently needed a pin and screws in a leg I busted in half and I now have firsthand experience in how screwed up the system is. Just bear in mind that this isn't a black-and-white argument with anything resembling an easy solution. The doctors are arguably getting screwed just as hard as the patients in most cases, what with the HMO's basically keeping everything but nominal fees paid to the docs even for complicated procedures, and paying more for malpractice insurance than they actually earn because they get sued by patients that don't know anything about their own conditions and lawyers who are too greedy to let that get in the way of their cut of the settlement check...

     

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    Dave, Jun 21st, 2007 @ 2:25pm

    Thanks!

    Thank you for writing that excellent post. There are so many forces supporting the status quo and going against good healthcare and access to it. The AMA juggernaut is very powerful, as are the drug-company lobbies; strong enough, as you say, to avoid normal market behavior.

    The consumer is left to take care of himself, essentially. Becoming very well-informed and living as healthy a lifestyle as possible is one of the few defenses against the current rotten state of affairs.

     

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    Anonymous Coward, Jun 21st, 2007 @ 2:27pm

    I like to comment about the remark that the market will weed out the quacks. I've been in the medicine for over 15 years so you may say I'm biased. However, I would like to add that quality of care is in some ways hard to measure. And it is even harder for those not in the field. There has been numerous times I see patients rave about a doctor that I feel provide poor quality of care. I have also seen the opposite. Sure, if the doctor does something catastrophically wrong, he might get a bad reputation. But most poor care are not usually perceived by the patients. If a car mechanic is fixing your car with lower tier parts, you may never know it unless that part is so bad it breaks. The bottom line is that I don't think the public can monitor quality of care very well by themselves. I am not saying the people's perception of care is irrelevant. But by itself, it's not entirely reliable.

     

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    JRK, Jun 21st, 2007 @ 2:28pm

    Doctors or Insurance

    You know what is funny to me is that 5 out of six of these comments are about Insurance companies, not Doctors. I agree that there are Doctors out there that look at a patient as a paycheck and not as a patient. But there is still a duty to provide services, and in most cases a doctor will not deny service to anyone.

    Doctors are losing out to Insurance companies and it is getting worse everyday. There are many problems with the healthcare system in the United States, but I don't think the problem lies solely within the ADA.

    Has anyone actually been to a Regional office of Blue Cross Blue Shield? These places are unreal. Try to find another "Not for Profit" that has offices like these Insurance companies.

     

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  14.  
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    Norman619, Jun 21st, 2007 @ 2:29pm

    Re: Cost

    Sorry but the cost of the drugs have nothing to do with the cost of making them. They cost so much because WE are willing to pay these inflated prices. Look in other countries and compare the prices. We are charged MUCH more than peopel in other countries. Do not fool yourself. The drug companies suffer just as much from greed as every other company which sells us things we simply can not live with out. When asked about this the drug companies never have a good reason for the inflated prices.

    I am soo greatful I rarely get sick. Even more greatful I haven't gotten sick enough to have to take a trip to the ER. Sicko may be one sided but the facts it brought to light speak for themselves. We are the richest nation in the world (well not if you take a look at a neat little film called Maxed Out) yet we are raped on a daily basis by medical insurance companies and the medical system in general.

     

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    Self-diagnosing Steve, Jun 21st, 2007 @ 2:30pm

    Professional Healthcare Unnecessary

    I agree with the "Fear Uncertainty and Doubt" post.

    I think people tend to massively underrate their ability to self-diagnose. Pick up a Mayo Clinic Family Heath book and don't be afraid of logging onto Web MD.

    Urine in the blood?

    Maybe cancer, maybe gallstones, but it may be a urinary tract infection. If you really focus on it, you might be surprised what you can figure out. At least try taking some of those antibiotics you never finished and see if it goes away. If it's cancer you're pretty well f***ed anyway, even after you see a doctor.


    Stomache ache for days without any digestive problems? Could be appendicities. If you can feel a solid painful lump down there, but your eating and digestive tract seem to be working okay otherwise, well, it's probably time to go see a doctor.

    And so forth...

    People's are over-reliant on medical professionals. Except for invasive surgery, antibiotics, and vaccines (two of which could probably be handled without doctors), most of it IS some level of quackery.

     

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    Norman619, Jun 21st, 2007 @ 2:30pm

    Re:

    They wouldn't keep it to themselves. THJat's bad busienss. They'd charge an arm, a leg, and your next born for it.

     

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    Wolferz (profile), Jun 21st, 2007 @ 2:41pm

    quacks in tech comparison

    Overall I find this article to be one of the best I've seen on Techdirt, so don't take this the wrong way.

    However your comparison of Doctors to IT Profesional in relation to "quackery" is entirely too accurate for your end conclusion. I have been an "IT Proffesional" for over 8 years now. I work in retail computer repair. I've had to develop a very broad skill set and am constantly exposed to new issues and technologies from a wide range of IT needs and uses. I've also had to work with people in a more narrow branches of IT such as those who spend their time setting up and maintaining large networks for corporations or developing software. The most disturbing thing I've noticed in this time is how prevalent "quackery" in the IT Industry is. I've had supposed "IT Professionals" tell me that scanning to JPEG format can not be done, that virus' can not infect the boot sector of a hard drive, that wifi is inherently more secure than wired networking, that putting a PSU with too much wattage will fry a computer, that you should use acidic human saliva (otherwise known as spit) for cleaning the sensitive plastic optics of your cd/dvd drive, and on and on. The scary part is this is the rule, not the exception. Less than 20% of the "IT Professionals" that I have met knew and understood basic computer concepts much less were knowledgeable enough that I would let them check their email on my computer. I'd break their hands if they even mentioned working on it. We're talking about people with 4+ years of college and more certifications than you can shake a stick at. People who have been working in the IT Industry since before Windows 95 came out, since before I was in high school.

    Why is this possible? I've watched them rattle off bullshit and blatantly wrong information to customers faces while looking them right in the eye. It's not that they are lying since they actually believe their own bullshit. Why wouldn't they believe it? They get paid to spout it time and time again. The customer of course has no idea. It only takes a hand full of obscure (often made up) terms and half truths to have a customer eating out of your hand. Not only that but the customer will likely never realize they were taken for a ride. They barely even understand enough about how a computer is supposed to work to realize when it isn't working the way it is supposed to (they don't want to). So they will bring the same computer that was never really fixed back to the same computer tech who never really fixed it to not really fix it time and time again for a supposedly different problem each time. Why bother actually knowing what your doing when you can get people to pay you for messing their computer up worse than it was. These are the people that work as sys admin at ISPs and banks. These are the people that get hired at firedog and geek squad. More often than not these are the people working at your local ma'n'pa computer shop.

    The same thing could easily happen in a deregulated Medial Industry thanks to the lack of consumer knowledge on how medicine really works and the fact that, out of necessity, people must trust their doctors. Thus, while I agree that the current regulation is used more for keeping prices high, I think some level of regulation is a must simply to ensure the safety of patients.

    Oh btw, my business model allows me to make obscene amounts of profit will still undercutting my competition 15%. I don't need regulation to make a healthy living. I just get irritated seeing people taken advantage of.

     

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    Greg, Jun 21st, 2007 @ 2:43pm

    You are way off

    Your comments on the AMA are, in my opinion, a little off. First of all, I am a physician, but do not practice primary care. The reason it is difficult to get into medicine, is to make sure the best and brightest are accepted, not to 'keep the quacks out' as you put it. Every industry does this, thats why you interview for a job and show your resume. You need to prove you can do the work before being hired. Every college and university does this, they accept the best and brightest that apply to their schools. I don't think they are trying to convince the public that they are protecting them from rampant quackery if they relax their standards.

    As to the increase in ancillary staff acting as care givers. Yes, doctors are trained to a much higher degree than nurses and nurse practitioners, and have a much deeper knowledge base. This comes at a cost. The article you refered to stated 'Someone who knows less medicine, but admits when they do not know, can do as well as someone who knows more, but is overconfident.' That is probably a true statement, however the reality is that the nurses who practice become overconfident, and then the worst combination happens: you get someone who is less knowledgeable, but thinks they know everything, and therefore, worse things happen. This is what the AMA is worried about, the quality of the care being given.

    Finally, I'd like to reply to the first commenter's story. If you are sick with a cold or the flu, go to your doctor, not the emergency room. The emergency room is not meant to be a primary care facility. You are a prime example of why the cost of medicine is so expensive. If you did have insurance, they would have paid the bill minus your co-pays or deductibles. However, if you had gone to your regular Family Practice doctor's office, the bill would have been significantly less. If you don't have a primary care doctor, get one, or at least pick one out to go to when you need one. Office visits are significantly less expensive for everyone involved than an emergency room visit. You can save yourself a few thousand dollars next time. If you want to help reform the system, start with yourself.

     

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    Joe, MD, Jun 21st, 2007 @ 2:56pm

    Think before you berate

    "Maybe cancer, maybe gallstones, but it may be a urinary tract infection. If you really focus on it, you might be surprised what you can figure out. At least try taking some of those antibiotics you never finished and see if it goes away. If it's cancer you're pretty well f***ed anyway, even after you see a doctor.


    Stomache ache for days without any digestive problems? Could be appendicities. If you can feel a solid painful lump down there, but your eating and digestive tract seem to be working okay otherwise, well, it's probably time to go see a doctor.

    And so forth...

    People's are over-reliant on medical professionals. Except for invasive surgery, antibiotics, and vaccines (two of which could probably be handled without doctors), most of it IS some level of quackery."

    First go to medical school and actually study the science before you critique something as quackery. Child has a headache, fever, neck pain? The doc was right to rule out meningitis. Medicine is a science, but it's a science of probabilities. People decided to keep the god-high expectations of the 50's that docs should know all, yet the freedom to criticize at will. If a child presents with those symptoms (HA, neck pain, fever), the most important thing to do is rule out meningitis. Why? Because it's life threatening. It may not be this, but would you rather have your child die?

    Yes, go ahead and diagnose yourself on web md. You might be right (and there's a fair probability that you could be), but you could also miss something that could lead to renal failure.

    I have no qualms about saying the system is flawed. Yes some docs make quite a bit of money. We also go to 4 years of undergrad, 4 years of medical school, and 3-7+ years of residency training. Add in several hundred thousand dollars of debt from all this schooling, and you'll understand why some docs push the AMA so hard to protect salaries. But also don't fool yourself that we're making more money. The salaries of docs have declined over the years when adjusted for inflation.

    http://www.nytimes.com/2006/06/22/business/22doctors.html?ex=1308628800&en=50abc81 5852111ce&ei=5088&partner=rssnyt&emc=rss

    Where's the money going? More middle-men (insurance companies, HMO's, drug companies). Not in the docs pockets.

    There are further difficulties in comparing all this to a free market system. Free market assumes no government interventions, of which there are many in healthcare. Too many, so might argue. Creating competition between doctors offices isn't gonna lower the prices because lab tests cost what they cost, as do the drugs. You have to lower the costs up the food chain.

    Costs are spriraling and access dwindling? Perhaps true, but those aren't necessarily related. There are a finite number of practitioners (even mid-level -- nurses, PA's), and an ever growing number of aging complex patients (especially with the aging baby boomers). Blame the AMA? There's more of a nursing shortage than there is a doctor shortage, and that has nothing to do with the AMA keeping nurses from full privileges. There's plenty of NP's doing solo practices in many states, and their privileges are only growing.

     

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    John, Jun 21st, 2007 @ 3:09pm

    Three children over 5 years, $12,000.00 then $16,000.00 then finally last March $20,000.00. Same hospital, same conditions, all C-sections, all discounted for cash payment. Even the same doctor on the last two. The only thing that changed over those five years was the general care for the mother that went from lousy to terrible. Why?

    Just last week I was able to go to a nation wide group and have a vasectomy for a third of what the local doctor was asking, $550.00 Why?

     

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    Haywood, Jun 21st, 2007 @ 3:16pm

    Re: You are way off

    Doctor huh. I too had to take my wife to an emergency room for severe dehydration due to vomiting, and she would be dead now if I'd oped for the doctors office. Within 15 minutes of entering the emergency room she went into convulsions, and was crash carted to ICU. I'm sure you have all that at your office, not.

     

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    Greg, Jun 21st, 2007 @ 3:37pm

    Re: Re: You are way off

    I'm sorry to hear that Haywood, but obviously, you have to use some common sense to determine what is an emergency and what is not. Going to the doctor before your symptoms get to that severity would be more preventative, and yes, most primary care physicians would be able to stabilize someone in your wife's situation and then get her to the hospital. Again, we are trained to do that. Just because a doctor works in an office, does not mean they are not familiar with and can deal with situations that are more at a hospital / emergency level.

     

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    Alex Hagen, Jun 21st, 2007 @ 3:42pm

    Uhh, your main argument kind of sucks

    "But there's a reason that most industries, even ones that are barely regulated, don't become lousy with quacks: quackery isn't good business. If you know that your local fruit stand consistently sells rotten plums, you won't go there."

    The consequences of eating a rotten plum and the consequences of getting a bad doctor are quite different. And for you to demean the years of schooling and practice that doctors go through as largely irrelevant and not needed is pretty arrogant and dumb. Doctors, with all that schooling and training, still make mistakes all the time that cost people their lives. Now you propose that we require less training for those that have the power of life and death over us? That is just moronic. There is a problem in the US health care system, but I don't think allowing less trained people to care for me is the answer.

    And to the idiot who said:

    "If a cure for cancer did exist - would the American Cancer Society keep it to themselves?"

    That has got to be the dumbest thing ever said on Techdirt, and that is quite a challenge. Doctors are people, they have patients they care for. I am sure that every one of the doctors in that organization have had beloved patients, friends, and family members die from Cancer. And you think that they will allow that to happen if they knew of a cure? Do the world a favor and remove yourself from the gene pool immediately please.

     

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    Haywood, Jun 21st, 2007 @ 3:46pm

    Re: Re: Re: You are way off

    She wouldn't have survived the 90 minute wait in the waiting room.:) I firmly believe; since she would have ended up in the hospital anyhow cutting out the middle man was the right thing to do. Could we have come to the conclusion that help was needed more quickly? Probably, but I did follow the advice of my doctor, which was; if she doesn't brighten up in an hour take her to the emergency room. Considering, the hospital is 10 blocks away and his office is across town, I commend him on his choice, he might have said do it immediately, but it is the "practice" of medicine not the science.

     

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  25.  
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    Vincent Clement (profile), Jun 21st, 2007 @ 4:19pm

    Re:

    The problem with the argument of free-market health care is that there have to be a few casualties before word gets around that some provider doesn't know what he/she is doing.

    People die under the current system where the AMA has 'our best interest' at heart. No one ever said the free market is perfect. It's the best system we have. The bad examples are the exception not the rule. Everyone likes to point out Enron as the free market 'gone bad'. But there are hundreds of corporations that satisfy their customers each and every day.

     

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  26.  
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    Vincent Clement (profile), Jun 21st, 2007 @ 4:20pm

    Re: Thanks!

    Most government regulations are meant to maintain the status quo under the guise of protecting the consumer or protecting the kids or protecting whatever. People need to be responsible for their actions, not the government.

     

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  27.  
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    dorpus, Jun 21st, 2007 @ 5:03pm

    Way off, as usual

    The vast majority of health care costs is eaten up by non-MD personnel, of which there are huge armies. MD's in the USA today are quite poor, between getting half their salary eaten up by malpractice insurance and the other half by med school loans. Ignorant people like to portray evil doctors driving health care costs, but it is not true. MD's are dropping out of health care in droves, especially in California, because they cannot make a profit from the low compensation.

    By comparison, many non-MD health professionals make salaries equal to doctors, do not have to buy malpractice insurance, and do not have such huge loans to pay back. Hospitals in the USA are usually unprofitable enterprises that spend vast sums on keeping facilities clean to prevent the news media from spreading panic about "flesh eating bacteria" or whatever, paying the salaries of all them nurses and anesthesiology technicians driving their sports cars, or dealing with illegal immigrants who don't pay medical bills and spread diseases all over everything and and everyone.

    And of course, the vast majority of patient costs is jacked up by aging patients with their many medical problems, who are not economically productive. Unless we open holocaust camps to get rid of all the old patients and highly paid anesthesiologists, health care costs will continue to go up throughout the world.

     

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  28.  
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    Not dorpus, Jun 21st, 2007 @ 6:26pm

    Re: Way off, as usual

    MD's in the USA today are quite poor, between getting half their salary eaten up by malpractice insurance and the other half by med school loans.
    Typical dorpus. That characterization is one of the biggest loads of bull I have read in some time. Doctors don't make any money? Yeah, right. Of course you've also claimed that patient choice is a fraud. So tell us another one dorpus, you're on a roll.

     

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  29.  
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    Anonymous Coward, Jun 21st, 2007 @ 6:31pm

    Re: Re: Re: Re: You are way off

    She wouldn't have survived the 90 minute wait in the waiting room.
    90 minute wait? How about the 2 to 3 week wait for an appointment?

     

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  30.  
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    Another Anonymous Coward, Jun 21st, 2007 @ 6:55pm

    Why isn't healthcare access easier?

    The problem with removing the barriers is that quackery breeds and spreads - look at religion. The entire medical profession could be replaced by witch doctors and priests and the patients would be just as happy, perhaps happier. They just wouldn't live as long or stay as healthy.

     

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  31.  
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    JoeBob, Jun 21st, 2007 @ 8:28pm

    Re: Doctors or Insurance

    Just realize that 6 out of 7 physicians in the US are paid *less* today than they were 10 years ago, and even less than 20 years ago (when adjusted for inflation) due to "managed healthcare."

    Don't blame the physicians. They're usually little more than specialist cogs in the machine with no real control over much at all other than getting you the best care they can deliver. Sure, there are some who are in it more for the money than for their patients' well-being -- there are mercenaries in any line of work -- but most are primarily concerned about doing right by their patients.

    Is healthcare ideally efficient, reliable, or equally accessible by all? Nope, but you'll not find a more _responsive_ healthcare system anywhere on the planet than in the US. And that responsiveness comes at a price: wasted resources and excess capacity, both of which increase costs.

     

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  32.  
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    Luci, Jun 21st, 2007 @ 10:05pm

    Re: Self-monitoring of quality of care

    I have to disagree with you on this for one important reason: most people who see doctors on a regular basis are actually monitoring health problems they already have. I cannot count the number of times I am correction nurses, interns, residents, and doctors (right up the line, here) about my own care. It should be EMBARRASSING to have a patient correct a doctor about medications, or remind them multiple times in the same appointment about adverse side effects they've had while the doctor tries to force them back on those same pills. When a patient knows what salt and caffeine do to their body, and have proved it time and again, then why is the doctor still trying to push more pills that aren't necessary? What about the nurses and residents in the renal wing who do not know how to set up a simple peritoneal dialysis machine, and have to rely on the patient to show them how to do it when they are in the hospital for some other condition?

    Granted, I was diagnosed with kidney disease 20 years ago, did my own dialysis, and monitor my own transplant quite closely, but from my experience, at least in my neck of the woods, that's the norm. Why? Because doctors are too expensive. The meds they want us on, even when not necessary, bleed us dry. Give the average citizen a little more credit, please. We may not have medical degrees, but in MY experience it isn't necessary for day to day care.

     

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  33.  
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    Greg, Jun 22nd, 2007 @ 5:27am

    Re: Re: Re: Re: You are way off

    So, you followed the good advice given to you by your physician. So, what are you complaining about then Haywood? Sounds like the system worked just fine for you. I get calls from my patients every day. I talk to them on the phone and offer advice. Some I ask to come to the office, some I send to the emergency room. I may just call in prescriptions for others. One other thing to consider is that doctors don't charge for all the advice they give over the phone (even when I get called at 3:00 am). How many other professions do that? Definitely not attorneys.

     

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  34.  
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    Joe, Jun 22nd, 2007 @ 5:44am

    Not even close

    So, you would see an undertrained tech for a medical problem...wait until you come into contact with something truly nasty that can resist common antibiotics...by the time your tech realizes that something is wrong, you are more than half the way down the road to dead. No thank you. The free market is not the answer to better medical care. It will just get lots of people killed.

     

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  35.  
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    Reed, Jun 22nd, 2007 @ 10:05am

    Welcome to the third world

    "he free market is not the answer to better medical care. It will just get lots of people killed."

    People die everyday because of HMO's refusal for treatment. The 50 million people (growing at over a million a year) who are uninsured in America have drastically higher death rates and infant mortality rates.

    Bush just vetoed the stem cell bill (again) on the premise you can't kill life to save life. Right now our medical industry is killing people in order to provide better profits for the rich.

    Someone made a comment about our medical care being the most responsive. Well it is if you have the big bucks, otherwise you still wait weeks for an appointment and months for elective surgery.

    Of course every major first world country has found the answer already in socialized medicine. In the end people in charge of our system are just ethnocentric *ssholes who are willing to put profits over the health of the American people.

     

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  36.  
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    b-mac, Jun 22nd, 2007 @ 10:13am

    this attitude astonishes me.

    I couldn't agree more about the red tape nightmare that is the insurance industry. But, physicians are people...and caring, selfless, hardworking ones at that.
    It amazes me how often their earnest efforts based on years of study and experiece get thrown under a bus. Not sharing a cure for cancer? Wrongly suggesting meningitis just to scare somebody? Get real. The vast majority of physicians are, indeed, screened for this type of rogue behavior. Right there in the AMCAS personal comments section.

    I will agree that months and months is too long to wait for office visits, and that 90 minutes is to long to wait in an ER. But...the whole operation is run by people. Healthcare is not a side of fries (which are still passable with too much salt or slightly cooler in temperature than you're used to). Healthcare is a tricky business that doctors all over the country are fighting uphill battles just to provide. They are low on resources and overflowing with patient loads. That's why you have to wait. Not because doctors are a bunch of arrogant jerks on a power trip.

     

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  37.  
    identicon
    Anonymous Coward, Jun 22nd, 2007 @ 10:39am

    Re: AMA

    CPT Codes are for billing, ICD-9 codes are for health conditions. ICD-10 would not replace CPT it would replace ICD-9, which is as free as ICD-10

     

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  38.  
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    Anonymous Coward, Jun 22nd, 2007 @ 11:43am

    Re: this attitude astonishes me.

    physicians are people...and caring, selfless, hardworking ones at that.
    Some may be, but more and more are somewhat less than caring and selfless. Several people I knew growing up went on to become doctors. Not a one of them did it because they just wanted to help people.

     

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  39.  
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    doctor's salaries.., Jun 24th, 2007 @ 8:06pm

    Doctor's don't make enough ?

    Previous statement>MD's in the USA today are quite poor, between getting half >their salary eaten up by malpractice insurance and the >other half by med school loans. ---------------------------------------------------- Study>The average reported net income for a primary care physician in 2003 was $146,405, according to the study, AFTER expenses like malpractice insurance but before taxes. The highest-paid doctors were surgeons who specialize in areas like orthopedics, who had an average net income of $271,652, nearly double what the primary care doctors said they earned. -------------------------------------------------------- *I think the above statistic speaks for itself. Please do weep for those who "poor" doctors who did not make "enough".* ----------------------------------------------------------- Study>Physicians have responded to the stagnant fees by producing more visits as well as more procedures," said Mr. Ginsburg. According to the study ---Doctors, he said, are reacting to the financial incentives under the current payment system by choosing to specialize and work in fields where they can increase their income by providing more services, like diagnostic tests or procedures. ---------------------------------------------------------- *I.e recommend more testing so that they can get kickbacks for their "referral" to rule out A,B C & D ailments*

     

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  40.  
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    t1206, Jun 26th, 2007 @ 10:02am

    Doctor's don't make enough ?

    #39, I agree that doctors are not poor, but I'm curious what you think is an acceptable salary for a doctor is. Please factor in a minimum of eleven years of education and on-the-job training (while incurring a typical debt of more than $100,000), being on call 24 hours a day, running your own business, and being available to take patient's phone calls without charge for any medically-related question or concern at any time of the day or night. Also factor in the number of hours worked seeing patients in the office full time, in the hospital, and the 3AM phone calls all seven days a week and holidays (adding up to considerably more than the standard 40 hour work week).

    Also, please understand that recommending "more testing so that they can get kickbacks for their "referral" to rule out A,B C & D ailments" is illegal and would result in federal prosecution and professional sanctions. I question if you understand the realities of practicing medicine.

     

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  41.  
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    doctor's salaries.., Jun 30th, 2007 @ 1:36pm

    Re: Doctor's don't make enough ?

    The question is not of what is an acceptable doctor's salaries. It has to be what the market will bear. I don't see science Ph.d's demanding high wages as birthright despite their also going through 4 yrs undergrad + 6 ys MS & Ph.D + 2 yrs post docs.

    Why should amount of loan burden dictate how much you should be paid- does your pizza shop owner say i have $40,000 in loans so you *should* pay me $40 for my pizza.


    http://www.newyorker.com/archive/2005/04/04/050404fa_fact?currentPage=1

    "Insurance meant that all anyone has to consider is the patients needs. It is a beautiful thing. Yet it’s also the source of what economists call “moral hazard”: with other people paying the bills, one does not care how much was spent or charged to seee the patient. To the patient all the members of the team deserved a million dollars for what they do. Others were footing the bill—so it’s left to them to question the price.

    Hence the adversarial relationship doctors have with insurers. Whether insurance is provided by the government or by corporations, there is no reason to think that the battles—over the fees charged, the bills rejected, the pre-approval contortions—will ever end."


    Everyone is trying to get as much money as they can out of it with the patient being least bothered who pays & how much. I believe that where the discrepancy lies. Each side of the equation is being paid with other people's money & nobody cares.

    In countries where patients pay doctors out of their own pockets the salaries are much more reasonable -with good doctors paid well & poor ones poorly

     

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  42.  
    identicon
    doctor's salaries.., Jun 30th, 2007 @ 4:51pm

    Re: Doctor's don't make enough ?

    As far as kickbacks go..it is often the letter of the law that is followed & not the spirit. Doctors may refer patients & get "compensated" in different ways. See below from an New York times investigation.

    http://www.nytimes.com/2007/05/09/business/09anemia.html?ex=1183348800&en=4ba8 93104f946706&ei=5070


    "Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment"

    The rebates are related to the *amount* of drugs that doctors buy, and physicians that agree to use one company’s drugs exclusively typically receive higher rebates.

    The report, prepared by F.D.A. staff scientists, said no evidence indicated that the medicines either improved quality of life in patients or extended their survival, while several studies suggested that the drugs can shorten patients’ lives when used at high doses. Yesterday’s report followed the F.D.A.’s decision in March to strengthen warnings on the drugs’ labels.

    Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers.

    Documents given to The New York Times show that at just one practice in the Pacific Northwest, a group of six cancer doctors received $2.7 million from Amgen for prescribing $9 million worth of its drugs last year.

     

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  43.  
    identicon
    Peter Durkson, Apr 21st, 2008 @ 6:03pm

    Digital home telehealth devices

    Aloha,
    Are you aware of any companies succesasfully selling ditial technologies to older adults and/ or their caregivers. Will thse new technologies help save lives and reduce healhtcare costs?
    Thank you,
    Peter
    www.mauiagewave.com

     

    reply to this | link to this | view in thread ]


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