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Discussion in 'Political Action Forum' started by okie drake, Mar 2, 2012.
Good communication skills determine pt satisfaction...it also keeps the doc from getting sued
Good post jaeger.
Pharm has seen a similar path.
Insurance reimbursements go one direction.
Medco recently tried to essentially mandate mail order for all state employees in OK. The offered contract to pharmacies was literally below cost on the vast majority of generics. Mass outrage and a joint front is the only thing that beat it down.......for now.
What does said mail order do? Routinely send meds worth $$$$$$ to patients that don't want them, don't need them, are dead, no longer take it etc.
Look at the Lipitor situation as we speak. Even with only one generic maker currently (that will expire, then it will plummet), brand is of course still significantly higher yet what are some plans mandating? Dispensing brand....and they give at times a quite low copay on such. Why? $$$$$, that's why. And not to patients, to them.
You forgot the biggest driver of all. The last 6 months of life. Remember the death panels? If everyone simply signed a health care directive we would save lots of money. Absent of one, people get put on life support and other heroic efforts at great cost. But it is hard to have an intelligent conversation around that when you inflame it with rhetoric.
Rationing is another issue that can't be discussed intelligently. It has been hit on in these threads but who gets what and how much, especially when they roll over to medicare? If I am obese or even somewhat overweight do I get dialysis? A kidney? If I am an alcoholic do I get a liver transplant? At what age do you cut off aggressive cancer treatments? I know an 85 year old that had pancreatic cancer and fought it all the way...spared no expense....none of it his own money? Should there be a copay based on procedure AND age? Who gets to make up these rules?
Is it politically safe to bring these questions to the table?
jaeger, I fully understand. I've never said that physicians are overpaid. However, in some markets there is an over supply of certain specialists and that does drive up procedural works and overall costs. The aging of American and general overall decline in health status has driven up costs, but so do other factors.
Now, I didn't have all the hospitals and physicians sitting around the table. But, that doesn't matter because healthcare is typically a locally driven issue.
In regard to my twenty years, I saw plenty of positive changes. That said, I also saw a lot of waste and if anyone thinks that in all markets across this country that competition has driven down healthcare price, you really need to learn about healthcare competition. Capitalism has nothing to do with making things better. It is totally related to providing a service, a product or even intellectual value none of which may be positive but only valued by the consumer. Heck, half the crap made today in the world isn't needed and provides no real value to daily life and existence but is a main driven of capitalism.
And, for years upon years, Americans have known that their pathetic and irresponsible life styles, eating habits and accountability have been lacking and will someday become a problem. However, they have relied upon someone, somewhere to cover those issues when they finally come about.
So, my only point has been that it's not a liberal vs conservative issue. It's our issue, regardless of your political affiliation. The conservatives are full of crap if they think the private sector will solve the problem with government help. The liberals are crazy to think that we are going to be able to do everything for everybody.
Religion has partly failed. Americans no longer celebrate a life long lived. Instead, it is only a success if we try to assure everyone lives forever.
Certain, non maintenance, drugs should be dispensed on 15 day quantities even though medical expertise they need to be taken for 30 days. Why, because most Americans only take them until they feel better. Rx waste is huge and the medical profession needs to help solve this problem instead of letting big pharma control it.
Just to point out.. the "last 6 months of life" bit is a little bit of rhetoric there...
Of course the last 6 months of life is going to be expensive.. because if you are dying ... whether 6 or 60.. its going to cost money to try and save you.
that statistic includes people who are 5 and are in car wrecks, and amazing and costly stuff is done to try and get them to recover...
I deal with this issue on a daily basis... and I can tell you that the number of folks going on expensive life support at 80 or 90 or even 70 is WAY less than it was just 10 years ago.
There is less of an attitude to prolong life at any cost now than there was among physicians 10 or 20 years ago.
In addition, families are much better prepared than they used to be legally and emotionally for the end of life.
Certainly it would lower costs if these decisions were sped up by having detailed information from the patient rather than just a "DNR" in the chart.
Thats why the whole death panel issue came up.. because obamacare pays physicians to HAVE a detailed conversation with their patients regarding exactly how they want things to play out...because life support is not that simple..
And things aren't that simple.... the man with pancreatic cancer that "fought it all the way"?
It may not have been more expensive and in fact it may have been CHEAPER to fight it all the way.
IT isn't like pancreatic cancer can kill you instantly.
So do I want my Dad having to go to the ER for intractable pain multiple times as he is dealing with cancer, or is it better for him and cheaper to undergo palliative radiation treatments???
Do I want the government to decide what is better?. Right now, I can tell you many many times, the government (medicare and medicaid) do things in the interest of "saving money" and in the long run it costs them more. (and not just the government, insurance companies do exactly the same thing)
For example: The won't pay for a bath tub bench for my patient (100 bucks).. even though with a few minutes of practice (say two half hour visits if that. about 160 bucks) ) I can teach the patient how to shower themselves...
So the won't pay for the tub bench in order to save 100 bucks
BUT THEY WILL PAY FOR A BATH AIDE TO GO TO HIS HOUSE AND HELP HIM SHOWER FOR THREE MONTHS... to a tune of about 1500 dollars give or take.
But Jaeger, at the end of life discussion, the question then becomes, if a person or family members wants "everything" done to extend life, even if it means laying in the bed in a comatose manner, who pays. And if a family can't pay, then what. Or, how about the transplants and such for individuals, lets say over 90, simply because they want to be able to continue to play golf or the like. Who pays? We are now a society of "i don't want to grow old gracefully, I don't want to grow old at all". Sure, I understand that, but at what cost and who pays. Or, maybe better said, someone has to figure out where the line is going to be drawn.
Just to point out, the number of specialities in and of itself DOES NOT drive up price.
15 independent orthopods doesn't drive up the price.. it means better choices for patients, better care and lower prices (to some degree since they will compete on payment plans, collection of co pays )...
15 orthopods in one large practice... that also owns a general outpatient clinic staffed with one GP and 8 PA's..... how many referrals do you think that generates? Everyone with a stubbed toe has to be seen "by the specialist"... and of course they must have an x ray, "oh look we have radiology department right here"... and here is a referral for some physical therapy from our therapy clinic and on your way out stop by our pharmacy to pick up your "prescription strength" Naproxen.....
But you are right, the problem will not be solved by a government takeover, nor will it be solved simply by the "free market"...
See, what I am saying is that for the most part a line doesn't really have to be drawn.
See your assumption is that this expense is something like real life support.. such as respiratory support and that if taken off of it.. the patient would die.
But a lot of that expense doesn't go toward prolonging life.. it goes to prolonging quality of life...
Most death at old age isn't "quick"... its really a long and slow progressive decline until the body finally gives out. Its not like taking the medicines away, or whatever is going to mean an instant death... the person just continues to linger and that too has costs.
Lets take your "replacement" because they want to play golf...
Okay, that hip replacement costs say 60 grand to medicare. So without the hip replacement.. is the old fart going to die? No.. but what will happen is that he now has a tough time getting around... more falls, more ER visits,
now he needs more assistance at home (someone has to pay) , oops, now he can't live at home and now has to live in a nursing home at 7,000 dollars a month.
Average lifespan in a nursing home is 3 years. 36 months at 7,000 dollars..
Thats 252,000 dollars.... that 60 grand is looking mighty cheap now isn't it.
Now he dies of a heart attack a week after having his hip...
If we really wanted lower end of life costs, the conversation that we need to be having is how to allow patients to safely, effectively and painlessly end their own life when they felt the time was right. THAT would lower costs if patients themselves were the final determiners of their life.
If patients could say to their physician..."doc. listen.. I am tired of fighting this but I don't want to suffer another 6 months while it kills me.. can you give me something so I can go to sleep and not wake up?
And the physician legally, ethically and morally allowed to do so? Less cost and better quality of life.
and just who do you think controls the medical profession?