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View Diary: US Health Care Unmasked: A true story (122 comments)

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  •  US doctors aren't sympathetic at all, generally, (21+ / 0-)

    about the high cost of medicine.

    Real reform means single payer and doctors willing to accept that the new system will allow them to exploit it for less gain than the current non-system.

    •  Fortunately the Clinic I use is aware and often (33+ / 0-)

      give out samples particularly if it is very expensive or short term. I ran into a friend this week end, pretty sharp cookie and a political junkie and she told me Obamacare is going to cut services for us no more hip replacements etc. WTF???? All because of the change from fee for service. People in general just don't understand fee for service medicine is NOT better medicine, in fact you are often over treated and over medicated and over tested. I have a hip issue, heard of tennis elbow? Well, I have tennis hip, LOL. It is not something surgery will correct, doesn't mean under the current plan I can't find a surgeon who would do a hip replacement. But as I told my friend why would anyone have that surgery if they didn't need it, the recovery is miserable. But they might not be able to get it in the future .... REALLY! I explained to her the differences and used my mother's recent passing as an example. As long as she was over all healthy she got everything she needed, pace maker, eye surgery etc. As her health declined we had to weigh whatever benefits against the strain on her ability to bounce back. Eventually her health got to the point no reasonable intervention would prolong her life. At that point she had a kidney infection and had suffered a stroke as well. The decision was made to stop treatment, make her comfortable and let nature take it's course. She was 92 had lived a wonderful life and frankly had suffered enough in the past few years being ill much of the time. Could we have added a feeding tube continued antibiotics etc., sure. No doctor said we couldn't get those things but they also made it clear NONE of those things would prolong her life or bring her back to how she had been even the day before, it was time. This is the way it should be. When my grandmother passed away she was on 32 different medications many of them conflicting. She was on uppers and downers and you name it. Not only is it unlikely they prolonged her life but the last years of her life were spent largely in a medication fog. Fee for service doesn't guarantee you will get what you need or what will help you either. No one is going to argue the Mayo Clinic is a premier medical facility with slightly higher success rates than the national average. They are not fee for service which should tell us all something very important about effective healthcare.

      The work goes on, the cause endures, the hope still lives and the dreams shall never die. ~ Edward M. (Ted) Kennedy

      by cherie clark on Mon Dec 10, 2012 at 06:55:38 AM PST

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    •  So long as Big Pharma (17+ / 0-)

      controls health care delivery in this country (and they do), doctors will still get their kickbacks for prescribing expensive medications that have generic or even over the counter alternatives that work as well. For instance, aspirin instead of a thousand-dollar bottle of blood thinners.

      If we were to create a universal single-payer system that negotiates the price of medications to the level of, say, Canada, Big Pharma would not be able to reap tremendous profits off of compounds largely created and tested by public universities and their associated hospitals/clinics, financed by public money.

      Poor babies.

      •  And we should not allow ... (20+ / 0-)

        ... direct to consumer marketing of drugs.  I'd love to know how many of the television commercials we're inundated with in a 24 hour period are for one pharmaceutical or another.  The European Union does not allow this.

      •  The other part of this equation is... (6+ / 0-)

        How drugs are developed, patented and released to the market has to be improved.

        Right now, all a new drug as to do is prove that it is a unique chemical composition and it is better than a sugar pill and it can be patented and marketed to doctors at whatever price they want.  They do not have to prove that it is better than an aspirin or better than the current leading treatment.  Doctors cannot possibly be expected to keep up with the hundreds if not thousands of news drugs put on the market every year so they get trained by the very same drug companies in which drugs to use.  Additionally, most of the watchdogs in the FDA moonlight for the drug companies and you have quite a few conflicts of interest at hand.

        The fix is simple:
        1.) Allow our government to negotiate prices with pharmaceutical companies.
        2.) Make new drug patent applicants test their drugs against the current most popular treatment.
        3.) Create a government "Best Practices" board that makes recommendations and provides training for doctors on advised pharmaceuticals based strictly on performance data.
        4.) Eliminate conflicts of interest in the FDA by outlawing part time jobs with pharmaceutical companies and replacing the revenue by offering bonuses for discovering law violations.

        "Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to procure them general favour..."

        by Buckeye Nut Schell on Mon Dec 10, 2012 at 09:14:18 AM PST

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      •  Joieau - paying physicians "kickbacks" (0+ / 0-)

        for prescribing a specific drug is a federal crime. The practice of providing incentives for physicians to prescribe specific drugs was outlawed a very long time ago.

        "let's talk about that"

        by VClib on Tue Dec 11, 2012 at 01:36:50 AM PST

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    •  I think they just don't know. (4+ / 0-)

      I don’t think they are being callous or uncaring (most of them anyway); I think a more likely explanation is they just don’t know what things cost. They may know relative costs, like Drug X is cheaper than Drug Y, but putting a dollar amount to either one would be tough.

      Also, look at it this way: If you’re a doctor, you can’t really know the price of something anyway. For every different insurance company, the ultimate payer probably pays a different amount. Ergo, in practice there may be dozens of different prices for the exact same thing. Patient A pays $1000 under their policy. Patient B pays $35 under theirs. Most doctors aren’t going to wade into that unless their patients demand it.

      Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

      by Joe Bob on Mon Dec 10, 2012 at 09:07:09 AM PST

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      •  Most of them are caring and honest. (2+ / 0-)
        Recommended by:
        Angie in WA State, Joe Bob

        But because they're trying to give every patient the "best" care regardless of economic factors, which are Evil, they prescribe the drug and/or treatment which they have been convinced is the best first.  And the education by which they determine that treatment is highly biased and skewed by the self-interest of every medical provider there is.  Companies that manufacture equipment sponsor studies proving that their equipment will increase early detection of cancer by 5% convince national boards that the test is therefore essential.  Pharma companies sponsor studies showing that their drug is the best under very controlled and specific conditions, then market it for every condition remotely related.  Device manufacturers sponsor studies that "prove" that their devices are good for "severe" Condition A, then market the device as absolutely essential for any degree of Condition A, even so mild that the patient is completely unaware they have a "condition".  Improvements of less than 10% over lack of treatment are considered "significant" and therefore justify price tags in the hundreds of thousands.  Every patient must be prescribed the BEST!

        Doctors are victims of the information which constitutes their training.  They are TRAINED to overprescribe, and disciplined for failure to overtest.  Even if they don't think a test is really necessary, they have to worry that their supervisor (most of them have those, these days) will second-guess them.  And they are rigorously trained to avoid pragmatic and expedient treatment in favor of extensive and expensive testing to determine every last factor . . . which, when you add up the likelihood of minor errors in a battery of a hundred tests, actually increases the probability that SOMETHING will show up that looks wrong, just by sheer random chance.

        Sorry, I've worked with the beast for twenty-five years, and I've never met a doctor who didn't prescribe unnecessary tests and futile or unnecessary treatments.

        •  while I mostly agree, consider also (0+ / 0-)

          that for 'family doctors', previously known as G.P.s (general practitioners); a considerable amount of the testing they order is to "rule out" specific conditions.

          Remember, medicine is still as much an art as it is a science, when it comes to determining the diagnosis for any given patient. The physician takes the patient's described symptoms and a physical examination, and goes from there. So, testing is as much to 'rule out' as it is to "confirm" the physician's preliminary (or working) diagnosis.

          This may be seen as "over-testing" to someone who does not know any better.

          "I like paying taxes...with them, I buy Civilization" -- me

          by Angie in WA State on Mon Dec 10, 2012 at 12:18:20 PM PST

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          •  In many cases (0+ / 0-)

            no doubt.  But as a patient, I don't think I needed 50 different things checked when I was obviously presenting with high blood pressure.  I needed medication for the high pressure.  And as a sleep tech, about 50% of our patients came in with a "rule out" order, which ended up in fully 80% of them diagnosed with sleep apnea which was so mild that it would never have caused them any harm EXCEPT that putting them on CPAP involved a second $2000 test night, equipment sales and fitting, and followup every six months for life.  Again, in people with mild to moderate "disease" that there is and was no research justifying treatment for.

            Doctors overtest, overdiagnose, and overprescribe.  No businessman is going to pass up an obvious opportunity for a sale.  And no one is so virtuous, as to lack a bias towards doing what is in his own best interest.

    •  A lot of times they don't know (5+ / 0-)

      Many times they don't know the cost of drugs they are prescribing and of course they can't be expected to know the coverage your insurance plan has: there are so many plans, each with their own rules. This is a problem: doctors are given all kinds of information, through  advertising and marketing, about the latest and greatest drugs, but they don't have information about cost, or any kind of cost/benefit ratio.

    •  my doctors have been very sympathetic (5+ / 0-)

      I have to disagree James. I've had continual treatment for cancer for more than 11 years and the 6 oncologists, 3 internists, 2 ophthalmologists, 2 ear nose throat specialists I've seen have ALL helped me figure out the cheapest treatments, when to postpone tests if there were no significant consequences and started out trying the least expensive therapies first if there was good evidence that could work as well.

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