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View Diary: Medicare also going over the "cliff" (108 comments)

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  •  When my pay is cut it's not magic (0+ / 0-)

    I choose to work and make money or not to work and make no money. Doctors are businesses, very very very profitable ones.

    I can fly half way around the world and get twice the quality at a quarter the cost. It's not rocket science. We got the insurance companies with the OFA, next is pharma and providers.

    How big is your personal carbon footprint?

    by ban nock on Tue Jan 01, 2013 at 04:40:52 AM PST

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    •  Many countries are doing better than we are (5+ / 0-)

      in terms of good care and low cost. Some are just cheaper because salaries and cost of living are lower across the board. But developed countries do it by things like running healthcare on a not-for-profit model (U.K. for example), regulating drug prices,, and following best practices that weed out procedures and tests that add cost without a health benefit. That is all possible but not easy in the U.S.

      •  all true (0+ / 0-)

        plus guns and butter which US has these choices

        Coriolis Effect: a plane headed from Miami (where the Earth's rotation is more pronounced) to New York would end up in the Atlantic Ocean if the pilot ignored the effects of the Earth's rotation.

        by anyname on Tue Jan 01, 2013 at 02:09:38 PM PST

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      •  Yeah, I think people understate that last issue. (1+ / 0-)
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        Tell people that they can't have (x) care or (y) test because it costs too much and even progressives will scream about death panels.

        When I had unusual and, it turned out, unexplainable ear problems a few years ago, I was sent for numerous tests, probably a half-dozen non-invasive CT and electrical studies (the proper term is escaping me, but they basically hooked me up to a bunch of wires to see if things worked correctly).

        I later learned that those tests were to rule out brain cancer.  Thankfully, my PCP and the ENT specialist that my PCP sent me to did me the mercy of not telling me that the tests were not of my ear but instead of my brain stem, so thankfully I didn't spend three weeks contemplating death.

        Did I need those tests?  I'm not sure, but I harbor doubts.  But how would Americans react when their doctors told them that they couldn't be screened for brain cancer because a pencil-pusher told them that those tests for their symptoms flunked a cost-benefit analysis?  Not well.  Not well at all.  In fact, I believe that the single strongest argument against ACA was the claim (largely false) that people in single-payer nations die on waiting lists for necessary surgeries.

        Getting the kind of reasonably-priced care that is provided in Canada and the UK will require more than legislation - it'll require a real shift in how we think as patients.

        "The first drawback of anger is that it destroys your inner peace; the second is that it distorts your view of reality. If you come to understand that anger is really unhelpful, you can begin to distance yourself from anger." - The Dalai Lama

        by auron renouille on Tue Jan 01, 2013 at 06:23:18 PM PST

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        •  routine prostrate cancer screening (2+ / 0-)
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          auron renouille, david78209

          is the best example: it is now considered unnecessary. First problem is, it isn't very accurate in determining if you have cancer. Second, even if you do have early stage cancer, many of the treatments for that can be more hazardous to your health than the cancer. So even if it seems counter-intuitive not to test, the studies show that it is fact a best practice.

          •  I read, probably in the NYT or somewhere, that (1+ / 0-)
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            there had been pretty significant patient backlash to that change in the standard of care.  Suppose that's a microcosm of the mindsets we'll need to change to really address the cost side of the equation.

            "The first drawback of anger is that it destroys your inner peace; the second is that it distorts your view of reality. If you come to understand that anger is really unhelpful, you can begin to distance yourself from anger." - The Dalai Lama

            by auron renouille on Tue Jan 01, 2013 at 06:37:09 PM PST

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        •  right you are (1+ / 0-)
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          Other countries ration care rationally.  We do it economically, those without insurance go without care.  You cannot control health care costs without rationing services.  Americans, including those bashing doctors on this thread, are very likely to be unhappy when their own wishes for services are denied because they are deemed unnecessary.  It might have to be that way, but you have to be careful what you wish for.

        •  Those tests you had, auron renouille, might well (0+ / 0-)

          have been ones that you wouldn't get in most countries.  Brain stem tumors are pretty rare, while ear problems are common if you include ringing in the ears and 'true' vertigo where you feel like you're spinning.  

          I generally tell patients over 70 who have those symptoms that the fancy tests usually don't even give us an answer you can hang your hat on, and that I've never seen an, "Oh my gosh, it's a good thing we looked and did all these tests!" situation in anyone in that age group.  So in what seem to be typical cases, I encourage the patient to take something like dramamine

          If your symptoms were not typical of ringing in the ears or vertigo, auron renouille, or if you aren't up in years, I wouldn't have the confidence to tell you that spiel.  I'd probably send you to a neurologist and/or an ENT doctor.

          We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

          by david78209 on Wed Jan 02, 2013 at 06:29:40 PM PST

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    •  no. (1+ / 0-)
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      "Doctors are businesses, very very very profitable ones."

      Actually most individual practices struggle to break even, and lose money on some Medicare and most Medicaid patients. A few procedure or imaging-based specialist practices are very profitable, usually by owning the dialysis or MRI machines, etc.

      I believe one aspect of the ACA is to make Medicaid reimbursement more similar to Medicare, which should help those patients get better access.

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