Saturday, July 11, 2009
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Sampler
Moving this post to the head of the list, I present a recently expanded sampling of what this blog has been about. Occasional rant aside, i...
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Finally I'm getting around to writing about the gallbladder. Don't know what took me so long, seeing as how, next to hernias it'... -
I finished the previous post with the sad story of my patient, illustrating diagnostic difficulties at the fringes of biliary disease. An... -
It's gratifying that despite my absent posting for many weeks, this blog still gets over five hundred visits and more than a thousand ...
29 comments:
Isn't it somewhat ironic that we're placing stock in what a guy has to say, when said guy admits to outright deception on the same topic while the only difference in the equation is where the money in his bank account is coming from?
Just a thought.
... but for $350k a year, I'd lie to your face too.
Interesting. For 350K, I'd tell the truth.
I've never seen Sicko, so I can't comment on the content of that particular documentary.
However Michael Moore is pretty easy to discredit. My antipathy for Michael Moore in general is why I haven't seen Sicko. This is a guy who relies on the magic of film to cherry-pick information (if those interviews in the clip are representative of the movie, then the movie is not representative of how people in Canada perceive the quality of their health-care) and goes for cheap stunts like trying to storm K-Mart HQ and attacking a senile Charleton Heston.
I don't know whether this man is a reliable source for criticism of the American health care system, but Michael Moore is certainly not.
Well, I'd say you need a better argument than that: you haven't seen what he says but dismiss it based on a statement that he's dishonest.
But the point is that a person who ought to know about how the insurance industry works is saying HE thought the film was accurate and discusses the ways in which the industry tried to discredit it. By saying, I might add, the sorts of things you seems to be repeating.
I don't think Michael Moore is above criticism: far from it. I think he is, in fact, the greatest enemy of his own work, by going too far over the top in his efforts. Which is not the same as saying he is wrong. One criticism is about style -- which sometimes makes me cringe -- and the other is about substance -- which I've not seen effectively refuted.
The more important issue is not whether Moore is a good filmmaker or not; it's about whether insurance companies are a good-faith, necessary, helpful, value-added part of our healthcare system. To that, I say no. To the question of Michael Moore's veracity -- as opposed to taste and style and likeability -- I say he gets it much more right than not.
When considering the value of insurance companies, consider our other option - a government funded universal system similiar to Canada's.
A close contact from just outside Toronto had a mammography done which showed a curious mass. She was unable to receive a biopsy until 8 months later, at which point there were now 6 masses. Her diagnosis was DCIS (Stage III cell type & comedo type) with 1-4mm of focal invasion. Her surgery was scheduled for 2 months after diagnosis, her first radiation treatment for 2 months after surgery, and her first meeting with a medical oncologist for 3 months after surgery.
I know DCIS is not a surgical "emergency", but the long wait times for biopsy & surgery may very well have contributed to the focal invasion & progression of stage of the cancer cells. I'm also aware my n=2 (contact's mom had to wait for chemo for her colon cancer, which she died from), but the samples are from just outside of one of Canada's largest cities, so they're very likely representative of the norm.
I've sat across the table sharing a beer with her brother & husband, and they rave about how wonderful the Canadian healthcare system is (just like the people in the video you linked) despite the wait times they are required to endure.
I don't know if that level of care will be acceptable to most Americans, even if they aren't required to pay insurance premiums or foot the tax bill. Time will tell, I guess.
Regards,
Precordial Thump
Well, I'd say you need a better argument than that
I recognize that it isn't an ironclad argument. I was trying to disclose that with my first line. I was just trying to make the point that there has been controversy over the substance of Bowling for Columbine and Farenheit 9/11, so anyone who gets wholeheartedly behind him should be greeted, not with disbelief, necessarily, but skepticism.
PT: Time probably won't tell, because I doubt we'd ever get to a single payer system. Not in my lifetime, at least. But, as I assume you know, there's a difference between our form of single payer, ie Medicare, and the Canadian form which is involves a much higher level of nationalization of the providers. If all that changes is who writes the checks, but the providers remain as they are, there's no necessary reason why wait times will change.
I do agree it'd depend on reimbursement to some extent: if there were a single payer and providers were given inadequate funding, fewer would choose to be docs, and docs would choose to work less hard, I'd assume. But that's not about the system per se, but about how much we're willing -- and able -- to pay for it.
Timmyson: skepticism. Fair enough. Especially when followed by open-minded inquiry. (And for the record, I admit to falling short of open-mindedness in all things. Possibly related to being right all the time.)
For 350k a year, I'd be able to afford decent health insurance.
Great watch - the dichotomy of the gold spoons and people waiting in lines to get basic care... you don't get any more France before the revolution than that.
Twenty years from now we'll hopefully be looking back and wondering why as a nation we had our priorities such that we couldn't give our taxpayers universal health care.
Probably along with the same view that we now look upon the Cold War and wonder how we didn't destroy ourselves. Then maybe we'll be seeing Doctor Mike posting here instead of Adjuster Mike ;)
i wish we all take our health care system's problem seriously and find a solution for it. i believe a one-payer system will solve part of the problem, at least it gets rid of the middleman - executives who gets paid enormous amount of money for what ? I am sure those people who says a one payer system is awful has an excellent insurance , well please tell that to an ordinary person who does not have one because of the prohibitive cost or to a family who is bankcrupt because of medical bills. health care is a human right and to make it as a money making enterprise is just plain wrong.
if the government can not fix this problem because of all the naysayers and the obstuctionist then perhaps a national referendum on health care reform or an election as to which system should be adopted will be an option for the people .
tess b. morales
I have a sobering health care experience to report. My 8 year-old injured her foot during a recent visit to Seoul. She received x-rays, an MRI, two doctor consultations, medicine (dispensed on the spot), and a lower leg splint. This took two hours and cost US$200. I can't say for sure this wasn't subsidized, but I doubt it as I pay no taxes there. This was by all appearances a completely modern facility.
Timmyson: However Michael Moore is pretty easy to discredit
How so? As far as I know Michael Moore has not been successfully sued for defamation.
In regards to the Canadian health care system, my Mom is Canadian as well as all of that side of my family. I also have several friends that are Canadian. Not one of them would choose to exchange their health care system for ours. There is the realization that there are problems with the Canadian system but I don't know anyone who believes that people should have to go bankrupt in order to receive health care.
I love the notion that Canadian health care is bad because gasp you have to wait to see a doctor. You have to wait to see a doctor with the American health care system only you have to pay a lot, sometimes more than you can afford, to see one. Or you go without seeing a doctor when you really should see one because you can't afford it. I personally have had to wait a month or two to get checked out for something that might have been cancerous and I can't tell you how many times I have witnessed someone who should go to the emergency room state that they can't because they don't have healthcare.
Government run health care plans are flawed but not for the reasons that are given for opposing health care reform in this country.
Hello Sam Spade,
It is sobering that a country that is less sophisticated and poorer than ours can actually have acceptable medical care as you have described for only $200. I hope your young daughter has received proper treatment in Seoul, Korea, and that all goes well with her recovery. That's the most important thing.
Does this in any way alter your opinion about the American system or the discussion we've been having on possible changes in our health care system?
Thanks for your comments.
EK
Ellen,
My daughter is fine, thank you. Her foot was merely tender for a couple of days.
My opinion about US health care has always been that the US should adopt a single-payer system. I am amazed at how inexpensively it can be done though, which is why I brought it up.
I do envy the can-do attitude in Seoul. The economist Mancur Olson theorized that stable economies inevitably become sclerotic over time as special interests become entrenched. I find it hard to disagree. Our health care stinks because of an entrenched health care insurance industry (some say the AMA is partially to blame also). Our internet bandwidth lags because of the phone companies. The FDA seems to worry over big pharma and big agriculture as much as the citizens. Korea, Japan and Germany were shattered socially in WWII and are thriving now.
I think the problem with health insurance is that people buy it with the knowledge that they are going to use it, unlike virtually every other kind of insurance. I don't buy car insurance to get my oil changed, and to get discounts on my gas. Why should I be buying health insurance to see a primary doc, or get labs drawn, or get meds? I think the system would work much better if 1) everyone 18 and older was forced to carry insurance for major illness(lets say X deductible scaled to AGI, and rest is covered), parents would have to carry it for their kids. And 2) if people wanted to they could buy additional coverage based on what they want. Then lets say the rest of uncovered routine medical care comes out of pocket, or is financed into a payment plan by the doctors themselves. Also make so doctors can charge patients that pay cash the reimbursable not the billed amount they get from medicaid/care. The point is each person living in America would be required to carry X amount of health insurance on themselves. The same as we require people who operate vehicles to carry a minimum amount. If we give people a "free" system and they feel no responsibility they are going to abuse it, and all the supposed savings we get from cutting the middle man will be gone and then some. We can cut the middle man out of most of it, and leave him for the catastrophic stuff, without adding more massive government bureaucracy. If we simplify the system this way I think the problem will be solved, why make things more complicated then they need to be?
Robert,
The system you suggest would work almost the same way as it does now. The rich people would receive the best quality health care while the poorer people would receive the lowest quality of health care. Also preventative health care would be non existent for poor people as they would still have to choose between paying for a visit to a doctor and paying their rent. Under your proposed plan, people could still be denied necessary treatment by their health insurance company based on the fact that their health insurance company considers the cost of the treatment not profitable compared to what they would make off of a lifetime of said person paying into the system.
The problem with health insurance is that it is a for profit system. There are just some things that should be done for the greater good and not for profit.
Heather: "How so? As far as I know Michael Moore has not been successfully sued for defamation."
That's a poor metric. As far as I know, Bill O'Reilly has never been successfully sued for defamation, but that doesn't mean he isn't one of the most odious examples of maliciously ignorant journalism (Outfoxed, the movie, had some information about obstacles to such lawsuits, specifically with respect to him). I mentioned a few criticisms, but you can Google rebuttals and assess their accuracy as well as I.
We Canadians frequently hold our health care system up as a reason we're better than Americans, and if you frame the question that way, then the vast majority of Canadians will extol the virtues of our system. Until recently, altering the Canadian system to be more like the American was a recurring election issue.
Comparing the Canadian and American systems is really complicated. Perhaps more so than democracy can comprehend. Certainly more complicated than "You have to wait to see doctors in both systems".
The news today of bills working their way through Congress makes it clear a single payer system is a long way off. We're still talking about funneling money into insurers and then back out, which is like watering in a drought with a leaky hose. Too bad not even President Obama has the will or power to bring the change that's actually needed.
Maybe, though, it's a necessary first step. But I see it as only nibbling.
Comparing the Canadian and American systems is really complicated. Perhaps more so than democracy can comprehend. Certainly more complicated than "You have to wait to see doctors in both systems".
And she did compare it. She specifically mentioend the fact that Americans go bankrupt thanks to our "awesome" system, many die because they cannot get treatment that is excessively expensive even with insurance. While Canadians, meanwhile, do not.
Care to actually address that issue? Or want to continue bloviating aimlessly. Both are fine mind you, I just want to know if I should grab a pillow.
The comedian that is Bill O'Reilly considers himself a commentator not a news anchor or journalist. He presents his rhetoric as fact but when he pressed states that they are just opinions, just like all of those fox douchebags. This advice is probably coming straight from the legal team to proclaim themselves as such so as to not get sued.
Every documentary film maker relies on the magic of film to tell the story of the subject. That's what makes it a documentary film.
Michael Moore states that everything proclaimed in his films are indeed facts. He provides an extensive amount of information about the state of health care in America on his website://www.michaelmoore.com/sicko/checkup/. Of course I implore anyone to do their own research and I am not one for believing information just because it is stated by one source as being fact.
My point is that it should be easy to sue Michael Moore and win if indeed he were lying or deliberately misinterpreting the truth to lead people to a false conclusion. Bush and co and the health insurance industry both have the money and means to do it.
Healthcare should not be a for profit operation. The fact that in Korea you can see two doctors, have a radiologist involved, and scanning, etc., for $200 shows that the problem is that doctors in the US make too much money. Even without technology and office staff, you couldn't get this much attention in the US because the docs all want to buy new cars and have bigger houses.
The obvious solution is to pay the docs half as much. Then we could have twice as many docs, cutting the wait time. Get rid of docs making profits!
--pillpusher
Wow, pillpusher, I hope you're kidding. If not, your logic leaves a bit to be desired. Your statement no more proves that doctors are making too much money than it proves hospitals charge too much, or that MRIs cost too much. As complex as health care costs are, doctor income is only a part of it -- and, compared to hospital costs, a small part at that. In addition, reimbursement to doctors is literally one third of what it was -- in actual dollars -- when I began practice thirty two years ago.
On the other hand, I'm pretty sure you were being facetious. So I won't respond to the rest of your "points." Good one.
pillpusher, you sound sarcastic rather than facetious to me. I can't figure out what you are getting at in either case. Do you care to elaborate?
Well, Sid, I saw in the comments that health care is a right. It seems we should all have it, but of course someone must provide it. I don't know how to provide it--only docs know how. So they're going to have to give it up, and at whatever price the master healthcare payer decides. Can't we just decide that health care should cost less so as to provide more of it at the same overall expenditure? Hospitals can do with less, too, if you like. Seems like that's the end of this path we're about to go down.
By the way--since the new health care will cost us less, why does it cost a trillion dollars more?
--pillpusher
Sid, another author (a woman lawyer and judge) who I interviewed a couple of years ago sent me this tonight about HEALTH CARE REFORM. How shall I respond?
It is all in a bright red font, so that means it must be something important.
Subject: Fw: (HEALTH CARE REFORM) THIS WOULD BE A DEATH WARRANT FOR ANYONE OVER 59 YEARS OLD !!
BY EMAIL, GET THIS OUT FAST TO EVERYONE.
Senior Death Warrants
The actress Natasha Richardson died after falling skiing in Canada. It took eight hours to drive her to a hospital. If Canada had our healthcare she might be alive today. We now have helicopters that would have gotten
her to the hospital in 30 minutes. Obama wants to have our healthcare like Canada's and England's.
In England anyone over 59 cannot receive heart repairs or stents or bypass because it is not covered as being too expensive and not needed.
I got this today and am sending it on. If Obama's plans in other areas don't scare you, this should.
Please do not let Obama sign senior death warrants.
Everybody who is on this mailing list is either a senior citizen, is getting close or knows somebody who is.
Most of you know by now that the Senate version (at least) of the "stimulus" bill includes provisions for extensive rationing of health care for senior citizens. The author of this part of the bill, former senator and
tax evader, Tom Daschle, was credited today by Bloomberg with the following statement.
Bloomberg: Daschle says "Health-care reform will not be pain free. Seniors should be more accepting of the conditions that come with age instead of treating them."
If this does not sufficiently raise your ire, just remember that Senators and Congressmen have their own healthcare plan that is first dollar or very low co-pay which they are guaranteed the remainder of their lives and are not subject to this new law if it passes.
Please use the power of the internet to get this message out. Talk it up at the grassroots level.... We have an
election coming up in one year and nine months. We have the ability to address and reverse the dangerous direction the Obama administration and its allies have begun and in the interim, we can make their lives miserable. Lets do it! If you disagree, don't do anything...
GET THIS OUT TO EVERYONE RIGHT AWAY
Ellen, I haven't read the bill, but I'd like to know the details. This letter sounds a lot like the ones that claim Obama apologized for the Declaration of Independence.
End of life care is, truly, a very thorny issue, and to limit certain treatments that have virtually no chance of working makes theoretical sense. It's in the execution (pardon the word) that the difficulties arise. A very serious subject, best discussed rationally. No perfect answers, unless we had all the money in the world.
Ellen,
You should respond by posting this email on myrightwingdad.com.
Thanks, Heather. I'll try posting at as a comment. If that doesn't work, I guess I'll email it to the owner of that site.
Appreciate the suggestion,
EK
Heather, just an update. The website you suggested had an anonymous response tonight. It led me to check the email out at www.snopes.com, which refuted much of the material I'd received by email.
Here's the link for those who would care to read it.
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