What's wrong with for profit healthcare

Chris

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May 30, 2008
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Conveyor Belt Cardiology

by Robert Bazell

I remember standing in scrubs outside a procedure room in Miami when the other doctors (who mistook me for a colleague) were bragging about how many “normals” they had done angioplasties on. That’s right, people came in complaining of shortness of breath or chest pain, so the doctors put them into the cauterization lab and examined their vessels, then told these patients they needed an angioplasty and did it knowing full well it was unnecessary.

For many doctors and hospitals, angioplasty has been the mother lode. I’ve had young interventional cardiologists brag to me of their multi-million dollar signing bonuses to change hospitals.

This specialty faces a mine field of potential conflicts because so much of it is based on self-referral. An interventional cardiologist diagnoses the blockage by injecting dye into the coronary arteries with tubes inserted from vessels near the groin. All too often the doctor will tell the lightly sedated patient he or she has one or more blockages, which can be taken care of right away with an angioplasty. That sure sounds great but it doesn’t always work. And there's no opportunity for the patient to weigh other options; no chance for a second opinion.

Angioplasty was first tried on humans in 1977, by inflating a tiny balloon on the wire that inserts the dye. But often the opened artery closes up again — a process called restenosis. Over the years doctors have tried to circumvent the problem by using the wire mesh devices called stents, either as bare metal or more recently infused with drugs that try to prevent the re-closing. Suffice it to say the efforts have not been entirely successful.

When a surgeon performs a bypass operation, the patient is almost always referred by regular cardiologist. So the dangers from self-referral do not affect this type of surgery.

But let’s go back to the radical notion that oftentimes neither procedure is necessary. For those with unstable angina, where the heart disease is rapidly getting worse, immediate treatment with one of these procedures is needed to restore blood flow to the heart. But most patients who have blockages in their arteries have what is called stable angina. They may be in discomfort but they are not in immediate danger.

One of the doctors who argued first and loudest that many angioplasties and surgeries were unnecessary was Dr. Thomas Graboys of Harvard Medical School. About a decade ago, after years of struggle, he finally got the American Heart Association to allow him to present a seminar on the subject at its annual scientific sessions. Almost no one showed up. Few have an interest in the less profitable path. (Sadly, Graboys is now fighting a particularly aggressive form of Parkinson’s disease.)

Then last March, Dr. William Boden of Buffalo General Hospital in New York announced the results of a trial called by the appropriate acronym COURAGE. He randomized more than 2,200 patients with significant blockages. All were treated with heart medicines to control their cholesterol and blood pressure and minimize blood clots and were counseled to diet, exercise and quit smoking. Half of the participants also were assigned to get angioplasty.

After four and a half years there were slightly more deaths and heart attacks in the group that got angioplasty. Interestingly, the U.S. Veteran’s Administration and the Canadian Health Service — organizations interested in providing the best, but not necessarily the most costly care — funded the research. So far the impact of this powerful evidence on medical care has been minimal.

Conveyor-belt cardiology puts profits first - Second Opinion - MSNBC.com
 
Last edited:
Conveyor Belt Cardiology

by Robert Bazell

I remember standing in scrubs outside a procedure room in Miami when the other doctors (who mistook me for a colleague) were bragging about how many “normals” they had done angioplasties on. That’s right, people came in complaining of shortness of breath or chest pain, so the doctors put them into the cauterization lab and examined their vessels, then told these patients they needed an angioplasty and did it knowing full well it was unnecessary.

For many doctors and hospitals, angioplasty has been the mother lode. I’ve had young interventional cardiologists brag to me of their multi-million dollar signing bonuses to change hospitals.

This specialty faces a mine field of potential conflicts because so much of it is based on self-referral. An interventional cardiologist diagnoses the blockage by injecting dye into the coronary arteries with tubes inserted from vessels near the groin. All too often the doctor will tell the lightly sedated patient he or she has one or more blockages, which can be taken care of right away with an angioplasty. That sure sounds great but it doesn’t always work. And there's no opportunity for the patient to weigh other options; no chance for a second opinion.

Angioplasty was first tried on humans in 1977, by inflating a tiny balloon on the wire that inserts the dye. But often the opened artery closes up again — a process called restenosis. Over the years doctors have tried to circumvent the problem by using the wire mesh devices called stents, either as bare metal or more recently infused with drugs that try to prevent the re-closing. Suffice it to say the efforts have not been entirely successful.

When a surgeon performs a bypass operation, the patient is almost always referred by regular cardiologist. So the dangers from self-referral do not affect this type of surgery.

But let’s go back to the radical notion that oftentimes neither procedure is necessary. For those with unstable angina, where the heart disease is rapidly getting worse, immediate treatment with one of these procedures is needed to restore blood flow to the heart. But most patients who have blockages in their arteries have what is called stable angina. They may be in discomfort but they are not in immediate danger.

One of the doctors who argued first and loudest that many angioplasties and surgeries were unnecessary was Dr. Thomas Graboys of Harvard Medical School. About a decade ago, after years of struggle, he finally got the American Heart Association to allow him to present a seminar on the subject at its annual scientific sessions. Almost no one showed up. Few have an interest in the less profitable path. (Sadly, Graboys is now fighting a particularly aggressive form of Parkinson’s disease.)

Then last March, Dr. William Boden of Buffalo General Hospital in New York announced the results of a trial called by the appropriate acronym COURAGE. He randomized more than 2,200 patients with significant blockages. All were treated with heart medicines to control their cholesterol and blood pressure and minimize blood clots and were counseled to diet, exercise and quit smoking. Half of the participants also were assigned to get angioplasty.

After four and a half years there were slightly more deaths and heart attacks in the group that got angioplasty. Interestingly, the U.S. Veteran’s Administration and the Canadian Health Service — organizations interested in providing the best, but not necessarily the most costly care — funded the research. So far the impact of this powerful evidence on medical care has been minimal.

Conveyor-belt cardiology puts profits first - Second Opinion - MSNBC.com

Well heck--the government is always honest and efficient. Let's let them run the show. :lol:
 
What's wrong with for profit healthcare

What's wrong with it?

This is part of it ........... $560.00 for a 30 day supply of medication, that has NO generic substitution - prescribed by your doctor (that most likely gets a "kick back" from the pharmaceutical company that manufactures it), and your insurance company will not cover it ............ to keep you alive!

:confused: Next question?
 
While I agree costs are out of control. I believe if you remove profit from the system you will remove the reason that the best and the brightest become doctors, and you will remove the inspirations for most advances in medical science.

We need to find the happy medium in the middle. where prices are not outrageously high, while we do not make the industry so non profitable that nobody wants to be part of it.
 
What's wrong with it?

This is part of it ........... $560.00 for a 30 day supply of medication, that has NO generic substitution - prescribed by your doctor (that most likely gets a "kick back" from the pharmaceutical company that manufactures it), and your insurance company will not cover it ............ to keep you alive!

:confused: Next question?

And you don't think the Pharmas have our government representatives by the pocket books ?????
 
This is the part that blows me away...

"After four and a half years there were slightly more deaths and heart attacks in the group that got angioplasty. Interestingly, the U.S. Veteran’s Administration and the Canadian Health Service — organizations interested in providing the best, but not necessarily the most costly care — funded the research. So far the impact of this powerful evidence on medical care has been minimal."

So more people are dying because doctors are using the more expensive procedure!
 
This is the part that blows me away...

"After four and a half years there were slightly more deaths and heart attacks in the group that got angioplasty. Interestingly, the U.S. Veteran’s Administration and the Canadian Health Service — organizations interested in providing the best, but not necessarily the most costly care — funded the research. So far the impact of this powerful evidence on medical care has been minimal."

So more people are dying because doctors are using the more expensive procedure!

Then don't be an idiot--choose the procedure that you want. Is that too complicated for you?
 
A big part of why prices are so high are costs that have become a neccessary evil. things like malpractice insureance and *gasp* government over regulation.

This is really basic economics folks and a little bit of common sense. We aren't the healthiest nation in the world, that is no secret. Last time I looked most docs weren't sitting on their thumbs waiting for patients to ask for their services. Now with UHC the cost to the consumer will be even lower and as basic econ tells us, that means demand for services will go up. So why is it proponents of UHC think, now that waits will be longer, that UHC will be a better product than what is currently in place?
 
Conveyor Belt Cardiology

by Robert Bazell

I remember standing in scrubs outside a procedure room in Miami when the other doctors (who mistook me for a colleague) were bragging about how many “normals” they had done angioplasties on. That’s right, people came in complaining of shortness of breath or chest pain, so the doctors put them into the cauterization lab and examined their vessels, then told these patients they needed an angioplasty and did it knowing full well it was unnecessary.

For many doctors and hospitals, angioplasty has been the mother lode. I’ve had young interventional cardiologists brag to me of their multi-million dollar signing bonuses to change hospitals.

This specialty faces a mine field of potential conflicts because so much of it is based on self-referral. An interventional cardiologist diagnoses the blockage by injecting dye into the coronary arteries with tubes inserted from vessels near the groin. All too often the doctor will tell the lightly sedated patient he or she has one or more blockages, which can be taken care of right away with an angioplasty. That sure sounds great but it doesn’t always work. And there's no opportunity for the patient to weigh other options; no chance for a second opinion.

Angioplasty was first tried on humans in 1977, by inflating a tiny balloon on the wire that inserts the dye. But often the opened artery closes up again — a process called restenosis. Over the years doctors have tried to circumvent the problem by using the wire mesh devices called stents, either as bare metal or more recently infused with drugs that try to prevent the re-closing. Suffice it to say the efforts have not been entirely successful.

When a surgeon performs a bypass operation, the patient is almost always referred by regular cardiologist. So the dangers from self-referral do not affect this type of surgery.

But let’s go back to the radical notion that oftentimes neither procedure is necessary. For those with unstable angina, where the heart disease is rapidly getting worse, immediate treatment with one of these procedures is needed to restore blood flow to the heart. But most patients who have blockages in their arteries have what is called stable angina. They may be in discomfort but they are not in immediate danger.

One of the doctors who argued first and loudest that many angioplasties and surgeries were unnecessary was Dr. Thomas Graboys of Harvard Medical School. About a decade ago, after years of struggle, he finally got the American Heart Association to allow him to present a seminar on the subject at its annual scientific sessions. Almost no one showed up. Few have an interest in the less profitable path. (Sadly, Graboys is now fighting a particularly aggressive form of Parkinson’s disease.)

Then last March, Dr. William Boden of Buffalo General Hospital in New York announced the results of a trial called by the appropriate acronym COURAGE. He randomized more than 2,200 patients with significant blockages. All were treated with heart medicines to control their cholesterol and blood pressure and minimize blood clots and were counseled to diet, exercise and quit smoking. Half of the participants also were assigned to get angioplasty.

After four and a half years there were slightly more deaths and heart attacks in the group that got angioplasty. Interestingly, the U.S. Veteran’s Administration and the Canadian Health Service — organizations interested in providing the best, but not necessarily the most costly care — funded the research. So far the impact of this powerful evidence on medical care has been minimal.

Conveyor-belt cardiology puts profits first - Second Opinion - MSNBC.com

You do realize that the United States government is the largest healthcare insurer in the US right?
 
Are you talking about Medicare :confused: Don't get me started. :lol:

Granny, let me ask you a serious question.

Would you rather have your medicare taxes back so you can choose your OWN insurance, and make your OWN choices, or are you happy that good ol' government has decided what is best for you instead, and has taken it upon themselves to TAKE your money and provide you with THEIR choice?
 
Granny, let me ask you a serious question.

Would you rather have your medicare taxes back so you can choose your OWN insurance, and make your OWN choices, or are you happy that good ol' government has decided what is best for you instead, and has taken it upon themselves to TAKE your money and provide you with THEIR choice?

Well, let me try to answer your question.

$98.00 a month is held out of (both) my husbands and my SS check monthly, a total of almost $200.00 monthly.

We pay AARP an additional $76.00 a month each for our "supplement" insurance. Which keeps our "co-payments" where they are .. (below).

Our normal co-payment for doctor appointments is $10.00 each visit. Regular doctor and specialists, (heart, pulmonoglist, urlogist), that both of us need, not want, but need.

Emergency room and admittance into a hospital runs much more.

Generic medication co-payment runs from $5.00 - $10.00 for a 30 day supply - unless you get it for 90 days which is a little less expensive. Non-Generic medication co-payment runs $25.00 and up depending upon medication. (My Advair, alone, would be over $350.00 a month without it).

Between the two of us we are on several medications, monthly.

Both of us were what I assume you would call .... "Blue Collar Workers - middle class America" ... we worked all of our lives until we retired on Social Security - I retired at 60 on Social Security Disability. No, we did NOT have huge retirement IRA's, etc.

When my husband retired at 65 (from a constuction trade he had worked at since he was 14) we had the option of continuing his "Health Insurance" that he had when he was working. At $1,500.00 a month, (COBRA - is higher), because both of us had pre-exisiting problems, it would be as if we were signing up with them for the very first time. Even though "they" had been paying our medical costs when he was working (and was provided by his employer as part of his salary package) ... no cost to us.

So as I see it ... we have NO choice. But to take what we can get and can get by with, which is what we now do. With Medicare and Supplement insurance.

A lot of people think that "Medicare" is free for Seniors ... it is not. Basic Medicare does not cover medication.

So see folks .... being a Senior Citizen in our Golden Years is not all that it is cracked up to be. And perhaps an insight to where your Social Secirity is being used, by we ole folks. :eusa_eh: We did not retire from Enron or one of those places. :eusa_whistle:

Hope that answers your question?
 

Question is how do you fix it?

My main concerns with a single payer, expecially when that single payer is the government are

1) That the quality of acutal care will decrease

2) It will be horribily inefficient since government has shown it does nothing efficiently

3) people will wait longer based on on supply/demand principles.

4) It certainly won't encourage people to be healthier as there will be no longer a direct financial insentive to be healthy.

My point is at this stage there really is no reason to throw the baby out with the bath water. I believe there is a solution to get healthcare to people that can't afford it without 1)taking a away a good from those that can 2) creating an even greater tax burden.
 

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