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June 28, 2009

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Danube of Thought

I just wish someone would press Gibbs on the question of which single-payer plan is Obama's favorite.

Jack is Back!

A doctor friend of mine says that you need more competition in the health care industry. The way it is now is the industry (Insurers, HMO's, etc.) are so focused on profit that the MD is at the pointy end of the process and quality care is suffering. You need a player who comes in and rebates for making good choices in diet, exercise, preventative care like yearly prostate, colon, mammograms, etc. Also, the big problem is catastrophic illness and care that sucks the bank dry. I have a very high deductible but still pay more than I use in any given year. I'd like to be rewarded just like in my driving for a good record.

Danube of Thought

I simply don't understand Cowan's #2. How is it that the suppliers are "monopolizing?" And why would the prospect of smaller revenue call forth additional output, or additional suppliers?

Strawman Cometh

"Forcing Prices Down Does Not Normally Increase Supply"
Yes, it seems they have the cause and effect reversed. Is this an Algore involved? They did the same thing with CO2 and temperature.

sylvia

I agree that there has to be some notice if a doctor is over testing. Now if a doctor under tests, eventually he'll get a lawsuit. But what's to prevent a doctor from ordering all the tests he wants? Actually come to think of it, a doctor doesn't get money from tests necessarily unless he is a co-owner of the lab. So there already is little incentive for that. The danger is unnecesary medcial procedures not testing, but I think there is already procedures in place to prevent that, as that would be more obvious. So just make sure the lab and the doctors have separate owenership to take care of the former.

Other than that, so what if the doctors take a little more tests. I don't know where this idea of overtesting comes from. From everyone I know you practically have to be dying of something to get a doctor to test for anything. They always make you feel like a hypochondriac first.

For instance, when I was younger I went through a period where I suddenly had continual dry cough and burning lungs that persisited for months. The doctors told me it was asthma and basically laughed at me and sent me on my way. Then when I heard that Chris Reeves' wife, a non-smoker like me, died of lung cancer, I heard that younger non-smoker women do get lung cancer, and the symptom is a sudden continous dry cough. Which is what I had. Did any doctor test me for lung cancer when I told them my symptoms? Nooo.

Well turns out I didn't have lung cancer but a reaction to my bathroom cleaner. But still, the point is, did they know that at the time? No. I'm lucky I didn't have lung cancer because the doctor would have figured it out after I was dead I suppose. And I have heard of many other similar examples. So where are all these over testings done? I think it's a myth. Better over testing than undertesting.

sylvia

"Forcing Prices Down Does Not Normally Increase Supply"

I suppose it's the Wal Mart theory, that if you sell a lot of products for lower prices, you'll make a greater profit.

sylvia

And another thing, I'm tired of hearing about prevention saving us money. Prevention will save us little if not nothing. We found out that you have to be very chubby to live long, so are we going to force people to eat more and exercise less? Also cancer treatments, let's be honest, do not save lives that often, they just prolong it for a few years. Testing for cancer in advance does not do that much to prevent illness. Look at Tony Snow. He knew colon cancer was in his family and got tested for it religiously. Then when they found the cancer he got the best treatment. He lasted what, a year after that?

We do not have the means to really prevent anything yet. Contrary to popular opinion, our medicine is not that advanced yet. So all of that idea of saving money through that is a pipe dream.

FB

It reminds me of the old saying. Fast, good, or cheap - pick two.

However, with the government involved in the process, we'll be lucky to get even one.

Rob Crawford

I suppose it's the Wal Mart theory, that if you sell a lot of products for lower prices, you'll make a greater profit.

That has utterly no relation to the statement you were responding to.

As for McAllen -- could the "overtesting" be the result of a spate of lawsuits? It would be interesting to compare the malpractice insurance rates and number of malpractice suits filed per year.

GSD

2. The buyer bargains down price and the monopolizing suppliers respond by expanding quantity.

(on the high volume existing services/products for which a reliable demand already exists. Meanwhile they stop development on new technologies and pharmaceuticals, which cost a fortune to develop and have an unknown market and a price point yet to be negotiated.)

gdb in central Texas

I have doubts about the study from another perspective, albeit anecdotal, from a Texan who travels widely across the state.

McAllen is a winter mecca for thousands of retirees from the mid-west. Winter Texans, as they are called, form a huge caravan of travel trailers from September through early November, becoming sem-permanent residents for several months, while still claiming actual resident status back in Minnesota or Michigan or Ohio. Having been in McAllen/Harlingen and needing to see a Dr. for a minor injury the waiting room was full of retired, older folks, many of whom, I'd suspect of being on Medicare. I'd expect the distortions caused by the influx of an older, semi-resident population would be significant and I've not seen any comments in the studies that take this demographic into account.

McAllen is hardly equivalent to El Paso, much less Grand Junction.

JorgXMcKie

gdb, why expect the NYT or a supporter of govt run national health care to worry about demographic data that would screw up their "narrative"?

My late aunt and uncle 'wintered' in Texas for a couple of decades. 'Al' was a diabetic who refused to quit drinking a six-pack or more a day. 'Audrey' was a long-time smoker. The lived in the Midwest the rest of the year, with 'family doctors' who had 40+ year medical histories on them. What do you want to bet that if they went to the doctor in Texas they would get a lot of tests to find out stuff their home town family doctor already knew and had at hand?

Nope. Nothing skewing the data here.

tyree

I wish I could remember where I read this but apparently McAllen, TX is also the closest US destination for a sizable population of US citizens who have retired to Mexico.

RC

Sylvia almost has it right but gets it wrong in the end. Frankly one thing that should be explored is INCREASING the number of tests that are run if they could credibly help. One of the biggest costs to hospitals is capital equipment. If hospital administrators had their heads screwed on straight they'd be demanding that every device be using for the maximum duty cycle it is designed for. If you double the number of times/week an MRI machine is used you can charge half as much and still pay for the thing in the same time frame.

sylvia

That was interesting inside info above from the Texas posters about the one town being a tourist town, which would surely skew the stats and might explain the extra testing because doctors aren't supposed to rely on other doctors tests usually.

But come to think of it, doctors do often have labs they partner with. I know my doctor's office has a new lab in the building. So I could see an incentive to over test if there are over laping finances. I have no problem in developiong guidelines just as as reference to make sure there is not some blatant crazy over testing going on for financial gain. If so, no one should have to pay for that. But short of obvious overtesting and testing abuse, doctors should have a large leeway. So a tricky balance there.

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