When you login first time using a Social Login button, we collect your account public profile information shared by Social Login provider, based on your privacy settings. We also get your email address to automatically create an account for you in our website. Once your account is created, you'll be logged-in to this account.
DisagreeAgree
Connect with
I allow to create an account
When you login first time using a Social Login button, we collect your account public profile information shared by Social Login provider, based on your privacy settings. We also get your email address to automatically create an account for you in our website. Once your account is created, you'll be logged-in to this account.
@MataHarley said> “I read that most are headed for the big bucks specialty biz. “
They won’t be after Obama gets his way. There will be little financial incentive to do so and the risk of lawsuits, which is much higher in a number of specialties, will be just as great. And, we’ll be having even longer waits to see those specialists just as they experience in Canada
But this doesn’t mean there will be more primary care physicians available to treat patients. Dumping 30 million new consumers into the system will make it difficult to get an appointment.
This fantasy that Larry and his fellow libs have that somehow THIS TIME, government will do this right when there is NO past experience when they have is truly frightening.
Larry and friends seem to be oblivious to the unintended consequences of good intentions.
Larry W, INRE Laurin’s denial of coverage for pre’existing…. She’s a Yale (or Harvard) grad, yes? Is she not working in a career (other than English Channel training…) and have access to a group plan? That cannot be denied for more than a exempt period of up to 12 months.
And the pre-existing bit would disappear if feds and the states would allow for individuals to form “groups” to have access to group plans. In other words, every individual would have at least one or more “groups” to choose from. This doesn’t need to be tied to employers either.
Thanks, Mata. Laurin was a Harvard swimmer; accepted for admission to the U of Colorado Med School; taking a year off to swim the English Channel and continue with some very exciting work she began with a stem cell group at Harvard who moved to continue the work with a start up biotech firm in the SF Bay area http://izumibio.com She’s got wonderful, employer-provided insurance. The (hopefully temporary) problem is the other daughter, a recent Yale econ grad (and rower, who’s Yale “4” took 3rd at this year’s NCAA Div I champs and then won the Senior Division at the Women’s Henley outside of London in late June. Not the greatest year to be an economics graduate, she’s deciding what she’s temporarily working in our family lab business (we don’t have group insurance; just individual coverage). Had had some sports injuries, now resolved and unlikely to recur, as she’s not training at the level as before. I’m sure she’ll get it resolved, but the denial was unexpected and it’s so freakin’ ironic that I, of all people (surely one of the world’s most paranoid people when it comes to health insurance, which I view as important as food, clothing, and shelter), should find a first degree family member among the ranks of the uninsured. – LW/HB
This fantasy that Larry and his fellow libs have that somehow THIS TIME, government will do this right when there is NO past experience when they have is truly frightening.
I’ve got one word for you: Medicare
Curt might have two words for you: County Sheriff
etc.
@mata:
Okay, Larry… INRE our base foundation from debate, we are getting somewhere. You and I disagree from the start that medical providers be non-profit “civilian govt employees” vs private enterprise entrepreneurs. This comes from a foundation of you believing health care is a “right”, and me believing that health care is a “service”.
Your post (#50) mischaracterizes my position. Just about everyone on this blog thinks that, in order to be supporting health care reform, one needs to be a socialist/marxist/whatever. For goodness sake, you’ve got 59% of the nation’s doctors preferring a single payer, government administered system over the mess we’ve got right now. They don’t favor this because they are socialists/marxists and want to be “government employees.” Neither do I. Read the article I linked about it and find out why they/we feel this way.
I don’t think that health care is a “right.” I think that free speech is a “right,” along with the other “rights” provided by our constitution. There is no constitutional “right” to public safety, but we do provide national defense, police protection, and fire protection. There is no “right” to a decent education and certainly not to college and graduate level education, yet we do provide these, because we recognize the advantages to our society in doing all the above things.
The elderly have no “right” to health care, yet we were wise enough to establish a system to provide this. An enormous amount of the total health care in the USA is provided through Medicare; I’d wager in cancer, alone, it’s close to 50%. I think that, of all health care spending in the USA, close to 50% is government-paid. 70% of the private hospitals are non-profit. Studies have shown that for-profit hospitals often provide inferior care to that provided in the non-profits. But virtually none of the doctors are “government employees,” any more than the employees of Boeing are government employees.
The point is, the health care system is already half-“socialized,” if you want to think of it in those terms. But our half-baked system is an administrative nightmare for physicians and hospitals, and the lion’s share of this nightmare is caused by the private insurance sector. Pre-authorizations. Restrictions on which drugs can be prescribed. Payment denials. And then there is the problem of the uninsured. And, for the rest of us, there is the specter of personal financial disaster which is only a diagnosis or accident away and against which it is currently impossible to insure. One can buy fire insurance which provides certain protection against fire losses; the irony is that it’s virtually impossible to find health insurance which provides certain protection against financial losses from health-related catastrophes.
What I personally favor is a gradual expansion of Medicare to cover increasing numbers of the population with a very good, basic level of service, with a robust system of private insurers to provide supplementary coverage for employers who want to offer (and for people who want to obtain) a very high (“concierge”) level of service. I believe that this is the best way to contain costs, provide near universal coverage, and to improve entrepreneurial medicine, through fostering competition. I think that principles of market economics can apply at the concierge level of medical service, but that they’ll never apply at the basic level of medical service.
When are we going to have a thread ranting and raving about our socialized sheriff’s departments?
I was merely making the point that the rules of market economics don’t apply to medical care, because “buy” decisions are made by the “sellers.”
Let’s take a poll of men on this blog:
O.K. Guys, how many of you would have a radical prostatectomy for a 1 in 48 chance – at best – that it would prolong your life? There’s a much greater chance that taking one baby aspirin per day would prolong your life (that’s been known for years). How many of you are taking one baby aspirin per day? Cutting out red meat has greater than a 1 in 48 chance of prolonging your life. How many of you are willing to cut out red meat?
But it never gets explained that way. Because the people who do the explaining are the same people who get paid for doing the procedure and who don’t get paid for counseling against the procedure.
Babes in the woods. True believers that the free market can do no wrong.
And, in an answer to another rant, Medicare is totally transparent/open doors. Private medical insurance companies are opaque and closed doors.
– Larry Weisenthal/Huntington Beach, CA
Mike
14 years ago
Wilson was correct!! No apology necessary either.
Dc
14 years ago
Larry,
I never said that the free market can do no wrong. It “is” our current system however (until we become socialist). There are solutions to the problems you mention and there are plenty of things we “can” fix without moving to a government run system.
There are plenty of babes in the woods here in america who believe socialism, communism, etc. are all better models for everything.
@Mike: Medicare has done a brilliant job at providing universal care of unsurpassed quality and consumer satisfaction at a total cost of substantially less than private health insurance (medical condition and age-adjusted). The reason it’s “going broke” is that advances in medical technology are running amok and Medicare can’t raise taxes at will, the way that private sector insurance can raise premiums at will (case in point: recent 30% PER YEAR rise in insurance premiums with more than doubling since the Bush 43 inauguration).
With respect to “gutting” Medicare, that’s just more scaremongering.
There are only two ways to control costs: (1) Raise taxes or raise premiums (either is an equivalent drain on our personal incomes, only private insurance increases are greatly outpacing what would be need to restore Medicare solvency) and/or (2) cut back on payments (e.g. as happens every day in the “rationed” private sector, where tests, procedures, drugs, and treatments are routinely denied on the basis of “no medical necessity” — in the eye of the insurance companies, who substitute their medical judgment for those of the patients’ own doctors).
– Larry Weisenthal/Huntington Beach, CA
Hard Right
14 years ago
More liberal propaganda from larry. Larry, I don’t deal with medicare the way you do, but I can tell that from my experience people are not happy with it.
I know responding to you is a waste of time as you are so deep into pathological denial you’ll never come back. You’re too busy watching a “legend” being made before our eyes.
Shouldn’t you be crashing thru a wall somewhere shouting “Oh Yeah”?
Larry doesn’t deal with Medicare at all….it was so wonderful and fantastic and super-d-dooper he had to opt out because of its’ greatness…..
Heh.
Hard Right
14 years ago
Aye, color me shocked. A trademark of liberals. Required for thee, but not for me.
While I rip on larry, I have to admit I really don’t hate him. He doesn’t seem like a bad guy, just waaaaaaaaaaaaaaaaaaay off into liberal fantasy.
Back to Medicare. In the last couple of years I’ve watched it cover less and less and talked to those struggling with the changes. They can put out all the polls they want because if what I’m hearing from the people using it is any indication, then Medicare is hardly as wonderful as larry claims.
My father has received Medicare coverage for (1) a quadruple bypass, (2) stomach cancer, and (3) chronic biliary obstruction from cholelithiasis, along with more routine matters, such as cataract surgery. My mother received Medicare coverage for giant cell arteritis, cataracts, and lung cancer. My sister (an MD) has received Medicare coverage for 6 years of ovarian cancer, including 6 major operations and 6 different forms of chemotherapy. Care and payment have been, in all cases, explempary.
In the case of my Mom (a resident of Kentucky), I had her go to NYU in New York to receive her primary lung cancer surgery from the thoracic surgeon who is the chief author of the most important textbook on lung cancer and then to Loma Linda University in California to receive proton beam therapy from the only such facility of the country which can treat para-spinal metastases with proton beam. Then she received her chemotherapy from the best oncologist in her metropolitan area. There were no geographic or “provider network” limitations, as there would have been with private insurance. No preauthorizations required. I doubt seriously whether any private insurance would have paid for her “experimental” proton beam, but Medicare did and it was brilliantly effective.
I had my Dad fly from Florida to California to have an 80% gastrectomy performed by a UCLA surgical oncologist who is one of the few surgeons to lecture on the topic of stomach cancer in Japan, the world leader in stomach cancer. He had his 4 vessel bypass performed by a cardiac surgeon who trained with DeBakey and who did a state of the art “beating heart” (off pump) 4 vessel bypass.
My sister has received her surgeries and chemotherapies likewise from the best doctors around, at the best facilities. No preauthorizations required. Medicare paid for certain (effective) chemotherapies which would have been denied for coverage by Blue Cross.
I previous provided the citation for the peer reviewed study of patient satisfaction with Medicare, compared to private health plans.
– Larry Weisenthal/Huntington Beach, CA
Old Trooper
14 years ago
Larry, with the grim Family history of medical issues it is a good thing that you are an MD.
I am very sure that taxes must go up to support a patient load of 40 to 30 k folks that are lacking insurance but get treated anyway. I am hoping that more folks take an interest in medicine and get a good education because we are going to need easily a thousand more Doctors to cover the load. Otherwise there will be rationed care. The old basic supply v demand thing that must be considered.
Well, medical history is grim, but medical care has been outstanding. My Dad (stomach cancer, 4 vessel bypass, biliary obstruction, cataracts, etc.) is now 96 and set a world age group record in the 200 meter backstroke and had the best times in the nation in 5 other swimming events in the past year. He’s meeting us in Dover, UK in 2 weeks to go on the boat with us which accompanies his granddaughter’s attempt to break the women’s English Channel swimming record. My sister is currently in complete remission after more than 6 years of battling stage 3B ovarian cancer. She travels all over the world and is doing great, thanks to great medical care. Even my late mother enjoyed 22 months of complete remission of stage 4 non-small cell lung cancer before dying of brain metastases (the drugs don’t get across the blood brain barrier very well). During this time, she got to attend a college graduation, the wedding of a son (my brother), and several holidays and birthdays, as well as taking 2nd place in a Las Vegas slot machine tournament and getting a free trip to Atlantic City for the world champs.
I truly believe that, with the usual constraints of Blue Cross, none of them would have done as well. I credit Medicare (plus great doctors) for their comparatively good fortune, given that they had the bad fortune to have the illnesses they did. Just as a theoretical consideration, had they not had Medicare, I’d have still sought to have them get the treatments they did, but it would have been a horrendous expense, which would have probably bankrupted the typical patient of average financial means.
Despite all the claims that I’m a Kool-Ade drinking socialist, it turns out that I’m squarely in the mainstream of American physicians, when it comes to health care reform.
Fully 63% of us (nearly 2/3 and well above the 60% filibuster proof majority) favor health care reform and favor a public option.
This is one of the main reasons why health care reform will pass. The people who know the health care system the best know best what’s wrong with it and how best to fix it.
63% of American doctors favor health care reform including both public and private options (just like me).
10% favor public only.
Meaning 73% favor either exclusive public or mixed public/private options
And 55% would favor expanding Medicare (i.e. “public only”) to cover down to age 55 (down from 65, where it is today). Why would doctors want that, Mata, were they losing money on Medicare patients, as you assert they are?
Only 27% favor exclusively private. These are disproportionately surgeons (e.g. like the ones pushing radical prostatectomies in a situation where you have to do 48 radical prostatectomies to benefit only 1 patient).
Wow, this is absolutely huge; it will be a game changer. No longer will the Party of No be able to assert that it’s only Obamamaniacs and socialists who want to get this done. Read all the stories flooding Google News right now.
The report, published in The New England Journal of Medicine and written by Salmoeh Keyhani and Alex Federman of the Mount Sinai School of Medicine, surveyed 2,130 physicians between June 25 and Sept. 3. The poll examined support for the public option geographically, too, finding thata majority of physicians in all regions supported it. “The clear message here is that physicians who are on the front line of the health-care system know the system is broken and that it’s time for us to do something about it,” says John Lumpkins, a senior vice president at the Robert Wood Johnson Foundation.
It’s not a Democrat versus Republican thing. It’s an American thing. Americans will recognize that Obama is just trying to do what the doctors who provide front line health care think should be done. And they will recognize that efforts to torpedo this are simply selfish partisan politics.
Watch and see. Filibuster-proof majority, for sure. This provides all the “cover” the moderates need.
Read all the stories on this currently breaking on Google News. This is a game changer. It provides all the “cover” the moderates need. Filibuster-proof majority.
@openid.aol.com/runnswim: You think respondents being paid to participate in a mail in survey has the same validity of a scientific public opinion poll?
Sounds to me like you are getting desperate Larry.
That’s how medical studies work, Mike. It’s long established precedent. Docs are busy people. They are always compensated for providing data for research studies. I’ve done the same thing, with my studies, requiring follow up. Provided compensation for time taken. The NEJM is universally acknowledged to have the highest publication standards of any peer review medical journal in the world. Unsurpassed credibility.
But that’s OK. Believe it or not. It’s game over. Filibuster-proof majority. All the cover the moderates need.
And the big winner is all of us. Even you, Mike. Which I predict even you will acknowledge, some day. And today was the most important day in the process.
Prior response still hasn’t been dug out of spam. Will try again.
The New England Journal of Medicine is universally acknowledged to be the most prestigious medical journal in the world and to have the highest publication standards. It is, if fact, customary to compensate physicians for providing information of this type. I have done this myself (provided compensation) in order to obtain follow up data in clinical studies.
@Patvann: Thanks for the backup. But it won’t stop Larry. Once he gets a talking point into his head, any information to the contrary gets pushed out.
I’m used to it by now. Don’t ask him about global warming… He thinks he’s an expert on that too!
Patvann
14 years ago
@Mike’s America Who loves ya baby? 😉
I’ll listen to him if he wants to talk Malignant Melanoma (Wifey is 3 year NED, stage 3) Or the perfect butterfly stroke (Santa Clara Int SwimClub 1974-79)
Aaaanywho…
There is also no word AT ALL about 60 votes, let alone the fact that there are not 60 voters.
One happened to have died recently.
Bird won’t vote for it in it’s present form, and is usually too sick to show up.
2 are Independents, and Lieberman isn’t sounding too enthusiastic.
That gives the Bill 58 at the most. (With Bird and 1 Indy)
The only thing on the move right now is the Senate leadership mulling over if they want to shove it through using parliamentary tricks (reconciliation) , but most members know that that would be political suicide.
Obama has signled that he’ll let Congress kill the Public-option part, but that still leaves a POS for a Bill. The whole thing needs to be scrapped.
Oh PLEASE bring up Glowbull wormining! I’m MORE than ready!!!
Larry W: Wow, this is absolutely huge; it will be a game changer. No longer will the Party of No be able to assert that it’s only Obamamaniacs and socialists who want to get this done. Read all the stories flooding Google News right now.
In May 2009, we mailed a confidential questionnaire to 2000 practicing U.S. physicians, 65 years of age or younger, from all specialties in order to explore these issues.
~~~
Of the 2000 potential respondents, 61 (3%) could not be contacted. Of the remaining 1939 participants, 991 returned completed surveys, for a response rate of 51%.
That means the “absolutely huge” news you tout is a poll of one-thousandth of a percent of all the physicians and surgeons holding jobs in the US prefer a mix of private/public option.
Then there’s the Reuters report you linked citing another poll of 2130 respondents. Wow… that’s an improvement… up to three thousandths of all the 2006 doctors/physicians.
Some “game changer”…. but I can see you will continue to demean the public’s opinion as irrelevant, and spin it as game-set-match.
You wouldn’t be ignoring that only 10% said they exclusively wanted public options in the 991 participants’ poll, and only 27% in the 2130 participants poll… which is what will be left when the feds destroy most the private insurers by cheaper coverage with less options.
Do they believe Obama’s promises, misrepresenting the House bill, and babbling about a bill that doesn’t exist? Are they aware of the oft stated quest for single payer by not only Obama and Rahm’bo, but most of the Dem leadership in Congress? If you’ll remember, it was predicted that 50-75% of the US population would end up on the public option. Doesn’t leave much privately insured to support the underpayments to the medical providers, does it, Larry. And works quite well with Obama’s vision that single taxpayer will take multiple steps.
Doesn’t sound like these physicians would approve of that goal.
Oh wait… I forgot you believe the medical profession should be non-profits. Oh wait again.. you said I “mischaracterized that. Did I?
MataHarley#32: Do you believe that medical providers should be a non profit?
Larry W#37: Of course, but here’s what American physicians earn:
ummmm… not sure what I misunderstood about “of course”…. But I digress. Back to your poll of 991 doctors, or one thousandth of all physicians and surgeons. (I notice they didn’t ask any medical facility owners in either of these polls. Wonder why?)
Then, of course, there’s a high aversion to cost effectiveness data that Congress slithered thru in the dark of night via another bill no one read – the stimulus/ARRA.
By contrast, physicians were divided almost equally about cost-effectiveness analysis; just over half (54%) reported having a moral objection to using such data “to determine which treatments will be offered to patients.”
I guess they also missed the reality of it now being law while busy with their stethoscopes and scalpels. As you said, they are busy guys/gals. Evidently too busy to keep up on the specifics, so they tend to listen to “just words” instead. My guess is they, like Obama and Congress, didn’t read HR 3200 either.
Aren’t they in for an ugly surprise when the bills don’t match the promises?
I say you are premature to call checkmate here. And worse yet, it’s offensive that you are ready to end the game based on these polls. I don’t care if you’re the Surgeon General… you haven’t any more authority or voice in this than I, or any other citizen does. And far more “participants” than your poll respondents were in the streets of US cities all over America on Sept 12th, saying something completely different. And many of them HAVE read the bill.
As for your theory as to why Medicare is going broke… bunk. You might want to remember that the government is collecting cash for Medicare from every tax payer’s paycheck… and they can’t support the small percentage of the population on medicare now. Considering there’s no cost reform in these bills… the real ones, not Obama’s imaginary bill… that’s not likely to improve. In fact, it requires the “willing suspension of disbelief” to swallow that you can throw 50-75% of the population on a similar program, and make it fiscally sustainable.
But here’s my biggest bone of contention with you.
Larry W: Thank goodness for Medicare. Without it, the country would be much worse off, paying for senior citizen care through private insurance policies which would probably cost in the neighborhood of $40,000 per year, or more, per beneficiary.
The country “paying for senior citizen care”?? Larry, your parents, you, my parents, me… we’ve been *paying* for medicare since 1965. We’ve been paying it forward for care denied to us until we reached a certain age. Those that are really shafted are the ones who die at 64… pillaged for the duration of their life, and unable to get back some of that highway robbery bootie. What your kids have put into Medicare wouldn’t amount to a drop in the bucket. You make it sound like some charity when, frankly, all Medicare was… and is… is yet another government ponzi scheme like Social Security.
I want my cash back. Period. And I’ll buy private insurance. Ooops… the government’s already spent it. No, make that blew it like a spoiled rich kid running amok on Daddy’s credit card in Bloomingdales.
BTW.. had to laugh listening to Mark Levin today, calling you and those like you, out on your Obama protection talking points. “It’s not his bill”. LOL Yes, good cover for his arse. Amazing to what extent the blind faithful go to have Obama’s back. This POTUS wants it all. When the fiscal disaster hits the fan, he’ll blame it on Congress. But for a few years, if everyone is in “free health care” euphoria before the bank breaks, he’ll take credit and retire from the WH in glory… so he thinks.
But Obama can’t straddle fences forever and his visions for a remade America have consequences. History has far more patience for legacies. And between quadrupling prior national debt in under a year, seizing control of banks, auto companies and dictating salary to private industry, shoving thru cap and trade and health care atop an obscene Omnibus, Obama’s is to be the destruction of the US economy. Then I’ll be happy to say, it’s your country… not mine. Show me to the death panels.
BTW, Larry… INRE your rower daughter now working at Weisenthal. You say you, as an employer, do not provide insurance. Obviously you know you’ll be mandated to do so, and my guess is you… like any P&L conscious employer… will opt for the cheaper public option if available.
My burning question is, why aren’t you seeking an avenue to be part of a group plan, instead of forcing yourself and your family into individual care? You have to recognize the obvious benefits of a group plan, yes?
I might also add that as an employer in the medical provider world, you tout one values version, and behave in a different way. You refuse Medicare patients and ceased being a participant while you get all slobbery over the greatness of Medicare. And you don’t provide your own employees with health care… especially since a group plan could not deny your daughter pre-existing for longer than 12 months max. Very weird.
Obama Bin Hussein
14 years ago
Boy did us Democrats show you haters a lesson or two. See how we manipulated you into staging a one million + march in DC?
Ha!!!!!! Got you there you militiamen.
Now it looks like you finally forced us to compromise even though we tried to bend you over a barrel and force our legislation down your throats.
Damn! Did we ever get the best of you.
Now your base is reinvigorated and we are on the defensive.
I hope you learn your lesson that I am playing you guys like a violin…
I might also add that as an employer in the medical provider world, you tout one values version, and behave in a different way. You refuse Medicare patients and ceased being a participant while you get all slobbery over the greatness of Medicare. And you don’t provide your own employees with health care… Very weird.
I’ll address the above in this post and your comments about the NEJM study in the following post.
Mata, I’ve explained some of this before. I’ll have to go into more detail, so that you can really understand it. I can’t do this without appearing to be promoting my own business/services. In my 14 years of internet debate, on Usenet and on blogs, I have assiduously avoided self-promotion. I hope that you’ll agree that this is the standard I’ve maintained on Flopping Aces. I haven’t exactly endeared myself to you guys, in the pursuit of your “business” — I hope that you’ll agree.
But here goes, only because you (and Aye and Mike) keep making such a “gotcha” point of this.
My background is that I trained in oncology at the National Cancer Institute, in Bethesda. During this time, I began what has become my lifelong research interest — receiving biopsy specimens of fresh, living human cancer and culturing the cancer cells and tissue in the laboratory and testing these specimens to determine if they are “sensitive” or “resistant” to the various drugs which could be used to treat this disease. I have several websites and blog devoted to this. The most convenient overview is my medpedia bio page: http://www.medpedia.com/users/110
This describes my background and gives links to my various websites, lists relevant publications, recent presentations at national and international cancer meetings, etc.
For the first 8 years after completing my training at the NCI, I continued this work as my academic research in my position as an Associate Professor at the U of California Irvine. I then left this full time position to found a venture capital backed company (Oncotech, since acquired by Exiqon), to provide services (based on my technologies) in the private sector. Later on, I recruited a successor and left the above company to start my own small business. I did this for a variety of good reasons, among them being that I wanted 100% ownership and what might be called “artistic control” over the direction taken. I basically cashed in my IRAs, took out 2nd and 3rd mortgages, cashed in kids’ college funds, etc. to start this business (which is described at http://weisenthalcancer.com).
We obtained Medicare approval and coverage in the year 2000. To this date, Blue Cross does not provide coverage, except in cases where they are sued by their subscribers, who have won 16 of 16 cases decided in Small Claims court (which pays claims up to $5,000 per claim, here in California). The history and controversies related to the area in which I work is described on another website: http://weisenthal.org
Between 2000 and July 2008, we participated in Medicare. However, oncology changed dramatically during this time. The “old” drugs were mainly non-specific “poisons.” Tests for these drugs were comparatively simple, straight forward. We were able to cover expenses and make a profit. But, over the years, new drugs were introduced; testing became more extensive and complex. We innovated and developed new tests for the new classes of drugs. We are the only laboratory which provides testing services for these newer drugs. At a certain point, we found ourselves doing more than double the work we’d been doing in the year 2000 and, on average, more than 4 times the work of Oncotech and the other labs which provide this service. We could no longer afford to provide our services for the reimbursement level provided by Medicare (but note that Blue Cross and a number of other private insurers provided no reimbursement whatsoever, meaning that they were “rationing” the care of their subscribers, refusing to pay for tests deemed necessary by the patients and their doctors). So I did what every physician or provider facility can do, if he/it finds it is losing money on Medicare — I opted out.
Now, the situation is this: If a cancer patient and cancer doctor want to obtain pre-treatment cell culture testing and the patient has Blue Cross or Aetnea or some other private insurance plans, the patient has to pay the full costs of this testing out of pocket. For a Medicare beneficiary, there are two choices: the patient can either elect to have a basic level of testing performed by one on the Medicare participant laboratories, with Medicare picking up the entire bill, less 20% co-payments (which will be paid by private Medicare supplementary insurance, which most Medicare patients elect to carry). Or else the patient can elect to obtain a higher, “concierge” level of service, for which they must pay out of pocket (or which is paid in full by certain “Cadillac”- (I’m dating myself; today we should probably say “Lexus”) level private insurance plans.
But do you see how brilliant this system is, compared to the purely private sector? Everyone in Medicare can receive at least a basic service, with Medicare (and Medicare supplemental insurance) paying. Every laboratory which can make a profit on Medicare payment can remain within Medicare. Patients who want premium service can pay for it themselves (or with premium insurance). Laboratories who want to offer premium service can opt out of Medicare. Meanwhile, patients with Blue Cross or Aetna, etc. are just stuck with the whole bill for even basic service, or else they have to go to court to get the companies to live up to the terms of their contracts.
With regard to the issue of employee health insurance: I have only a total of 10 employees, including myself. The majority of these are part time. I currently provide health care coverage for only a single employee; health care for this single employee costs us $13,000 per year. We’d be one of the 90% of businesses exempt, under the House plan, to my knowledge, but, of course, we’ll have to comply with whatever law gets passed. As a small business owner in the private sector, I reserve the right to run it as I darn well please, within the confines of all local, state, and federal statutes and regulations. And my employees have the obvious freedom to determine whether or not the combination of wages and working conditions we provide makes sense for them, as well.
In a recent reply to me you said “give a girl some credit.” This was a nice, folksy way of putting it; it made me smile. I want to give you some credit here, but you are making it difficult. You are looking at a study which was a purely random sampling, in which the sampling methods passed the statistical peer review of the most respected medical publication in the world, and you imply that it is not valid, because it is only “one-thousandths of a percent” (actually, I think you need to leave off the “of a percent”) of physicians. While Mike and others gleefully quote Rasmussen polls which are not peer reviewed by other statisticians, which use opaque/proprietary sampling methods, “weighting” the sample to reflect what Rasmussen considers to be “likely voters,” and which samples on the order of 1,000 respondents (not providing any information about how many voters they tried to sample or did sample to come up with their final respondent pool) to represent 170 million registered voters which (rough calculation) is about 6 X 10 to the minus 6, or 0.000006 or 6 millionths of registered voters. 3 thousandths of physicians (your calculations of physicians) versus 6 millionths (my calculations of registered voters) means that the NEJM poll of physicians was 500 times more robust than the Rasmussen polls of “likely” voters. And the NEJM study was statistically peer reviewed, with transparent methodology, as opposed to Rasmussen, which is neither.
Some “game changer”…. but I can see you will continue to demean the public’s opinion as irrelevant, and spin it as game-set-match.
Come on, Mata. This is a straw man and you know it. When did I ever once “demean” the public’s opinion as irrelevant, much less “continue to” do it? Answer this. I don’t do this sort of thing to you, and you shouldn’t do it to me.
You make other statements which are pure conjecture.
America’s doctors wouldn’t be supportive of health reform if they knew the details of the House bill. Well, that’s not what the poll was about. The poll asked doctors what type of plan they’d favor: private, public, or mixed. 63% said mixed. 27% (disproportionately surgeons) said private. 10% said public. That’s 73% in favor of some form of “public option.” 55% would be in favor of having Medicare-style “single payer” down to age 55 (down from 65, as it is today). They didn’t ask the question of what would you prefer, purely public or purely private, so your comment that they won’t be getting what they want is invalid on two accounts: firstly, there is no chance that the USA will go to a Canadian style single payer system ; all proposals on the table are robust mixtures of private and public or quasi-public. Yes, I agree that it’s likely that, over time, the “public option” will become dominant, as it is in France and the other countries which have the type of system I believe to be optimal: public plan providing basic coverage for everyone; those wanting more pay for more, as opposed to everyone having to obtain private insurance for even basic coverage. I provide a concrete example, pertaining to my own work, in #85. Secondly, the doctors weren’t given a choice of only two things: pure public vs pure private; so we don’t know how they’d have responded to a hypothetical about Obamacare morphing from mixed private/public to pure public (which isn’t going to happen, anyway, no matter what Barney Frank or even Obama may wish).
With regard to “my theory” on why Medicare is going broke; no, it’s not “bunk.” Health care costs have spiraled out of control not because of bureaucratic inefficiency and/or fraud, but because medical technology has exploded in ways which were simply unimaginable. When I went to med school, there were no CT scans, no MRIs, no PET-CTs. Ultrasound was just starting to be introduced; it was only used for brains (to detect “midline shift” after head trauma) and not for obstetrics. We didn’t have a third the cancer drugs we have today and the new drugs cost ten times a much as the old. We didn’t have coronary artery bypass surgery. We didn’t have fiberoptic endoscopy (for colonoscopy, gastroscopy, etc.) On and on and on and on. And we didn’t have an aging population of baby boomers. These are the reasons health care costs have exploded, and the explosion has been worse in the private sector than in the public sector. In California, Blue Cross changed from being non-profit to being for-profit. Since then, the services they cover have gone down and their premiums have exploded (for example, as a non-profit, they used to pay for our testing services; as a for profit, they stopped paying for this, in contradistinction to Medicare, which does pay).
You claim that people could save and invest as young people to pay for their medical care as retired people. Yeah, right, we saw how well that worked with 401Ks.
The ugly fact which ruins your beautiful theory is that US private sector health care is the most expensive in the world; private health insurance premiums have more than doubled since the inauguration of President George W Bush. Private insurance remains solvent by raising its premiums at will. Medicare hasn’t been able to do this.
There are only two ways to pay for health care, either private sector or public sector. Raise premiums/taxes or restrict payment for services. Medicare provides the bigger bang for the buck, but there will always be a role for private insurance to provide both supplements and for a premium level of care, for those who wish to purchase it.
The people who understand the health care system best are physicians. Their views, as revealed in the NEJM study, will give the moderates all the “cover” they need. This is simply a personal prediction, which may or may not prove to be correct.
The doctors were all AMA members. Which are not even 35% of all doctors.
None of the questions had anything to do with Obamacare.
There was only 3 questions.
Less than half responded at all.
More than 3/4 of the respondents are Liberals.
They were paid.
This survey has nothing to do with the topic at hand.
Incorrect. The doctors were listed in the AMA Master file. This is the most complete listing of American physicians available. It also includes the 65% of physicians who are not AMA members. For example, I am listed on this database, even though I’ve never been a member of the AMA.
They asked many questions relating to health care. Not simply three. Read the study
The respondent rate compares very favorably with that of any poll of a large population group (e.g. Rasmussen, Gallup, etc.) which you can find. See my reply in #82. And the methodology passed stringent statistical peer review.
28% were conservatives. 42% were moderates. 28% were liberals. These numbers are similar to data for the electorate as a whole, especially considering that people with post-baccalaureate degrees are, on the whole, significantly less conservative than the electorate as a whole.
As I noted before, it is entirely customary for physicians (and other professionals) to be compensated for their participation in surveys relevant to their professions. The level of compensation provided ($25) was nominal, at any rate.
The survey has quite a bit to do with “the topic at hand.” Discussed by me in prior comments. Although the issue of public versus private health insurance is certainly of importance to the average American, it is of intense importance to the average physician, and physicians understand the problems with the current health care system much better than do average Americans.
Larry, personally I wouldn’t mind you nabbing some “self-promotion” for your business. When I worked in the LA film industry (and music industry prior) for 17 years, I used to have a saying about the celebs and their attitudes. On more than one occasion I’d have to remind them.. “We aren’t curing cancer here. We’re making a mediocre movie”.
You, genuinely, are striving for treatment, prevention and elimination of cancer. Frankly, I think that’s the cat’s meow. My regard could not be higher. So do not misconstrue my comment about you opting out of Medicare. I thank you for your links and, when I have some time in my very busy work life (which is *not* curing cancer….) I intend to explore more. Tho I’ve already visited some of your stuff, and the medical technology may as well be another language for me.
So let me concentrate on this simple statement you made:
We could no longer afford to provide our services for the reimbursement level provided by Medicare (but note that Blue Cross and a number of other private insurers provided no reimbursement whatsoever, meaning that they were “rationing” the care of their subscribers, refusing to pay for tests deemed necessary by the patients and their doctors). So I did what every physician or provider facility can do, if he/it finds it is losing money on Medicare — I opted out.
I don’t have a problem with you and your Medicare opt out. And I most certainly want you to make a profit so you can be (hopefully) a successful risk taker. I am a fan of what you do, and it wows me.
What I do have a problem with is you can justify yourself opting out for reasons of profit and advancement, but you don’t seem to realize others in your profession deservedly have that same attitude. The more they cut Medicare services, the more will opt out and it will be harder for my parents, you and I, to find care in a system we are mandated to use at the age of 65 (unless we want to give up our SS checks).
I understand that technological advances have driven up costs. I also understand that often that technology is overused in order for doctors to pay for their advanced equipment. I also understand that when a provider is undercut for his costs, he overcharges the privately insured to make up for the difference.
Therefore, it makes no sense to put even more people on a system designed to undercut the providers base cost. It does, however, make a great deal of sense to reign in what drives up their costs…. i.e. malpractice premiums, cost of advanced tech equipment, negotiation of both equipment and drugs without the middle man (as even you suggest as one segment of the cure).
The bill before us doesn’t do this. It just expands the number of people on a program that cannot be fiscally sustained.
Now… INRE “the poll”.
Come on, Mata. This is a straw man and you know it. When did I ever once “demean” the public’s opinion as irrelevant, much less “continue to” do it? Answer this. I don’t do this sort of thing to you, and you shouldn’t do it to me.
Allow me to answer that. You demeaned the public’s opinion as irrelevant with an attitude that now the doctors have spoken, the matter is close. Or, as you put it:
The people who understand the health care system best are physicians.
Now I know you don’t mean to sound pompous nor arrogant, but … forgive me… you do. This is much like Congress who ignores public opinion on bail outs, fiscal responsibility, and does what they want because they believe we, the public, aren’t smart enough to make a reasonable decision.
You may be a doctor with experience in the costs of business and delicate balancing act of too low of reimbursements. But I assure you, the public who has dealt with having to accept “some treatment” over the “best possible treatment”, and less doctors who are willing to treat them, also have experience. The medical professionals are not the end all, be all magi of how the system works. Therefore, just because 2130 plus 991 professionals would like to see a public and private mix (which we already have, with an unworkable in balance *mostly* do to the deficiency of payouts for the public option) doesn’t overrule the public opinions. People are mostly trying to “katie bar the door” for further erosion of current coverage, and prefer to find a way to cut the costs of doing unneccessary business. Again, none of which the proposed legislation does.
Last, about the poll itself. You must be confusing me with others when you say I laid out a straw man about the numbers. You are not addressing a “poll” fan. I’m on record here in multiple threads about how I put *no* stock in polls. Sampling 1000 to 3000 people out of a population of over 300 million, and prounouncing this the opinion of the nation, is simply ludicrous.
So this same attitute carries over to your 1-3 thousandths of medical practitioners.
Nor do I put stock in Rasmussen particularly… same reasoning. What I do look at is the cross section of those in protest (across party lines), and their increasing personal involvement with public protests, as a sign of the rising opposition. These voices should not be cast aside as uneducated and unimportant because doctors and PharMa have another opinion. Nor do I accept “the AMA support” since there are many dissenting doctors within that body. I was a union member for years, and I assure you… they took many positions I personally opposed.
I read the poll info you provided. And as I said, what struck me is that these doctors overwhelmingly did not want a single payer system, nor an effective comparative database. I’d say they, and the public, are in agreement.
So it again comes down to the base difference you and I have. You believe these are not steps to a single payer system by design because you want to believe that. I, however, believe this POTUS and his Congressional cronies who have stated, in no undercertain terms, that single payer is the quest. I do not possess your blind faith in promises when I can read the legislation that states otherwise. And blind faith will be the death of us… literally.
I have only one follow up comment, which is just a clarification.
I read the poll info you provided. And as I said, what struck me is that these doctors overwhelmingly did not one a single payer system, nor an effective comparative database. I’d say they, and the public, are in agreement.
I don’t want a single payer system either. There is no bill under serious consideration which has a single payer system. But only 27% of the physicians wanted a purely private system, without a public component. As I stated previously, these were disproportionately surgeons, who benefit disproportionately from a private insurance care system which reimburses generously for procedures but which pays comparatively little for primary care medicine. Most Medicare reforms under discussion call for narrowing the gap between specialty and primary care reimbursement, which means that surgeons would be gored while other doctors would benefit. So it’s a bit of a civil war, fighting over shares of the pie. As I tried to illustrate with the prostate cancer example, surgery has a way of generating its own demand.
– Larry Weisenthal/Huntington Beach, CA
Patvann
14 years ago
Larry, if you don’t want a single-payer system, then why do you support a bill that will inevitably shut them down????
I KNOW it does not have that specific language in it, so spare me…But it WILL eventually force them out due to the government’s ability to operate at a loss!!
Larry, if you don’t want a single-payer system, then why do you support a bill that will inevitably shut them down????
I KNOW it does not have that specific language in it, so spare me…But it WILL eventually force them out due to the government’s ability to operate at a loss!!
Even the CBO agrees!!
Do you not see it????
Now we are starting to make some progress.
What I favor is a system in which there is a baseline level of healthcare service for everyone, provided by private doctors in private hospitals, but paid for by the government, as in the case of Medicare. In addition to this, there would be private insurance to pay for premium levels of service, for those who want premium levels of service. Physicians and hospitals would be free to provide services within the public (“baseline”) system or in the private (“premium”) system, but not both. This is the way that Medicare works now. This is also basically the heart of the French system (except I think that French providers can participate in both public and private systems, which I personally don’t favor, but this particular point would be a matter for debate).
I agree with you and with the CBO that, with regard to providing the baseline service, the public system would eventually win the lion’s share of business, as it does in France. This leaves the private insurance companies to compete with each other in providing plans to pay for premium service levels, as they do all over Europe and Australia (though not in Canada, where the system is not friendly to this approach).
Therefore, everybody wins and nobody worried about rationing need get rationed, provided they are willing to pay for it (I agree with Mata that premium health care is not a “right,” anymore than personal bodyguards are a “right” in a system in which there is a public police force to provide for a baseline level of personal protection). And please remember that there is already a lot of rationing going on, and it is going on mainly in the private insurance system. I also think that these reforms would gradually move private insurance funding from employers to individuals, which would make the entire economy more efficient, by increasing job portability (which having the public plan paying for most baseline services would also do).
@openid.aol.com/runnswim said: ” nobody worried about rationing need get rationed, provided they are willing to pay for it “
Larry finally admits what many of us have said all along. The Dems health care plan will lead to rationing except for the rich. This will create a two tier system where everyone who is not rich will be treated to the horror of government care (or the lack of care, but with all the nastiness and indifferrence govt. is famous for).
Does that sound like change we can believe in?
What will all the ACORN types do when they see the rich get better care than the poor?
Larry finally admits what many of us have said all along. The Dems health care plan will lead to rationing except for the rich. This will create a two tier system where everyone who is not rich will be treated to the horror of government care (or the lack of care, but with all the nastiness and indifferrence govt. is famous for).
That is total baloney.
First, as I keep saying, there already IS rationing! And it’s much worse with Blue Cross, Aetna, United Healthcare, et al than it is with Medicare.
With Medicare (and with any public option to come), all coverage decisions are made with complete transparency. There are 5 levels of appeal, with the last being the congressperson. With the private companies, it is opaque and the appeal process is much less patient friendly.
Right now, we already have a two tier system in the private sector. This is why I thought it necessary to have
both
Blue Cross ($12 K per year) plus my AMA Catastrophic (another $12 K per year). The catastrophic was to take care of all the expenses that Blue Cross rationed me out of. Denials for state of the art treatment and drugs. Disallowance of care by providers “out of network,” as when I want to go to NYU for thoracic surgery or Loma Linda (near Palm Springs) for Proton Beam radiotherapy or to Florida for a DeBakey trained “beating heart” bypass surgeon or to Louisville for a recommended hepatobiliary surgeon or to St. Johns Santa Monica for a specific stomach cancer surgeon. This is what I mean by “premium” level health care, and if you think your own health care plan would give you the flexibility to do these things (as Medicare does and as the “public option” surely would), then I suggest you read the fine print in your insurance policy, which is perfectly good, until you really need it! Lifetime limits on coverage, etc.
At the time when I started purchasing both “basic” and “premium” insurance, Blue Cross was only about $6K and the AMA catastrophic $3K. Within 5 years, they’d increased from a combined total of $9K to $23K. And I still thought it was worth it, until the AMA started limiting coverage for oral cancer drugs to $15K per year (for drugs which can easily reach $100K per year). So I dropped the AMA and switched to an $8K deductible Blue Shield plan for nearly $12K per year which I consider to be inadequate. I’m exposed to risk of personal bankruptcy for certain highly foreseeable catastrophic illness. And I lack the complete flexibility to choose the provider and hospital of my choice, which I won’t again have until I’m eligible for Medicare.
This whole “rationing” business is part of a shameless campaign of scaremongering, from the same people who gave us “death panels.” It’s frankly disgusting.
@openid.aol.com/runnswim: Multiply every complaint you have about the current health care system TIMES TEN and you will understand the unintended consequences of a federal takeover of health care. THEN, factor in the negative impact on small business and the picture gets even worse.
Larry, you have used more words here to mask the disease that is the Dem plan than you even did with global warming. You think that by flooding the board with thousands of words, most of which are repeated over and over, that somehow your words will become fact? I don’t think so.
Multiply every complaint you have about the current health care system TIMES TEN and you will understand the unintended consequences of a federal takeover of health care. THEN, factor in the negative impact on small business and the picture gets even worse.
That’s absolute nonsense. I think that Medicare already is more than a third of total heathcare and total federal funded health care is about half.
Medicare works beautifully — much better than Blue Cross, Aetna, etc. for both patients and most doctors — and gradually expanding Medicare would be a relatively easy thing to do. That’s where health care reform is headed. This will increase patient choice, decrease provider red tape, and lower the overall cost of health care, which is why 72% of American doctors prefer a public component in health care reform.
– Larry Weisenthal/Huntington Beach, CA
Patvann
14 years ago
Larry.
Gotcha. On every count and point you’ve spewed forth.
And if you pay that much for healthcare, you are either stupid, or a lier. Or both.
I pay my own Kaiser HMO for around $5G a year and it covers two adults and 3 kids, with a $1000/year deductible. The max payout is in the millions. (Payments went down by 300/yr after my eldest left the home for the Corps.)
It also paid for my wife’s stage3 3mmdeep Malignant melanoma biopsy/surgery/treatments for $240 out of pocket atop the premium/deductible.
And I KNOW you know what that treatment entails…and what the survival-rate is.
After twenty years of Obamacare would a 45 year-old woman who has a 5% chance of living 5 years be guaranteed a 1/4 million dollars of treatment? I think not.
Was my wife lucky, and possibly a fluke? I’ll say 50-50. All I know is that NO ONE second-guessed my doctor, and NO ONE in the government hinted at giving up.
Because I’ve done the research on you, and even went so far to ask my wife’s doctor about you, (She’s read your work, and is sending me the papers, so I’m not CHARGED FOR EDUCATING MYSELF ABOUT THE WORK OF A MEDICALLY GIFTED PERSON.)
I am willing to send you her entire history, and billing. Dr. Vampithy gave it to me on CD.
DON’T doubt me. Dual-Mastered Engineers who are former SeALs tend to do their prepwork.
And for G-ds sake stop the backtracking and obfuscation. It’s unbecoming.
@openid.aol.com/runnswim: That’s right Larry… Just keep repeating that B.S. over and over and over and hope no one notices you don’t have a leg to stand on.
It’s really getting rather tiresome. I don’t think you have made an original point in days.
I need to belay my offer, as the wife was not asked, and when I just did, she said: Not unless it’s done through Dr. Vampithy.
I was wrong to make such a personal offer, but you may be contacted in the near future by Kaiser California through professional channels via your practice. (Not UC Irvine)
I may disagree with you, but professionalism and integrity must remain paramount, not to mention patient confidentiality laws.
This public admission takes nothing away from all other statements.
@Patvann. Kaiser is a very high quality health care organization, but you are limited to the (generally excellent) physicians and hospitals within the Kaiser network. For me, the most important thing in my health care plans is the ability to see who I want, where I want, and when I want. And to get whatever state of the art therapy which the responsible physician and I feel is indicated. You couldn’t have seen any of the physicians and surgeons across the country who provided the many services to my first degree relatives. Virtually anyone, anywhere with Medicare could have seen and been cared for by these truly world class doctors. I will say that Kaiser has been generally reasonable in paying for our services. It does require that a Kaiser oncologist initiates the order, provides a justification, and receives preauthorization, but, when these conditions are met, Kaiser has been decent about paying for it. Kaiser is way better than Wellpoint, Aetna, and US Healthcare.
P.S. Kaiser does have a $1 million cap on “out of network” lifetime benefits. As long as your health care needs can be met within network and they have the doctors and equipment you want (e.g. they don’t have a proton beam machine), then you are OK. But Medicare has no cap at all on any of its benefits and it has the nation’s largest “network” of providers, hospitals, and equipment.
With regard to Obamacare paying for expensive care for long odds cancer, you are speculating, but Medicare certainly does this, every day. The details and expenses paid by Medicare of/for my sister’s 6 year illness are every bit as impressive as your wife’s experience. I could say, well, Kaiser won’t be paying for this 20 years in the future with as much conviction as you can muster about Medicare or whatever “public option” emerges.
If you ever want to talk to me about a personal/professional matter, or just want to talk swimming, give me a call at 714-596-2100 and ask for Larry.
Mike’s continued personal attacks are duly noted. And I won’t tolerate being called a “lier” [sic] by anyone, no matter how good his butterfly stroke.
Of course Medicare is in financial trouble. Private insurance raises its premiums at will. Medicare can’t do this. But private insurance is having and producing huge problems of its own, which are not sustainable.
Sorry if I don’t tolerate your repeating filibusters of failed talking points but you simply cannot be left unchallenged when you pull this routine. It’s not a personal attack in any way. It’s an OBSERVATION!
@MataHarley said> “I read that most are headed for the big bucks specialty biz. “
They won’t be after Obama gets his way. There will be little financial incentive to do so and the risk of lawsuits, which is much higher in a number of specialties, will be just as great. And, we’ll be having even longer waits to see those specialists just as they experience in Canada
But this doesn’t mean there will be more primary care physicians available to treat patients. Dumping 30 million new consumers into the system will make it difficult to get an appointment.
This fantasy that Larry and his fellow libs have that somehow THIS TIME, government will do this right when there is NO past experience when they have is truly frightening.
Larry and friends seem to be oblivious to the unintended consequences of good intentions.
Larry W, INRE Laurin’s denial of coverage for pre’existing…. She’s a Yale (or Harvard) grad, yes? Is she not working in a career (other than English Channel training…) and have access to a group plan? That cannot be denied for more than a exempt period of up to 12 months.
And the pre-existing bit would disappear if feds and the states would allow for individuals to form “groups” to have access to group plans. In other words, every individual would have at least one or more “groups” to choose from. This doesn’t need to be tied to employers either.
Lovely girl, BTW.
Thanks, Mata. Laurin was a Harvard swimmer; accepted for admission to the U of Colorado Med School; taking a year off to swim the English Channel and continue with some very exciting work she began with a stem cell group at Harvard who moved to continue the work with a start up biotech firm in the SF Bay area http://izumibio.com She’s got wonderful, employer-provided insurance. The (hopefully temporary) problem is the other daughter, a recent Yale econ grad (and rower, who’s Yale “4” took 3rd at this year’s NCAA Div I champs and then won the Senior Division at the Women’s Henley outside of London in late June. Not the greatest year to be an economics graduate, she’s deciding what she’s temporarily working in our family lab business (we don’t have group insurance; just individual coverage). Had had some sports injuries, now resolved and unlikely to recur, as she’s not training at the level as before. I’m sure she’ll get it resolved, but the denial was unexpected and it’s so freakin’ ironic that I, of all people (surely one of the world’s most paranoid people when it comes to health insurance, which I view as important as food, clothing, and shelter), should find a first degree family member among the ranks of the uninsured. – LW/HB
@mike:
I’ve got one word for you: Medicare
Curt might have two words for you: County Sheriff
etc.
@mata:
Your post (#50) mischaracterizes my position. Just about everyone on this blog thinks that, in order to be supporting health care reform, one needs to be a socialist/marxist/whatever. For goodness sake, you’ve got 59% of the nation’s doctors preferring a single payer, government administered system over the mess we’ve got right now. They don’t favor this because they are socialists/marxists and want to be “government employees.” Neither do I. Read the article I linked about it and find out why they/we feel this way.
I don’t think that health care is a “right.” I think that free speech is a “right,” along with the other “rights” provided by our constitution. There is no constitutional “right” to public safety, but we do provide national defense, police protection, and fire protection. There is no “right” to a decent education and certainly not to college and graduate level education, yet we do provide these, because we recognize the advantages to our society in doing all the above things.
The elderly have no “right” to health care, yet we were wise enough to establish a system to provide this. An enormous amount of the total health care in the USA is provided through Medicare; I’d wager in cancer, alone, it’s close to 50%. I think that, of all health care spending in the USA, close to 50% is government-paid. 70% of the private hospitals are non-profit. Studies have shown that for-profit hospitals often provide inferior care to that provided in the non-profits. But virtually none of the doctors are “government employees,” any more than the employees of Boeing are government employees.
The point is, the health care system is already half-“socialized,” if you want to think of it in those terms. But our half-baked system is an administrative nightmare for physicians and hospitals, and the lion’s share of this nightmare is caused by the private insurance sector. Pre-authorizations. Restrictions on which drugs can be prescribed. Payment denials. And then there is the problem of the uninsured. And, for the rest of us, there is the specter of personal financial disaster which is only a diagnosis or accident away and against which it is currently impossible to insure. One can buy fire insurance which provides certain protection against fire losses; the irony is that it’s virtually impossible to find health insurance which provides certain protection against financial losses from health-related catastrophes.
What I personally favor is a gradual expansion of Medicare to cover increasing numbers of the population with a very good, basic level of service, with a robust system of private insurers to provide supplementary coverage for employers who want to offer (and for people who want to obtain) a very high (“concierge”) level of service. I believe that this is the best way to contain costs, provide near universal coverage, and to improve entrepreneurial medicine, through fostering competition. I think that principles of market economics can apply at the concierge level of medical service, but that they’ll never apply at the basic level of medical service.
When are we going to have a thread ranting and raving about our socialized sheriff’s departments?
– Larry Weisenthal/Huntington Beach, CA
@DC: #47
I was merely making the point that the rules of market economics don’t apply to medical care, because “buy” decisions are made by the “sellers.”
Let’s take a poll of men on this blog:
O.K. Guys, how many of you would have a radical prostatectomy for a 1 in 48 chance – at best – that it would prolong your life? There’s a much greater chance that taking one baby aspirin per day would prolong your life (that’s been known for years). How many of you are taking one baby aspirin per day? Cutting out red meat has greater than a 1 in 48 chance of prolonging your life. How many of you are willing to cut out red meat?
But it never gets explained that way. Because the people who do the explaining are the same people who get paid for doing the procedure and who don’t get paid for counseling against the procedure.
Babes in the woods. True believers that the free market can do no wrong.
And, in an answer to another rant, Medicare is totally transparent/open doors. Private medical insurance companies are opaque and closed doors.
– Larry Weisenthal/Huntington Beach, CA
Wilson was correct!! No apology necessary either.
Larry,
I never said that the free market can do no wrong. It “is” our current system however (until we become socialist). There are solutions to the problems you mention and there are plenty of things we “can” fix without moving to a government run system.
There are plenty of babes in the woods here in america who believe socialism, communism, etc. are all better models for everything.
@openid.aol.com/runnswim: Medicare is going broke and has ALWAYS exceeded the costs that politicians predicted Larry.
You’ll have to do better than that. Especially since Obumma wants to CUT Medicare for seniors.
NEXT!
@Mike: Medicare has done a brilliant job at providing universal care of unsurpassed quality and consumer satisfaction at a total cost of substantially less than private health insurance (medical condition and age-adjusted). The reason it’s “going broke” is that advances in medical technology are running amok and Medicare can’t raise taxes at will, the way that private sector insurance can raise premiums at will (case in point: recent 30% PER YEAR rise in insurance premiums with more than doubling since the Bush 43 inauguration).
With respect to “gutting” Medicare, that’s just more scaremongering.
There are only two ways to control costs: (1) Raise taxes or raise premiums (either is an equivalent drain on our personal incomes, only private insurance increases are greatly outpacing what would be need to restore Medicare solvency) and/or (2) cut back on payments (e.g. as happens every day in the “rationed” private sector, where tests, procedures, drugs, and treatments are routinely denied on the basis of “no medical necessity” — in the eye of the insurance companies, who substitute their medical judgment for those of the patients’ own doctors).
– Larry Weisenthal/Huntington Beach, CA
More liberal propaganda from larry. Larry, I don’t deal with medicare the way you do, but I can tell that from my experience people are not happy with it.
I know responding to you is a waste of time as you are so deep into pathological denial you’ll never come back. You’re too busy watching a “legend” being made before our eyes.
Shouldn’t you be crashing thru a wall somewhere shouting “Oh Yeah”?
@Hard Right:
HR,
Larry doesn’t deal with Medicare at all….it was so wonderful and fantastic and super-d-dooper he had to opt out because of its’ greatness…..
Heh.
Aye, color me shocked. A trademark of liberals. Required for thee, but not for me.
While I rip on larry, I have to admit I really don’t hate him. He doesn’t seem like a bad guy, just waaaaaaaaaaaaaaaaaaay off into liberal fantasy.
Back to Medicare. In the last couple of years I’ve watched it cover less and less and talked to those struggling with the changes. They can put out all the polls they want because if what I’m hearing from the people using it is any indication, then Medicare is hardly as wonderful as larry claims.
My posts seem to be winding up in the filter.
You’re right….I’ve had to fish you out several times now.
I’ve emailed Curt.
Kind of funny considering I’m being nicer than usual . Is that a sign from the spam filter gods?
😉
Thanks.
My father has received Medicare coverage for (1) a quadruple bypass, (2) stomach cancer, and (3) chronic biliary obstruction from cholelithiasis, along with more routine matters, such as cataract surgery. My mother received Medicare coverage for giant cell arteritis, cataracts, and lung cancer. My sister (an MD) has received Medicare coverage for 6 years of ovarian cancer, including 6 major operations and 6 different forms of chemotherapy. Care and payment have been, in all cases, explempary.
In the case of my Mom (a resident of Kentucky), I had her go to NYU in New York to receive her primary lung cancer surgery from the thoracic surgeon who is the chief author of the most important textbook on lung cancer and then to Loma Linda University in California to receive proton beam therapy from the only such facility of the country which can treat para-spinal metastases with proton beam. Then she received her chemotherapy from the best oncologist in her metropolitan area. There were no geographic or “provider network” limitations, as there would have been with private insurance. No preauthorizations required. I doubt seriously whether any private insurance would have paid for her “experimental” proton beam, but Medicare did and it was brilliantly effective.
I had my Dad fly from Florida to California to have an 80% gastrectomy performed by a UCLA surgical oncologist who is one of the few surgeons to lecture on the topic of stomach cancer in Japan, the world leader in stomach cancer. He had his 4 vessel bypass performed by a cardiac surgeon who trained with DeBakey and who did a state of the art “beating heart” (off pump) 4 vessel bypass.
My sister has received her surgeries and chemotherapies likewise from the best doctors around, at the best facilities. No preauthorizations required. Medicare paid for certain (effective) chemotherapies which would have been denied for coverage by Blue Cross.
I previous provided the citation for the peer reviewed study of patient satisfaction with Medicare, compared to private health plans.
– Larry Weisenthal/Huntington Beach, CA
Larry, with the grim Family history of medical issues it is a good thing that you are an MD.
I am very sure that taxes must go up to support a patient load of 40 to 30 k folks that are lacking insurance but get treated anyway. I am hoping that more folks take an interest in medicine and get a good education because we are going to need easily a thousand more Doctors to cover the load. Otherwise there will be rationed care. The old basic supply v demand thing that must be considered.
Well, medical history is grim, but medical care has been outstanding. My Dad (stomach cancer, 4 vessel bypass, biliary obstruction, cataracts, etc.) is now 96 and set a world age group record in the 200 meter backstroke and had the best times in the nation in 5 other swimming events in the past year. He’s meeting us in Dover, UK in 2 weeks to go on the boat with us which accompanies his granddaughter’s attempt to break the women’s English Channel swimming record. My sister is currently in complete remission after more than 6 years of battling stage 3B ovarian cancer. She travels all over the world and is doing great, thanks to great medical care. Even my late mother enjoyed 22 months of complete remission of stage 4 non-small cell lung cancer before dying of brain metastases (the drugs don’t get across the blood brain barrier very well). During this time, she got to attend a college graduation, the wedding of a son (my brother), and several holidays and birthdays, as well as taking 2nd place in a Las Vegas slot machine tournament and getting a free trip to Atlantic City for the world champs.
I truly believe that, with the usual constraints of Blue Cross, none of them would have done as well. I credit Medicare (plus great doctors) for their comparatively good fortune, given that they had the bad fortune to have the illnesses they did. Just as a theoretical consideration, had they not had Medicare, I’d have still sought to have them get the treatments they did, but it would have been a horrendous expense, which would have probably bankrupted the typical patient of average financial means.
– Larry Weisenthal/Huntington Beach, CA
Despite all the claims that I’m a Kool-Ade drinking socialist, it turns out that I’m squarely in the mainstream of American physicians, when it comes to health care reform.
Fully 63% of us (nearly 2/3 and well above the 60% filibuster proof majority) favor health care reform and favor a public option.
http://www.reuters.com/article/GCA-HealthcareReform/idUSTRE58D67120090914
This is one of the main reasons why health care reform will pass. The people who know the health care system the best know best what’s wrong with it and how best to fix it.
– Larry Weisenthal/Huntington Beach, CA
My comment on the breaking news story below went to spam:
http://www.reuters.com/article/GCA-HealthcareReform/idUSTRE58D67120090914
63% of American doctors favor health care reform including both public and private options (just like me).
10% favor public only.
Meaning 73% favor either exclusive public or mixed public/private options
And 55% would favor expanding Medicare (i.e. “public only”) to cover down to age 55 (down from 65, where it is today). Why would doctors want that, Mata, were they losing money on Medicare patients, as you assert they are?
Only 27% favor exclusively private. These are disproportionately surgeons (e.g. like the ones pushing radical prostatectomies in a situation where you have to do 48 radical prostatectomies to benefit only 1 patient).
– Larry Weisenthal/Huntington Beach
Wow, this is absolutely huge; it will be a game changer. No longer will the Party of No be able to assert that it’s only Obamamaniacs and socialists who want to get this done. Read all the stories flooding Google News right now.
Here is the link to the full text NEJM article: http://healthcarereform.nejm.org/?p=1785&query=home
And, for e.g. (from Newsweek):
It’s not a Democrat versus Republican thing. It’s an American thing. Americans will recognize that Obama is just trying to do what the doctors who provide front line health care think should be done. And they will recognize that efforts to torpedo this are simply selfish partisan politics.
Watch and see. Filibuster-proof majority, for sure. This provides all the “cover” the moderates need.
– Larry Weisenthal/Huntington Beach, CA
Link to NEJM article:
http://healthcarereform.nejm.org/?p=1785&query=home
Read all the stories on this currently breaking on Google News. This is a game changer. It provides all the “cover” the moderates need. Filibuster-proof majority.
LW/HB
Link to full text of NEJM study on where American doctors stand on health care reform:
http://healthcarereform.nejm.org/?p=1785&query=home
@openid.aol.com/runnswim: You think respondents being paid to participate in a mail in survey has the same validity of a scientific public opinion poll?
Sounds to me like you are getting desperate Larry.
That’s how medical studies work, Mike. It’s long established precedent. Docs are busy people. They are always compensated for providing data for research studies. I’ve done the same thing, with my studies, requiring follow up. Provided compensation for time taken. The NEJM is universally acknowledged to have the highest publication standards of any peer review medical journal in the world. Unsurpassed credibility.
But that’s OK. Believe it or not. It’s game over. Filibuster-proof majority. All the cover the moderates need.
And the big winner is all of us. Even you, Mike. Which I predict even you will acknowledge, some day. And today was the most important day in the process.
Historic.
– Larry Weisenthal/Huntington Beach, CA
Reply to #71 to spam.
Prior response still hasn’t been dug out of spam. Will try again.
The New England Journal of Medicine is universally acknowledged to be the most prestigious medical journal in the world and to have the highest publication standards. It is, if fact, customary to compensate physicians for providing information of this type. I have done this myself (provided compensation) in order to obtain follow up data in clinical studies.
This study is a game changer. You’ll see.
– Larry Weisenthal/Huntington Beach, CA
@openid.aol.com/runnswim: Put down the crack pipe Larry.
A paid mail in survey does NOT have the validity of a scientific opinion poll no matter WHO publishes it!
Besides, the number of so-called “moderates” is misleading. My bet is that more than half of them are liberals and lying about it.
If this is the best you can do, why bother?
Game changer my ass!
I’ve just finished reading the whole survey, including the supplemental PDF.
Here are my findings:
The doctors were all AMA members. Which are not even 35% of all doctors.
None of the questions had anything to do with Obamacare.
There was only 3 questions.
Less than half responded at all.
More than 3/4 of the respondents are Liberals.
They were paid.
This survey has nothing to do with the topic at hand.
The use of this survey is a red-herring argument, and a trained oncologist should know better.
@Patvann: Thanks for the backup. But it won’t stop Larry. Once he gets a talking point into his head, any information to the contrary gets pushed out.
I’m used to it by now. Don’t ask him about global warming… He thinks he’s an expert on that too!
@Mike’s America Who loves ya baby? 😉
I’ll listen to him if he wants to talk Malignant Melanoma (Wifey is 3 year NED, stage 3) Or the perfect butterfly stroke (Santa Clara Int SwimClub 1974-79)
Aaaanywho…
There is also no word AT ALL about 60 votes, let alone the fact that there are not 60 voters.
One happened to have died recently.
Bird won’t vote for it in it’s present form, and is usually too sick to show up.
2 are Independents, and Lieberman isn’t sounding too enthusiastic.
That gives the Bill 58 at the most. (With Bird and 1 Indy)
The only thing on the move right now is the Senate leadership mulling over if they want to shove it through using parliamentary tricks (reconciliation) , but most members know that that would be political suicide.
Obama has signled that he’ll let Congress kill the Public-option part, but that still leaves a POS for a Bill. The whole thing needs to be scrapped.
Oh PLEASE bring up Glowbull wormining! I’m MORE than ready!!!
Whoa there, pardner… “absolutely huge”?? From your Health Care Reform blog of the NEJM link above:
991 participants. In 2006, the Bureau of Labor statistics had about 633,000 physicians and surgeons in the US. Presumably more in 2009… perhaps not. Let’s play with the 2006 figures as worst case scenario.
That means the “absolutely huge” news you tout is a poll of one-thousandth of a percent of all the physicians and surgeons holding jobs in the US prefer a mix of private/public option.
Then there’s the Reuters report you linked citing another poll of 2130 respondents. Wow… that’s an improvement… up to three thousandths of all the 2006 doctors/physicians.
Some “game changer”…. but I can see you will continue to demean the public’s opinion as irrelevant, and spin it as game-set-match.
You wouldn’t be ignoring that only 10% said they exclusively wanted public options in the 991 participants’ poll, and only 27% in the 2130 participants poll… which is what will be left when the feds destroy most the private insurers by cheaper coverage with less options.
Do they believe Obama’s promises, misrepresenting the House bill, and babbling about a bill that doesn’t exist? Are they aware of the oft stated quest for single payer by not only Obama and Rahm’bo, but most of the Dem leadership in Congress? If you’ll remember, it was predicted that 50-75% of the US population would end up on the public option. Doesn’t leave much privately insured to support the underpayments to the medical providers, does it, Larry. And works quite well with Obama’s vision that single taxpayer will take multiple steps.
Doesn’t sound like these physicians would approve of that goal.
Oh wait… I forgot you believe the medical profession should be non-profits. Oh wait again.. you said I “mischaracterized that. Did I?
ummmm… not sure what I misunderstood about “of course”…. But I digress. Back to your poll of 991 doctors, or one thousandth of all physicians and surgeons. (I notice they didn’t ask any medical facility owners in either of these polls. Wonder why?)
Then, of course, there’s a high aversion to cost effectiveness data that Congress slithered thru in the dark of night via another bill no one read – the stimulus/ARRA.
I guess they also missed the reality of it now being law while busy with their stethoscopes and scalpels. As you said, they are busy guys/gals. Evidently too busy to keep up on the specifics, so they tend to listen to “just words” instead. My guess is they, like Obama and Congress, didn’t read HR 3200 either.
Aren’t they in for an ugly surprise when the bills don’t match the promises?
I say you are premature to call checkmate here. And worse yet, it’s offensive that you are ready to end the game based on these polls. I don’t care if you’re the Surgeon General… you haven’t any more authority or voice in this than I, or any other citizen does. And far more “participants” than your poll respondents were in the streets of US cities all over America on Sept 12th, saying something completely different. And many of them HAVE read the bill.
As for your theory as to why Medicare is going broke… bunk. You might want to remember that the government is collecting cash for Medicare from every tax payer’s paycheck… and they can’t support the small percentage of the population on medicare now. Considering there’s no cost reform in these bills… the real ones, not Obama’s imaginary bill… that’s not likely to improve. In fact, it requires the “willing suspension of disbelief” to swallow that you can throw 50-75% of the population on a similar program, and make it fiscally sustainable.
But here’s my biggest bone of contention with you.
The country “paying for senior citizen care”?? Larry, your parents, you, my parents, me… we’ve been *paying* for medicare since 1965. We’ve been paying it forward for care denied to us until we reached a certain age. Those that are really shafted are the ones who die at 64… pillaged for the duration of their life, and unable to get back some of that highway robbery bootie. What your kids have put into Medicare wouldn’t amount to a drop in the bucket. You make it sound like some charity when, frankly, all Medicare was… and is… is yet another government ponzi scheme like Social Security.
I want my cash back. Period. And I’ll buy private insurance. Ooops… the government’s already spent it. No, make that blew it like a spoiled rich kid running amok on Daddy’s credit card in Bloomingdales.
BTW.. had to laugh listening to Mark Levin today, calling you and those like you, out on your Obama protection talking points. “It’s not his bill”. LOL Yes, good cover for his arse. Amazing to what extent the blind faithful go to have Obama’s back. This POTUS wants it all. When the fiscal disaster hits the fan, he’ll blame it on Congress. But for a few years, if everyone is in “free health care” euphoria before the bank breaks, he’ll take credit and retire from the WH in glory… so he thinks.
But Obama can’t straddle fences forever and his visions for a remade America have consequences. History has far more patience for legacies. And between quadrupling prior national debt in under a year, seizing control of banks, auto companies and dictating salary to private industry, shoving thru cap and trade and health care atop an obscene Omnibus, Obama’s is to be the destruction of the US economy. Then I’ll be happy to say, it’s your country… not mine. Show me to the death panels.
BTW, Larry… INRE your rower daughter now working at Weisenthal. You say you, as an employer, do not provide insurance. Obviously you know you’ll be mandated to do so, and my guess is you… like any P&L conscious employer… will opt for the cheaper public option if available.
My burning question is, why aren’t you seeking an avenue to be part of a group plan, instead of forcing yourself and your family into individual care? You have to recognize the obvious benefits of a group plan, yes?
I might also add that as an employer in the medical provider world, you tout one values version, and behave in a different way. You refuse Medicare patients and ceased being a participant while you get all slobbery over the greatness of Medicare. And you don’t provide your own employees with health care… especially since a group plan could not deny your daughter pre-existing for longer than 12 months max. Very weird.
Boy did us Democrats show you haters a lesson or two. See how we manipulated you into staging a one million + march in DC?
Ha!!!!!! Got you there you militiamen.
Now it looks like you finally forced us to compromise even though we tried to bend you over a barrel and force our legislation down your throats.
Damn! Did we ever get the best of you.
Now your base is reinvigorated and we are on the defensive.
I hope you learn your lesson that I am playing you guys like a violin…
@Mata:
I’ll address the above in this post and your comments about the NEJM study in the following post.
Mata, I’ve explained some of this before. I’ll have to go into more detail, so that you can really understand it. I can’t do this without appearing to be promoting my own business/services. In my 14 years of internet debate, on Usenet and on blogs, I have assiduously avoided self-promotion. I hope that you’ll agree that this is the standard I’ve maintained on Flopping Aces. I haven’t exactly endeared myself to you guys, in the pursuit of your “business” — I hope that you’ll agree.
But here goes, only because you (and Aye and Mike) keep making such a “gotcha” point of this.
My background is that I trained in oncology at the National Cancer Institute, in Bethesda. During this time, I began what has become my lifelong research interest — receiving biopsy specimens of fresh, living human cancer and culturing the cancer cells and tissue in the laboratory and testing these specimens to determine if they are “sensitive” or “resistant” to the various drugs which could be used to treat this disease. I have several websites and blog devoted to this. The most convenient overview is my medpedia bio page: http://www.medpedia.com/users/110
This describes my background and gives links to my various websites, lists relevant publications, recent presentations at national and international cancer meetings, etc.
For the first 8 years after completing my training at the NCI, I continued this work as my academic research in my position as an Associate Professor at the U of California Irvine. I then left this full time position to found a venture capital backed company (Oncotech, since acquired by Exiqon), to provide services (based on my technologies) in the private sector. Later on, I recruited a successor and left the above company to start my own small business. I did this for a variety of good reasons, among them being that I wanted 100% ownership and what might be called “artistic control” over the direction taken. I basically cashed in my IRAs, took out 2nd and 3rd mortgages, cashed in kids’ college funds, etc. to start this business (which is described at http://weisenthalcancer.com).
We obtained Medicare approval and coverage in the year 2000. To this date, Blue Cross does not provide coverage, except in cases where they are sued by their subscribers, who have won 16 of 16 cases decided in Small Claims court (which pays claims up to $5,000 per claim, here in California). The history and controversies related to the area in which I work is described on another website: http://weisenthal.org
Between 2000 and July 2008, we participated in Medicare. However, oncology changed dramatically during this time. The “old” drugs were mainly non-specific “poisons.” Tests for these drugs were comparatively simple, straight forward. We were able to cover expenses and make a profit. But, over the years, new drugs were introduced; testing became more extensive and complex. We innovated and developed new tests for the new classes of drugs. We are the only laboratory which provides testing services for these newer drugs. At a certain point, we found ourselves doing more than double the work we’d been doing in the year 2000 and, on average, more than 4 times the work of Oncotech and the other labs which provide this service. We could no longer afford to provide our services for the reimbursement level provided by Medicare (but note that Blue Cross and a number of other private insurers provided no reimbursement whatsoever, meaning that they were “rationing” the care of their subscribers, refusing to pay for tests deemed necessary by the patients and their doctors). So I did what every physician or provider facility can do, if he/it finds it is losing money on Medicare — I opted out.
Now, the situation is this: If a cancer patient and cancer doctor want to obtain pre-treatment cell culture testing and the patient has Blue Cross or Aetnea or some other private insurance plans, the patient has to pay the full costs of this testing out of pocket. For a Medicare beneficiary, there are two choices: the patient can either elect to have a basic level of testing performed by one on the Medicare participant laboratories, with Medicare picking up the entire bill, less 20% co-payments (which will be paid by private Medicare supplementary insurance, which most Medicare patients elect to carry). Or else the patient can elect to obtain a higher, “concierge” level of service, for which they must pay out of pocket (or which is paid in full by certain “Cadillac”- (I’m dating myself; today we should probably say “Lexus”) level private insurance plans.
But do you see how brilliant this system is, compared to the purely private sector? Everyone in Medicare can receive at least a basic service, with Medicare (and Medicare supplemental insurance) paying. Every laboratory which can make a profit on Medicare payment can remain within Medicare. Patients who want premium service can pay for it themselves (or with premium insurance). Laboratories who want to offer premium service can opt out of Medicare. Meanwhile, patients with Blue Cross or Aetna, etc. are just stuck with the whole bill for even basic service, or else they have to go to court to get the companies to live up to the terms of their contracts.
With regard to the issue of employee health insurance: I have only a total of 10 employees, including myself. The majority of these are part time. I currently provide health care coverage for only a single employee; health care for this single employee costs us $13,000 per year. We’d be one of the 90% of businesses exempt, under the House plan, to my knowledge, but, of course, we’ll have to comply with whatever law gets passed. As a small business owner in the private sector, I reserve the right to run it as I darn well please, within the confines of all local, state, and federal statutes and regulations. And my employees have the obvious freedom to determine whether or not the combination of wages and working conditions we provide makes sense for them, as well.
– Larry Weisenthal/Huntington Beach, CA
@mata (#82).
In a recent reply to me you said “give a girl some credit.” This was a nice, folksy way of putting it; it made me smile. I want to give you some credit here, but you are making it difficult. You are looking at a study which was a purely random sampling, in which the sampling methods passed the statistical peer review of the most respected medical publication in the world, and you imply that it is not valid, because it is only “one-thousandths of a percent” (actually, I think you need to leave off the “of a percent”) of physicians. While Mike and others gleefully quote Rasmussen polls which are not peer reviewed by other statisticians, which use opaque/proprietary sampling methods, “weighting” the sample to reflect what Rasmussen considers to be “likely voters,” and which samples on the order of 1,000 respondents (not providing any information about how many voters they tried to sample or did sample to come up with their final respondent pool) to represent 170 million registered voters which (rough calculation) is about 6 X 10 to the minus 6, or 0.000006 or 6 millionths of registered voters. 3 thousandths of physicians (your calculations of physicians) versus 6 millionths (my calculations of registered voters) means that the NEJM poll of physicians was 500 times more robust than the Rasmussen polls of “likely” voters. And the NEJM study was statistically peer reviewed, with transparent methodology, as opposed to Rasmussen, which is neither.
Come on, Mata. This is a straw man and you know it. When did I ever once “demean” the public’s opinion as irrelevant, much less “continue to” do it? Answer this. I don’t do this sort of thing to you, and you shouldn’t do it to me.
You make other statements which are pure conjecture.
America’s doctors wouldn’t be supportive of health reform if they knew the details of the House bill. Well, that’s not what the poll was about. The poll asked doctors what type of plan they’d favor: private, public, or mixed. 63% said mixed. 27% (disproportionately surgeons) said private. 10% said public. That’s 73% in favor of some form of “public option.” 55% would be in favor of having Medicare-style “single payer” down to age 55 (down from 65, as it is today). They didn’t ask the question of what would you prefer, purely public or purely private, so your comment that they won’t be getting what they want is invalid on two accounts: firstly, there is no chance that the USA will go to a Canadian style single payer system ; all proposals on the table are robust mixtures of private and public or quasi-public. Yes, I agree that it’s likely that, over time, the “public option” will become dominant, as it is in France and the other countries which have the type of system I believe to be optimal: public plan providing basic coverage for everyone; those wanting more pay for more, as opposed to everyone having to obtain private insurance for even basic coverage. I provide a concrete example, pertaining to my own work, in #85. Secondly, the doctors weren’t given a choice of only two things: pure public vs pure private; so we don’t know how they’d have responded to a hypothetical about Obamacare morphing from mixed private/public to pure public (which isn’t going to happen, anyway, no matter what Barney Frank or even Obama may wish).
With regard to “my theory” on why Medicare is going broke; no, it’s not “bunk.” Health care costs have spiraled out of control not because of bureaucratic inefficiency and/or fraud, but because medical technology has exploded in ways which were simply unimaginable. When I went to med school, there were no CT scans, no MRIs, no PET-CTs. Ultrasound was just starting to be introduced; it was only used for brains (to detect “midline shift” after head trauma) and not for obstetrics. We didn’t have a third the cancer drugs we have today and the new drugs cost ten times a much as the old. We didn’t have coronary artery bypass surgery. We didn’t have fiberoptic endoscopy (for colonoscopy, gastroscopy, etc.) On and on and on and on. And we didn’t have an aging population of baby boomers. These are the reasons health care costs have exploded, and the explosion has been worse in the private sector than in the public sector. In California, Blue Cross changed from being non-profit to being for-profit. Since then, the services they cover have gone down and their premiums have exploded (for example, as a non-profit, they used to pay for our testing services; as a for profit, they stopped paying for this, in contradistinction to Medicare, which does pay).
You claim that people could save and invest as young people to pay for their medical care as retired people. Yeah, right, we saw how well that worked with 401Ks.
The ugly fact which ruins your beautiful theory is that US private sector health care is the most expensive in the world; private health insurance premiums have more than doubled since the inauguration of President George W Bush. Private insurance remains solvent by raising its premiums at will. Medicare hasn’t been able to do this.
There are only two ways to pay for health care, either private sector or public sector. Raise premiums/taxes or restrict payment for services. Medicare provides the bigger bang for the buck, but there will always be a role for private insurance to provide both supplements and for a premium level of care, for those who wish to purchase it.
The people who understand the health care system best are physicians. Their views, as revealed in the NEJM study, will give the moderates all the “cover” they need. This is simply a personal prediction, which may or may not prove to be correct.
– Larry Weisenthal/Huntington Beach, CA
@Patvann (#79):
Incorrect. The doctors were listed in the AMA Master file. This is the most complete listing of American physicians available. It also includes the 65% of physicians who are not AMA members. For example, I am listed on this database, even though I’ve never been a member of the AMA.
They asked many questions relating to health care. Not simply three. Read the study
The respondent rate compares very favorably with that of any poll of a large population group (e.g. Rasmussen, Gallup, etc.) which you can find. See my reply in #82. And the methodology passed stringent statistical peer review.
28% were conservatives. 42% were moderates. 28% were liberals. These numbers are similar to data for the electorate as a whole, especially considering that people with post-baccalaureate degrees are, on the whole, significantly less conservative than the electorate as a whole.
As I noted before, it is entirely customary for physicians (and other professionals) to be compensated for their participation in surveys relevant to their professions. The level of compensation provided ($25) was nominal, at any rate.
The survey has quite a bit to do with “the topic at hand.” Discussed by me in prior comments. Although the issue of public versus private health insurance is certainly of importance to the average American, it is of intense importance to the average physician, and physicians understand the problems with the current health care system much better than do average Americans.
Santa Clara flyer: awesome
Global Warming: some other time
– Larry Weisenthal/Huntington Beach, CA
Larry, personally I wouldn’t mind you nabbing some “self-promotion” for your business. When I worked in the LA film industry (and music industry prior) for 17 years, I used to have a saying about the celebs and their attitudes. On more than one occasion I’d have to remind them.. “We aren’t curing cancer here. We’re making a mediocre movie”.
You, genuinely, are striving for treatment, prevention and elimination of cancer. Frankly, I think that’s the cat’s meow. My regard could not be higher. So do not misconstrue my comment about you opting out of Medicare. I thank you for your links and, when I have some time in my very busy work life (which is *not* curing cancer….) I intend to explore more. Tho I’ve already visited some of your stuff, and the medical technology may as well be another language for me.
So let me concentrate on this simple statement you made:
I don’t have a problem with you and your Medicare opt out. And I most certainly want you to make a profit so you can be (hopefully) a successful risk taker. I am a fan of what you do, and it wows me.
What I do have a problem with is you can justify yourself opting out for reasons of profit and advancement, but you don’t seem to realize others in your profession deservedly have that same attitude. The more they cut Medicare services, the more will opt out and it will be harder for my parents, you and I, to find care in a system we are mandated to use at the age of 65 (unless we want to give up our SS checks).
I understand that technological advances have driven up costs. I also understand that often that technology is overused in order for doctors to pay for their advanced equipment. I also understand that when a provider is undercut for his costs, he overcharges the privately insured to make up for the difference.
Therefore, it makes no sense to put even more people on a system designed to undercut the providers base cost. It does, however, make a great deal of sense to reign in what drives up their costs…. i.e. malpractice premiums, cost of advanced tech equipment, negotiation of both equipment and drugs without the middle man (as even you suggest as one segment of the cure).
The bill before us doesn’t do this. It just expands the number of people on a program that cannot be fiscally sustained.
Now… INRE “the poll”.
Allow me to answer that. You demeaned the public’s opinion as irrelevant with an attitude that now the doctors have spoken, the matter is close. Or, as you put it:
Now I know you don’t mean to sound pompous nor arrogant, but … forgive me… you do. This is much like Congress who ignores public opinion on bail outs, fiscal responsibility, and does what they want because they believe we, the public, aren’t smart enough to make a reasonable decision.
You may be a doctor with experience in the costs of business and delicate balancing act of too low of reimbursements. But I assure you, the public who has dealt with having to accept “some treatment” over the “best possible treatment”, and less doctors who are willing to treat them, also have experience. The medical professionals are not the end all, be all magi of how the system works. Therefore, just because 2130 plus 991 professionals would like to see a public and private mix (which we already have, with an unworkable in balance *mostly* do to the deficiency of payouts for the public option) doesn’t overrule the public opinions. People are mostly trying to “katie bar the door” for further erosion of current coverage, and prefer to find a way to cut the costs of doing unneccessary business. Again, none of which the proposed legislation does.
Last, about the poll itself. You must be confusing me with others when you say I laid out a straw man about the numbers. You are not addressing a “poll” fan. I’m on record here in multiple threads about how I put *no* stock in polls. Sampling 1000 to 3000 people out of a population of over 300 million, and prounouncing this the opinion of the nation, is simply ludicrous.
So this same attitute carries over to your 1-3 thousandths of medical practitioners.
Nor do I put stock in Rasmussen particularly… same reasoning. What I do look at is the cross section of those in protest (across party lines), and their increasing personal involvement with public protests, as a sign of the rising opposition. These voices should not be cast aside as uneducated and unimportant because doctors and PharMa have another opinion. Nor do I accept “the AMA support” since there are many dissenting doctors within that body. I was a union member for years, and I assure you… they took many positions I personally opposed.
I read the poll info you provided. And as I said, what struck me is that these doctors overwhelmingly did not want a single payer system, nor an effective comparative database. I’d say they, and the public, are in agreement.
So it again comes down to the base difference you and I have. You believe these are not steps to a single payer system by design because you want to believe that. I, however, believe this POTUS and his Congressional cronies who have stated, in no undercertain terms, that single payer is the quest. I do not possess your blind faith in promises when I can read the legislation that states otherwise. And blind faith will be the death of us… literally.
@mata: thanks for #88
I have only one follow up comment, which is just a clarification.
I don’t want a single payer system either. There is no bill under serious consideration which has a single payer system. But only 27% of the physicians wanted a purely private system, without a public component. As I stated previously, these were disproportionately surgeons, who benefit disproportionately from a private insurance care system which reimburses generously for procedures but which pays comparatively little for primary care medicine. Most Medicare reforms under discussion call for narrowing the gap between specialty and primary care reimbursement, which means that surgeons would be gored while other doctors would benefit. So it’s a bit of a civil war, fighting over shares of the pie. As I tried to illustrate with the prostate cancer example, surgery has a way of generating its own demand.
– Larry Weisenthal/Huntington Beach, CA
Larry, if you don’t want a single-payer system, then why do you support a bill that will inevitably shut them down????
I KNOW it does not have that specific language in it, so spare me…But it WILL eventually force them out due to the government’s ability to operate at a loss!!
Even the CBO agrees!!
Do you not see it????
@Patvann:
Now we are starting to make some progress.
What I favor is a system in which there is a baseline level of healthcare service for everyone, provided by private doctors in private hospitals, but paid for by the government, as in the case of Medicare. In addition to this, there would be private insurance to pay for premium levels of service, for those who want premium levels of service. Physicians and hospitals would be free to provide services within the public (“baseline”) system or in the private (“premium”) system, but not both. This is the way that Medicare works now. This is also basically the heart of the French system (except I think that French providers can participate in both public and private systems, which I personally don’t favor, but this particular point would be a matter for debate).
I agree with you and with the CBO that, with regard to providing the baseline service, the public system would eventually win the lion’s share of business, as it does in France. This leaves the private insurance companies to compete with each other in providing plans to pay for premium service levels, as they do all over Europe and Australia (though not in Canada, where the system is not friendly to this approach).
Therefore, everybody wins and nobody worried about rationing need get rationed, provided they are willing to pay for it (I agree with Mata that premium health care is not a “right,” anymore than personal bodyguards are a “right” in a system in which there is a public police force to provide for a baseline level of personal protection). And please remember that there is already a lot of rationing going on, and it is going on mainly in the private insurance system. I also think that these reforms would gradually move private insurance funding from employers to individuals, which would make the entire economy more efficient, by increasing job portability (which having the public plan paying for most baseline services would also do).
– Larry Weisenthal/Huntington Beach, CA
@openid.aol.com/runnswim said: ” nobody worried about rationing need get rationed, provided they are willing to pay for it “
Larry finally admits what many of us have said all along. The Dems health care plan will lead to rationing except for the rich. This will create a two tier system where everyone who is not rich will be treated to the horror of government care (or the lack of care, but with all the nastiness and indifferrence govt. is famous for).
Does that sound like change we can believe in?
What will all the ACORN types do when they see the rich get better care than the poor?
That is total baloney.
First, as I keep saying, there already IS rationing! And it’s much worse with Blue Cross, Aetna, United Healthcare, et al than it is with Medicare.
With Medicare (and with any public option to come), all coverage decisions are made with complete transparency. There are 5 levels of appeal, with the last being the congressperson. With the private companies, it is opaque and the appeal process is much less patient friendly.
Right now, we already have a two tier system in the private sector. This is why I thought it necessary to have
Blue Cross ($12 K per year) plus my AMA Catastrophic (another $12 K per year). The catastrophic was to take care of all the expenses that Blue Cross rationed me out of. Denials for state of the art treatment and drugs. Disallowance of care by providers “out of network,” as when I want to go to NYU for thoracic surgery or Loma Linda (near Palm Springs) for Proton Beam radiotherapy or to Florida for a DeBakey trained “beating heart” bypass surgeon or to Louisville for a recommended hepatobiliary surgeon or to St. Johns Santa Monica for a specific stomach cancer surgeon. This is what I mean by “premium” level health care, and if you think your own health care plan would give you the flexibility to do these things (as Medicare does and as the “public option” surely would), then I suggest you read the fine print in your insurance policy, which is perfectly good, until you really need it! Lifetime limits on coverage, etc.
At the time when I started purchasing both “basic” and “premium” insurance, Blue Cross was only about $6K and the AMA catastrophic $3K. Within 5 years, they’d increased from a combined total of $9K to $23K. And I still thought it was worth it, until the AMA started limiting coverage for oral cancer drugs to $15K per year (for drugs which can easily reach $100K per year). So I dropped the AMA and switched to an $8K deductible Blue Shield plan for nearly $12K per year which I consider to be inadequate. I’m exposed to risk of personal bankruptcy for certain highly foreseeable catastrophic illness. And I lack the complete flexibility to choose the provider and hospital of my choice, which I won’t again have until I’m eligible for Medicare.
This whole “rationing” business is part of a shameless campaign of scaremongering, from the same people who gave us “death panels.” It’s frankly disgusting.
– Larry Weisenthal/Huntington Beach, CA
@openid.aol.com/runnswim: Multiply every complaint you have about the current health care system TIMES TEN and you will understand the unintended consequences of a federal takeover of health care. THEN, factor in the negative impact on small business and the picture gets even worse.
Larry, you have used more words here to mask the disease that is the Dem plan than you even did with global warming. You think that by flooding the board with thousands of words, most of which are repeated over and over, that somehow your words will become fact? I don’t think so.
@Mike:
That’s absolute nonsense. I think that Medicare already is more than a third of total heathcare and total federal funded health care is about half.
Medicare works beautifully — much better than Blue Cross, Aetna, etc. for both patients and most doctors — and gradually expanding Medicare would be a relatively easy thing to do. That’s where health care reform is headed. This will increase patient choice, decrease provider red tape, and lower the overall cost of health care, which is why 72% of American doctors prefer a public component in health care reform.
– Larry Weisenthal/Huntington Beach, CA
Larry.
Gotcha. On every count and point you’ve spewed forth.
And if you pay that much for healthcare, you are either stupid, or a lier. Or both.
I pay my own Kaiser HMO for around $5G a year and it covers two adults and 3 kids, with a $1000/year deductible. The max payout is in the millions. (Payments went down by 300/yr after my eldest left the home for the Corps.)
It also paid for my wife’s stage3 3mmdeep Malignant melanoma biopsy/surgery/treatments for $240 out of pocket atop the premium/deductible.
And I KNOW you know what that treatment entails…and what the survival-rate is.
After twenty years of Obamacare would a 45 year-old woman who has a 5% chance of living 5 years be guaranteed a 1/4 million dollars of treatment? I think not.
Was my wife lucky, and possibly a fluke? I’ll say 50-50. All I know is that NO ONE second-guessed my doctor, and NO ONE in the government hinted at giving up.
Because I’ve done the research on you, and even went so far to ask my wife’s doctor about you, (She’s read your work, and is sending me the papers, so I’m not CHARGED FOR EDUCATING MYSELF ABOUT THE WORK OF A MEDICALLY GIFTED PERSON.)
I am willing to send you her entire history, and billing. Dr. Vampithy gave it to me on CD.
DON’T doubt me. Dual-Mastered Engineers who are former SeALs tend to do their prepwork.
And for G-ds sake stop the backtracking and obfuscation. It’s unbecoming.
@openid.aol.com/runnswim: That’s right Larry… Just keep repeating that B.S. over and over and over and hope no one notices you don’t have a leg to stand on.
It’s really getting rather tiresome. I don’t think you have made an original point in days.
P.S. Even Medicare admits they are in trouble:
http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2008.pdf
Larry.
I need to belay my offer, as the wife was not asked, and when I just did, she said: Not unless it’s done through Dr. Vampithy.
I was wrong to make such a personal offer, but you may be contacted in the near future by Kaiser California through professional channels via your practice. (Not UC Irvine)
I may disagree with you, but professionalism and integrity must remain paramount, not to mention patient confidentiality laws.
This public admission takes nothing away from all other statements.
@Patvann. Kaiser is a very high quality health care organization, but you are limited to the (generally excellent) physicians and hospitals within the Kaiser network. For me, the most important thing in my health care plans is the ability to see who I want, where I want, and when I want. And to get whatever state of the art therapy which the responsible physician and I feel is indicated. You couldn’t have seen any of the physicians and surgeons across the country who provided the many services to my first degree relatives. Virtually anyone, anywhere with Medicare could have seen and been cared for by these truly world class doctors. I will say that Kaiser has been generally reasonable in paying for our services. It does require that a Kaiser oncologist initiates the order, provides a justification, and receives preauthorization, but, when these conditions are met, Kaiser has been decent about paying for it. Kaiser is way better than Wellpoint, Aetna, and US Healthcare.
P.S. Kaiser does have a $1 million cap on “out of network” lifetime benefits. As long as your health care needs can be met within network and they have the doctors and equipment you want (e.g. they don’t have a proton beam machine), then you are OK. But Medicare has no cap at all on any of its benefits and it has the nation’s largest “network” of providers, hospitals, and equipment.
With regard to Obamacare paying for expensive care for long odds cancer, you are speculating, but Medicare certainly does this, every day. The details and expenses paid by Medicare of/for my sister’s 6 year illness are every bit as impressive as your wife’s experience. I could say, well, Kaiser won’t be paying for this 20 years in the future with as much conviction as you can muster about Medicare or whatever “public option” emerges.
If you ever want to talk to me about a personal/professional matter, or just want to talk swimming, give me a call at 714-596-2100 and ask for Larry.
Mike’s continued personal attacks are duly noted. And I won’t tolerate being called a “lier” [sic] by anyone, no matter how good his butterfly stroke.
Of course Medicare is in financial trouble. Private insurance raises its premiums at will. Medicare can’t do this. But private insurance is having and producing huge problems of its own, which are not sustainable.
http://online.wsj.com/article/SB125306132331814219.html
(n.b. “reducing benefits” means “rationing”)
http://www.reuters.com/article/domesticNews/idUSTRE58E45420090915
– Larry Weisenthal/Huntington Beach, CA
@openid.aol.com/runnswim: Want to point out the comment where I called you a “lier” Larry?
Sorry if I don’t tolerate your repeating filibusters of failed talking points but you simply cannot be left unchallenged when you pull this routine. It’s not a personal attack in any way. It’s an OBSERVATION!