One of the best books to read regarding this subject is “Worried Sick.”

In it, Dr. Hadler voices the theme of your post in great detail and backs it up with statistics. I recommend it.

Your post as well.

Another excellent analysis, Jon, thank you.

One wonders if ever the political class, which includes the media, might begin, as is their genuine responsibility, to recognize and to respond, responsibly and to the best interests of “the people”, to the clear evidence of actual truth?

When the truth is not permitted to be discussed, when it is ignored, it does not go away, it merely grows more persuasive and becomes much more powerful …

Your truthing is much appreciated, Jon, I assure you.

DW

Yes, we pay too much for drugs, and the Medicare Part D language forcing government to overpay for drugs is part of the problem. But there are other things that could be done as well.

What I would like to see is government funding for drug comparison tests. Drug companies tweak old drugs with expiring patents a bit, then wine and dine doctors to prescribe the new drug, which costs 20 times as much as the old drug since generic versions of the old drug are now available. They have testing showing that the new drug is at least somewhat safe and effective, but they don’t have to present any comparative data: maybe the new drug is no better than the old one. They don’t even have to prove that their brand spanking new drug is any better than aspirin for the disease it’s supposed to treat.

Independent data could either force ineffective drugs off the market, or drive competition between multiple drugs that are equally good.

Evidently there is a lot of profit in some procedures. So what is wrong with that? Isn’t that what capitalism is all about? Get a couple of your buddies together and buy an MRI machine, charge the highest price you can and send all your patients for a test. Good business. The insurance companies pay it and just pass it along. American business that pays the insurance companies will seldom, if ever, question the increase in premiums. So tell me, is there anything in the ACA that would change any of this dynamic?

Right on target Jon. Some of the other recommendations include limited or none cancer screening for people on dialysis or otherwise have shorter life expectancy. Does this include someone who is 80?

“We need to especially direct attention to where the (I think) excessive profits actually go. Over half the premium dollars beyond direct care go to corporate shareholders and CEOs, primarily to the pharmaceutical and insurance industries and not into the direct cost of care and operating costs.

IMO we must avoid the temptation to seek to cut costs by cutting benefits.

The money is in the corporate profits. Particularly egregious are the laws that permit unbelievable charges for pharmaceuticals in the US so that the pharmaceutical corporations can have a larger share of the foreign market by way of lowering their charges outside the US.

A better system, other than single payer, would at least treat medical insurance and pharmaceuticals as public utilities with guaranteed but capped profit margins. Also before the 1970s give or take, most private hospitals were non-profits and there were charity hospitals supported by taxes. The mega-physician corporations were for the future. Even Blue Cross Blue Shield insurance began as a non-profit.”

From my comment on another column.
http://gamountains.net/joanking/?p=679#

So tell me, is there anything in the ACA that would change any of this dynamic?

Rhetorical question. But has to be answered loudly. NO!

The simpletons and sociopaths haven’t figured out or won’t figure out that medical care wont work in a market system, if for no other reasons (and there are many — including the fact there are no levels of acceptable care. It is good enough or not good enough.) the incentives are paradoxical.

“Some of the other recommendations include limited or none cancer screening for people on dialysis or otherwise have shorter life expectancy”

If you get sick, die quickly! Who cares if a patient has cancer, just so long as we can speed up their death as quickly as possible so as to maximize profits.

Enormous profits from care of the largely helpless citizens is one of the most egregious obscenities that occur as a result of a bought and paid for government whose primary reason for existence has become is to nourish commerce and enrich the rich.

This is counter to one of the suggestions as to why Japan’s costs for MRIs is lower that ours. According to them, one of the reasons the cost is low is because MRIs are a standard procedure there and are commonplace.

The people who run the asylum can’t seem to let go of the idea that health care is not like the market for DVDs. Supply and demand may not work as they are suggesting it will. We may find ourselves in the same bind we are now finding with some of the pharmaceuticals(short supply)by making procedures less commonplace.

Putting myself in the shoes of the MD, when a patient exhibits any signs, and when in any doubt, do an extra test. If it is unnecessary there is no harm tot he Doc. On the other hand, if the patient falls into the 1/10th percent that the test maybe could have caught, you get sued for malpractice.

My answer is to eliminate all malpractice lawsuits, set up a federal panel of professionals to evaluate any claims of malpractice and have the feds pay the damages. It would cut a substantial part of all Doctor costs and reduce the everyday price of medical care.

It isn’t so much that malpractice costs are high because of jury awards, it is the practice of requiring extra tests to protect the Doctor.

These guidelines will decrease if not eliminate malpractice for failure to go the defined extra mile of diagnosis.

I am extremely uncomfortable and untrusting of binding guidelines determined by boards away from the bedside. . The waffle language means nothing. I do accept that beside physicians should be encouraged to look at some of this data as they make their recommendations and write orders. However we all know t;hat guideline quickly becomes a binding denial of payment by insurance certification processes

But as Jon points out though some money and angst can be saved by being more discriminating the real money is someplace else.

This road of cutting benefits is not a good route to take. Obama is a conservative scoundrel for promoting this immoral approach.

Which is why Jon’s post ends thus:

The real problem is that the price we pay for identical medicines, tests and procedures is radically higher than any other first world country. Eliminating waste so that the United State only uses MRIs when it is actually necessary will save some money, but as long as we are paying ten times as much for each MRI as other countries, our overall spending will remain out of control.

Yes, lets make the medical industry to big to fail and give them federal bailouts in case of any wrong doing.

Think of all the extra competition when Goldman Sachs and the rest of the financial market decides to get into the medical profession. Its heads I win tails you lose! What’s not to love?

The problem rests with western medicine’s approach to the treatment of illness. It’s a system that’s based on treatment of symptoms without isolating and treating the cause. If you cure people rather than managing their illness, you deprive the industry of cash flow, and with an economic system that emphasizes profits over people’s welfare, that’s just not logical.

“Yes, lets make the medical industry to big to fail and give them federal bailouts in case of any wrong doing.”

We did – it’s called ACA. No corporate healthcare lobbyist was left behind.