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POLICY/POLITICS: I love the guy’s moxie

Say what you like about Arnold, but you got to give him credit for being a proper flip-flopper with real moxie. While Bush drowns in his stay-the-course quagmire, Arnold has repudiated basically everything he claimed to care about when he first came into office, and is now running like the unaligned centrist everyone thought they were voting for back in 2003.

Today he called for universal coverage based on a comprehensive pay or play, surrounded by an individual mandate. He even brought back the notion of provider taxes, a beast last seen in the wild in the pre-HillaryCare years, but thought to be extinct having been shot by the AMA and AHA back then.

But my favorite of all is the fact that the pay-or-play employer mandate he’s calling for includes all employers with more than 10 employees. In November 2004, just 26 months ago, he told people to veto Prop 72, which had a pay-or-play system for employers with more than 20 employees. Boy, times and people change, don’t they!

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Adrian BlakeypgbMDMike OldBarry CarolStuart Browning Recent comment authors
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Jack Lohman
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Adrian Blakey
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Did anyone read the proposed CA ballot initiative called: A Proposal To Cover
The Uninsured In California
that was written by George C. Halvorson, Francis J. Crosson, and Steve Zatkin of Kaiser?
Any comments? It seems very similar to Arnold’s with the additional proposal for catastrophic coverage.

pgbMD
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pgbMD

“You are wearing blinders, pgbMD” Actually, I am clearing the air of the ‘smoke and mirrors’ that I see commonly espoused on this website. “…when physicians use new high-profit technology as cash cows.” Show me the data!!! I think I won this argument already. “Our health care costs are increasing at 17% per year” Wrong again! Using the per capita OECD spending data and calculating percent increases year over from 2000 to 2004 the USA has averaged 7% per year. The UK on the other hand is 8% per year. Additionally, just released data out of Washington stated via the… Read more »

Jack Lohman
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You are wearing blinders, pgbMD, and no amount of real-life experience is going to convince you that we have a serious problem when physicians use new high-profit technology as cash cows. Our health care costs are increasing at 17% per year because …. well, just because! To the public: Get over it! My articles on the subject are at: http://www.throwtherascalsout.org/Lohman_articles.htm Call it an axe to grind, if you wish, but I would call it more a concern for where the whole economy is going, the health care system being just part of it. My kids and grandkids are the current… Read more »

pgbMD
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pgbMD

“When that happens in a private clinic it is usually because the new system is a cash cow, not because they have tripled patient volumes.” Prove it! The same occurs in private practice as occurs in my military clinic, but because it is in private practice it is now somehow a “cash cow”. Please. “If I had access to insurance payments to physicians both before and after they purchased a system for their office, I would show you the data.” Of course insurance payments to a private practice will go up after the purchase of ancillary devices for in-office use!… Read more »

Jack Lohman
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I have absolutely no issue with the volume of imaging increasing in a military facility tripling after installing a CAT scan, especially if the patient volume tripled as you imply. The physicians performing these tests are salaried and not ordering them because of a profit motive. When that happens in a private clinic it is usually because the new system is a cash cow, not because they have tripled patient volumes. I am not now nor ever have been a lobbyist for the device industry, nor do I have any financial interest in the field (other than as a knowledgeable… Read more »

pgbMD
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pgbMD

“Our volume of in-office CAT scans has tripled since its installation”
Sorry, the above should read:
“Our volume of IN-OFFICE IMAGING has tripled since its installation”

pgbMD
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pgbMD

“You doubted what I call “overutilization,” the process of performing 15 Holters per month when only two patients need them. Or doing five times the number of echocardiograms than needed because they are profitable as hell.” Again, PLEASE SHOW ME THE DATA supporting your assertions. Maybe as a Holter monitor supplier you saw the cardiologist’s office volume of testing go up after you sold them a monitor. Isn’t that what you would expect and what should happen? Show me the data that supports your notion that that same cardiologist’s office didn’t order the same number of Holter monitor tests per… Read more »

Jack Lohman
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I just re-read your post, pgbMD. I said “overtreating,” what I would describe as unnecessary treating, is not a major factor.
You doubted what I call “overutilization,” the process of performing 15 Holters per month when only two patients need them. Or doing five times the number of echocardiograms than needed because they are profitable as hell.
I’m sure you agree that treatments and testing are two different things.

Jack Lohman
Guest

What data needs proving? That tests are becoming easier to perform or that it results in higher utilization in the physician’s office? I didn’t think either claim was under dispute. I would agree that getting rid of the fee-for-service model is difficult under current or even a Medicare-for-all system, though not impossible. Clinics could put physicians on salary and not reward them for procedures performed, but since they are usually partners in the clinic that is negated. But they could prohibit the expensive and profitable tests from being performed in the clinic setting, unless by an on-site independent lab as… Read more »

pgbMD
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pgbMD

“I don’t know where I’d find a quick copy of the “over treating” stats, but maybe others know where they are. I would agree that this is not a major contributor.” I agree as well that you are overemphasizing “overutilization” a bit. “tests being “easier” should not justify the overutilization of which we are agruing, especially when in the hands of the physician with dollar signs in his eyes.” Show me the data to back up your claims. “If a salaried system (sans “production incentives” or salaries that rise with production) could be developed, that would be acceptable.” Salaried systems… Read more »

Jack Lohman
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Barry, tests being “easier” should not justify the overutilization of which we are agruing, especially when in the hands of the physician with dollar signs in his eyes. I wouldn’t have a problem if a clinic were to lease space to an independent lab so the patients could be tested on site, but few physicians would allow those profits to go into the hands of others. They want ownership in that lab so it is they who can benefit from the ordering (and subsequent over-ordering). pgbMD does not face that criticism because he is salaried, but when doctors’ incomes are… Read more »

Barry Carol
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Barry Carol

Jack, Even if we put aside the issue of doctors’ financial incentive for a moment, as technology makes procedures easier and less uncomfortable for the patient, more of them are likely to be performed, other things equal. Virtually all imaging is comparatively easy for a patient, even if he or she has to drink a contrast solution first. Several vials of blood can be drawn in, probably, 30 seconds as the patient endures little more than a pinprick. X-Rays are a breeze. Standard stress tests, thalium stress tests, and stress echos are all pretty easy on the patient. Yet, plenty… Read more »

Jack Lohman
Guest

I should clarify that when I said over treating is not an issue, I meant the medical consequences thereof. Not the high cost of the tests (which is a major issue).

Jack Lohman
Guest

You are giving patients more credit than they deserve. Yes, there are some very intellegent ones but there are also others (most) that think doctors walk on water. I don’t know where I’d find a quick copy of the “over treating” stats, but maybe others know where they are. I would agree that this is not a major contributor. And you are also giving physicians credit where it is often not due. I have the highest regard for “most” physicians, but I also know which ones to avoid in my community. My own cardiologist refused to give me a cath… Read more »