Matthew Holt

“Money driven medicine” on PBS tonight

Tonight the documentary based on Maggie Mahar’s book Money-Driven Medicine is on Bill Moyers’ show on PBS.

Meanwhile if you haven’t seen this clip of Oklahoma Republican Senator Tom Coburn seriously suggesting to a completely desperate woman that her neighboors should be the ones helping her look after her husband with a traumatic brain injury, you’ll be illuminated by how out of touch (and that’s putting it very kindly) he and lots of his colleagues are on the real life actual needs of people suffering now as opposed to inciting vitriol from the fringe over vague concerns in the future.

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  1. Alas, Deron S, the Congressional whores only act as they think enough voters to get them re-elected think or as will bring in enough money from lobbyists to pay for lobotomizing enough voters to insure their re-election. What gets me is how these hyenas invoke Jesus Christ to bless their predatory cannibalism. The problem is not Congress. We have met the enemy and he is us small people who there go by but for the grace of God. The attitude you seek to expose is the same as the “ain’t my kid going to Iraq” disconnect syndrome of so many Americans, now that there is no conscription, who only want cheap oil to “fill-er up” their gas guzzling SUVs so are willing to send heroic moms and dads in harm’s way, making their families widows and orphans. For these people a hand shake and a perfunctory, “thanks for you service” is all they get; from then on who really knows how many broken promises vets lived with, especially in health care until now?

  2. Most health insurance IS HMOs, Nate! And why do you bring up the Nixon statement and then refer to Kennedy? What’s your point relative to WHY I brought up the Nixon statement? All you really said is a slander that I believe in the “flat earth,” which I never said, and that everything I wrote is wrong, giving NO specific retorts. Once again, placard type “retort” is all I get from people who don’t want to constructively discuss specifics. I thought that in the 1960s the Berkley radicals– fully supported by Cal Conservatives for Political Action– demanded MEANINGFUL DIALOGUE and in the end that’s what we got. But, it seems, now that the kids from the 60s “grew up,” they’ve become me-ists able to put forward at townhall meetings and in postings non-substantial zingers like your zingering drive by shooter statements. It was very hard work for me to type my post—due to various disabilities for me typing is as uncomfortable as a colonoscopy. But I didn’t think all that all I would get in return is not dialogue but just a lot of manure, Nate.
    Do you really want to come to some constructive accord or just stand across the street with a sign: “I HATE SOCIALIZED MEDICINE (sic)” and fling all the feces your mind can conjure up? My concern is the healthcare of younger people…I’ve got Medicare. But I’m in the field seeing people get mis-care if physicians don’t want to or can’t do the hours of fighting with HMOs that taking care of them requires. When an antelope on the savanna is sick, the big cats and eat it up. Is that what you want from healthcare– for the fat cats in the for-profit HMOs to eat you up when you are sick and helpless? If you don’t have an HMO you are among the 20%– that’s right– of Americans with some sort of PPO or other “insurance.” That’s expensive and since both the fat cats and the sick “insured” by them are both homosapiens, that makes you an advocate of cannibalism among conspecifics per my biology book.
    It’s amazing how Senator Baucus could be reversed in less than one year by $3,000,000 in contributions to him by the Healthcare for-profits. Last year he was FOR A UNIVERSAL HEALTH PLAN– MEDICARE!!!– for Americans over 40. Now he is for cannibalism– putting the sick before the appetite of for-profit entrepreneurs! What do you think of that, Nate?

  3. It’s not that woman’s neighbors’ problem that her husband is in such bad shape. We as individuals have no responsibility for these healthcare problems we’re facing, therefore we should not have to be part of the solution. It’s all the government’s fault, therefore the government must take care of her husband.
    I don’t know about all of you, but I have never made a mistake in my life. For all that goes wrong in my life, I think the government should be prepared to step in and clean up. Those Congressmen and other officials that go to Washington cease to become humans and neighbors. They become Mr. Fix-It machines.

  4. I was working in a hurricane shelter post-Katrina in Galveston, TX. The local congressman came through, a fellow named Ron Paul. I was standing behind him as he enthused that “This is the way to do it, neighbors helping neighbors, not government.” The neighbors-helping-neighbors thing hasn’t done much to rebuild NOLA yet, now has it? Idiot.

  5. DE Teodoru how can you get some much wrong in one post? Your complaining the earth is flat, sorry to break it to you buddy it aint.
    No the rest of the world does not have single payor
    80% of people don’t have HMOs so what are you blabbering about?
    What Nixon said about HMOs? Apparently you don’t know who Ted Kennedy is, the one that wrote the bill, forced it through Congress, then bragged about it for 15 years until they turned into a nightmare. oops that kills your narrative.

  6. should it be a public plan like Medicare that limits you to 90 days? Or should we copy the widely successful Medicaid home care and nursing home benefits?
    If Medicare and Medicaid are both insolvant and BK, how do we offer richer benefits to more people and not also go BK as a nation? Medicare and Medicaid have already proven government is not the answer.

  7. “I thought ‘government’ is just a collective representation of ‘us as neighbors’.”
    However, Margalit, Dave doesn’t believe that the foundation of our country is built on Governmental intervention to pool “communal resources.”
    Do Americans view health care as a communal resource that should benefit everyone or do we view it mainly from the standpoint of “what’s in it for me?”
    The republicans had over 160 amendments to the Senate bill and they still won’t vote for health care reform. Democrats will vote it alone.
    Good posting Matt.

  8. When Cong. Conyers described his single payer bill I pointed out to him that we do not have enough primary care MDs (PMDs) to go around and those now in the field are swamped as specialists, each with his/her favorite organ, throws back the patient to the PMD, to manage as a WHOLE patient. The notion of “best practices” is also very problematic as statistics will be sloppy and so broad that they won’t apply to any individual. Remembers figures never lie but liars figure so don’t let it be on your survival. I am told that “hip-hop dress” is designed to mimic Southern prisons wear. For example, size 36 waist on pants may be the average, but it seems to fit no single individual. As a result most wear falling pants because they are not allowed belts in case they might try to hang themselves. It’s the same with PHARMA. Here are some more PMD nightmares: (1) PMDs are hit from all sides with requests. The specialist orders some prescriptions but when the patient’s plan doesn’t cover that drug, it is the PMD, not the specialist that the pharmacist calls, figuring he’ll get less lip from the latter. Now the PMD is responsible for what the specialist got paid big bucks for. Most specialists depend on letter from PMD introducing patient. (2)PMDs are so swamped with patients that they every minute of a visit is precious. Yet, many a patient will waste most of the visit insisting that he/she wants something prescribed that he saw advertised on TV. (3) Patients don’t like specialists so they blame PMD for sending the there, not realizing that their plan prohibits any other specialists. (4) When a patient has a reaction to or is not satisfied with a drug prescribed by a specialist, the PMD gets all the anger. What is she/he to do? (5) Most specialists demand that the PMD order all tests (MRI, CAT Scan, Lab works etc.) before seeing the patient. That means that PMD has to spend an hour on the phone for each giving the data to a clerk, to Nurse “NO,” and finally to a medical reviewer MD who treats you like you are an idiot until you present the case well and he begins to show you respect, at times is even collaborative. What’s not calculated is that in between each of these people, the PMD has to sit listening to bad music interrupted by the HMO’s self-promoting ads every 15 sec. that are so loud that he can’t concentrate on anything else while waiting. Because the HMOs work by clinical data, the PMD can’t use a clerk but must do it himself. I remember a friend tried using a nurse. When she went to the chart to see why a patient needed an MRI of the head, she said “dizziness.” By the time she got to the medical reviewer, he said in a tone of derision: “We don’t do MRIs for dizziness, young lady.”
    We are at the threshold of a new field in medina: GENOMICS. It is really molecular medicine. The data is gradually coming in to enable us to individualize the disease process– even predict its development– and individualize the treatment to maximize benefits and minimize side effect. The problem now is that Pharma provides FDA with only statistical results from populations like Andean Indians and Lapland deer herders…all people who will not sue the Pharma if people get sick or don’t get better. Besides liability, Pharma gives incredible sums to physicians doing a “study” on their patients; but should he report problems with the drug under test, the money is pulled back immediately, both as punishment to the bearer of bad tidings and as example to any other pay-to-play-MD. The same happens to great big medical centers that rely on Pharma cash to maintain research centers. As a result, as soon as a drug presents problems to a threshold of 10% of patients using it in the post-marketing public use, it is “black-boxed” and the 90% who benefited from it are out in the cold. I can think of innumerable older patients taking a betalactm antibiotic prescribed by a dentist for dental infection who so fear that the antibiotic that “stopped my unbearable pain” will be discontinued that they hide from the doctor taking of the antibiotic when he is trying to understand a skin rash. Not knowing what caused it, there’s a malpractice case. I don’t need mention the fad of herbal therapies people use and never bother to tell the PMD in order to avoid a dangerous interaction.
    All in all, for most patients, their diseases are like a big bag of manure. As soon as it gets too heavy to carry around, they bring it to the PMD, throw it in his/her lap and say: “Here my HMO is paying you to take care of this; I just want to get back to my regular life.” They expect to leave relieved because now it is no longer their problem.
    What Obama is trying to do is revolutionize medicine so that the PMD and the specialists are a “Tx Team” and the patients and PMDs are a “Dx Team.” He is trying to integrate all aspects of healthcare. Most importantly, he is trying to expand care from the office to the home. Any PMD that doesn’t get to see the patient’s home is like a general fighting a battle without a G2 intelligence service. The more care is integrated and a shared responsibility between patient and care givers, the better the outcome and, ONLY THEN, is there a chance of preventive medicine.
    Most importantly, we can’t treat patients like a statistic as if they were size pants for Alabama prison farm inmates. Preventive and therapeutic care must be INDIVIDUALIZED. For the first time GENOMICS is on the threshold of making that possible. Alas, most MDs do not understand the basic lingo of molecular medicine. So they need time to study– paid time because they now don’t have any off time. PMDs get paid less per hour of patient care than do plumbers. Yet we ask of the constant updating when their kids grow up not recognizing them by face because they are so busy. PMDs don’t ask to be rich, only to have time to look into everything in depth and to consider all the possibilities rather than play “gotcha!” with patients’ lives. That takes time. It takes time to squeeze the “history of complaint” from, a patient. Given its critical importance to Dx and Tx, a PMD must have time to coax the facts out of the patient. Too often patients don’t want to talk about it and just throw out confusing evidence that misleads. Furthermore, from the point of view of a PMD, the patient’s personal problems are as much a part of the picture as are signs&symptoms. It takes time to get a good outcome and that’s what Obama wants to provide: an outcome based rather than in-and-out number of procedures payment system. Right now the HMOs go by algorithms as if dealing with 2006 Honda Civic two-door cars rather than multivariate humans. If the standards of care become such a rat study like statistics and algorithms, then we will all get 1950s level of care. But if we come to inculcate genomics into healthcare, we can prevent rather than treat hit-and-miss. But to use genomics, patients must be assured that insurance plans will not use that against them. Here is hey key element for the single-payer system. Insurance is an attempt to make money for investors by making premiums sum up to a lot more than costs. young people tend to be real cash-cows to health insurers. It is only from 45 to 65 that you become a possible problem. For the sake of profits rather than the insurance you had paid fro since your first day of work at 18, they have gimmicks to minimize care and to dump you so that you are on your own for 20 heath wise dangerous years until– and IF– you survive to go on Medicare. The chances of your house going on fire are small; but you get insurance anyway, just in case. But the chances of you getting really sick are very high after 45– after all, by then, everyone gets sick. Who do you trust to pay your medical bills then…a cannibal who sees you as profit maker or a single payer whose only role in life is taking care of you in the best way possible?
    HMOs are “entrepreneurs”– that’s a French word meaning “TAKER IN BETWEEN.” HMOs are like predatory animals that go after the most vulnerable and drop them when that vulnerability burdens them. That’s why the entire civilized world has single-payer health care other than the US. And still we pay more than 2X as much as they do for healthcare and we are still 35th in longevity in the world. What Madoff did to your investments, HMOs are doing to your health. There’s no reason for cannibalism by the taker-in-between in this era of high tech. 80% of people are happy with their healthcare because they don’t know what their employers are doing to pay the HMO extortions. But what Wall Street did with your retirement 401Ks is what the HMOs will do with your health as you approach 45. Obama is trying to save you from all that with a single payer option to keep your HMOs forced to serve you rather than to eat you as predator’s profits. Don’t just say: “aaahhh, what does that Schwarta know!” He is betting his whole career on YOUR life. Recall, for contrast, from the Nixon White House tapes what he said to Erlichman when they were discussing HMO: “You mean, it gets people to pay for healthcare and then doesn’t give it when they’re sick. I like that.” So you’ve got a choice: that “schwartza” Obama as a savior of your health” or the “Great White Hope” Republicans who are trying to keep you as a cash cow until the final slaughter somewhere around 45. Join the world, support single payer so America will rise above its paltry return on its massive investment in health care– 35th nation on this planet in longevity

  9. Yes, I agree with Senator Coburn. “Us as neighbors’ should be “helping people who need our help”.
    We should be helping by making sure that the woman’s uninsured husband has insurance that will pay for his home care.
    We should be helping by making sure that an affordable public option is in place for him and other folks in similar situations.
    We should be helping by stepping out of our little comfort zones of “I want to keep the plan I have and I don’t want to pay for other people’s health care” and realize that we are all one step away from becoming those “other people”.
    I thought “government” is just a collective representation of “us as neighbors”.

  10. Good point Matt. He should have just given her a big hug and told her everything would be ok, and then walked away.

  11. So when Hillary says it takes a Village to raise kids your OK with that, the Village helps out with family care and that is just unacceptable. I think I would be much more comfortable with my neighbor watching my spouse while I took a break then raising my kid. Why is this Matt, nothing to do with the fact that it came from a conservative is it?

  12. Well, Sen. Coburn is also a doctor, so maybe that’s what he meant by offering help. But to say that he is against reform is flat out wrong, he’s just against Obamacare. I don’t see anybody on the left even rationally debating the merits of the Coburn/Ryan reform bills.