Free Republic

I just can’t believe the sheer amount of ignorance that some people can demonstrate. I am a doctor that for 15 years has helped people with the drugs that you vilify. Have you ever suffered from insomnia or restless leg syndrome? Have you ever had to deal with a child that has ADHD. Obviously not!! We live in a time of true medical wonders. Yes, medications have side effects and risks. As mentioned above the government requires that any side effect occurring greater than 1% of the time be listed.(Did you catch that -1%) Life is full of trade offs. We accept the risks of certain things for their benefits. I drive a car everyday and accept the risk of an accident. What about all of the lives that are saved every year with high blood pressure medication and lipid lowering drugs? What of all the chemotherapy that wipes out the cancers and gives people a chance at life? If you want to remain ignorant and refuses good medical care that is your right, but how dare you criticize others, or for that matter the pharmaceutical industry that has brought us such incredible medications and treatments! If you want to criticize anyone turn your attention to the government who stands in the way of good treatments and slows progress by the ludicrous system we call the FDA. I had patients cry in my office when they banned Vioxx because it was the only drug that gave them relief of their arthritis. They were more than willing to accept the risks for the benefits that they had. How dare anyone take that freedom from them?

Eric Roth, M.D.

This article is misleading on several points. First, as mentioned above, what is the percentage of doctors that actually own CT scanner’s? I’ve been in practice for 10 years and know very few physicians that own or have an investment in any large pieces of equipment. I do not doubt that there are probably some doctors out there who overuse expensive tests but the overuse of tests in general is much more complicated. Most of the overuse is due to patient demand and defensive medicine. His use of the term “fee for service” is a bit misleading. Under Medicare and most insurances a doctor does not get paid what he charges. The doctor must except what the insurance company is willing to pay for any given service. The doctor’s only choice is to simply not take that particular insurance. Mr. Bach is correct in pointing out that doctors do not spend enough time with their patients. The reason for this is not due to sending people for tests but for the current E&M (evaluation and management) system. This stratifies patients into five levels of care but the stratification is arbitrary and confusing. I can see a young healthy patient for a sore throat and charge a level four for 10 minutes of work or see an elderly patient with four medical problems for half an hour and can still only charge that same level. The solution to this is for all of us doctors to stop taking insurance and start billing for our time just like any other professional does. I would love to spend an hour with a patient if I’m getting paid for that hour.

Good article. Very well written and reasoned. Thanks for posting it.

I love it, thanks

Boy..some people find fault like there’s a reward for it.

Ooo.. good one, Thanks

Saw this the other day and could not resist coming up with my own quick math test. The original article was posted a few weeks ago from www.city-journal.org by Sopater I would love to see what everyone else could come up with

Dr. Roth’s Radical Math quiz

Mrs. Cho made the equivalent of $0.25 a week on her family’s farm but now makes $5 a week making your Tennis shoes. What percentage increase in her income does she enjoy because you bought her companies shoes?

Mr. Jones runs a small furniture making shop. He has two employees that make $20/hr and produce for him $35/hr of merchandise. He also has two new young employees that make minimum wage ($5.15). Because of their inexperience they only make Mr. Jones $7.00/hr of merchandise. The politicians (who want to pander to their labor union buddies) are going to force Mr. Jones to pay his new employees $7.50/hr. Which employees are Mr. Jones going to fire.

Dr. Smith makes $120k dollars a year as a family doctor after spending 23 years in school and making less than minimum wage as a resident. He is also $100k in debt for the experience but because he “won life’s lottery” the government confiscated $20k from him last year. Dr. Smith is pretty good with his finances and has a balanced household budget including savings and retirement. But because he is an “evil rich person” the government is going to repeal the tax cuts and tax him $30k next year. Dr. Smith decides to make up the difference by putting less in his 401k. How many jobs will not be created because Dr. Smith was not able to put more money into the stock market?

Mrs. Black is a widow who is having a pretty good retirement on her savings and investments. She inherited a small family farm and enjoys taking care of her garden. The Teachers Union of her state continually whines and lobbies the legislature to spend more money on “education.” If the millage rate increases by 10% a year how long will it be before Mrs. Black must sell the farm that has been in her family for 5 generations?

The “evil” oil companies make $0.13 on a gallon of gasoline and the federal government makes $0.18 (California makes $0.40 on a gallon of gasoline) Which number is greater and who makes more on a gallon of gas?

Dave dropped out of school at 15 and says that he cannot hold down a job because of ADHD. He is on food stamps but can sell them for $0.75 on the dollar. How many food stamps does he have to sell to afford a new $100 DVD player.

All politicians/government are concerned about is taking our money anyway that they can.

Some Wisconsin men got hit with taxes for cooking up Biodiesl

http://domesticfuel.com/?p=1773

So you’re comparing oppressive socialist taxation with clothing – sorry missed that one

That’s the problem, we have too many people that actually like our socialist system.

I do agree: It’s the best of some lousy options.

Of course it’s by force. What happens if I don’t pay my taxes? They put a lien on my land or a man with a gun comes to my house and takes me to jail. What in the world is your definition of “force.” As far as voting goes, I vote against socialist taxes every chance I get but democracy is not a guarantee of freedom (democracy is two wolfs and a sheep voting on what’s for diner). I’m so glad I live in Alabama where the millage rate is capped (any millage increase over a certain level has to be voted on by the entire state) and there is a check on the greed of the socialist “government school” crowd. Eliminate the “government school” system and give me my money back!!

There is an angle here that I never see discussed when it comes to “government schools.” By its very nature “government schools” are SOCIALIST in nature. You are taking by force money from one group (only some of which have children in school) and giving it to another group (wasting a lot of it in the process). There are legitimate forms of taxation for such things as defense, law enforcement and the courts, then there are the redistributive/socialist taxes such as medicare, welfare, “government schools” etc. Forget the debate on who does it better (though it is important) – what about freedom. Freedom to send my children to the school of my choice without paying double (as I do now – Christian school tuition and property taxes.) As it is now the government forces me at the point of a gun to pay into a system that I don’t want.

There are, in my opinion, five things that the admission people look at when reviewing a medical school applicant. GPA(and type of course work), MCAT, interview skills (including your essay), extra curricular activities, and graduating university. This is in order of decreasing relative importance with some probable overlap.

The type of degree that you obtain and your GPA are of high importance. If you want to go to medical school do not get a degree in biology. These degrees are a dime a dozen and are probably the easiest degree in science to obtain.(Sorry no offense to the biologists.) In my experience people with biochemistry, chemistry, mathematics or physics faired a lot better than those with the ubiquitous biology degree. Your GPA stands out a lot more with these types of degrees. Think about it, how do you think a 4.0 GPA in biology compares to one in biochemistry or physics. There is another thing to think about as well. If you do not get into medical school what are you going to do then. These other fields of study are much more lucrative and are in much higher demand.

MCAT scores are very important(could be considered most important). This is actually the only thing objective that admissions has in front of them. This can back up or diminish a good GPA. Testing skills are important (don’t let anyone tell you otherwise) you will be taking tests for the next 10 – 15 years. Start studying early.

You must be able to present yourself to an interview in a professional manner. You must be able to articulate well and answer questions on your reasons for wanting to go to medical school, your undergraduate training, your extracurricular activities etc. Be yourself and be honest. I know that this sounds somewhat contradictory but it is not. If you are not a clean shaven, suit and tie kind of person then tell them that, but show up in a suit and tie (nice dress ect) anyway. They like diversity but want to know that you can adapt to the needs of any situation (such as interviews).

Your life outside class is very important to medical schools. They are looking for well rounded individuals with a variety of experiences. I got more questions on my charity work (which wasn’t all that much) and my summer job as a lab tech than I did about anything else. I don’t think that you have to be some super-volunteer but you have to show them some community mindedness. I would highly recommend getting a summer job that has something to due with medicine. (becoming a phlebotomist is great since they are usually in high demand and have very flexible working hours)

Lastly and what you actually were asking about is undergraduate schools which I think is the lowest priority on the list. Obviously going to a well known school is generally going to serve you better than some smaller school or going to a community college (which I would highly discourage). I went to a small private university in Arkansas called Harding University. No one that I interviewed with had heard of it. It didn’t take me long to figure out how to capitalize on the size of the school. I told them about our small class sizes, our repoir with the professors, how much personal attention that we received and our opportunities to do things and work with equipment that my piers just could not boast of. (I worked on NMRs, IRs, UV-Vis, GCs etc while my piers had only learned about them or had very limited experience. Bottom line: choose a school with a good basic science reputation and then play up its strengths.

Sorry that I took so long to respond, it’s really being a Monday, and sorry for the length I’m a sucker for being asked my opinion/advice.

Eric Roth, M.D.

I was a family practice resident 10 years ago so it may have changed some, but the main problem is a failure of the faculty attending physicians to provide good oversight. I had some very good attendings (supervising faculty physicians) but far too many had the attitude of “don’t call me” when covering our call. I agree with caddie a bit that there is a certain amount of need for what we used to call “learning under stress.” When you leave residency for private practice things can be just as difficult so you do need some preparation. I think the best solution is to hire better qualified faculty physicians. Faculty physicians tend to be the private practice “washouts” in my experience (not all of them I’ve worked with some great ones).

Your right, individual health insurance is very expensive because the demand is currently low and there are few companies that provide it. If health insurance was like car insurance the picture would be very different. Yes, there is a difficulty with those that have such severe pre-existing conditions that they may not be insurable. But even there I would prefer a solution that does not involve confiscating other people’s money. Individual charity could go a long way just as it used to.

I agree that the current employer/government provider system is not going away anytime soon. The crux is that this system is the problem and healthcare costs will continue to rise unless the system is changed.

I have never said anything about abolishing private insurance. One of the solutions would be for everyone to have and pay for their own health insurance. The availability of private insurance is not the problem but instead employer and government provided insurance which fosters higher healthcare costs.

I would love to see Medicare/caid phased out but I know that this is not going to happen because the American people are addicted to government.

I have no problem increasing the supply of doctors if it is done by the free market. I’m simply stating that under our current payer system it will not result in lower costs. If we go back to a fee for service system where the doctor can set his own prices than increasing supply would lower cost. You are right that there are many doctors who want to see supply limited because it would protect their pocketbook (so they think). I’m not one of them. I want a free and open market in which to compete.

I agree with you 100% that socialism is not the answer – it will only make things worse.

“But the reality is that the mere fact that your health ins. co. is picking up most of the bill does not mean you’re going to use vastly more healthcare than you need.”

No, that is exactly what the research shows. If someone else is picking up the bill you are going to spend more.

“No one likes to go to the doctor.”

Oh you need to spend some time as a doctor. There is a quite a percentage of the population (especially the elderly) that quite enjoy coming to the doctor. (I have the graying hair to prove it.)

“A system that emphasizes bureaucratic review….”

Did you read my post? I want much much less bureaucracy. The only area that I think that the government might and I mean might be of help is that of standardizing certain clinical recommendations and thus reduce defensive medicine.

You can increase the supply of doctors all you want but this is not going to decrease healthcare costs because we are not dealing with a supply and demand situation. The government and the insurance companies do not reimburse for services based on the number of doctors but on the complexity of the medical visit or the procedure rendered. If healthcare was pure fee for service then the supply of doctors would matter. If there were many doctors in a given area then competition would lower the cost of their services. As it is now, doctors do not set their own prices.

You’re right, there is no “political will.” I spilled a lot of ink above but all of it boils down to a very simple idea: Americans as a whole want the government to take care of their problems. Until this changes things will only get worse.

You have some very good comments and thoughts on Medicare and healthcare costs, but I think that you are a bit off on the idea of physician supply. Our current healthcare system is not a market based system (Oh, how I wish that it was). If it was then you would be absolutely right that increasing the supply of physicians would generally decrease the cost of healthcare. Most people do not understand that physicians in general do not get paid on a fee for service/market price type system. We get paid according to what the insurance companies/government decide our services are worth. This causes some major problems with physician supply. There is a shortage of primary care physicians (disclaimer: I’m a primary care physician) because we are reimbursed at a much lower rate than the specialists. If you are a young medical student and you are $100k+ in debt and you have a choice of Family Practice or Gastroenterology what are you going to choose? Of course, most are going to go into specialties where they are going to be paid more for their services and get rid of their debt faster.

This thread is mainly about Medicare/SS and I agree with Extremely extreme extremist (great name) that it should all be abolished. Medicare/caid/SS are all socialist programs. You are taking money by force from one group of people and giving it to another group which I believe is completely immoral.

As far as health care costs are concerned below is my diatribe that I will submit for your consideration. I know it’s lengthy.

How to reduce Healthcare costs.

As a physician this topic is near and dear to my heart. I was a family practice physician for six years and have recently changed to occupational medicine. Probably the best article I have ever read on the costs and potential solutions for health care comes from the Cato Institute at http://www.cato.org/pubs/pas/pa211.html.

The greatest cause of increased Healthcare costs is simply over utilization. This is due to a dissociation between the consumer and the product. When someone else pays your Healthcare bill whether it be your employer or the government you naturally will over utilize those services because you do not see the direct cost. Of course we all actually pay for our own Healthcare either in the form of taxes (of coarse some pay more than others aka Socialism) or decreased wages but we do not directly see this and therefore it does not influence our healthcare decisions. (See John Stossel’s excellent article at http://www.townhall.com/columnists/JohnStossel/2006/10/25/getting_medical_insurance_from_your_boss_is_a_bad_idea) The solution to this is simple. Employers should stop offering health insurance. The only reason that employers offer health care is because of antiquated tax laws. If everyone had their own individual insurance over utilization would be reduced. Think about it. Almost everyone driving has automobile insurance. You very well know what happens if you get a speeding ticket or in an accident that was your fault: you’re rate will go up. If you know that you’re rate will increase if you go to your doctor excessively or demand expensive services you naturally will become wiser when it comes to utilizing these services. Also if everyone has their own individual policies competition will increase among providers and innovation such as Healthcare savings plans will increase. What about the Medicare crowd? I see two possibilities to improve over utilization. One would be to stop paying the doctors directly. Roll the clock back to the time when the doctor simply gave the patient the bill and the patient submitted the bill to Medicare. This way the consumer actually sees the cost of the care. Since Medicare obviously would not pay the entire bill the consumer would be responsible for the deference and this alone would be reduced over utilization. The other option would be to make an average payment to each Medicare recipient in the form of a health savings account for them to spend on their health care. Talk about the sudden resurgence in frugality!

The next cause of increased Healthcare costs is technology. Here I will take to task my colleagues. We love the latest and greatest pills and tests. Many physicians enjoy pulling out the latest and greatest drug despite how much it costs or recommend the newest test without much thought to its cost. The only solution to this is better education for the physicians (I actually did get quite a bit of instruction in family practice residency on how to make the most cost-effective decisions) and making the consumer more aware of the costs. Part of the drive for the newest and best technology leads us to our next topic: risk of malpractice.

Defensive medicine significantly drives up the cost for health care. My favorite example is the headache patient. There is really no good scientific evidence that helps a physician decide when to get a CT or an MRI. A good rule of thumb is the patient’s age and neurological findings. But what most often happens? We get a CT or MRI on everyone just to make sure we don’t miss that one in a million brain tumor. I could go on and on: x-rays for minor trauma, cancer screening tests that are marginal at best, unnecessary C-sections, etc. etc. How do we improve this? First, a true loser pay legal system. Second, a government sponsored set of clinical recommendations. (I know I’m not really thrilled about the idea of the government being involved in anything in Healthcare but actually I think this would be of benefit, let me explain……) Using our above example of headache and MRIs: the government would issue a set of recommendations for this specific scenario stating that a physician should only order a CT or MRI for a headache patient if they are over 45 or have neurological signs or symptoms. If that physician follows these recommendations,(they would not really be law so they don’t have to) and they miss the one in a million brain tumor they would have protection from litigation. These evidence based very specific objective recommendations could then be used by the insurance industry to either justify or deny a given test. If a patient insists on having any of these tests they simply would be on their own to pay for them.

Another major cause of high Healthcare cost is regulation. There is entirely too much time and money spent on paperwork and regulations that have nothing to do with the care of the patient. There are many potential solutions that are beyond my meager knowledge of economics but I have one solution that I believe would go a long way to reduce costs. Physicians as a group need to stop accepting payment from insurance carriers. If you come to see me as a patient I simply gave you a bill and you pay it at the time of service. It would then be your responsibility to haggle with the insurance company over reimbursement. This would actually have several effects. It would greatly reduce the overhead for the physician. It would introduce greater competition among the physicians. If you tried to charge more than your competitors you would be expected to provide greater service. Most people do not realize that physicians must accept a certain level of pay from the insurance carrier despite the actual level of care given. And again it would reduce over utilization by making the consumer more aware of the actual cost of care.

The last major cause of high Healthcare cost (at least that I can think of) is indigent care. I hear people discuss the idea of socialized medicine all the time. We already have socialized medicine either in the form of higher taxation or cost shifting. The solution to this problem is very simple and I know will be very shocking to many people. Stop providing indigent care. Stop forcing hospitals to care for those who cannot pay. Oh! horror of horrors you say, who will care for those who cannot pay for health care? First there is an underlying philosophy to be discussed. Is Healthcare a right or a privilege? Healthcare is not a right but a privilege. You and I should not be forced to pay higher taxes or higher Healthcare costs because someone chooses not to purchase Healthcare insurance. (Yes, I believe there is a sizable portion of the populace who spend their money on beer, cigarettes and lottery tickets instead of purchasing health insurance or saving it for a rainy day.) Stopping indigent care would make those who could be responsible for their health care responsible for it. What about those who truly are in need or those who are faced with emergency our tragedy? Simple: charity. I do feel that you and I have a responsibility to help our common man who is truly in need. The big difference is that you and I should do this privately and should not be forced by the barrel of the government’s gun. Let’s bring back the charity hospital. Let’s encourage and support organizations that pay for health care of those who are truly in need. Let’s stop our current wasteful system of socialized medicine.

I know this is a lengthy post. I’ve discussed this on various forums over the years and have finally decided to put these ideas together in one post.

Eric Roth M.D.

Fantastic documentary from the BBC

http://www.youtube.com/watch?v=u6IPHmJWmDk