Money Driven Medicine

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Re: Money Driven Medicine

Matt,

You and I seem to be on the same wavelength lately. Over the weekend, while waiting for my wife to do some shopping, I sat in Barnes & Noble scanning the book you refer to.

One of the things that struck me was how it explained in a pretty clear way: 1) the history of healthcare as a political issue and industry since the Nixon days and; 2) how healthcare is inherently poorly suited to market mechanisms, especially in the extremely distorted market structure (and political and media systems) we have in this country.

As you suggest, the data on cost and performance of the U.S. system was unambiguously damning, as was the stat that drug companies spent $45 billion on marketing, advertising and admin, and made $31 bil. in profits, but spent only $19 bil. on R&D, with the government (read taxpapers) subsidizing their R&D and other costs to an outrageous degree. And, as I recall, it also had some stats comparing the U.S. with other countries that pretty clearly refuted the idea that a big part of our country's healthcare problem is tied to U.S. malpractice premiums.

From my quick look, the good seemed pretty readable and comprehensive. I look forward to reading your comments on it.

What was missing from its "diagnosis" from my perspective, was its lack of discussion of the importance of preventive, natural, wholistic, personally-empowering and lower-cost healthcare approaches vs. the current system, which reflects the intersection of excess corporate market power; distorted intellectual property laws; excess reliance on over-specialization and reductionist science vs. more wholistic and humanized approaches (including diet, which ties into advertising and media issues) to healthcare, and, of course, an incredible amount of political corruption, both in Congress and in the relationship between big-pharma, corporate medical institutions, medical schools, and the AMA.

If I remember correctly, the book did talk some about the value of well organized and accessible databases with information on "performance-based" evaluation of hospitals, procedures, doctors, etc. That seems like a good idea, and is related, at least in some ways, to the Internet freedom theme we've both discussed.

There's also the tele-medicine aspect to this. There are a lot of potential applications in that arena, but their implementation suffers not only from a lack of really high-capacity and ubiquitous broadband, but also from the overwhelming dysfunction of the system's poorly coordinated components and legal requirements and restrictions.

And, with healthcare sucking up an incredibly large and growing amount of the GNP, this should clearly qualify as one of those long-term "vision" issues you referred to in your earlier post.

Unwinding the mess, however, would be really hard even without the political aspects of it. That's partly why I'd like to see some amount of emphasis on wholistic approaches to health...not only because I think this will help Americans be healthier, but also because much of this "alternative" system--which is what I mainly use for healthcare--is much less tied into the tangle of corruption and distortion that threatens to bankrupt the country while killing off its citizens at the same time.

And, if I remember correctly, a surprisingly large percentage of Americans make some use of "alternative" healthcare, so maybe there's a constituency out there for a solution that includes those elements.

I confess that the political challenges seem daunting at best for something like this, but I also think that there are threads of solution-development out there that can perhaps be knit together (a good job for some new or existing think-tank, maybe).

by mitchipd 2006-05-28 07:01PM | 0 recs

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Re: Money Driven Medicine

Unwinding the mess, however, would be really hard even without the political aspects of it.

Absolutely right.

You're combining a maximum of complication in the current healthcare system with a minimum of capability to deal in the checked and balanced to buggery US political system.

I'm ever more pessimistic of a decent outcome in the foreseeable future.

In terms of intractability, I'd place it on the same planet as slavery or Jim Crow. (Comparing the respective amounts of misery caused is beyond my grasp.) Only if it's brought to a real crisis - where poor bastards are dying on their gurneys in dozens every day - will politics as usual be shortcircuited and something get done.

Check: now someone will tell me that they are dying in dozens like that...

by skeptic06 2006-05-29 07:38AM | 0 recs

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Netroots as Implants of Healthy Tissue

I don't disagree. One thing that keeps me relatively optimistic about this and other issues (perhaps naively so), is that I see most "solutions" coming from the bottom up, from local communities and networked "organizations" enabled by the Internet.

It seems possible, even likely, (though hard to really imagine in any detail) that much of what we call our "system" could collapse from various forms of "rot" (e.g., political, ethical, financial, functional), and that individuals, families, communities, networks, organizations, states, etc. will have no real choice but to "wake up and respond differently" or be buried in the collapsing rot.

That's one of the things I love about the netroots movement (and its parallel in geekdom's Web 2.0 developments), and also what Dean seems to be trying to do with the Democratic party.

All these efforts (and others that are more quietly using the web to build networks) are helping to create some bone, nerves and muscle that can take on more functions and responsibilities as the existing systems of political and economic power continue their decline in effectiveness and credibility, and face a continuing series of potentially collapse-inducing crises.

My "optimistic" scenario would be that the netroots, geekroots and other "roots" movements are able to "implant" enough healthy tissue into existing social, economic and political systems that the impacts of the "die off of diseased cells" are mitigated in terms of suffering and do not cause major systemic collapses. The "pessimistic" scenario...well, that's another, ugly story that I'll leave to Hollywood scriptwriters and apocalyptic-minded believers.

Sorry for the mixed metaphors.

by mitchipd 2006-05-29 08:35AM | 0 recs

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Re: Netroots as Implants of Healthy Tissue

You're right - again!

Looked at from the top - with the prospect of trying to enact some kind of Hillarycare II - it's dire.

As you say, the place to look for progress - not a solution, but incremental improvements - is at and below state level.

Like (possibly) the much-trumpeted MA healthcare plan - which I've yet to see a detailed, impartial, CRS-style analysis of, by the way.

Mustn't let the best be the enemy of the good, and all that.

I suspect that most of the Federal advances one might call progressive have come first at state level or below - including (God help us all!) prohibition. (Though 14th Amendment/Lochnerism will have stamped on a good many of them, they tended to spring right back up again!)

We have the same thing today with, say, city and state minimum wage laws that are more generous than the Federal rates.

On healthcare, here's hoping...

by skeptic06 2006-05-29 10:12AM | 0 recs

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Re: Money Driven Medicine

Holistic medicine is certainly going to have to be a part of a national health care system. Holding down the cost of health care through diet and herbs of medicinal value can be achieved.

There are many foods that can be made from the hemp plant. Among other things, the food value of hemp is that it has all the amino and essential fatty acids the body needs in nearly ideal proportions.

Breads, hemp nut butter, waffles, pancakes, cereals, milk, cheese and the hemp seeds themselves are all rich in nutrients that can keep a body healthy.

The THC of the hemp plant, more commonly referred to as "marijuana" also has health and medicinal value.

Recently a WebMD article entitled Pot Smoking Not Linked to Lung Cancer said, "People who smoke marijuana do not appear to be at increased risk for developing lung cancer... " http://www.webmd.com/content/Article/122 /114805.htm

Much to the chagrin of the FDA, the THC of hemp not only does not run the risk of lung cancer if smoked, but also may contains ingredients that can cure lung cancer.

Unfortunately, the negative nannies of the government will not allow hemp to be researched by American universities. All this denial of knowledge is due to the Controlled Substances Act (CSA) and the so-called $69 billion a year "War on Drugs" that the Wall Street Journal calls a failure.

This "War on Drugs" is a war on families. It damages families who use and possess THC. It also denies families a relatively low-cost means of personal health and healing care as a part of holistic medicine.

A critical component of a cost-effective public health care system is the legalization of all things hemp, and removing all references to hemp, cannabis and "marijuana" from the CSA.

by Hempy 2006-05-29 08:32AM | 0 recs

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Challenge to 'money-driven' premiss

Having access for the while to a range of ejournals, I turn up a 2005 article in Social Science Quarterly (86:1) entitled A Meta-Analysis of Campaign Contributions' Impact on Roll Call Voting.

First I learn that the CW amongst polisci folk is that campaign contributions do not affect the way an MC votes.

And that studies on this area started when the FEC got going in the early 70s, but peaked around 1980.

Cutting a long and highly math-heavy story short, the article finds some influence - on around a third of RCVs. But with no idea about why some votes would be affected, but others not.

It's clearly counterintuitive that contributions should have no (the CW) or only a partial (the meta-analysis) effect on voting - but so are a lot of hypotheses that have stood the test of time.

I'm not one of the polisci folk; but it seems to my untutored eye that some input from them into the lefty sphere would not be a bad idea.

by skeptic06 2006-05-28 07:31PM | 0 recs

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Re: Money Driven Medicine

Should be an interesting set of posts.

As someone who is involved in an important segment of the health care industry, I even have trouble figuring out where the problems lie.

Technological adoption is poor, certainly, but blaming all the woes of the health care delivery system on a lack of technology, "frivolous lawsuits" and a lack of "health savings accounts," as Bush does, is simplistic and purposely slanted.

I look forward to reading your thoughts.

by Bush Bites 2006-05-28 09:19PM | 0 recs

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Re: Money Driven Medicine

Don't forget Michael Moore's upcoming film "Sicko" which investigates Big Pharma.

by Populism2008 2006-05-28 10:44PM | 0 recs

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I just read "The Conservative Nanny State" by Dean Baker. On his chapter on health care he suggests that we could begin by letting people buy into Medicare as one of their insurance options.

(The focus here is to make the health care industry sound like a spoiled child for complaining that it's unfair to have to compete with the government, while at the same time arguing that the government can't do anything right. They can't have it both ways.)

It is likely that as more people would chose Medicare, often simply because it is the least expensive, Medicare would improve. He also talked about how good the Veterans Administration was in health outcomes because they tracked all of their patients over a lifetime.

His book is online and I think its very useful. Not just informative, it gives possible solutions and ways to argue. It's free online:
www.conservativenannystate.org

by prince myshkin 2006-05-28 11:41PM | 0 recs

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Re: Money Driven Medicine

A nice overview of the topic in the NY Review of Books:

http://www.nybooks.com/articles/19055

by rdf 2006-05-29 06:59AM | 0 recs

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Great NYROB piece

Much goodness to be extracted.

Just skimming, this graf struck me (emphasis mine):

In my book I discussed the conflicts of interest pervading the FDA, including the fact that many members of FDA advisory committees are paid consultants for drug companies. Although they are supposed to recuse themselves from decisions when they have a financial connection with the company that makes the drug in question, that rule is regularly waived. With that in mind, I checked the minutes of the 1999 advisory committee meeting that led to the approval of Vioxx. Sure enough, four of the six members, including the chairman, were granted waivers because they had a "potential for a conflict of interest."

In 1999, mark you. When Bush was still infesting just the one state.

(For a little historical perspective, a dissertation (PDF) on the 1961-2 Kefauver bill (S 1552 87th Cong) amending the Food Drug and Cosmetic Act.)

by skeptic06 2006-05-29 08:02AM | 0 recs

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Re: Money Driven Medicine

The big problem is that of blind devotion to capitalism as the "best" solution to all problems.

The mere mention of "socialized" health care just kills the idea in so many minds because of the unfair notions they have that equate socialism with communism.

Unbridled Capitalism just isn't an effective solution to providing quality health care. People don't make rational choices when their health is on the line and they're open to being bilked. Increases in "efficiency" that capitalism seek so often result in decreased quality of care.

I mean, it's one thing for a quality ice cream maker to drop quality and hope people don't notice. Suddenly your favourite ice cream isn't so good any more, and you decide it isn't worth buying for $6 a pint. Fine. You switch brands, and eventually the ice cream maker has to drop prices or improve quality again. Market correction at its finest.

But if you doctor cuts corners and you die, other people switching to another doctor is no comfort to you.

It is useful to note that though so many people have a viceral negative reaction to "socialized" health care, they do accept other "socialized" systems in government: like roads, the police, firefighters and the military. No one calls for that to be privatized (except extreme libertarian wackos).

So in principle, people already accept some forms of socialism. Health care is just another thing that works better when the government at least regulates it to be universal for all citizens.

by scientician 2006-05-29 09:20AM | 0 recs

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"So in principle, people already accept some forms of socialism."

I agree, and your comment raises a question:

How can we find simple, clear and compelling language (probably not using too-loaded words like "socialism") and a logical framework to go with it, that helps people understand:

1) that they already do, in fact, accept (and value) various forms of "public good-oriented" services and organizations

2) why some goals and areas of society are well served by competitive markets and others are not

3) that the operation of unregulated markets lacking sufficient competition and competitors can resemble those of communist, fascist or feudalist systems more than they do the ideal of free market capitalism. I think we may have made a little headway on this front in the net neutrality debate (put another way, we need to clearly untangle the terms "deregulation" from "healthy market competition")

I like this Thom Hartmann piece on Jefferson's efforts to include in the Bill of Rights the "freedom of commerce against monopolies": http://www.thomhartmann.com/restoredemoc racy.shtm,

by mitchipd 2006-05-29 12:11PM | 0 recs

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Re: Money Driven Medicine

I hate to tell you how old I am, but I remember medical care before it was profitable. The biggest problem we had then was that too many hospitals wanted the newest and finest of equipment and weren't willing to share resources. Now we have that problem AND greed-is-good capitalism thrown into the mix.

It wasn't perfect then, but it's way worse now.

The health care capitalists are adding to the salary reduction epidemic, too, as Bob Kuttner pointed out in a recent Boston Globe oped. You may be interested in my Daily Kos diary on that.
http://www.dailykos.com/story/2006/5/29/ 663/23261

Carolyn Kay
MakeThemAccountable.com

by Caro 2006-05-29 10:54AM | 0 recs

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Re: Money Driven Medicine

Yes, you're right we have already accepted socialism in many areas of our lives--including health care.
It's called "Medicare." I find that in interviews, when I use the phrase "Medicare-for-all" my host begains to listen. People like Mediare. Even physicians like Medicare much more than they like private insuers.
Letting indidivduals (and their employers) buy into Medicare is an excellent idea, and John Conyers has a bill in Congress that would do just that. I hope to post something about it on mydd.com in the near future.
In the meantime, experiments in the states can be useful, but the states really aren't in a position to make health care affordable. (See the Massachusetts bill).
And if we try to do this from the bottom up, the danger is that we end up with a patchwork of "poor programs for the poor"-- like Medicaid--or SCHIP, the program for poor children which leaves it up to the states as to whether or not they fund the program.
. Some Republicans in Congress would like to turn healthcare over to the states-- states rights, etc.-- They even talk about "Medicaid for All."
Maggie Mahar
P.s. the offer still stands: if any of you would like a free copy of Money-Driven Medicine, just send me your mailling address (maggiemahar@yahoo.com) and I'll ask my publisher to send you a copy. mm

by Maggie Mahar 2006-05-31 07:48AM | 0 recs