1/31/07

1. Leader Of The Pack
2. Gorback’s Thoughts by Michael Gorback MD
3. Placebo Journal Update
4. Out Of Sync
5. Bacharach’s Beliefs by Ted Bacharach MD, retired
6. Accuracy
7. Kudos
8. Ignoring Your Doc
9. China
10. More China
11.  Nostradougus
12. Feedback About The Placebo Gazette
    
    

1.  Leader Of The Pack

 

When I was threatened by Cigna for my SICKNA parody a while back, I quickly started to learn how much power the health insurance companies have in the country.  This power is pervasive as it touches consumers, Wall Street, hospitals, doctors and the government.  All parties cower to them.  They are quickly becoming the leader of that I have labeled in the past the Medical Axis of Evil (along with lawyers and pharmaceutical companies).  In this healthcare climate, who else continues to rake in double digit profits almost every year and still has the audacity to raise their rates double digits as well?  Sure some people whine about it but they continue to slip under the radar as they laugh all the way to the bank.  Julie Appleby article in a recent USA Today exposed another one of their nasty tactics.

The article points out that even if you are approved for insurance and pay for it over the years, the company can still revoke your policy if they find anything in your past medical history that wasn’t listed when you applied.  The piece described a bunch of cases that will blow your mind away; including a lady who had ruptured a stomach ulcer but was denied payments because she didn’t tell them she had been to an OB/GYN for menstrual problems a few months before getting her policy.    There are other cases where people are getting left with bills for over a $100,000!

What astonishes me is that these managed care companies have people scouring your records just to find these cases.  It’s unbelievable.    Insurers review 25% to 50% of cases to look for fraud.  But is it really fraud?  What if it does not medically relate to the illness that the insurer has to pay for?  It also makes you wonder whether the application forms were purposely made to be confusing.  You should see the one shown in the paper.  By confusing the patients, insurance companies can find more and more “lapses” so they can renege on the deal.  What a perfect scam. 

The bottom line is that managed care companies are the 400 lb elephant in the room that no one wants to do anything about.  They are too profitable and too powerful.  They are the middle man than no one seems to want to get rid of.  Until we deal with them then nothing about the healthcare system will get better.

2. Gorback’s Thoughts by Michael Gorback MD

Several points need to be made here. First of all, anyone who has filled out one of these forms knows firsthand that the questions are often ambiguous. Secondly, everyone who has ever taken a health history knows that people have trouble remembering exact details. Third, and most relevant here, is the fact that there is a Big Brother organization known as the Medical Information Bureau. The MIB knows more about you than you do - especially if you're seeing a shrink, because although your shrink may not tell you his or her working diagnosis, you can rest assured they have sent a written copy of their psychodynamic formulation to the insurance company, who has sent it to the MIB.

When you apply for insurance, they check your MIB file. I always thought it was to look for discrepancies that they could ask the patient to clarify. I am now starting to think that maybe they find discrepancies and deliberately leave them as such as an excuse to deny benefits at a later date. Perhaps I'm being paranoid - after all, one should never attribute to malice that which can be explained by common ignorance. However, i think a state or federal law requiring the MIB to disclose whether or not the insurance carrier ever did a query would at least cause doubts about mens rea on the part of the carrier - or at least negligence that they didn't act on information that they had in hand when they issued the policy.

The whole situation has gone on long enough. The insurance companies seized control of medicine 15 years ago and it has been a constant process of looting, rape, and pillage ever since. The improvements in cost containment have not translated into lower premiums. Instead it has funneled billions of health care dollars into the bank accounts of a handful of avaricious businessmen.

It's time to remove naked greed from its controlling position in American health care.

3. Placebo Journal Update

You have until midnight tonight to get in on our most recent issue of the Placebo Journal.  They are going in the mail very shortly.  You do not want to miss this one.  From Jackie Chantrix (our smoking cessation drug) to our incredible true but funny medical stories, this February edition is definitely a winner. 

SUBSCRIBE

Study: Doctors out of sync with cancer patients’ wishes.  That was the title of the article by Liz Szabo in a recent USA Today.  The only problem is that the study she quoted really didn’t show this.  It is all about perception and her perception was to see doctors as “bad” and title her piece in a way that bashed us.

In a small study of 150 patients, researchers found that 35% with colorectal cancer would go through more chemotherapy, with its devastating side effects, even if it could only cut their risk of relapse by 1%.  Doctors thought only 19% would agree.  Big freaking deal?  The article makes this into an issue that patients and doctors don’t communicate well.  First of all, it is a very small study.  Second, these are cancer survivors so they may think they can survive anything.  And lastly, it was all paid for by Sanofi-Aventis, the maker of the chemo drug who would benefit from exposing doctors who don’t understand that patients would want more of Sanofi-Aventis’s drugs.

The beauty in this article is that there is a much bigger point.  In an era where the country is leaning to socialized medicine, how the hell can we ration care when 35% of these cancer patients are will to go through physical torture (and tons of money on chemo) just for the chance to cut their risk of relapse by 1%?  Who is going to be the one that says no to them in the future?  One chemo treatment with a 99% failure rate may be enough to pay to vaccinate a whole community.  That was the story that was missed by the authors; both of the study and by Liz Szabo. 

 

The above heading is from our local hospital’s newsletter. The sentiment
expressed is quite appropriate for the institution. The days when the primary
interest of the community hospitals was to provide medical care and appropriate
services to the area served have long disappeared. The goal as seen above is simple —”get the Gold”.

The outstretched hand for as many additional funds as possible is maintained and advertising is considered a necessary expenditure for the hospital. I had always thought that charitable endeavors on the part of hospitals were appropriate and deserved support. In today’s environment the patient with the least amount of money is charged far more than his more affluent neighbors who have insurance. I believe that a donation for medical services to the indigent would be a far more desirable expenditure than another billboard telling people how great they are. The only good thing about the above masthead is that it is an honest statement of intent and goals

A report by the Pew Internet & American Life Project states that 53% of almost 3000 people polled felt that the information they got on the internet impacted the way they took care of themselves.   Here’s the kicker: Only 15% “always” check the source for this information.  A staggering 75% “hardly ever” or “never” check.   The problem with this is that many sites are crap.  Much of the information out there is used to sell some product or to bash allopathic medicine.  In many of the sites you can’t even find the source or what kind of “doctor” the person is who is dolling out the advice.  I have even heard rumors of one site with an accompanying newsletter which is fraught with ridiculous opinions of a maniacal family doctor from Maine.  Shameful. 

7. Kudos

I want to give some kudos to the AMA President William G. Plested III, MD.  He has decided to shorten his name so that we just have to call him “Paco”.  I’m kidding.  In a recent American Medical News, however, he did go on record blasting the whole P4P garbage.  P4P (Pay-for-performance), or “Physician Profiling” prior to 9/11, is a way for the government and the managed care companies to screw doctors.  It is a system of control, plain and simple.  As Paco states, “I will point out that – reminiscent of the managed care debacle – P4P will allow insurers to dictate the treatments that we give our patients and will publicly label any physician foolish enough to contract with them and not follow their dictates as nonpreferred, substandard or some such label”.  You go, girl!  Uh..I mean boy.  Like the AAFP, the AMA has guidelines which they feel must be adhered to before P4P takes place.  No program is truly following all the guidelines.  It is all a crapshoot.

I believe doctors are afraid to truly speak up and block the whole P4P phenomenon (Physician Profiling) because they don’t want others to think that they have something to hide.  In other words, as Shakespeare wrote “The lady doth protest too much, me thinks”.  Physicians believe they are truly helping patients; and they are.  They are worried that if they block P4P the public would think they are hiding something.  Maybe this is why one AMA resolution to strongly oppose and discredit the P4P concept was blocked.  Wussies. 

Doctors are not hiding anything.  We would accept any system improvements to aid our patient care as long as it is not too onerous, force us to fire non-compliant patients, or make our salary dependent on our grade.  We should block P4P for no other reason than it is “Physician Profiling”!

Here is a nice corollary piece to the piece above.  The American Diabetes Association's journal Diabetes Care reports that fewer than 40 percent of diabetic get exercise.  Even better, the worse the patient diabetes is, the less likely they are to be active.  This is from a survey of 22,000 patients.  Is it the physician’s fault?  Well, three-quarters of diabetics said their doctors had advised them to exercise. In fact, the patients who got the strongest warnings to get moving were the least likely to listen.  And yet with all this, we as physicians are supposed to be graded on their Hemoglobin A1C levels, BP, and weight?  Yeah, P4P is a real good idea - to get doctors to leave managed care, Medicaid and Medicare. 

Here is an example of when things seem great but eventually go bad.  In China, there is a physician who makes an extreme effort to provide advice to patients on how to be healthier.  He also treats the poor by dispensing cheaper yet still effective medication.  Unfortunately, Dr. Hu is getting scorned by his hospital and peers.  It seems if you pad the bill in China and bring in the most revenue, you get the biggest bonus.  In that country, 50% of all healthcare spending is on drugs whereas it is 10% in the US.  This was all reported in the NY Times.

In a land where private spending accounts for 64% of the system, much of the population’s healthcare is financially out of reach.  This is the risk, I guess, of not protecting those who can’t afford it.  It’s obvious that good old China has a broken healthcare system also.  The difference in our country, however, is that we do protect our poor (Medicare and Medicaid); we just miss out on the working middle-class.  We also have a better system which would lean itself to comparison shopping.  In China, the doctors and hospitals just need to be exposed for their gouging.  This would certainly happen in our media happy society.

The article really wasn’t about the healthcare industry, though.  It was about Dr. Hu and how his heart and his conscience have given him strength to endure hardship and humiliation to help the people.  .  Dr. Hu has been treated like garbage, beaten up and even thrown off the hospital wards and yet he continues.  With doctors like him around, in any country, there is still hope left in this world.

10. More China

Interestingly enough, another article in the NY Times shows how another hospital in China has a tiered service.  You can share rooms with other patients for $6.70 a night or get a suite for $3,200 a night.  They compare it to an airplane with coach and first class services.  By providing cheap medical care, it is a way for the hospital to appease the Communist officials while still courting the wealthier patients.  It seems to be working well.  The hospital is top notch in design and technology.  Everyone gets good care at a price they can afford; it’s just the accommodations that differ.  Could that possibly be a model for us over here?  Read the next article.

If our country goes to socialized medicine, there is no way we have the cajones to ration care.  However, without rationing, we would go bankrupt in about 8 days after the program started.  Let’s just say, for the sake of argument, the public is convinced to ration care.  As you know, from Canada, there is going to be a huge delay in getting such services as CT Scans, MRIs, back surgeries, etc.  What if a rich person was willing to pay for his or her procedure to get it earlier?  What if a rich person wanted to pay for the best hospital suite, like I mentioned in the Chinese hospital?  I believe that there is no way the ACLU would ever allow this to happen.  This brings me to my prophecy. 

I have been regaled by my friends as the second coming of Nostradamus for the accuracy of my predictions (slightly exaggerated).  As Nostradougus, I predict that the future of socialized medicine in our country will spawn an industry of floating hospitals in the waters outside US jurisdiction.  Like the Love Boat show, these would be beautiful cruises for the rest of the family while the patient gets knee surgery or a heart stent.  Instead of there just being one Bernie Kopell, like in the TV series, there would be dozens of Docs walking around (hopefully they wouldn’t be as horny).

I also predict that there will be entire islands out of US jurisdiction that will be doing the same medical care as the boats above.  It would be like that show Fantasy Island but instead it will be called Medical Island.  I predict some guy like Mr. Rourke would be waiting at the dock on Medical Island and some midget, we’ll call him Botox, will start screaming, “The Patients! The Patients!”

You heard it here first.  

12. Feedback About The Placebo Gazette

All future feedback will be posted as reviews for each issue.  Please go below and post your thoughts under the WRITE A REVIEW section.

Until next time, keep smiling, keep laughing and keep out of the sample closet.

Doug

King of Medicine