Wednesday, May 27, 2009

Health Care: A Necessity Not A Privilege. Conflicts of Interest Abound In America.

Even small American firms are now being forced to give up health insurance for their employees. Many employers are saying they must do so because it's the last benefit to go before they lay off employees in this harsh economic downturn.

Doctors are in positions of trust from patients, and have the power to abuse that trust. In turn, they work within the framework of the health care system and want to work within a trustworthy and financially rewarding framework.

Conflicts of interest at the heart of doctor/patient relationships are contributing to unfairness and unnecessary expenses within the system. Until this unfairness is sorted out, those in prison get free medical care, while many patients go to the great effort and expense of travelling to Canada for cheaper drugs and going to Asia for cheaper medical treatments. Access of care, its convenience and its cost, can make doctors' orders difficult to obey. While offering to pay at least 50/50 of the payments and increasing co-pays would satisfy some employees, there is clearly the need for more nationwide health care reform.

President Obama's Administration has already,

"appropriated $19 billion in the stimulus package to help implement an electronic medical record system, and has set aside hundreds of billions to overhaul the health care system in the budget."

S.Stein, Huffington Post

"Doctors for America" are helping. A grassroots organization of 11,000 doctors from all 50 states, they are the voices of physicians in support of health care reform. The group will

"work to convey the ideas and experiences of physicians to achieve healthcare reform based on four key pillars:

1)affordable coverage,

2)expanded access to care,

3)high quality care, and

4)practice environments that allow physicians to focus on patient care."

Huffington Post"The Erosion of Employer-sponsored health insurance"

Some statistics about the American health care system remain quite shocking:

Private insurance overhead and profits eat up 20% and more of health care premiums while Medicare overhead (and no profit) is closer to 3%. There is big money to be made in health insurance. The top 7 "for profit" health insurers made a combined $12.6 billion in 2007-- an increase of 170.2% from 2003. The same year, the average CEO compensation package for these health insurance companies was $14.3 million. Pay packages ranged from $3.7 million to $25.8 million.

All of that money could have gone to paying for health care for children, cancer treatments or diabetes screening -- in other words, health care.

Despite fear mongering about government run health care, seniors aren't asking for their Medicare to be taken away. Quite the contrary. People with Medicare can choose between public and private plans that contract with Medicare and an overwhelming 80 percent choose Medicare's public plan over the privately contracted plans.

D. Cohen, Huffington Post

Who can be sure this isn't happening:

By federal law a doctor cannot refer patients to himself or to a business in which he has a significant financial stake, like a laboratory or imaging center... The reasoning is that such behavior can interfere with clinical judgment, decrease quality and increase costs.

The New York Times

An area of possible efficiencies of scale could be the doctor/patient referral system. Doctors are prohibited from being paid for referrals, yet America has a referral system that is too easily corrupted. There is so much pressure to generate referrals that lines become crossed....

A major driver of referral proliferation is that doctors are paid piecework. There is less of an incentive to increase volume if payments are bundled rather than discrete for every service.

A bundled-payments system is already in place for hospitals, dialysis centers and nursing homes. Extending such a strategy to individual doctors’ payments seems to be the logical next step.

The New York Times

Also, doctors in a study were unconsciously swayed by name-brand freebies in offices and prescribe them rather than the generic alternative. The New York Times says that pharmaceutical companies have agreed to a "voluntary moratorium on branded goodies" freely given to physicians. Unless drugs promise to be profitable, they are not made. Without international research and collaboration, new drugs would not be invented. "Without us [the original drug-makers], there can be no generic" as a drug company CEO said on CNBC. American drug-makers are offering certain drugs free, but is it simply a limited, well-publicized PR goodwill-generating stunt?

Which conflicts of interest bother you the most?

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