Tuesday, May 26, 2009

Swine Flu, Physician Honorarium, Health Care Reform May 26 2009

1. No new data from the CDC's website [which will only update 3 times per week instead of all 5 weekdays] or SC DHEC. WHO's site lists 12,954 confirmed cases.

2. I was asked by a drug rep if I thought that AstraZeneca's policy of publishing on the internet "payments to physicians for speaker programs, advisory boards, consulting fees, honoraria, and related travel expenses" went overboard. No. To have the highest integrity, you must have, among other things, the most transparency. I can only hope that EVERY company in health care will do the same (pharmaceutical, devices, insurance carrier). Thus far, to my knowledge, no other company has taken public steps in this direction. For that matter, I hope other "professional" fields, such as all in the dental, pharmacists, and lawyers, will follow suit.

3. I read a lot about health care reform. Does something need to be done? Yes. Is something being done? Yes. Is there even a sliver of agreement? No. Will things change? Yes, they already are, whether we want it or not. Will things improve? May be, it depends on your perspective, who's asking? Will meaningful health care reform occur soon in the U.S.? No. Why not? Because this is a very large and complex problem. It affects everyone to a great degree. The insurance companies are the largest and strongest block in this equation. The companies are only in the U.S. and very profitable. Nationalizing health would eliminate them, which they will fight to the utmost. Hospitals, drug and device manufacturers, physicians and other health care providers, pharmacies and pharmacists all answer to the insurance payors. If you have insurance, and do not qualify for Medicaid or Medicare, then you have to work with their rules. They are very well run, for-profit companies that are thriving very well, in part due to the patchwork quilt of arcane rules between the states and federal levels and the inability of the other major players, including the public, to agree. INSURANCE COMPANIES TELL EVERYONE ELSE WHAT THEIR RULES ARE PERIOD. They are the big dog, the 800 pound gorilla in the equation, not the government nor any other group. Their bottomline is simple: take in as money as they can through premiums and then pay out as little as possible. The net difference is profit. The second way that insurance companies try to pay claims as slowly as possible, because the money they are holding onto is invested in interest-earning bonds or other more profitable investments. The longer they hang onto the money, the more interest they earn. Will health care reform come quickly? No, not when the major player is trying to obstruct or at least keep carving out the most profitable and center piece of the pie. I can see it from their point of view. It's survival. Whoever's got the gold, makes the rules. Thus, I would like to see in the face of the most recent threat to their survival what they actually in federal legislation lobby for and allow to be signed into law. So far, they promise lots of incentives to use more computers in healthcare and cost-savings through more "efficient" programs, read more paperwork and harder access for ordinary people. I predict that nothing truly major will be passed, just something that the politicians and insurance companies can say saves face, while they keep the marketplace confused and divided. How do I know? Tutankhamun words,"I saw the past and I know the future." What have they done so far? Just so some of my critics, those that send me nasty e-mails and make foul, four-letter comments on my blog, don't ride me, I am the first one to say that physicians had their collective chance to improve the health care system earlier in the twentieth century and they chose the money instead.

4. Health care systems can not be transplanted onto other countries. They have evolved over time into separate species. They are a direct result of the country's culture. For Americans, it means no prevention and take no responsibility for your own actions, only react to the max with the latest technology and medications, even if they are expensive and have never been shown to be superior to the standard of care. And the bill? That should be some one else's problem too. So no matter what we see or hear, in the media or on the internet or at the movies, changing how we collectively take responsibility, costs and benefits, for our health will be a very difficult process.

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