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AdLib On August - 29 - 2009

TV Bill Moyers JournalBill Moyers is possibly the last of the breed of journalists who carry the trust and respect of the people.

If you didn’t see it last night, he used his show to host a screening of the film, based on the book, “Money Driven Medicine”.  As much as I’ve tried to educate myself about the state of medicine in this nation, I have a feeling that you will learn a few things you didn’t know by watching this as I did. I highly recommend it:

http://www.pbs.org/moyers/journal/08282009/watch.html

Written by AdLib

My motto is, "It is better to have blogged and lost hours of your day, than never to have blogged at all."

27 Responses so far.

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  1. tyler-durden says:

    this Moyers piece is great. thank you for posting the link.

    another interview by Bill that is a real eye opener on the corrupt health insurance industry is with Wendell Potter. Link here:
    http://www.pbs.org/moyers/journal/07312009/profile.html

    i agree that a single payer system now is too big a sandwich to put in your mouth right now. but i want a public option that is as efficient as possible, with a commitment to expanding its abilities as far as possible, up to becoming a single payer system if the public support is still there. i’m tired of dancing around this as if the interests of health ins. co’s are something valuable to protect. they’re not!! they’ve been getting away with gouging us for years. they don’t deserve protection; they brought this on themselves with their greed!

    this is not the same as microsoft crying when they were forced to offer more than IE with Windows.

    it would be comparable to a situation where microsoft cried about firefox being available for free, so firefox should be forced to charge a fee for it, because microsoft got used to charging so much for IE when they were the primary browser.

    i want a public option, that is well funded, and is most efficient!

  2. KQuark says:

    Cheers AdLib I’ll have to check it out later.

  3. Questinia says:

    Thank-you AdLib. I Love Bill Moyers. ILBM!

    I went into primary care medicine… I got $10,000 bonus to start the program. I wanted to be a community medicine doc. Did one year of internal medicine during my residency, saw the writing on the wall and got out fast. Primary care docs are responsible for all and get paid peanuts. Consequently they’re becoming less and less like holistic caretakers and more and more like switchboard operators connecting people to specialists.

    I am lucky since medical school was paid for me by my parents. Really lucky. My friend, who stayed in the primary care medicine field owed $200,000 in tuition costs. She works like a dog, on call all the time and has to fight tooth and nail for every dime she gets from the insurance companies.

    Primary care docs are expected to take insurance, specialists aren’t. Those specialists who do take insurance might not be that special. You get what you pay for.

    There was no broken system when the agreement was an 80/20 split (way before my time), it’s just insurance companies weren’t making a lot of money. As soon as they got into the making money game the health care system started going where it’s going.

    If I had practiced medicine back then, I would have had an older office manager named Mildred who was much smarter than I, still looked dynamite in mini-skirts, kept her hair long and blond, spoke with a Brooklyn accent and chided me for being such an administrative wreck. She’d smile and shake her head and then we’d go out for a drinkie-poo.

    • AdLib says:

      First, appreciate the first hand POV on this and may I say, very impressed with the many sides of Questinia!

      It seems to be a system that has been indirectly remade out of neglect and greed then intentionally engineered to become what it is now.

      I remember way back that it was often said being a specialist is where you make the money. I also remember, from a patient’s standpoint, how doctors were stepping away from GP and becoming specialists. I’ve been fortunate to have PPOs but I’ve known that those in HMOs had to do the Multi-Doctor-Shuffle, mandated to go to a GP first then only being able to go to a specialist if referred by that doctor and the HMO. As you say, the GP was forced to act as more of a screener for the “real” doctors.

      The key revelation from the documentary for me was the insurance companies flipping from a policy of denying treatments to a policy of embracing treatments (which generated more revenue all the way around) and in doing so, escalated the raising of deductibles and premiums to cover their costs for doing so…and creating skyrocketing profits in that way.

      Sure wish I could get a client to pay me handsomely to provide a service then when it comes time to provide that service, the client has to pay for most or all of the cost of providing that service. (In a bad Russian accent) America, what a country!

      BTW, I don’t know that any of the reforms being considered will address this critical issue. As the documentary mentions and as would seem to be common sense, if GPs were paid on a par with specialists and were as plentiful and strong as their counterparts, their POV on patients would seem to be far better, seeing a variety of patients, conditions and treatments, than specialists who are experienced and focused in a much narrower field.

      If I have a severe problem in a specific area of medicine, I would go to a specialist first. But if I didn’t know what was causing an issue, an experienced , quality GP would be my first stop.

      It really isn’t so complicated to get this right and pay GPs like all other doctors so there’s not a disincentive to become one.

      I mean, come on, it’s not exactly brain surgery.

      • KQuark says:

        We are making our reforms far too late. If we had made our reforms in the 60’s and 70’s like every other industrialized country did we would have a change of reform in one step. Now our problems are so thick it’s like peeling an onion. We can’t financially make all the reforms at once so instead we have to start peeling the onion. That’s the reason I don’t buy the argument that no reform is better than what some people call real reform. Because it’s going to take multiple iterations to fix the system.

        Kalima might attest to this as well but the more I look at the Japanese healthcare system the more I see how they reformed their system in steps because they started relatively late as well.

        • Questinia says:

          I agree with this. I’ve been saying all along a revolutionary move to a single -payer system would yield a system fraught with problems.

          I addition it should be really doctor-friendly. If people want good medicine, they need to be mindful of that. Doctors spending too much time with administrative tasks is pointless.

          I work one day per week in a clinic. We are supposed to use a computer, but by the time I log in the three times I need to and bring up the multiple screens and scroll to find the medications etc… I could have seen another patient. So I gave up, still write my notes and give them to someone to scan them into the system.

          • KQuark says:

            People are so simple minded in this country when I see someone say “single payer now” I just want to slap them because they make solving all the problems in our healthcare system sound like a solution you can put on a bumper sticker.

            Like you said not having enough PCPs is a huge problem and having doctors in debt is a huge problem. One reason France is the best healthcare system in the world is because doctors do not pay tuition. So obviously they don’t have the burden to make money like our doctors do.

            The other thing is delivery is being overemphasized in this debate. How the money is delivered to providers is the main problem we have with access but not all the problems we have with cost. Provider costs are a much bigger problem. Sure we should take profit and overhead costs out of our insurance delivery but that’s just the beginning.

            People also have no idea how much our mentality and culture needs to change for us to lower healthcare costs. We live in a society with minimal preventative medicine and wellness care.

      • Questinia says:

        “It seems to be a system that has been indirectly remade out of neglect and greed then intentionally engineered to become what it is now”.

        That is it precisely. There was a general scam, (you know, that American contract between people that says “Don’t blow my scam and I won’t blow yours”) then it became organized and codified.

        Healthcare is a violent and sexy world, AdLib.

        • AdLib says:

          I like my healthcare like I like my children’s birthday party clowns, violent and sexy.

          • Questinia says:

            Yes, but you PAY children’s birthday clowns to be violent and sexy!

            • AdLib says:

              Not if we invited your Dick Cheney clone and he dropped acid in the hot tub.

              And a violent, sexy clown or two.

            • AdLib says:

              I am open to having a public plan for violent and sexy birthday party clowns.

            • Questinia says:

              Because the alcohol would burn off, leaving everyone sober, smelling of cheap perfume and feeling like violent sexy birthday clowns.

              And, lo, we come full circle.

            • AdLib says:

              In fact, why not fill the hot tub with it and invite some friends over?

            • Questinia says:

              Why get out?

            • AdLib says:

              Do both! You can fill the tub with it then get out and have a Chanel Mojito!

            • Questinia says:

              C’est practique non? Quelque chose on peut appliquer et boire?

              Vive le Chanel de la Costcotterie!!

              (DAMN straight, I’m interested).

            • AdLib says:

              BTW, was just at Costco and they had a generic brand of Chanel perfume that comes in a wine box.

              Interested?

            • Questinia says:

              And we should have a public option for those who require their violent and sexy birthday clowns be drenched in French perfume.

    • KQuark says:

      Interesting life story. I knew you were my fellow formally trained sciency geek.

      I’ve personally seen a big change in the expertise level of primary care physicians and access to your PCP. When I lived in FL I had two very good PCPs the first one was the doctor who early diagnosed my lymphoma.

      But since I’ve been in GA I’ve had four PCPs. I had a good one at first but he moved his practice and I got this one PCP just out of residency. Even though she did chest X-rays she never diagnosed my enlarged heart, only my pneumonia. I cannot even be too tough on her because when I first went to the ER they mis-diagnosed my heart failure again.

      • Questinia says:

        Chemo did your heart no good. Right KQ?

        • KQuark says:

          Yup adriamycine was the specific chemo drug that did the most damage but radiation didn’t help either. They still use it but they changed the protocol and added another drug to help mitigate the toxic effects of that specific drug.

          • Questinia says:

            I remember that about adriamycin. Ejection fraction fairly decent KQ?

            • KQuark says:

              Still pretty low 15-20%. I’ve had some renal insufficiency as well but I’ve gone on O2 again at night and increased the dose of my diuretic which seems to have helped.

            • Questinia says:

              Good. I wish they had a way of tightening up the heart, making it smaller and more efficient. I think about you KQ!

  4. Kalima says:

    Could it be as these people as they age, faced with their imminent own mortality, have a flash of sanity?

    Many a tyrant would call God’s name after slaying thousands of innocent lives, I say fry for your sins, it’s not all up to God.


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