6 ms·

The Myth of Prevention

41 points by absconditus 17y ago

varaon 17y ago
Refreshingly honest. I'm impressed to see this sort of viewpoint in the WSJ.
- adamc 17y ago
  Not sure why you got downrated (I had exactly the same thought, based on years of reading the WSJ). I found the piece thoughtful and plausible.
pj 17y ago
How about not letting the AMA artificially limit the supply of doctors? How about letting patients care for themselves? Acquire their own medicine? Ask for their own blood tests and monitor their own hormone and chemical levels without having to go to a doctor? This guy is a doctor, no wonder he doesn't mention allowing people to not need him. Imagine if we forced companies and individuals to go to people with computer science degrees to get help with their computers. Seems like if we'd remove the medical doctor gatekeepers and allow people to care for themselves, then health care costs would go down. It seems so strange that in a free nation, it is illegal for citizens to care for their own health.
- physcab 17y ago
  You really think people are smart enough to care for themselves? The government is trying to protect us from ourselves, hence the "click-it or ticket" seat-belt law. Maybe the best way to fix our health-care system is to fix our educational system first.
  - randallsquared 17y ago
    You really think people are smart enough to care for themselves? Of course. I know more than one person who was forced to diagnose themselves and then insist on the tests that would prove it to the doctor. People know more about themselves than their doctors do, and have a much higher incentive to get it right.
    - physcab 17y ago
      Just because they...err we...have a higher incentive doesn't mean we have a better ability to diagnose. I'd like to think I'm a smart guy (3rd year PhD student) and I can't tell the difference between a cold, flu, allergies, or mono.
      - stcredzero 17y ago
        My girlfriend works in Public Health, and finds herself in the position of correcting doctors' misconceptions about illnesses she is monitoring. Seems like she gets to correct someone who should've known better about once or twice a month. What makes this even more ironic -- as a patient, she has a very difficult time communicating with doctors. When she was in graduate school, she did studies on disparities in health care based on race. Somehow she gets caught up in those mechanisms without seeing the patterns she once studied in grad school. (She's African American, and she constantly has problems convincing doctors that she's not exaggerating the degree of her pain, and at the same time constantly disregarding her doctor's instructions. A couple of days ago, I did a double-take and said, "OMG, a little voice in my head is yelling 'African American Health Disparities!' Do you realize you're living a stereotype?")
      - gnaritas 17y ago
        > and I can't tell the difference between a cold, flu, allergies, or mono. Then you haven't had them enough to get to know them well. Get something often enough and you don't need a doctor to tell you which it is, you learn from experience to know exactly which it is.
    - Evgeny 17y ago
      Looking at the number of people who are overweight/obese, who are smoking, who are abusing alcohol etc, I can not agree. It seems very simple to me to understand how to eat/exersice properly and how to not poison myself. All the information is readily available to anyone who needs it. Now if so many people can not even get this bit right, what chance is there that they would be able to diagnose more complex cases?
      - 17y ago
  - pj 17y ago
    Yes, I do think people are smart enough to care for themselves. It's more philosophical than whether or not people are smart enough though. I think people should be able to choose. If I make a mistake in my own health care and I die, then that is okay. I could fall off my roof while I'm trying to fix that too or repair my car's brakes wrong. Doctors make mistakes in patient care too and they are still allowed to practice medicine. I also think we should fix our educational system and one way would be to allow students to break free from the lowest common denominator factors that are also ruining our health.
    - physcab 17y ago
      I think you're totally right. And honestly I think the side-effect of having a ridiculously costly health-care system is that people just end up caring for themselves anyways. Unless of course you're my dad, who fainted at the wheel, was taken to the hospital unconscious, and then charged because he didn't call our insurance to pre-approve the ambulance...
  - Zak 17y ago
    I don't know if they are, but I do know that a lot of times, doctors aren't smart enough[0] to make medical decision for patients. Twice, I have correctly identified effective treatments for chronic conditions following years of failures by doctors. I'm a hacker, not a doctor; I have no medical training, but I know how to reverse-engineer a system enough to figure out what knobs there are to turn, and I know how to use Google. The first case was a woman suffering from prolonged, heavy menstrual bleeding. I don't mean an extra few days a month. I mean 45 days in a row with maybe a week between periods. The bleeding was enough to cause anemia, itself requiring medical treatment. The response of doctors was always the same: birth-control pills. At first they worked, but eventually they didn't. Certain pills, I don't remember which, made it significantly worse. She finally insisted on alternate treatment. The doctor insisted on another month on yet another pill, certain that her problem was polycystic ovarian diseas despite having found no cysts or other matching symptoms in an examination. It didn't work, so he decided the problem must be uterine polyps and scheduled a dilation and curettage - essentially scraping out the inside of the uterus. He could see no polyps during the procedure, but insisted that they're sometimes too small to see. It worked for a month. After that, the bleeding was back just as bad as ever. I came along to the doctor's office to help insist on a hormone test. He resisted, but eventually gave in. He resisted more when we wanted a copy of the results sent to us directly - in Florida, it's illegal for a test lab to deliver test results to anybody, including the patient without the doctor's permission. A couple weeks later, the results came in. All the levels were within the normal range, though luteinizing hormone was near the top of what seemed to be a rather wide range. A quick trip to Wikipedia made it clear this was part of the problem[1]. I went looking for a way to reduce the LH level, and quickly found that supressing the activity of another hormone called GNRH would do the trick, and that there are prescription drugs to do so. We brought the test results to an endocrinologist and first waited to see if she saw what I did. She didn't, so I told her. She agreed and wrote the prescription. With a retail price of around $60,000 an ounce, nafarelin acetate is the single most expensive substance I've interacted with, but it beats bleeding to death. In the second case, I found a treatment simply by talking to the patient on IRC. He had a seizure disorder. The actual cause wasn't and still isn't known, but he had been seeing a neurologist. At one point, the neurologist prescribed gabapentin, a drug that acts an an analog of the inhibitory neurotransmitter gamma-aminobutyric acid. This was effective for about a week, but the patient quickly built up a tolerance. After reading what gabapentin was, and how GABA itself is made in the body, I asked the patient if he noticed a decrease in seizures when he ate foods high in MSG. It turns out that he did. He has been taking glutamine in pill form for about two months now, almost completely suppressing the seizures. So, is everyone smart enough to care for themselves? Of course not. Are doctors necessarily smarter? At least some of the time, the answer appears to be no. I think most people should see a doctor for treatment of most medical conditions, but the idea of laws that prevent people from treating themselves seems like a fundamental violation of the rights of the individual. [0] The actual cause of repeatedly coming up with wrong answers may be any number of biases, incorrect uses of heuristics or otherwise bad decision-making rather than a lack of intelligence. [1] http://en.wikipedia.org/wiki/File:MenstrualCycle2.png http://en.wikipedia.org/wiki/File:MenstrualCycle2.png
- gabrielroth 17y ago
  Perhaps a more realistic proposal than self-care is clinic-based care by registered nurses and other well-trained non-MDs.
- randallsquared 17y ago
  Imagine if we forced companies and individuals to go to people with computer science degrees to get help with their computers. If the occasionally recurring calls for licensing of "software engineers" is any guide, some of the people reading this are imagining the legislation of supply and salivating at the higher salary this would mean for them. :/
  - deleted 17y ago
    [deleted]
- logjam 17y ago
  Disclaimer: I am a physician. There are greedy physicians. There are bad physicians. These physicians can drive up health costs. I do not find, however, much evidence to support the idea that physician reimbursement has anything to do with our high national health costs. Most I know are neither bad nor greedy. Generally, my colleagues are the best, most compassionate, smartest humans I know. The physicians I know have worked 60-80 hours a week for their entire professional lives, went into enormous debt to finance their professional educations and make between $140-200K annually before paying for their own expenses, health care insurance, sick time, vacations, etc. I understand what you are saying about taking your health destiny into your own hands. Most physicians, including myself, want you to do just that, and will work with you to encourage you to efficiently and cheaply monitor and care for your own conditions. Most of us feel that has to be the future. Most of us believe strongly in preventive medicine, and feel caring for chronic disease is like trying to put the toothpaste back in the tube. I'm with you, notwithstanding your hyperbole about the illegality of caring for your own health in a free nation. But I think you might agree that when your 9 month old starts wheezing one February day in the midst of a common respiratory syncytial virus outbreak, despite all the self-learning you did on the Internet, you're probably best advised to seek counsel, evaluation, and treatment from someone who has seen a few cases of RSV, seen a few more cases of how fast children can go down with something so seemingly simple, and can treat it effectively.
  - bokonist 17y ago
    The problem is not with physicians, rather its a structural problem with the American political system. I have no doubt that you and many of your colleagues are compassionate and well intentioned. But you also pay dues to an organization that has a political lobbying arm. This is of course, entirely understandable. Washington has a ton of power, power which can be used to steam roll you. Thus you support an organization that has a goal of looking out for your interests in Washington. It does so quite well. Too well, in fact. As a result of AMA lobbying, America has far fewer doctors than most other developed countries. The result is higher prices for consumers, and no evidence of better care. See: http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-of-trying-to-control-health-care-costs-in-a-country-short-of-doctors/ http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-o... Again, I don't blame the doctors, I blame the design of the political system that creates constant factional fighting over the resources of the country, with some factions getting screwed and others doing the screwing. ( Oh Madison, how wrong you were ... ) Part of the way the restrictions of new doctors work is by restricting medical schools. This of course drives up the price of medical schools, sending doctors into massive debt. Frankly, there is no reason that doctors need four years of college on top of four years of college on top of four years of high school. I'm sure the whole thing could be compressed into eight years, as other countries have done. For new doctors, loosening the barriers to entry would be a Pareto optimum improvement. Salaries would fall, but so would the costs of schooling. Overall the public would benefit without harming new doctors. But existing doctors would get screwed, as you point out. To be fair, any reducing of the barriers to entry should include compensation for current doctors.
jsz0 17y ago
Sounds like fear mongering to me. If a doctor wants to spend time with their patients having electronic medical records shouldn't stop them from doing so. I don't think I even agree with the premise that people want their doctors to be their buddies holding their hands. I think most sick people want to be cured. The days of having one family doctor are gone. You'll get bounced around to various specialists if you have any serious problems anyway. As we've seen in other areas technology has an incredible ability to get results if used correctly. I have faith most medical professionals are smart enough to use a computer or electronic testing equipment. Either way the status quo is unsustainable. If something isn't done about it now we'll have a medical crisis in a few years/decades that is every bit as bad as the credit crisis was. And we'll sit around and say gee, someone should have done something about it sooner. It's too bad everyone was so terrified of change and willing to let the rich & powerful con them into thinking everything was just fine when it really wasn't.
mblakele 17y ago
"It means that all of us—doctors, hospitals, pharmacists, drug companies, nurses, home health agencies, and so many others—are drinking at the same trough which happens to hold $2.1 trillion, or 16% of our GDP." 16% of GDP? Other developed nations pay much less: on average 9% of GDP (http://opencrs.com/document/RL34175 http://opencrs.com/document/RL34175). Health care in the US isn't 67% better than in other developed countries.
zmimon 17y ago
I liked it up until the part about cost-cutting: > Which brings me to my problem with the president’s plan: despite being an admirer, I just don’t see how the president can pull off the reform he has in mind without cost cutting. This suffers from two fallacies - the first is that this is not a zero sum game. We may spend just as much on health care but get more value for the dollar and thus live healthier lives and thereby be more productive. The second problem is the "broken window" fallacy. Doing unnecessary healthcare is a not a reasonable thing to keep people employed. If you take that money out of healthcare it won't just vanish, it will go elsewhere and be productively employed to generate real value for the economy. Far from being a problem with the plan it is the most powerful argument in it's favor.
giardini 17y ago
We need to change all parts of the system: For most situations most doctors are over-educated: why should a podiatrist require 8 years of schooling to remove bunions or do surgery on an ingrown toenail? Does a general practioner need 12 years of training to prescribe an antibiotic for a severe infection? Are economics, politics, physics, calculus and other courses really necessary for a brain surgeon to do his job or for a nurse practioner to give tetanus shots? 1. Break the entire medical profession down into smaller specialties and provide only the necessary training within those specialties. Sure, some should take the entire 12 years college + med school + internship + specialist training, but most won't. This would open the profession to competition and provide thousands more medical workers.Doctors won't like this: they'll fight it every inch of the way, down to refusing to train people. But it must happen. Perhaps only a massive natural or man-made disaster can overcome the resistance of the AMA and doctors and cause this to happen. 2. Mandate that statistics be maintained and published, complete with names, so you can judge who's good and who isn't; who takes risks and who doesn't; who's pricey and who is cheap. That way you can choose better and practitioners can be more easily regulated. 3. Eliminate HMOs and private insurance companies: they just don't work. The only insurance solution that will work is one wherein the government maintains the insurance pool. As long as insurance companies exist they will continue to cherry-pick patients and use legal tricks to eliminate patients who develop costly medical conditions. 4. Eliminating the HMOs and insurance companies immediately gives a gain equal to the profit of those firms. Increasing efficiency (automation of paperwork, scheduling, etc.) gives further gains. Improved technology can also reduce costs (something rarely pointed out about medicine). And we haven't brought up the drug companies yet. There's lots of room for improvement in the current system, but the doctors, insurance companies, drug companies and the HMOs don't want to change the status quo. And they're the only ones with representatives (their lobbyists) in Washington.
spakalavach 17y ago
doctors are part of the problem and this entire process has shown them out. most people already understood that their health insurer was scum, but few know their doctor is in on it too
octover 17y ago
I have experienced health care in the US and now Sweden. I can say whole heartedly that I prefer the Swedish system. Perhaps that's cause I have a chronic condition that is costly. I could never get insurance on my own in the US, at any price. I pay more in taxes in line with what my perfectly healthy friends in the US have paid to get comparable insurance (of course if they use it for much they risk rescission and will have to fight the insurance company to pay the bills they should). In Sweden they worked quickly to put me on a safer and cheaper drug, one that most of the US is dragging its heels to get into place, why cause it costs less than half to treat a patient this way. Office visits go down because it is entirely self-administrable, instead of an IV that has to be done in a clinic. No matter what medical system you choose there are going to be mistakes and deaths, I just prefer the Swedish system that seems to triage and try and use resources wisely. I've had things in the US turn into unnecessary tests and hospital stays, in Sweden they recognize this and treat me appropriately. Of course I can't blame doctors in the US, they have the fear of a big malpractice suit if anything unordinary were to happen.
- berntb 17y ago
  The problem in Sweden is (a) queue time and (b) the administration burden disincentives doctors from finding complex problems that aren't obvious. About (b), I think it might be better in the rest of Scandinavia. My personal experience -- I had a simple knee problems for decades (the sport doctors finally fixing that said it was common to drag them around for that long...) My experience here isn't that atypical.
geezer 17y ago
My solution: Free market. Let anybody practice medicine. No state licenses, no medical school degrees required. No controlling number of physicians entering the system each year. If you are good, you will stay in business. Let free market weed out the good from the bad.
edw519 17y ago
I'm glad someone else finally said it: Early detection is neither.
Retric 17y ago
This is written by someone who in their own words is more focused on treatment than success. “The Doctor” happens to be my favorite painting, mostly because of the story behind it: Sir Luke Fildes lost his oldest son I have a print of the Fildes painting close at hand, a reminder that all the marvels of science, all the advances of medicine don’t replace what patients want of their doctors and what most of us wanted to offer when we felt the calling to medicine: the opportunity to be fully present at the bedside, to bring the human comfort that only the presence of an attentive physician can bring, to convey to patient and family the unspoken promise, “I will stay with you through thick and thin.” I don't care if it's a person, robot, or pill, just fix me.

41 points by absconditus 17y ago

varaon 17y ago

Refreshingly honest. I'm impressed to see this sort of viewpoint in the WSJ.

adamc 17y ago
Not sure why you got downrated (I had exactly the same thought, based on years of reading the WSJ). I found the piece thoughtful and plausible.

pj 17y ago

How about not letting the AMA artificially limit the supply of doctors? How about letting patients care for themselves? Acquire their own medicine? Ask for their own blood tests and monitor their own hormone and chemical levels without having to go to a doctor? This guy is a doctor, no wonder he doesn't mention allowing people to not need him. Imagine if we forced companies and individuals to go to people with computer science degrees to get help with their computers. Seems like if we'd remove the medical doctor gatekeepers and allow people to care for themselves, then health care costs would go down. It seems so strange that in a free nation, it is illegal for citizens to care for their own health.

physcab 17y ago
You really think people are smart enough to care for themselves? The government is trying to protect us from ourselves, hence the "click-it or ticket" seat-belt law. Maybe the best way to fix our health-care system is to fix our educational system first.
- randallsquared 17y ago
  You really think people are smart enough to care for themselves? Of course. I know more than one person who was forced to diagnose themselves and then insist on the tests that would prove it to the doctor. People know more about themselves than their doctors do, and have a much higher incentive to get it right.
  - physcab 17y ago
    Just because they...err we...have a higher incentive doesn't mean we have a better ability to diagnose. I'd like to think I'm a smart guy (3rd year PhD student) and I can't tell the difference between a cold, flu, allergies, or mono.
    - stcredzero 17y ago
      My girlfriend works in Public Health, and finds herself in the position of correcting doctors' misconceptions about illnesses she is monitoring. Seems like she gets to correct someone who should've known better about once or twice a month. What makes this even more ironic -- as a patient, she has a very difficult time communicating with doctors. When she was in graduate school, she did studies on disparities in health care based on race. Somehow she gets caught up in those mechanisms without seeing the patterns she once studied in grad school. (She's African American, and she constantly has problems convincing doctors that she's not exaggerating the degree of her pain, and at the same time constantly disregarding her doctor's instructions. A couple of days ago, I did a double-take and said, "OMG, a little voice in my head is yelling 'African American Health Disparities!' Do you realize you're living a stereotype?")
    - gnaritas 17y ago
      > and I can't tell the difference between a cold, flu, allergies, or mono. Then you haven't had them enough to get to know them well. Get something often enough and you don't need a doctor to tell you which it is, you learn from experience to know exactly which it is.
  - Evgeny 17y ago
    Looking at the number of people who are overweight/obese, who are smoking, who are abusing alcohol etc, I can not agree. It seems very simple to me to understand how to eat/exersice properly and how to not poison myself. All the information is readily available to anyone who needs it. Now if so many people can not even get this bit right, what chance is there that they would be able to diagnose more complex cases?
    - 17y ago
- pj 17y ago
  Yes, I do think people are smart enough to care for themselves. It's more philosophical than whether or not people are smart enough though. I think people should be able to choose. If I make a mistake in my own health care and I die, then that is okay. I could fall off my roof while I'm trying to fix that too or repair my car's brakes wrong. Doctors make mistakes in patient care too and they are still allowed to practice medicine. I also think we should fix our educational system and one way would be to allow students to break free from the lowest common denominator factors that are also ruining our health.
  - physcab 17y ago
    I think you're totally right. And honestly I think the side-effect of having a ridiculously costly health-care system is that people just end up caring for themselves anyways. Unless of course you're my dad, who fainted at the wheel, was taken to the hospital unconscious, and then charged because he didn't call our insurance to pre-approve the ambulance...
- Zak 17y ago
  I don't know if they are, but I do know that a lot of times, doctors aren't smart enough[0] to make medical decision for patients. Twice, I have correctly identified effective treatments for chronic conditions following years of failures by doctors. I'm a hacker, not a doctor; I have no medical training, but I know how to reverse-engineer a system enough to figure out what knobs there are to turn, and I know how to use Google. The first case was a woman suffering from prolonged, heavy menstrual bleeding. I don't mean an extra few days a month. I mean 45 days in a row with maybe a week between periods. The bleeding was enough to cause anemia, itself requiring medical treatment. The response of doctors was always the same: birth-control pills. At first they worked, but eventually they didn't. Certain pills, I don't remember which, made it significantly worse. She finally insisted on alternate treatment. The doctor insisted on another month on yet another pill, certain that her problem was polycystic ovarian diseas despite having found no cysts or other matching symptoms in an examination. It didn't work, so he decided the problem must be uterine polyps and scheduled a dilation and curettage - essentially scraping out the inside of the uterus. He could see no polyps during the procedure, but insisted that they're sometimes too small to see. It worked for a month. After that, the bleeding was back just as bad as ever. I came along to the doctor's office to help insist on a hormone test. He resisted, but eventually gave in. He resisted more when we wanted a copy of the results sent to us directly - in Florida, it's illegal for a test lab to deliver test results to anybody, including the patient without the doctor's permission. A couple weeks later, the results came in. All the levels were within the normal range, though luteinizing hormone was near the top of what seemed to be a rather wide range. A quick trip to Wikipedia made it clear this was part of the problem[1]. I went looking for a way to reduce the LH level, and quickly found that supressing the activity of another hormone called GNRH would do the trick, and that there are prescription drugs to do so. We brought the test results to an endocrinologist and first waited to see if she saw what I did. She didn't, so I told her. She agreed and wrote the prescription. With a retail price of around $60,000 an ounce, nafarelin acetate is the single most expensive substance I've interacted with, but it beats bleeding to death. In the second case, I found a treatment simply by talking to the patient on IRC. He had a seizure disorder. The actual cause wasn't and still isn't known, but he had been seeing a neurologist. At one point, the neurologist prescribed gabapentin, a drug that acts an an analog of the inhibitory neurotransmitter gamma-aminobutyric acid. This was effective for about a week, but the patient quickly built up a tolerance. After reading what gabapentin was, and how GABA itself is made in the body, I asked the patient if he noticed a decrease in seizures when he ate foods high in MSG. It turns out that he did. He has been taking glutamine in pill form for about two months now, almost completely suppressing the seizures. So, is everyone smart enough to care for themselves? Of course not. Are doctors necessarily smarter? At least some of the time, the answer appears to be no. I think most people should see a doctor for treatment of most medical conditions, but the idea of laws that prevent people from treating themselves seems like a fundamental violation of the rights of the individual. [0] The actual cause of repeatedly coming up with wrong answers may be any number of biases, incorrect uses of heuristics or otherwise bad decision-making rather than a lack of intelligence. [1] http://en.wikipedia.org/wiki/File:MenstrualCycle2.png http://en.wikipedia.org/wiki/File:MenstrualCycle2.png
gabrielroth 17y ago
Perhaps a more realistic proposal than self-care is clinic-based care by registered nurses and other well-trained non-MDs.
randallsquared 17y ago
Imagine if we forced companies and individuals to go to people with computer science degrees to get help with their computers. If the occasionally recurring calls for licensing of "software engineers" is any guide, some of the people reading this are imagining the legislation of supply and salivating at the higher salary this would mean for them. :/
- deleted 17y ago
  [deleted]
logjam 17y ago
Disclaimer: I am a physician. There are greedy physicians. There are bad physicians. These physicians can drive up health costs. I do not find, however, much evidence to support the idea that physician reimbursement has anything to do with our high national health costs. Most I know are neither bad nor greedy. Generally, my colleagues are the best, most compassionate, smartest humans I know. The physicians I know have worked 60-80 hours a week for their entire professional lives, went into enormous debt to finance their professional educations and make between $140-200K annually before paying for their own expenses, health care insurance, sick time, vacations, etc. I understand what you are saying about taking your health destiny into your own hands. Most physicians, including myself, want you to do just that, and will work with you to encourage you to efficiently and cheaply monitor and care for your own conditions. Most of us feel that has to be the future. Most of us believe strongly in preventive medicine, and feel caring for chronic disease is like trying to put the toothpaste back in the tube. I'm with you, notwithstanding your hyperbole about the illegality of caring for your own health in a free nation. But I think you might agree that when your 9 month old starts wheezing one February day in the midst of a common respiratory syncytial virus outbreak, despite all the self-learning you did on the Internet, you're probably best advised to seek counsel, evaluation, and treatment from someone who has seen a few cases of RSV, seen a few more cases of how fast children can go down with something so seemingly simple, and can treat it effectively.
- bokonist 17y ago
  The problem is not with physicians, rather its a structural problem with the American political system. I have no doubt that you and many of your colleagues are compassionate and well intentioned. But you also pay dues to an organization that has a political lobbying arm. This is of course, entirely understandable. Washington has a ton of power, power which can be used to steam roll you. Thus you support an organization that has a goal of looking out for your interests in Washington. It does so quite well. Too well, in fact. As a result of AMA lobbying, America has far fewer doctors than most other developed countries. The result is higher prices for consumers, and no evidence of better care. See: http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-of-trying-to-control-health-care-costs-in-a-country-short-of-doctors/ http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-o... Again, I don't blame the doctors, I blame the design of the political system that creates constant factional fighting over the resources of the country, with some factions getting screwed and others doing the screwing. ( Oh Madison, how wrong you were ... ) Part of the way the restrictions of new doctors work is by restricting medical schools. This of course drives up the price of medical schools, sending doctors into massive debt. Frankly, there is no reason that doctors need four years of college on top of four years of college on top of four years of high school. I'm sure the whole thing could be compressed into eight years, as other countries have done. For new doctors, loosening the barriers to entry would be a Pareto optimum improvement. Salaries would fall, but so would the costs of schooling. Overall the public would benefit without harming new doctors. But existing doctors would get screwed, as you point out. To be fair, any reducing of the barriers to entry should include compensation for current doctors.

jsz0 17y ago

Sounds like fear mongering to me. If a doctor wants to spend time with their patients having electronic medical records shouldn't stop them from doing so. I don't think I even agree with the premise that people want their doctors to be their buddies holding their hands. I think most sick people want to be cured. The days of having one family doctor are gone. You'll get bounced around to various specialists if you have any serious problems anyway. As we've seen in other areas technology has an incredible ability to get results if used correctly. I have faith most medical professionals are smart enough to use a computer or electronic testing equipment. Either way the status quo is unsustainable. If something isn't done about it now we'll have a medical crisis in a few years/decades that is every bit as bad as the credit crisis was. And we'll sit around and say gee, someone should have done something about it sooner. It's too bad everyone was so terrified of change and willing to let the rich & powerful con them into thinking everything was just fine when it really wasn't.

mblakele 17y ago

"It means that all of us—doctors, hospitals, pharmacists, drug companies, nurses, home health agencies, and so many others—are drinking at the same trough which happens to hold $2.1 trillion, or 16% of our GDP." 16% of GDP? Other developed nations pay much less: on average 9% of GDP (http://opencrs.com/document/RL34175 http://opencrs.com/document/RL34175). Health care in the US isn't 67% better than in other developed countries.

zmimon 17y ago

I liked it up until the part about cost-cutting: > Which brings me to my problem with the president’s plan: despite being an admirer, I just don’t see how the president can pull off the reform he has in mind without cost cutting. This suffers from two fallacies - the first is that this is not a zero sum game. We may spend just as much on health care but get more value for the dollar and thus live healthier lives and thereby be more productive. The second problem is the "broken window" fallacy. Doing unnecessary healthcare is a not a reasonable thing to keep people employed. If you take that money out of healthcare it won't just vanish, it will go elsewhere and be productively employed to generate real value for the economy. Far from being a problem with the plan it is the most powerful argument in it's favor.

giardini 17y ago

We need to change all parts of the system: For most situations most doctors are over-educated: why should a podiatrist require 8 years of schooling to remove bunions or do surgery on an ingrown toenail? Does a general practioner need 12 years of training to prescribe an antibiotic for a severe infection? Are economics, politics, physics, calculus and other courses really necessary for a brain surgeon to do his job or for a nurse practioner to give tetanus shots? 1. Break the entire medical profession down into smaller specialties and provide only the necessary training within those specialties. Sure, some should take the entire 12 years college + med school + internship + specialist training, but most won't. This would open the profession to competition and provide thousands more medical workers.Doctors won't like this: they'll fight it every inch of the way, down to refusing to train people. But it must happen. Perhaps only a massive natural or man-made disaster can overcome the resistance of the AMA and doctors and cause this to happen. 2. Mandate that statistics be maintained and published, complete with names, so you can judge who's good and who isn't; who takes risks and who doesn't; who's pricey and who is cheap. That way you can choose better and practitioners can be more easily regulated. 3. Eliminate HMOs and private insurance companies: they just don't work. The only insurance solution that will work is one wherein the government maintains the insurance pool. As long as insurance companies exist they will continue to cherry-pick patients and use legal tricks to eliminate patients who develop costly medical conditions. 4. Eliminating the HMOs and insurance companies immediately gives a gain equal to the profit of those firms. Increasing efficiency (automation of paperwork, scheduling, etc.) gives further gains. Improved technology can also reduce costs (something rarely pointed out about medicine). And we haven't brought up the drug companies yet. There's lots of room for improvement in the current system, but the doctors, insurance companies, drug companies and the HMOs don't want to change the status quo. And they're the only ones with representatives (their lobbyists) in Washington.

spakalavach 17y ago

doctors are part of the problem and this entire process has shown them out. most people already understood that their health insurer was scum, but few know their doctor is in on it too

octover 17y ago

I have experienced health care in the US and now Sweden. I can say whole heartedly that I prefer the Swedish system. Perhaps that's cause I have a chronic condition that is costly. I could never get insurance on my own in the US, at any price. I pay more in taxes in line with what my perfectly healthy friends in the US have paid to get comparable insurance (of course if they use it for much they risk rescission and will have to fight the insurance company to pay the bills they should). In Sweden they worked quickly to put me on a safer and cheaper drug, one that most of the US is dragging its heels to get into place, why cause it costs less than half to treat a patient this way. Office visits go down because it is entirely self-administrable, instead of an IV that has to be done in a clinic. No matter what medical system you choose there are going to be mistakes and deaths, I just prefer the Swedish system that seems to triage and try and use resources wisely. I've had things in the US turn into unnecessary tests and hospital stays, in Sweden they recognize this and treat me appropriately. Of course I can't blame doctors in the US, they have the fear of a big malpractice suit if anything unordinary were to happen.

berntb 17y ago
The problem in Sweden is (a) queue time and (b) the administration burden disincentives doctors from finding complex problems that aren't obvious. About (b), I think it might be better in the rest of Scandinavia. My personal experience -- I had a simple knee problems for decades (the sport doctors finally fixing that said it was common to drag them around for that long...) My experience here isn't that atypical.

geezer 17y ago

My solution: Free market. Let anybody practice medicine. No state licenses, no medical school degrees required. No controlling number of physicians entering the system each year. If you are good, you will stay in business. Let free market weed out the good from the bad.

edw519 17y ago

I'm glad someone else finally said it: Early detection is neither.

Retric 17y ago

This is written by someone who in their own words is more focused on treatment than success. “The Doctor” happens to be my favorite painting, mostly because of the story behind it: Sir Luke Fildes lost his oldest son I have a print of the Fildes painting close at hand, a reminder that all the marvels of science, all the advances of medicine don’t replace what patients want of their doctors and what most of us wanted to offer when we felt the calling to medicine: the opportunity to be fully present at the bedside, to bring the human comfort that only the presence of an attentive physician can bring, to convey to patient and family the unspoken promise, “I will stay with you through thick and thin.” I don't care if it's a person, robot, or pill, just fix me.