nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Tuesday, June 24, 2008

Doc D Rises From the Ashes

I’m going to start commenting again. If you don’t want to receive, please let me know…it won’t hurt my feelings at all.

Lack of Health Insurance for Many U.S. Residents 'Merely a Symptom' of Larger Problem With Costs, According to Opinion Piece

The major presidential candidates have "talked frequently" about proposals to expand health insurance to more U.S. residents but have failed to "recognize that lack of coverage is merely a symptom of a larger problem: the high cost of medical care," Dwight Bartlett, a former Social Security Administration chief actuary and a former Maryland insurance commissioner, writes in a Baltimore Sun opinion piece

Doc D: This is an important point. I find that ALL of the candidates, in their rush to provide benefits for the uninsured (to get elected, of course), have not addressed the underlying problem: people are uninsured because it costs too much. Folks think “if I can just get coverage, things will be OK.” But won’t the costs then keep climbing? Each candidate has a cost-control idea, but none get to the root of how cost is driven, just nibbling at the edges like we did in the 90’s. And, if the government pays for coverage, they will get the money from…you…through taxes. If you can’t afford it now, but still have the choice to choose less, what will it be like when the Fed saves you HAVE to pay whatever it costs?

I want to see a plan that gets at the root of ALL our healthcare system issues: coverage, cost, and access.

BTW, in Massachusetts, which passed an attempt at near-universal coverage into law, the problems are emerging: cost is still rising at double-digits, and access is falling (i.e., can I get an appointment when I want it?)

House expected to vote on Medicare bill this week.

In continuing coverage from previous editions of Morning Rounds, Congressional Quarterly (6/21) reported that the "House is planning to vote on a 'modified' version of a Senate Medicare bill early [this] week," according to a House Democratic aide. The legislation is "based on a bill by Senate Finance Committee Chairman Max Baucus (D-Mont.) to replace deep cuts to Medicare's physician rates, with 18 months of stable payments." While Sen. Baucus's "bill has yet to pass the Senate," CQ pointed out that it "was unclear if the House was moving alone, to put pressure on the Senate to complete a Medicare package, or if the legislation was the product of a deal struck after several days of negotiations between key players in both chambers."

Doc D: In the late 90’s a law was passed to cut Medicare reimbursement to doctors by over 10%. Congress has had to postpone that cut several times in order to ensure that physicians won’t stop seeing Medicare patients. Some doctors got fed up with government reimbursement a long time ago, and don’t accept new Medicare patients already. I suspect that many more will do so if Congress doesn’t fix this situation. Time spent in administration is about 15% now, rising every year, and reducing appointments available.

Once again the issue is cost, not coverage. In other countries with universal coverage, cost is controlled by rationing care to the population.

California Supreme Court to decide if physicians can refuse to treat patients for religious reasons.

The Washington Post (6/19, A2, Surdin) reported that California's Supreme Court "will decide...whether doctors can refuse to treat certain patients for religious reasons." The case involves a lesbian couple who 10 years ago "was trying to conceive." The couple said that "doctors violated [the couple's] civil rights because they refused her a fertility treatment." The "two doctors and their employer, North Coast Women's Care Medical Group, say they denied...treatment because it is against their Christian beliefs to perform insemination on unwed women, whether heterosexual or lesbian." According to University of California-Berkeley professor Joan Hollinger, "The case raises a whole series of questions about the basis" on "which people can be denied medical treatment, particularly the extent to which gays or lesbians could be denied access to reproductive technology."

Doc D: This is interesting. It comes up in the context of a lesbian couple, but there’s an underlying issue. No matter for whom, is fertility a “necessary” treatment (that is, what disease does it treat?) and, if so, is there a “right to conceive” in the same way we think of a right to life, liberty, etc? This is important in itself, but it bears on whether the doctors and hospital are “refusing to treat”. As a doctor I have NO obligation to treat where there is no harm to the individual without it. Is lack of conception a “harm”?

Anyway, this is one of those philosophical things that I think are fascinating and my family thinks are silly.

BTW, the United Nations published a document of Universal Human Rights some time ago. If I remember correctly, there were 29 of them…one of which was the right to marry. This might be a difficult right to enforce if no one wants to marry you.

Opinions are entirely my own. Quotations from Kaiser Daily Health Policy Report ( © Kaiser Family Foundation) and AMA Morning Rounds (© U S News Custom Briefings)

Doc D

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