Medicaid for All Would ‘Bankrupt the Nation,’ Warns Bernie Sanders—In 1987 – Hit & Run : Reason.com

“Notably absent from Sanders’ proposed single-payer system was a detailed plan to pay for it. The senator said he would lay out the tax hikes necessary to fund his new system in separate legislation.

That may be because enthusiasm for single payer tends to die down pretty quickly once people get a sense of what sort of tax increases would be necessary to fund it. An Urban Institute analysis of a previous version of Sanders’ plan estimated that it would cost $32 trillion over a decade.

It promises huge overall savings along with coverage that would be far more expansive, and far more expensive, than Medicaid for all, with no clear way to pay for it, and no specific strategy for driving costs or spending down.

In 30 years of political advocacy, Sanders has not solved any of the fundamental problems with single payer. He has merely opted to pretend they do not exist.”

[Note: On annualized basis, that would more than double the amount we currently spend annually on healthcare.  And past projections related to the costs of gov’t programs always vastly underestimate the actual costs, as evidenced below. – The Sovereign Patient]

“The House Ways and Means Committee estimated that Medicare would cost only about $12 billion by 1990 (a figure that included an allowance for inflation). This was a supposedly “conservative” estimate. But in 1990 Medicare actually cost $107 billion.” http://reason.com/archives/1993/01/01/the-medicare-monster

Source: Medicaid for All Would ‘Bankrupt the Nation,’ Warns Bernie Sanders—In 1987 – Hit & Run : Reason.com

Save Us From The Health Care Reformers: They’re The Problem, Not The Solution

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John C. Goodman

Dr. Goodman’s article is a fantastic foray into the dark history organized medicine, culminating with a brutally honest assessment of the cartel that resulted. He gives a great preview of the good stuff in Greg Scandlen’s new book, Myth Busters: Why Health Reform Always Goes Awry, summarizing the oft-repeated myths we hear about healthcare economics thrown around like dogma.

Source: Save Us From The Health Care Reformers: They’re The Problem, Not The Solution

Did PSA Testing Save Ben Stiller’s Life?

One of the best articles I’ve ever read that explains the judgment pitfalls and snares we fall prey to when debating “screening” tests and gives some perspective on evidence vs proof.

 

Radiologist Saurabh Jha on how the actor’s recent disclosure of his prostate cancer diagnosis has increased the public uncertainty about PSA screening, and why that’s a good thing.

Source: Did PSA Testing Save Ben Stiller’s Life?

The Problem With ‘Pay for Performance’ in Medicine – The New York Times

The idea is intuitively appealing: Reward doctors for positive outcomes, not per procedure. But it doesn’t seem to work as well as hoped.

Source: The Problem With ‘Pay for Performance’ in Medicine – The New York Times

Death of the Great Laboratory of Clinical Medical Science – Private Practice

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Dr. Gerald Gianoli

People may ask, “How is it that no one in the UK-NHS was able to help her, but a guy in private practice in Louisiana could?” Such people have been conditioned to believe that government or universities are the sole source of innovation. This is far removed from reality.

Throughout the last 70 years, the U.S. has been the greatest mover and shaker in the world of medicine. Most major medical innovations have either been born or significantly developed here. And, many of the major innovations have come from small private practices—certainly not from the government. Innovative changes do not come from out of our universities—they come from individuals who work at our universities. However, true radical, transformative innovations have often come from private practices.

 

by Gerard J. Gianoli, M.D. http://EarAndBalance.net Free-market capitalism has brought unimaginable innovations to mankind in the last 200 years, more so than any other economic system in the history of the world: airplanes, telephones, personal…

Source: Death of the Great Laboratory of Clinical Medical Science – Private Practice

This Physician Declined to Do MOC. See What Happened to Her

The American Board of Medical Specialties says “.” This is echoed by my board, the American Board of Pediatrics, who says, “Board certification is a voluntary process that goes above and beyond state licensing requirements for practicing medicine.”

Over the past few years, the definition of “board certified” has changed from a one-time test to an ongoing series of tests, hoops, and fees to maintain certification through the MOC program. Not participating in any portion of the convoluted and expensive MOC program results in loss of board certification, but so what? Board certification, either as initial certification or 20 years into maintaining certification is voluntary, so what’s the big deal?

Well, it turns out, not complying with MOC is a big deal. Not only has the definition of “board certified” changed, apparently so has the definition of “voluntary.”

Source: This Physician Declined to Do MOC. See What Happened to Her

Physician Shortage: An Alternative View by the Numbers | Robert Nelson, MD | LinkedIn

LW439-MC-Escher-Waterfall-19611For the sake of brevity, I am not going to show my math.  Trust me, I’m a doctor!  Here are the average panel sizes based on the assumptions above using 2012 census data.

  • FP/GP = 1,041 patients per doc
  • IM/IM-Peds = 464 patients per doc
  • Pediatrics = 552 patients per doc
  • Ob-Gyn = 642 patients per doc
  • Geriatrics = 1,237 patients per doc (this was tough to estimate, maybe way off)

Take a close look at the patient panel sizes.  Yes, they are derived from raw data and don’t represent actual practices, but they do represent every single individual via census data that were represented in the categories that I used.  Why are they so much lower than the “average” U.S. primary care doctor patient panel numbers we see quoted so often?  The panel sizes would be larger if we count those with more than one doctor, but that would be a wild guess.  But, that effect is dwarfed by the fact that I assumed every single American in the age/gender categories that I used has a personal physician, which we know is not the case. There is the issue of uneven distribution of doctors, with more in urban/suburban area compared to rural areas, tending to skew sampling surveys to higher panel sizes.  The other sampling bias of surveys may be web presence of the practice.  Again, these practices are easier to locate and contact; which might also account for why they have larger patient populations.

So it the physician shortage real?  I don’t know.  I do know access to supply is out of balance and we can do much better with some efficiency enhancers.

Source: Physician Shortage: An Alternative View by the Numbers | Robert Nelson, MD | LinkedIn