On 08/31/09 16:45, Darren New wrote:
> Neeum Zawan wrote:
>> My guess is that the oversight for Medicare is not as good (I wouldn't
>> know, though).
>
> Or maybe that medicare tends to cover the people old enough to have lots
> of things that might be causing their symptoms.

	Well, no. In some locales the Medicare cost is a lot more per patient - 
and it's not always due to different lifestyles/worse/better health:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

	Two counties - similar demographics, similar health stats. One much 
more expensive than the other. He focuses on those two, but occasionally 
talks about the general issue across the country. These aren't 
necessarily nasty doctors just trying to exploit Medicare:

"It was a depressing conversation—not because I thought the executives 
were being evasive but because they weren’t being evasive. The data on 
McAllen’s costs were clearly new to them. They were defending McAllen 
reflexively. But they really didn’t know the big picture of what was 
happening.

And, I realized, few people in their position do. Local executives for 
hospitals and clinics and home-health agencies understand their growth 
rate and their market share; they know whether they are losing money or 
making money. They know that if their doctors bring in enough 
business—surgery, imaging, home-nursing referrals—they make money; and 
if they get the doctors to bring in more, they make more. But they have 
only the vaguest notion of whether the doctors are making their 
communities as healthy as they can, or whether they are more or less 
efficient than their counterparts elsewhere."

>> Dentists are probably more famous for this. I don't know the
>> prevalence for (other) doctors.
>
> It's also a judgement call. I've had my dentist say "You have a small
> cavity. Let's wait to see if it is getting bigger before we fill it."
> Would filling the small cavity be "wrong"?

	For small numbers, sure. But one dentist saying 8 and the other saying 
none? That's a bit too drastic to simply account for judgment calls. The 
second dentist _did_ see some potential cases, but he suggested that if 
I took good care of my teeth, they won't need to be filled. Also, some 
of those would require quite a lot of drilling just to fill the cavity, 
which didn't seem worth the trouble for what was (and still seems to be) 
a minor problem.

	There is a cost (nonfinancial) to filling a cavity. Just because you 
have a small cavity doesn't mean filling it is the best thing to do at 
that point.

-- 
Bozone (n.): The substance surrounding stupid people that stops bright 
ideas from penetrating. The bozone layer, unfortunately, shows little 
sign of breaking down in the near future.

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