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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One reason for the high cost of medical stuff is that
medicare only pays about 20% of what they are billed
for. So a doctor might order up extra tests just to
pad the bill up enough to break even money wise.

Of course they can't really bill medicare patients
5X more than others, so the costs get reflected
onto other non-medicare patients. In a lot of cases
they'll just deny medicare.

Adding more patients to a medicare-like system 
without funding it will just mean that the
percentage the doctors get paid is smaller,
and the on-paper costs higher.

Politicians are acting like a bunch of bandits that
have stolen beer from a tavern, they've drunk the 
beer, so they figure they'll go back and steal
more of it, but all the beer is gone now.

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On 1-9-2009 2:10, Neeum Zawan wrote:
> On 08/31/09 16:45, Darren New wrote:
>> Neeum Zawan wrote:
> 
> http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all 
> 
Interesting read. WRT "The decision is whether we are going to reward 
the leaders who are trying to build a new generation of Mayos and Grand 
Junctions. If we don’t, McAllen won’t be an outlier. It will be our 
future." It won't be your future, or only for a very short time. You 
simply won't be able to afford it.

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On 1-9-2009 2:10, Neeum Zawan wrote:

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

It is also a nice analysis why sometimes when everybody strives to get 
the best for themselves the whole community suffers. Very obviously at 
the level of the doctor/entrepreneur, something close to fraud already 
and where laws and regulations are possible to tip it over the edge.
More subtle at the level of the patient. It seems in every patients 
interest to get the best tests and treatment available, yet it evidently 
harms the entire community, even the patient itself. You can not 
legislate against that directly. Both because it is technically too 
difficult but more importantly it is so counter-intuitive that you can 
not pass the law by an elected body.

There are also tons of examples where looking preferentially at the 
majority will have very detrimental results. (although in the case of US 
health care specifically it seems more FUD than fact. But in other 
fields, sure).

Don't expect me or anybody else (e.g. Obama) to come up with solutions 
that always work. Common sense might be the best solution, but sense is 
not the most common thing in these health care discussions.

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On Mon, 31 Aug 2009 21:09:09 -0700, Tim Attwood wrote:

> One reason for the high cost of medical stuff is that medicare only pays
> about 20% of what they are billed for. So a doctor might order up extra
> tests just to pad the bill up enough to break even money wise.

The only way the math works with that, though, is if the extra tests 
themselves have no cost associated with them....and then it would be 
called "fraud".

Jim

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