Jeremy "UncleHoot" Praay wrote:
> It's similar in hospital situations.  The doctor can be 99% certain that
> you don't have cancer (which is good enough for me), but because of that
> 1% uncertainty, he has send you to have test after test, just to make sure
> that he doesn't get sued by you for missing some step along the way. 

On malpractice:

http://photos-a.ak.fbcdn.net/hphotos-ak-snc1/hs134.snc1/5729_136982164496_20950654496_2232000_7359633_n.jpg

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On 31-8-2009 22:21, Jeremy "UncleHoot" Praay wrote:
> "andrel" <a_l### [at] hotmailcom> wrote in message 
> news:4A9### [at] hotmailcom...
>> Another factor that you did not include is the professional standard of 
>> doctors. In general they won't do unnecessary procedures. Those few that 
>> do and are found out are kicked out of the profession. Not because of the 
>> fraud, though that is a factor, but for unprofessional conduct.
>>
>> The trick of insurance is to punish those who let unnecessary procedures 
>> happen. If your car insurance pays such bogus repairs as in your example, 
>> it has to raise the amount people have to pay for the insurance. That will 
>> result in people going to other companies and there fore a loss of money. 
>> Another thing is that regularly someone brings a car with the same problem 
>> to different garages and publishes what they charge. Most firms don't like 
>> it when they appear in a paper showing that they charge 10 times a much 
>> than a competitor.
>>
> 
> Actually, there were no "bogus" repairs in my example.  The "spec" 
> (specification) for rotors pretty much requires that you get your rotors 
> replaced, perhaps every 5 years or so.  Realistically, they can last much 
> longer, but the lawyers get involved and due to some lawsuit have made the 
> spec state that the rotors must have less than X millimeters or wear.  I'd 
> love to have the ability to say, "Thanks, but I'll take my chances," but 
> it's not an option.  They cannot do a brake job without swapping out the 
> rotors too, but they can send me on my merry way without replacing my 
> brakes.  Doing so would open them up to a lawsuit (at a minimum) and 
> possibly criminal negligence, if I somehow died as a result.
> 
> It's similar in hospital situations.  The doctor can be 99% certain that you 
> don't have cancer (which is good enough for me), but because of that 1% 
> uncertainty, he has send you to have test after test, just to make sure that 
> he doesn't get sued by you for missing some step along the way.
> 
> Obviously that's where the lawyers come in, that I initially referred to. 
> But my original point is that we'd still be up in arms, if our insurance 
> wasn't paying for it.  Whether it's a private insurance company, or 
> government footing the bill, we could care less.  Give me every test out 
> there, because I want to be absolutely certain that I don't have cancer.  In 
> fact, test me every year.  I don't care because I'm not paying for it (so we 
> say).
> 
> Would a co-op help in this example?  It could help to some extent, but I 
> really don't think it would have a huge impact.  Whether we pay out of our 
> pockets (directly), or pay an insurance company (indirectly), or a co-op, I 
> think we're still stuck in this same mentality.  Add to that the malpractice 
> issues, and it's greatly compounded.  I really don't know how we could get 
> out of this short of some legislation that people would consider "insane". 
> If some new machine that costs 50 million dollars will save 10 lives per 
> year, then we have to have it, and we demand that our insurance pay for it. 

My point was that if you organize it in such a way that people don't 
feel the pain you have implemented it wrong.
Your other point is IMHO simply that you have let things go out of hand 
and now the lawyers are dictating what happens in hospitals and not the 
doctors (who have taken an oath and have professional standards) nor the 
patient (who has the most to gain or loose). So don't blame the doctors 
or the people that try to reform health care and start solving the real 
problem.
Suggestion: here it is in most cases illegal for a lawyer to do a case 
on a 'no cure no pay' base. Try that for starters. I am pretty you won't 
be able to pass a law like that because some of those who did such cases 
have enough money to influence a couple of re-elections. Therefore I 
suggested that you may have to start with freeing your political system 
from 'gifts' by companies and wealthy people.

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On 08/31/09 14:43, andrel wrote:
> Yet I simply don't want the dentist to pull my teeth if not absolutely
> necessary. Moreover preventive medicine is also insured. In fact you can
> pretty much get away with not insuring for extensive dental work because
> a checkup every 6 months or so will prevent that from happening in most
> cases.
> Another factor that you did not include is the professional standard of
> doctors. In general they won't do unnecessary procedures. Those few that
> do and are found out are kicked out of the profession. Not because of
> the fraud, though that is a factor, but for unprofessional conduct.

	Over here, it's not rare for dentists to do unnecessary procedures. I 
hadn't gone to a dentist in about a decade, so I thought my teeth may be 
in bad shape (no symptoms, though). The first dentist I went to said I 
needed 10 cavities filled. I did 2. Then I went to another dentist. He 
looked at the X-Ray and said I didn't need any more.

	Mine is not the only story when it comes to dentists. That I was 
covered by insurance may well have been a factor...

	And I do know of doctors doing lots and lots of "unnecessary" tests. 
The thing is, they're not really unnecessary in that the patient has 
symptoms, and it may be a certain condition (albeit an unlikely one), 
and they decide to do a test to rule it out. I hear this happens more 
with Medicare (government paid) patients than with private insurance 
patients. The insurance companies have some muscle and can simply say 
"No" to excessive testing. My guess is that the oversight for Medicare 
is not as good (I wouldn't know, though).

	Dentists are probably more famous for this. I don't know the prevalence 
for (other) doctors.


-- 
DOS means never having to live hand-to-mouse

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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.

>     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"?

-- 
   Darren New, San Diego CA, USA (PST)
   Understanding the structure of the universe
    via religion is like understanding the
     structure of computers via Tron.

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On Mon, 31 Aug 2009 16:43:03 -0500, Neeum Zawan wrote:

> 	Over here, it's not rare for dentists to do unnecessary 
procedures. I
> hadn't gone to a dentist in about a decade, so I thought my teeth may be
> in bad shape (no symptoms, though). The first dentist I went to said I
> needed 10 cavities filled. I did 2. Then I went to another dentist. He
> looked at the X-Ray and said I didn't need any more.
> 
> 	Mine is not the only story when it comes to dentists. That I was
> covered by insurance may well have been a factor...

Similar case here, no cavities but about 10 years since my last visit 
when I started going again this year (and that was only because of 
headaches that seemed localized in my jaw - turns out they were tension 
headaches - something my dentist suggested I check into).

I really like my dentist, but he's tried several times to get me to agree 
to a gingevectomy and/or facings on my teeth.  Purely cosmetic stuff, 
which he agrees isn't absolutely necessary, but he keeps trying to 
"upsell" these to me, even though he wouldn't do the procedures.

I'm going to have to suggest that he stop the attempts to upsell stuff I 
don't want the next time I see him.

Jim

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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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