Why are medical tests so expensive? (1 Viewer)

[Joseph DeMartino]

This would probably do little or nothing. The fraud and waste in government often comes at much lower levels than senators and representatives, and new people are under no less pressure to bring home the pork than those who have served for a long time.

Most congressmen and senators who leave office go to work as high-price lobbyists, trading on their connections and their familiarity with the legislative process to help their clients. Term limits would just increase the available pool of well-connected lobbyists with insider knowledge of the system. How is that a good thing?

As I said, most of the corruption, fraud, waste and abuse isn't even at the federal level. You're being nickled and dimed to death by your city council, your county commission, your state senators and representatives. Not to mention the public services commission and the planning and zoning board.

And the inefficiency of government is, in the main, inherent. Because the government has to take into account the needs, wants and desires of all sorts of people anytime it does anything, and because it cannot discriminate in the most neutral and begnign sense of the word (simply "to choose among") it can't be efficient. If I run a soup kitchen or a half-way house for drug addicts or any other charity, I can establish and enforce house rules. If you break them I can kick you out and refuse to readmit you. If I'm administering a goverment program chances are I can't throw you out, or can only do so after some long administrative hearing process, and that even if I do you can probably sue to get back in. Private charity has the option (the tool, really) of withholding help from people who don't obey the rules - which sometimes motivates them to get their acts together. Government isn't allowed to do this.

The way to eliminate government waste, fraud and abuse is to let government do fewer things. If government isn't running it, it can't screw it up.

Regards,

Joe

 

[Chu Gai]

Well yeah Joe, but I'd still like to see term limits! Happy New Year.

 

[Dome Vongvises]

First word that came to mind was idiots.

 

[Joseph DeMartino]

I'm sorry, but I don't follow this at all. What made you think of the word "idiots"? The government? The people pressuiring it? The people served by government programs? Me, as author of the statement? All of them are directly or by implication involved in both the entire quotation and the part you hightlighted, so "First word that came to mind was idiots. " leaves the reader with no idea who you are talking about.

Could you clarify?

Thanks,

Joe

 

[PhillJones]

Actually, where you were lucky was to be living in Massachusetts. Ma recently became the first US state with universal (in principle) healthcare.
http://www.nytimes.com/2006/04/05/us...rssnyt&emc=rss

Even before this, they had a fund for cases like yours. This enables doctors to take the attitude that they don't care about the money, only the medicine. Not every state has this. If you lived in Texas for example, (my wife's home state) you'd not have got the surgery. in many states, you can get free emergency room treatment, they stabalize you and out the door you go.

Massachusetts is a utopia of healthcare by comparison to almost everywhere. There are many complex reasons for this that may not be duplicable in other states.

 

[Jeff Gatie]

I didn't live in Massachusetts, I lived in Pennsylvania. I also could have gone to Maryland. That aside, the reason Mass is a "utopia" for medicine is that some of the finest hospitals in the world are located in Mass (aside from Johns Hopkins, that is). Mass General, Children's, Brigham and Womens, Shriner's Burn Institute, Tuft's, Mass Eye and Ear, etc., all "teaching" hospitals that allow for the care of individuals to come first, regardless of insured status. In case anyone didn't know it, the leeway institutions such as these have in distributing care and (especially disconcerting) providing specialized education would have been eliminated under previous federally funded healthcare proposals. Layman's translation - More funding for general practitioners, less funding for special treatment and no ability to decide for themselves who gets what type of care without going through the government system (with harsh penalties issued for those who do not comply).

No thanks.

 

[Marianne]

Another cost issue is that it is in the financial interest of doctors/hospitals to treat patients. The more tests they order the more money they make. The more prescriptions they write the more money they make. The more things they find wrong with a patient the more money they make. (Except in Massachusetts!)

I realize that this is partly driven by "possible" litigation so who can say what the solution is.

 

[Joseph DeMartino]

Doctors don't make more money by ordering tests or writing prescriptions. The labs and the hospital make the money, and the pharmacies and the drug companies.

Are you seriously suggesting the doctors "make up" disease or "find" problems that aren't there just to make money? So, the entire medical establishment is corrupt, filled with human beings who will ignore evidence and their scientific training if there is something in it for them. But move these same corrupt individuals onto the government payroll and they're magically transformed into ethical paragons who have only the interest of their fellow persons at heart - just like all the other people who work for the government.

Ha!

Among other things, no doctor I know has time to pull this crap. You spend some time around residents - or worse, interns - and see how many extra tests and procedures they want to screw around with. Show me a doctor at a clinic or an urban hospital who barely has time to dictate her notes and I'll show you someone who is not eager to add to her own crushing workload.

It is easy to be cynical. It is easy to stand on the outside throwing rocks. It is easy to blame the people who are actually trying to get the job done despite all the obstacles that the lawyers and the government and insurance companies put in their way. It is much harder to come up with practical solutions to the problem that are based on real-world facts instead of gassy theories and failed paradigms from other countries that are desperately trying to figure out how to fix their own collapsing systems.

Regards,

Joe

 

[Jeff Gatie]

Yeah all those corrupt doctors out there are taxing the system. Like my horrible surgeon who, along with my current eye doctor, spends a few months in Lebanon every two years to treat retinas and corneas for free. And not to get too political, but my current eye doc is Jewish and he still goes to the Middle East to perform this greedy and selfish act. They should all be drawn and quartered. Jeez, even the most loathesome plastic surgeons making millions are called upon to rebuild a disfigured face once in a while. Let's cut these guys some slack, huh? They work their ass off for years, only to be crippled by student loans, malpractice insurance, 24 hour shifts, etc., and they have the nerve to cash in and make some money for talents that approach superhuman in nature? How dare they!

 

[PhillJones]

Why thank you. (I'm a researcher at MGH)

That's at least part of the reason, and a good chunk of why the hospitals are so wealthy (that and their highly paid investment portfolio managers) but there has been an established pool of money to treat the uninsured in Ma for some time now, a situation which doesn't exist in all states. Your situation may have been different, they may have treated you because they were interested in your eyeballs but most people don't have interesting diseases, just your boring old diabetes induced kidney failure or some such.

A very good friend of mine helped negotiate the new Ma health care bill. The politics and economics of health care in the states is both insanely complicated and deeply disturbing.

Marrienne is somewhat overstating the issue when she accuses doctors of making up diseases so they can treat them although under some conditions, doctors are paid per procedure. There's also the heavy marketing of proprietary prescription drugs, often when the evidence that they're any better than the generic simply isn't there (REF: Marcia Angell, MIND seminar series, MGH), their participation in continuing medical education meetings (CME) has been criticized recently (REF:Arnold Relman, op-ed piece in NEJM). There's also the marketing of drugs to patients which although solid arguments do exist to give patients more control, some practices go too far and many believe are leading to over-prescription of certain classes of drugs. (REF: Marcia Angell).

Reining in the power of the drug companies would do a lot to bring down the cost of health care perhaps.

 

[Jeff Gatie]

Yeah, the marketing of drugs is positively insane. My mom is an RN (Boston City Hospital, Class of '55) and still works 3 days a week at age 73. She not only gets just about any script she needs from the samples left at her clinic, she gets to eat out 2-3 times a month at fine establishments for drug "seminars" and has lunch delivered on a weekly basis by drug reps.

 

[Greg_R]

I have to get MRIs of my head every few years and they run $5500... you are getting away cheaply

 

[Dome Vongvises]

It was more or less explained by your soup kitchen example. I just substituted the words idiot for drug-addicts.