The Great Debate

iPhone app makes doctors iRate

vox– Ford Vox is a medical journalist and a physician. The opinions expressed are his own. –

That iPhone 3G you’re packing comes with a truly killer app: one guaranteed to hurt your relationship with your doctor if you use it to secretly tape your appointments.

That’s what happened recently inside one Washington state hospital, according to the irate physician, who complained about his experience to colleagues on Sermo, an MD-exclusive social network.

Dr. Anonymous examined a woman recovering from surgery to see if she needed rehabilitation. He found signs his new patient might not handle all the therapy that goes along with a spot in a rehab hospital. After discussing her choices for about 15 minutes, Dr. Anonymous discovered that the patient’s daughter’s iPhone displayed a metering bar moving as he spoke. “I had no idea I was being recorded,” he wrote.

Fellow doctors chimed in with near unanimity: call the hospital’s risk management officer, call your malpractice carrier, and fire that patient! While it’s a rare event, doctors can “fire” any patient from their care after supplying 30 days notice and a referral.

A faulty prescription for reform

– Dr. Steffie Woolhandler is a co-founder of Physicians for a National Health Program, an organization of 17,000 doctors who support single-payer national health insurance. She is a professor of medicine at Harvard Medical School and co-director of the school’s General Internal Medicine Fellowship program. The views expressed are her own. —

President Obama, at today’s summit and in his proposal earlier this week, has embraced a deeply-flawed bill – the Senate bill – as his model for reform.

That bill would leave about 24 million people uninsured in the year 2019, according to the Congressional Budget Office. Leaving 24 million people without health insurance is neither “universal care” nor even serious reform. As my research team has recently shown, that 24 million uninsured people would translate into about 24,000 unnecessary deaths annually. As a doctor, I find that prospect completely unacceptable.

Your health plan’s Toyota complex

 Ford Vox is resident physician at Washington University School of Medicine’s neurology department.

– Ford Vox is a medical journalist and a physician. The opinions expressed are his own.–

A trade group by the name of America’s Health Insurance Plans began the week with oddly revealing rhetoric against a key proposal under debate at the health care summit today – controlling insurance premium hikes. Obama’s proposal “would be like capping the prices auto makers can charge consumers, but letting the steel, rubber, and technology manufacturers charge the auto makers whatever they want,” said Karen Ignagni, AHIP’s president.

Ignagni’s analogy shifted blame onto doctors and hospitals — the rubber and whatnot — but her analogy is apt in one way – we’ve got to pay attention to where the rubber hits the road. Relying on face-to-face relationships and earned trust, doctors are better poised to control costs than any federal agency or insurance company. Family practice doctors, who wield the referral, are the key to reigning in the excessive outpatient specialist care that accounts of much of the waste in American medicine. But they need some skin in the game.

Massachusetts vote a referendum on health care reform

Trudy Lieberman, a long-time health care and consumer journalist, is a contributing editor to the Columbia Journalism Review and has blogged about health care for cjr.org since the beginning of the presidential campaign. The views expressed are her own.

A few year’s back, a joke on the cocktail circuit went like this:  you know the world is  topsy-turvy when the best rapper is white; the best golfer is black, and the Germans don’t  want to go to war.  Tuesday’s vote in Massachusetts that sent Republican Scott Brown to the Senate taking over the seat held by Edward Kennedy for nearly fifty years produced a new twist to the old joke.

Things are indeed upside down when the advocates for a single-payer, national health insurance system supported a Republican.  On Sunday, one of those advocates, Diane Cooper Bridges, sent a letter to the president and to his adviser David Axelrod saying:

America’s perennial Vietnam syndrome

cfcd208495d565ef66e7dff9f98764da.jpg –  Bernd Debusmann is a Reuters columnist. The opinions expressed are his own. –

Prophetic words they were not. “By God, we’ve kicked the Vietnam syndrome once and for all…The specter of Vietnam has been buried forever in the desert sands of the Arabian Peninsula.”

Thus spoke a euphoric President George H.W.Bush early in March, 1991, shortly after the 100-hour ground war that chased Iraqi forces out of Kuwait, the oil-rich U.S. ally they had invaded and occupied in the summer of 1990.

from Rolfe Winkler:

A healthcare failure could save Obama

The rising costs of Medicare and Medicaid threaten to destroy the nation's fiscal future, but President Obama is pushing for healthcare reform that would increase costs. Instead, he should refocus his presidency on paying down debt.true-national-debt-updated1

America's obligations over the next 75 years now surpass $62 trillion, up 8 percent since last year. And a new report released today by the Peterson Foundation suggests that total will go even higher if the House's health care legislation is passed.

(Click table to enlarge in new window)

With today's pliant bond market, it's easy to pretend we can have things that can't be paid for. But that's the kind of attitude that led California into the fiscal abyss. We have to get serious about bringing our expenses in line with our income. Now.

from Commentaries:

Debt on autopilot

At first glance this week's budget projections paint President Obama as a spendthrift. The White House itself offered a grim glimpse of a future in which U.S. debt more than doubles to $17.5 trillion in a decade -- an increase of nearly $10 trillion.

Merely servicing the U.S. debt will cost more than America currently spends on either defense or social security.

But the yawning deficit can't be blamed on Obama -- or for that matter, on Bush or on the financial crisis. Instead the government's finances are locked on autopilot, with entitlement programs driving the country towards a fiscal crisis.

from Commentaries:

Deficit hypocrisy

There's something scary about big numbers. It's one reason we in the media often like to put the biggest number we can find into a headline.

So it was no surprise that most media outlets went gaga over the Obama administration's projection that the nation's debt will grow by $9 trillion over the next decade. And sure enough, critics of the administration's efforts to reform healthcare were quick to seize on that scary number as another reason to advocate doing nothing.

But without wading into the muck of the current debate over healthcare reform, it's worth taking stock of just how much hypocrisy there is when it comes to the subject of government spending and those big bad deficits.

Is a public health insurance option essential?

The debate over healthcare reform heated up this weekend when a top U.S. health official called into question the government-run health insurance option favored by President Barack Obama.

Health and Human Services Secretary Kathleen Sebelius
said on Sunday a public option was “not the essential element” of any overhaul, and that non-profit cooperatives being considered by a Senate panel could also fulfill the White House goal of creating more competition on insurance.

Democratic dissenters of this view come out in full force.

“You can’t have reform without a public option,” Howard Dean, a former Democratic National Committee chairman and a vocal supporter of an overhaul, said on CBS’s “Early Show.”

“I don’t think it can pass without the public option,” Dean said. “There are too many people who understand, including the president himself, the public option is absolutely linked to reform.”

Fixing health care

morici– Peter Morici is a professor at the Smith School of Business, University of Maryland School, and the former Chief Economist at the U.S. International Trade Commission. The views expressed are his own. –

American health care is broken.

At 16 percent, the United States spends a much larger share of GDP on health care than Western European economies. Yet the United States has about 45 million uninsured, while its peers do not.

Many Americans between 50 and 65 cling to jobs they don’t want simply to keep health benefits. Their European cohorts are not so constrained.