Health Culture Daily Dose #7

Posted by on @

In today’s Dose:

Health care reform
(Public health insurance option, Congressional Budget Office, Optimism in the White House, Doctors and reform, Doctors pay)

The Medical profession
(What doctors earn)

Health care reform

  • Paul Krugman, in the New York Times, writes about health care today with his usual intelligence and trenchant prose. His argument: Democrats who oppose the public option could torpedo reform that the public clearly wants.

What the balking Democrats seem most determined to do is to kill the public option, either by eliminating it or by carrying out a bait-and-switch, replacing a true public option with something meaningless. For the record, neither regional health cooperatives nor state-level public plans, both of which have been proposed as alternatives, would have the financial stability and bargaining power needed to bring down health care costs. …
… Senator Ben Nelson of Nebraska initially declared that the public option — which, remember, has overwhelming popular support — was a “deal-breaker.” Why? Because he didn’t think private insurers could compete: “At the end of the day, the public plan wins the day.” Um, isn’t the purpose of health care reform to protect American citizens, not insurance companies? …
Honestly, I don’t know what these Democrats are trying to achieve. Yes, some of the balking senators receive large campaign contributions from the medical-industrial complex — but who in politics doesn’t? If I had to guess, I’d say that what’s really going on is that relatively conservative Democrats still cling to the old dream of becoming kingmakers, of recreating the bipartisan center that used to run America.

[T]hese projections didn’t include the savings that a public option would generate by negotiating lower drug prices, doctor fees, and hospital costs, and forcing private insurers to be more competitive. Projecting the future costs of universal health care without including the public option is like predicting the number of people who will get sunburns this summer if nobody is allowed to buy sun lotion. Of course the costs of universal health care will be huge if the most important way of controlling them is left out of the calculation.

The post takes form of a letter to the President and makes six points: Go to the nation; Be LBJ; Forget the Republicans; Insist on a real public option; Tax the wealthy; and Put everything else on hold. It’s signed “Your obedient servant.” Obama has listened to Reich’s economic advice in the past. Maybe this time …

  • But maybe Obama already is acting in a way Reich would approve.

Mr. Obama now rarely lets a day pass without pushing the case for broad-based change. His cool-headed analysis is increasingly sprinkled with impassioned rhetoric. “If we do not fix our health care system,” he told the American Medical Association on Monday, “America may go the way of G.M.”

Kathleen Sebelius, secretary of health and human services, says she’s been impressed by Obama’s “absolute focus on the fact that this is a moment — we’re not going to lose this moment.”
This is from a New York Times piece from last Thursday that sums up the current situation. The general consensus: the White House is surprised at how well things are going. Could this simply be a strategic front, as in a poker game?
The article has a nice list of the factors that have converged at this time to make health care reform a real possibility:

Democratic control of the White House and Congress; the exasperation of big business and consumers with uncontrollable health costs; heightened economic insecurity during the recession; the Massachusetts model for achieving near universal coverage; Mr. Obama’s determination that health care is central to economic recovery; the presence of health care enthusiasts at the helm of key Congressional committees; and even Senator Edward M. Kennedy’s battle against brain cancer.

  • Jim Jaffe, a former Congressional staffer, has a piece at The Huffington Post about the role of doctors in health care reform. He argues that things have changed since the last time doctors resisted the government’s efforts to reform health care.

[C]hange is inevitable and the only question for physicians is whether they’ll help drive or risk becoming road kill. … Doctors are being asked to gamble about the future, something they often do in making treatment decisions. The Administration is betting that they’ll ultimately conclude that joining the process and trying to influence it, both now and later, is the best of the imperfect options they face.

  • The topic of the most recent Room for Debate column in the NY Times is “Doctors’ Pay, a Key to Health Care Reform.” There are pieces by Elliott Fisher of the Dartmouth Atlas, Kevin Pho of Kevin MD, the president of the AMA, two physicians who are professors at Harvard Medical School, among others. I was struck by one of the many comments to this page — this one from a doctor — on palliative care at the end of life:

The elephant sitting squarely in the middle of our US health care reform room is the nasty “R” word or rationing.
Viewed as an untouchable third rail for politicians, we the American Citizens must flesh it out by having an open national dialogue about it.
We can no longer deny it as an imperative strategy.
My own way of framing one aspect of rationing is to say “EVERY SINGLE AMERICAN CITIZEN DESERVES A DIGNIFIED AND AS PAIN FREE A DEATH AS IS POSSIBLE”
Rationing is indeed the issue around which we as a very young nation can finally mature.

The medical profession

  • Speaking of doctor’s pay, there’s an article in the Wall Street Journal with specifics on starting salaries for physicians coming out of residencies. The information comes from the Medical Group Management Association, and the numbers are medians – half earn more, half earn less. The medical specialties with the biggest increase in income since last year were:

Non-invasive cardiology: $400,000
Anesthesiology: $312,500
Neurology: $230,000
Emergency medicine: $215,040
These aren’t the highest incomes. The starting salary for a neurological surgeon is $605,000. Of course, if someone is operating on your brain, you might be grateful that they’re well paid.
At the bottom of the list are pediatricians at $132,500, and they’re just below doctors who practice family medicine, geriatrics, urgent care, internal medicine, and infectious disease.
Responses to the survey were voluntary, so it may not be a representative sample.

Share

Sorry, comments are closed for this post.

Skip to toolbar