<p>^I hear you NYMomof2. And I don’t mean to demonize docs or hospitals (well, maybe hospitals). I’m just making the point that health insurance and pharma employ a lot of folks, educated folks with good incomes who pay a LOT of taxes, don’t pollute environment and actually do positively impact health in some major ways. Yet they are scapegoated routinely as the culprits in all this mess.</p>
<p>Also, whether we like it or not there has been very special treatment of the doc in this country for generations. Medical school admissions is carefully limited so that there is always a shortage. Training is expensive and contingent of completing an undergrad curriculum (unlike much of Europe). There is very little government assistance with tuition. All this creates huge barriers to entry into a profession that we clearly need more of, not less of. And yes, our docs earn a lot more than their counterparts in other countries. That’s why so many foreign docs try to come here. </p>
<p>If we want to bring down the overall costs of care, we really need to take a look at how we produce our doctors and how we compensate them. As for the hospitals, I really do think they are outrageous bandits.</p>
<p>NYMomof2, I love your posts. Did I say that already? :)</p>
<p>" Two reasons. He has not saved for his retirement or for his two children’s college education, because both are provided under the German system"</p>
<p>Do UK doctors also have their retirement and kids’ college education provided for? I am curious.</p>
<p>cbreeze, yeah…the cost of medical school is pretty amazing.</p>
<p>It’s not always a matter of “dying.” It’s how to live. As I said, my mom is in her 80s and had more than $50,000 of testing and procedures in the last three months. That care wasn’t intended to keep her alive and there was no question of changing her life in any meaningful way because of other problems. It was done because it could be done. No consideration given to the fact that it wouldn’t change anything. The best outcome was always clear, to manage her pain and coordinate her meds. Nothing changed about that from before to after, except that the money was spent, family members lost days at work to take her, and she is more tired.</p>
<p>“In my experience, dstark, most people in their 80’s are not at all interested in dying soon!”</p>
<p>Yeah…I went to a funeral of an 82 year old. His daughter told me a day before he died of a terminal illness, and he knew he was dying, a story. She said her father told her, “I want to go play tennis”. He was serious. He had his mind. He was very bright. The guy could not get out of a chair.</p>
<p>sewhappy, I couldn’t agree more about the artificial shortage of doctors and the barriers to entry into the profession. Medical schools are horrendously expensive and students who don’t have families who can pay have no choice but to take out huge loans (except for a few programs trading medical school tuition for service in the military or in underserved areas). We also have to make better use of physician’s assistants, nurse practitioners, etc.</p>
<p>I think that the current system of developing and marketing pharmaceuticals is unsustainable and comes with bad consequences. For example, there is a doctor in Boston who has very positive results treating diabetes with a commonly available vaccine (for TB, I believe). This treatment may actually restore function to the pancreatic cells. But there is no incentive for drug companies to do clinical trials on this drug, which is very cheap. </p>
<p>And is no one but me upset that pharmaceutical companies make huge profits on drugs that have been, in many cases, developed in universities using NIH research funds? NIH makes no money on patents coming out of the research it funds. </p>
<p>I don’t think there’s any room for profit in healthcare. Health insurance and pharmaceutical companies may provide nice, clean jobs for educated people, but is that really enough justification for their existence?</p>
<p>Thanks, dstark! I love your posts, too, and hanna’s, and zm’s, and JHS’, and many others’. </p>
<p>dstark, my father died at 79, with serious heart disease, mild Parkinson’s, painful neuropathy that made it very hard for him to walk, and a few other assorted maladies. Shortly before he died, he said that except for the neuropathy, he felt like a million dollars. Fortunately, he had no dementia.</p>
<p>Oh my, NYMomof3, we part company when it comes to pharma.</p>
<p>Do you really think that colleges or the NIH are going to fund the basic early phase discovery and clinical trials required by our very own FDA for getting a drug approved? It runs around a billion bucks. I guess if you want to double your fed taxes then maybe we could fund that all through universities and the NIH. But even if you got that, you’d be captive to the government deciding which compounds to study, which diseases to go after, etc. What we have instead is a profit margin for companies to take on huge risk to sink huge sums into studying and occasionally – something like 1 in 300 compounds even makes it to human trial – getting it approved and on the market. Of course then, you have to compete with generics which are well over half the market now. </p>
<p>Going back to the Kaiser piece, drugs are 10 percent. Yet if you think about it, drugs are extraordinarily effective at driving down overall health care costs.</p>
<p>We all think of the docs as Marcus Welby or George Clooney and drug and insurance companies as evil corporations. It really is amazing.</p>
<p>The best outcome was always clear, to manage her pain and coordinate her meds. Nothing changed about that from before to after, except that the money was spent, family members lost days at work to take her, and she is more tired.</p>
<p>Bet if you took a look at the hospital bill it’s a doozy. So some folks earned a pretty penny.</p>
<p>sewhappy, I believe that the NIH system would lead to much better decisions about which drugs to pursue than the private pharma system (driven only by the profit motive). (Colleges are not going to fund any research; they get research dollars from NIH or NSF.) I’d be happy to be “captive to the government deciding which compounds to study, which diseases to go after, etc.” - because do you know who makes these decisions about NIH research funding? Peer review panels composed of scientists in the field. It’s not a perfect system, but it works much better than the profit-driven incentive model. Who do you want making decisions about which directions to pursue in drug development? Eminent scientists or Wall Street??</p>
<p>And NIH is funding much basic early phase research and some clinical trials. Unfortunately, the NIH budget is being squeezed these days and it is currently not able to fund even basic research.</p>
<p>I did look at all of the bills. I was upset from the get-go about this. Not because I don’t love my mother but because the specific testing was completely incidental. She believes one has to accept doctor recommendations, the doctor believes he has to catch every possible eventuality, no matter how remote. Which does not work well together.</p>
<p>I respectfully think sometimes people (i.e., my mother) need to be told: “You’re 82, have your wits about you and have a life worth living. There are discomforts and limitations that come with getting to your age, which is a great thing since prior generations didn’t get to your age, and you are just going to have to accept that even modern medicine can’t make you 50 again.”</p>
<p>dstark, I’m not sure about the UK situation for doctors, but I believe that it is more like the German system than like ours.</p>
<p>I agree, zm, that there is much overtreatment in our system. Most of it is out of a desire to do something, anything, to help a patient, some of it is out of the profit motive. The medical system is moving toward evidence-based medicine (as someone brought up earlier in the thread), in an effort to reduce this.</p>
<p>I’ve worked on NIH funded research at a number of universities. My DH has served on many NIH review panels for grant funding. We have friends in the FDA, the NIH, at Universities, in Biotech and in Pharma.</p>
<p>You would not believe the politics and personal vanity that goes into many an FDA or NIH “decision.” For example, in the papers just this week is a longterm huge study showing that being slightly overweight is protective and actually lessons our risk of death. My DH knows the NIH researcher who ran this study and she’s been trying to get it publicized for years and another very prestigious researcher at a very elite university with endless huge NIH grants in his career has simply not allowed her research to go forward because it does not correlate with his own hypotheses.</p>
<p>You seem to think those in government health care positions or at universities are saints! They are human beings with egos and greed and power complexes just like all humans. Some are also wonderful. It’s a mixed bag.</p>
<p>What is scary is to contemplate a world in which all the money and all the decisions were concentrated in one entity. I know so many think that will be utopia. I think it will be terrifying.</p>
<p>sewhappy, I have been principal investigator on a major NIH grant for 19 years, and I have been on 42 NIH review panels and 4 DOE review panels. So I have some experience here. I don’t think that everyone involved in these decisions (not “government health care positions,” but scientists mostly from universities) is a saint; as I said, the system is not perfect. But most of the time it works reasonably well. And I have much more confidence in the motives and capabilities of scientists to make these decisions than I do in those of bean counters .</p>
<p>" For example, in the papers just this week is a longterm huge study showing that being slightly overweight is protective and actually lessons our risk of death"</p>
<p>Really? Why do you think we are living so much longer? Aerobics? It’s the drugs.</p>
<p>And I hate to be snarky, but 19 years is awfully long for an NIH study. Was there an end point? An actual finding. What breakthrough is it exactly that I can thank you for?</p>
<p>After all, everything funded by NIH is wonderful.</p>
<p>sewhappy, the grant was funded multiple times, for 4-5 years. There were many published findings on a number of topics. It was not a single study; each 4-5 year funding period led to at least 10 publications. It is not unusual for NIH grants to be renewed multiple times; renewal applications compete with other renewals and new applications. </p>
<p>You are being snarky, and it is clear that you don’t know much about the NIH system.</p>