Monday, August 31, 2009
Bill Moyers With Bill Maher
Great interview segment where Moyers makes several good points. The most important one being that we have two political parties that are both beholden to corporate interests leaving the whole of the electorate disenfranchised. I really dig his comments against incrementalism too!
The Democrats are simply craven corporatist sheep to the last one of them.
Bill Moyers Journal:
Money-Driven Medicine
http://www.pbs.org/moyers/journal/08282009/watch.html
http://www.pbs.org/moyers/journal/08282009/watch2.html
http://www.pbs.org/moyers/journal/08282009/transcript1.html
Best Bits:
DR. DONALD BERWICK: It is, I guess, politically correct, widely believed, that to say that American health care is the best in the world. It's not. There's a much more complicated story there. For some kinds of care my colleague Brent James calls it rescue care. Yes, we're the best in the world. If you need very complex cardiac surgery or very advanced chemotherapy for your cancer or some audacious intervention with organ transplantation, you're pretty lucky to be in America.
You'll get it faster and you'll probably get it better than in at least most other countries. Rescue care we're great. But most health care isn't that. Most health care is getting people with diabetes through their illness over years or controlling the pain of someone with arthritis or just answering a question for someone who is worried or preventing them from getting into trouble in the first place. And on those scores: Chronic disease care, community-based care, primary care, preventive care. No no, we're no where near the best. And it's reflected in our outcomes.
We're something like the… We're not the best health care system in the world in infant mortality rates. We're like number 23. There is an index that is used in rating health care systems, which is the rate of mortality that could have been prevented by health care. There are at least a dozen countries with lower rates of preventable mortalities than the United States and not one of those countries spends 60 percent of what we do on health care.
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LARRY CHURCHILL: We're now treating medicine as if it were an industrial product. Through put. How many units of care can you deliver? The idea that you are going to see a patient on average for between 12 and 15 minutes, no matter what their condition or how many kinds of problems they have or how complicated their diagnoses or how much reassurance they might need is an idea that you can treat medicine like a production line product and you can turn out patients in the same way like we produce widgets. That's a commercialization and an industrialization of the relationship. So this is a system which is fundamentally broken in terms of the kind of conflicts it raises in the minds of physicians and, also, in the minds of the patients.
------
MAGGIE MAHAR: What's truly staggering is how much waste there is in our health care system. Up to one out of every three of the more than two trillion dollars that we spend is wasted on ineffective, often unproven procedures, overpriced drugs and devices that are no better than the drugs and devices that they're replacing. Unnecessary hospitalizations, unnecessary tests. Now this may seem like an overstatement. I mean, how can it be that 1/3 of the money is wasted? We actually have close to three decades of research done by doctors at Dartmouth University proving how much waste there is in the system. What the Dartmouth research ended up doing was looking at health care all across the country and what they discovered is that in some high treatment states, like New Jersey, Medicare was spending 20 percent more per patient than the average. And in other low treatment states, like Iowa, Medicare was spending 25 percent less than average. They tended to focus in on what happened to patients during their final two years of life.
So in that way you're comparing apples to apples, pretty sick patients, and they began looking at sick patients who had the same disease etcetera- Finding these enormous differences in what Medicare spent. Some people said, "Well maybe patients in New Jersey are simply more demanding than the stoic citizens of Iowa." But, in fact, very few people demand a chance to spend more days in the hospital during their final two years of life. Very few people cry out for a chance to die in an ICU or to have that fourth procedure or to be poked and prodded by eleven or twelve specialists during your final six months of life. In the states where Medicare spends more, these are the things that happen to people.
They're getting more aggressive, intensive, and expensive care. And here's the stunner: The outcomes are no better. Often they are worse on average in states like New Jersey or New York or California than they are in low treating states like Iowa or North Dakota.
------
DR. JAMES WEINSTEIN: My daughter's name is Brieanna. She had beautiful blue eyes, curly brown hair; your first child, the light of your life. 13 months later I get a call from our pediatrician saying, "Could you come over to the hospital?" And I walk into the pediatrics hospital and I ask my wife what's wrong and she says, "They won't tell me. They won't tell me." The doctor walks in with about, it seems like, 10 other people other people. Very intrusive. And said, "I think your daughter has leukemia and we need to treat her, immediately."
The protocol for a treatment was very intense chemotherapy. She would lose her hair quickly. She would be sick. She would develop sores in her mouth. She wouldn't be able to eat because of sores from the chemotherapy in her esophagus. She would have all kinds of rashes. Her blood counts would be almost zero so her risk of infection would be very high. We couldn't take her any place. She had to be protected. And it sounds, "Well, that's not so bad, we can do that for a week." But the protocol was for 3 years. She did pretty well for about, I think, 2 years and then the leukemia came back. And they said, "We need to re-induce her with the bad medicines again and we have to consider brain and spinal radiation.
So spinal taps every day for three weeks." I said, "I don't get it. I mean, you just told us if we followed this protocol, these are the results. We did everything you said and it is still not working. And now you want us to do something worse." "Well, you have no choice and if you don't do that we will sue you." I said, "What?" "If you don't do what we tell you, we'll sue you."
------
MAGGIE MAHAR: If you can believe it, Rashi Fein has survived 5 decades of the battle for health care reform. In 1953 he served on President Truman's commission on the health needs of America at a time when Truman was pushing for universal coverage. Then he worked with JFK when he fought unsuccessfully for Medicare, a battle that LBJ would later win. As a professor of medical economics at Harvard, Fein has never given up. He firmly believes that medicine should not be all about money. As he puts it, "We live in a society not just in an economy."
------
MAGGIE MAHAR: A physician takes an oath to put his patient's interests ahead of his own. A corporation is legally bound to put its shareholders' interests first. And this is part of the inherent conflict between health care as a business, part of our economy, and health care as a public good and part of our society. Health care has become a growth industry. That means higher health care bills. That means more and more middle class people cannot afford health care in this country.
------
BILL MOYERS: ...And remember that television ad Barack Obama made as a candidate for president?
BARACK OBAMA: The pharmaceutical industry wrote into the prescription drug plan that Medicare could not negotiate with drug companies. And you know what, the chairman of the committee who pushed the law through went to work for the pharmaceutical industry making $2 million a year. Imagine that. That's an example of the same old game-playing in Washington. I don't want to learn how to play the game better. I want to put an end to the game-playing.
BILL MOYERS: Now look at this recent story in the LOS ANGELES TIMES. Lo and behold, since the election, the pharmaceutical industry's $2 million dollars a year superstar lobbyist Billy Tauzin has morphed into President Obama's pal. Tauzin says the President has promised not to pressure the drug companies to negotiate with the government for lower drug prices and has agreed not to allow cheaper drugs to be imported from Canada or Europe - contrary to the position taken by candidate Obama…
Each of these stories illuminates the scarlet thread that runs through Maggie Mahar's book - the story of how today's market-driven medical system gives Wall Street investors life and death control over our health care, turning medicine into a profit machine instead of a social service to meet human need. That's the conflict at the heart of next month's showdown in Washington.
------
I don't really have a comment. Just see it or read it. Amazing stuff.
http://www.pbs.org/moyers/journal/08282009/watch2.html
http://www.pbs.org/moyers/journal/08282009/transcript1.html
Best Bits:
DR. DONALD BERWICK: It is, I guess, politically correct, widely believed, that to say that American health care is the best in the world. It's not. There's a much more complicated story there. For some kinds of care my colleague Brent James calls it rescue care. Yes, we're the best in the world. If you need very complex cardiac surgery or very advanced chemotherapy for your cancer or some audacious intervention with organ transplantation, you're pretty lucky to be in America.
You'll get it faster and you'll probably get it better than in at least most other countries. Rescue care we're great. But most health care isn't that. Most health care is getting people with diabetes through their illness over years or controlling the pain of someone with arthritis or just answering a question for someone who is worried or preventing them from getting into trouble in the first place. And on those scores: Chronic disease care, community-based care, primary care, preventive care. No no, we're no where near the best. And it's reflected in our outcomes.
We're something like the… We're not the best health care system in the world in infant mortality rates. We're like number 23. There is an index that is used in rating health care systems, which is the rate of mortality that could have been prevented by health care. There are at least a dozen countries with lower rates of preventable mortalities than the United States and not one of those countries spends 60 percent of what we do on health care.
------
LARRY CHURCHILL: We're now treating medicine as if it were an industrial product. Through put. How many units of care can you deliver? The idea that you are going to see a patient on average for between 12 and 15 minutes, no matter what their condition or how many kinds of problems they have or how complicated their diagnoses or how much reassurance they might need is an idea that you can treat medicine like a production line product and you can turn out patients in the same way like we produce widgets. That's a commercialization and an industrialization of the relationship. So this is a system which is fundamentally broken in terms of the kind of conflicts it raises in the minds of physicians and, also, in the minds of the patients.
------
MAGGIE MAHAR: What's truly staggering is how much waste there is in our health care system. Up to one out of every three of the more than two trillion dollars that we spend is wasted on ineffective, often unproven procedures, overpriced drugs and devices that are no better than the drugs and devices that they're replacing. Unnecessary hospitalizations, unnecessary tests. Now this may seem like an overstatement. I mean, how can it be that 1/3 of the money is wasted? We actually have close to three decades of research done by doctors at Dartmouth University proving how much waste there is in the system. What the Dartmouth research ended up doing was looking at health care all across the country and what they discovered is that in some high treatment states, like New Jersey, Medicare was spending 20 percent more per patient than the average. And in other low treatment states, like Iowa, Medicare was spending 25 percent less than average. They tended to focus in on what happened to patients during their final two years of life.
So in that way you're comparing apples to apples, pretty sick patients, and they began looking at sick patients who had the same disease etcetera- Finding these enormous differences in what Medicare spent. Some people said, "Well maybe patients in New Jersey are simply more demanding than the stoic citizens of Iowa." But, in fact, very few people demand a chance to spend more days in the hospital during their final two years of life. Very few people cry out for a chance to die in an ICU or to have that fourth procedure or to be poked and prodded by eleven or twelve specialists during your final six months of life. In the states where Medicare spends more, these are the things that happen to people.
They're getting more aggressive, intensive, and expensive care. And here's the stunner: The outcomes are no better. Often they are worse on average in states like New Jersey or New York or California than they are in low treating states like Iowa or North Dakota.
------
DR. JAMES WEINSTEIN: My daughter's name is Brieanna. She had beautiful blue eyes, curly brown hair; your first child, the light of your life. 13 months later I get a call from our pediatrician saying, "Could you come over to the hospital?" And I walk into the pediatrics hospital and I ask my wife what's wrong and she says, "They won't tell me. They won't tell me." The doctor walks in with about, it seems like, 10 other people other people. Very intrusive. And said, "I think your daughter has leukemia and we need to treat her, immediately."
The protocol for a treatment was very intense chemotherapy. She would lose her hair quickly. She would be sick. She would develop sores in her mouth. She wouldn't be able to eat because of sores from the chemotherapy in her esophagus. She would have all kinds of rashes. Her blood counts would be almost zero so her risk of infection would be very high. We couldn't take her any place. She had to be protected. And it sounds, "Well, that's not so bad, we can do that for a week." But the protocol was for 3 years. She did pretty well for about, I think, 2 years and then the leukemia came back. And they said, "We need to re-induce her with the bad medicines again and we have to consider brain and spinal radiation.
So spinal taps every day for three weeks." I said, "I don't get it. I mean, you just told us if we followed this protocol, these are the results. We did everything you said and it is still not working. And now you want us to do something worse." "Well, you have no choice and if you don't do that we will sue you." I said, "What?" "If you don't do what we tell you, we'll sue you."
------
MAGGIE MAHAR: If you can believe it, Rashi Fein has survived 5 decades of the battle for health care reform. In 1953 he served on President Truman's commission on the health needs of America at a time when Truman was pushing for universal coverage. Then he worked with JFK when he fought unsuccessfully for Medicare, a battle that LBJ would later win. As a professor of medical economics at Harvard, Fein has never given up. He firmly believes that medicine should not be all about money. As he puts it, "We live in a society not just in an economy."
------
MAGGIE MAHAR: A physician takes an oath to put his patient's interests ahead of his own. A corporation is legally bound to put its shareholders' interests first. And this is part of the inherent conflict between health care as a business, part of our economy, and health care as a public good and part of our society. Health care has become a growth industry. That means higher health care bills. That means more and more middle class people cannot afford health care in this country.
------
BILL MOYERS: ...And remember that television ad Barack Obama made as a candidate for president?
BARACK OBAMA: The pharmaceutical industry wrote into the prescription drug plan that Medicare could not negotiate with drug companies. And you know what, the chairman of the committee who pushed the law through went to work for the pharmaceutical industry making $2 million a year. Imagine that. That's an example of the same old game-playing in Washington. I don't want to learn how to play the game better. I want to put an end to the game-playing.
BILL MOYERS: Now look at this recent story in the LOS ANGELES TIMES. Lo and behold, since the election, the pharmaceutical industry's $2 million dollars a year superstar lobbyist Billy Tauzin has morphed into President Obama's pal. Tauzin says the President has promised not to pressure the drug companies to negotiate with the government for lower drug prices and has agreed not to allow cheaper drugs to be imported from Canada or Europe - contrary to the position taken by candidate Obama…
Each of these stories illuminates the scarlet thread that runs through Maggie Mahar's book - the story of how today's market-driven medical system gives Wall Street investors life and death control over our health care, turning medicine into a profit machine instead of a social service to meet human need. That's the conflict at the heart of next month's showdown in Washington.
------
I don't really have a comment. Just see it or read it. Amazing stuff.
On the Financial Crisis
All You Need to Know
Watch CBS Videos Online
More here: http://www.cbsnews.com/video/watch/?id=5274961n
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Kroft seems at pains NOT to mention the politicians behind this insane bullshit, so here's that stuff from the comments at the above link and which checks with what I recall about it without making any further research into it right now:
I watched how you connected the dots, the mess we have with people losing their homes and the financial meltdown that was caused by "Legislation of Congress in 2000, the Commodity Futures Trading Modernization act" that opened the door to CDS's and Derivatives. The "Side Betting" that put our country at the greatest financial risk since the Great Depression. I noticed that you did NOT mention the man behind it, Phil Gramm, who introduced the bill, look a Wikipedia about Phil Gramm, aka "Foreclosure Phil". The Modernization bill, along with the repeal of the Glass Steagal Act of 1933 with the Gramm-Leach-Biley law of 1999. Pushed through by the Republican Controlled Congress, supported by Democrats and signed by Bill Clinton, and of course Alan Greenspan are the supporting architects and a Lot of their friends made "Billions" from moving money around and skimming from every working, notice the term working, man, woman, and child in America. I noticed that you DID NOT interview US Senators like Grassley and Hatch and other US Senators that were in office in 1999 and 2000, who pushed for and voted for the Modernization Act. They are running for cover, and judging by the smoke screen they are not really wanting to talk about how they "Screwed the American People" with the Modernization Act that permitted "side betting" and "having insurance on someone else's life(business or mortgage) hoping they will die" as with CDS's and Derivatives in home mortgages that were built around Fraud.
Let's be clear, because they ought not to be able to have it both ways. All of these asshats, politicians and financial gurus alike, are:
1. Genius types, smartest people in the room, too big to fail, and perfectly deserving of all of their bonuses. And therefore, all equally deserving of metal connecting bracelets and prison cells to call home because they absolutely knew what they were doing.
2. Ignorant know-nothings that should still be dealt with harshly because they had the effective "fiduciary responsibility" to know better and therefore also to behave better.
3. I suppose some kind of middle ground between those poles is possible, but is there really anything that let's any of them off the hook?
This shit was illegal and then made legal again. If you rob someone on the street corner you go to prison. Rob someone via Wall Street financial instruments and you receive a house in the Hamptons, hookers, cocaine and a golden parachute with which to float away.
There is no law.
Friday, August 21, 2009
Private Health Insurance Industry =
Death-by-Spreadsheet
Brought to you by "Americans United For Change":
http://americansunitedforchange.org/about/
And don't forget the HMO and Nixon nexus:
Propaganda: We are Now and Have Always Been at War with Eurasia!
Tom Ridge on National Security After 9/11
http://www.usnews.com/blogs/washington-whispers/2009/08/19/tom-ridge-on-national-security-after-911.html
Ridge was never invited to sit in on National Security Council meetings; was "blindsided" by the FBI in morning Oval Office meetings because the agency withheld critical information from him; found his urgings to block Michael Brown from being named head of the emergency agency blamed for the Hurricane Katrina disaster ignored; and was pushed to raise the security alert on the eve of President Bush's re-election, something he saw as politically motivated and worth resigning over.
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Be afraid. We will save you and keep you from harm. This has been a message brought to you by the Grand Old Party. Yee-Haw!
Matt Taibbi: Sick and Wrong
This is Rolling Stones current information on this week's lead political story:
http://www.rollingstone.com/nationalaffairs/index.php/2009/08/19/matt-taibbi-on-health-care-reform-sick-and-wrong/
Maybe I just like free content, but I hate the way RS plays hide and seek with their most important political content this way. The videos don't seem to work, so I therefore provide links to alternative information sources below. ASAP I will have the full text from some probably independent online source and edit it into this blog entry. Why? Because...
...WE STEAL CONTENT!
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The take-away (most of which occurs between minutes 6:00-7:15): Health Care Reform properly has two prongs that have been utterly gutted by the political process. The first significant thing you could do to reduce health care costs is to eliminate or radically reduce the administrative overhead (i.e. the amount of papers that get filed and pushed around from place to place, a.k.a. "chasing claims"); and the second thing that could be done is to create a public run plan that would force private health insurers to compete with the cost-cutting methods of the VA and Medicare and thereby force costs down across the industry.
Thirty percent of the waste in health care delivery arises from the administration of hundreds of different plans that simply don't need to exist between health care professionals and their clients. This simple goal could be accomplished by a single-payer system the terms of which could easily be understood because it's just one plan instead of hundreds; and can be easily illustrated as the difference between a walk down a single hallway versus being trapped in a labyrinth with hundreds of hallways and dead-ends.
The only real reform being contemplated now is regulation over the existing health care insurance system that prohibits these private insurers from dumping patients or from denying them the care which they have legally contracted to receive. In other words, the private health insurance industry will now have to play fair. If they intend to continue making the profits they make right now they'll have to hike up their prices instead of denying people care. But they get to continue to exist and go on their merry way if they can behave like tolerable corporate citizens even while their business model is bankrupting the whole country.
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OMG, Maria Bartiromo is a complete tit. She desperately needs a pink slip. If nothing else, just remember this moment the next time she tries to come across as sage.
Yes, the U.S. has the best health care system in the world and to which most people are denied access; or even when they have access they may still face bankruptcy due to astronomical prices. Wonderful...we should be so proud.
What kind of health insurance would Jesus carry?
http://www.rollingstone.com/nationalaffairs/index.php/2009/08/19/matt-taibbi-on-health-care-reform-sick-and-wrong/
Maybe I just like free content, but I hate the way RS plays hide and seek with their most important political content this way. The videos don't seem to work, so I therefore provide links to alternative information sources below. ASAP I will have the full text from some probably independent online source and edit it into this blog entry. Why? Because...
...WE STEAL CONTENT!
------
------
The take-away (most of which occurs between minutes 6:00-7:15): Health Care Reform properly has two prongs that have been utterly gutted by the political process. The first significant thing you could do to reduce health care costs is to eliminate or radically reduce the administrative overhead (i.e. the amount of papers that get filed and pushed around from place to place, a.k.a. "chasing claims"); and the second thing that could be done is to create a public run plan that would force private health insurers to compete with the cost-cutting methods of the VA and Medicare and thereby force costs down across the industry.
Thirty percent of the waste in health care delivery arises from the administration of hundreds of different plans that simply don't need to exist between health care professionals and their clients. This simple goal could be accomplished by a single-payer system the terms of which could easily be understood because it's just one plan instead of hundreds; and can be easily illustrated as the difference between a walk down a single hallway versus being trapped in a labyrinth with hundreds of hallways and dead-ends.
The only real reform being contemplated now is regulation over the existing health care insurance system that prohibits these private insurers from dumping patients or from denying them the care which they have legally contracted to receive. In other words, the private health insurance industry will now have to play fair. If they intend to continue making the profits they make right now they'll have to hike up their prices instead of denying people care. But they get to continue to exist and go on their merry way if they can behave like tolerable corporate citizens even while their business model is bankrupting the whole country.
------
Visit msnbc.com for Breaking News, World News, and News about the Economy
OMG, Maria Bartiromo is a complete tit. She desperately needs a pink slip. If nothing else, just remember this moment the next time she tries to come across as sage.
Yes, the U.S. has the best health care system in the world and to which most people are denied access; or even when they have access they may still face bankruptcy due to astronomical prices. Wonderful...we should be so proud.
What kind of health insurance would Jesus carry?
Thursday, August 20, 2009
Value for the Money
Author David Sedaris shares a personal anecdote about healthcare
http://trueslant.com/allisonkilkenny/2009/08/19/author-david-sedaris-shares-a-personal-anecdote-about-healthcare/
Allow me to answer with kidney stones. I had my first one at the age of 34. At the time I was living in New York, and had no health insurance. Never in my life had I experienced such pain, but I couldn't afford to go to the hospital, and so I passed it at home, not knowing until the end what it actually was. (I thought I was delivering Satan's baby through my penis.)
I had my second kidney stone seven years later, in Paris. It was ten o'clock in the morning, and after looking at my options in the phone book, I took the metro to a hospital in the 15th. Two minutes after walking through the door, I was in a private room. Delicious, mind-numbing drugs were delivered to my blood stream by way of a tube and life was beautiful. I was in the hospital for four hours, and as I was leaving, I asked the receptionist how I was supposed to pay.
“Oh,” she said, “We'll send you a statement.”
“But you never even asked me my name.”
“Really?”
A few weeks later I got a bill for the equivalent of seventy dollars, this because I'm not a French citizen, and am therefore not entitled to free care.
I got my third kidney stone a few months ago, while on a lecture tour of the United States. The hospital I went to was in Westchester county and the service was outstanding. Maybe I arrived at the slowest time, but, like in France, I was waited on immediately, and the doctor and nurses could not have been more pleasant. Again I was there for four hours, though this time the bill came to $5,800. Not including medicine.
I'm completely fascinated by the health care debate going on in the United States, especially by posters of Obama with a little mustache drawn on his upper lip. Is that what Hitler is really known for, his health care plan? To quote Bill Maher, “I haven't seen this many pissed off old white people since they canceled, “Murder She Wrote.”
Now I live in England. I've just been granted Indefinite Leave To Remain, which allows me access to the NHS.
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The only way to prefer what we do in the U.S. is if you are actually insane. I'm a fiscal conservative so I like to get my money's worth with everything. You tell me:
$70 vs $5,800+
http://trueslant.com/allisonkilkenny/2009/08/19/author-david-sedaris-shares-a-personal-anecdote-about-healthcare/
Allow me to answer with kidney stones. I had my first one at the age of 34. At the time I was living in New York, and had no health insurance. Never in my life had I experienced such pain, but I couldn't afford to go to the hospital, and so I passed it at home, not knowing until the end what it actually was. (I thought I was delivering Satan's baby through my penis.)
I had my second kidney stone seven years later, in Paris. It was ten o'clock in the morning, and after looking at my options in the phone book, I took the metro to a hospital in the 15th. Two minutes after walking through the door, I was in a private room. Delicious, mind-numbing drugs were delivered to my blood stream by way of a tube and life was beautiful. I was in the hospital for four hours, and as I was leaving, I asked the receptionist how I was supposed to pay.
“Oh,” she said, “We'll send you a statement.”
“But you never even asked me my name.”
“Really?”
A few weeks later I got a bill for the equivalent of seventy dollars, this because I'm not a French citizen, and am therefore not entitled to free care.
I got my third kidney stone a few months ago, while on a lecture tour of the United States. The hospital I went to was in Westchester county and the service was outstanding. Maybe I arrived at the slowest time, but, like in France, I was waited on immediately, and the doctor and nurses could not have been more pleasant. Again I was there for four hours, though this time the bill came to $5,800. Not including medicine.
I'm completely fascinated by the health care debate going on in the United States, especially by posters of Obama with a little mustache drawn on his upper lip. Is that what Hitler is really known for, his health care plan? To quote Bill Maher, “I haven't seen this many pissed off old white people since they canceled, “Murder She Wrote.”
Now I live in England. I've just been granted Indefinite Leave To Remain, which allows me access to the NHS.
------
The only way to prefer what we do in the U.S. is if you are actually insane. I'm a fiscal conservative so I like to get my money's worth with everything. You tell me:
$70 vs $5,800+
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