People get the health care they deserve. Some folk don't appear to grasp the economic and financial foundations of the medicine business. That is perplexing, because they are very simple and easy to understand. Health care is extortion -- "Your money or your life." A doctor is a criminal, a member of an organized crime syndicate no government can control. Lawyers may reduce their fees to attract customers, but any doctor who reduces her fees is condemned by all her medical peers as an incompetent, until she has no customers. The very last thing the medicine business can tolerate is competition. They must remain a Mafia, in which every member is sworn to loyalty and the code of silence.
To repeat, no government can control the medicine mafia. We will all need a doctor someday, politicians and senior officials as much as anyone else. No one -- no one -- in any government can breath a word against doctors, or make any attempt to control their rapacious demands for more and more money for less and less work. Someday they will need a doctor, and the mafia never forgets, and never forgives.
The juvenile daydream that we can ever reduce the cost of the medicine mafia is a fairytale fantasy. The medicine business rules, and they will never surrender power. "Your money or your life," forever. Do you want out of this trap? Don't go to a doctor. Chose to die instead. That's your only escape route.
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Cures for an Ailing System
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Meanwhile, virtually every Western health-care system is light-years ahead of ours. In Denmark, every primary-care doctor is wired. The United States will eventually catch up. It has to. And patients can speed the process by avoiding doctors and hospitals who stubbornly resist the Information Age.
—David Blumenthal, M.D. Professor of Medicine and Health Care Policy at Harvard Medical School and Massachusetts General Hospital
Make Sure New Treatments Are Properly Studied
When you have a medical problem, you and your doctor usually have treatment options. If you have breast cancer, will it be lumpectomy or mastectomy? If a narrowed coronary artery needs opening, should you go with a "drug eluting" or a "bare metal" stent? If you're a smoker, should you have a screening CT scan to look for lung cancer, or not?
As you decide on a course of treatment, you may well think that medical studies comparing your options have revealed the best choice. Unfortunately, that often is not the case. The time-tested way to compare options—a randomized clinical trial—requires a lot of time and money, and often involves patients who are younger and healthier than the people who may ultimately need the new treatment. Today there are more new diagnostic and therapeutic approaches than can practically be studied in such trials. From 2004 to 2006, approximately 90 truly new medicines were approved by the FDA, multiple new radiology tests to detect disease were introduced and several new kinds of laparoscopic surgery were launched. While many were compared against a placebo or against doing nothing, very few were compared with other already available options.
Every year millions of patients have a new test or treatment that has not been systematically compared with other options. Did they benefit? Our society needs to do a better job of recording and aggregating pertinent information from those millions of people. The effort must be rigorous and transparent. It will cost a substantial amount of money, but it will benefit everyone—patients, doctors, employers and insurers.
—Barbara J. McNeil, M.D., PH.D. Head of the Department of Health Care Policy at Harvard Medical School and professor of Radiology at the School and Brigham and Women's Hospital
Curb Drug Spending Without Hurting Drug Development
New drugs can protect us against life-threatening and disabling diseases, but they also place big demands on the nation's finances. By 2016 we can expect to spend roughly half a trillion dollars per year on prescription drugs. Health spending is stressing household and public budgets, and almost 20 percent of the growth in that spending is due to prescription drugs.
The collision of growing costs and expanding science is forcing the institutions that pay the bills for health care to try to restrict the use of expensive medicines to those people for whom they clearly are necessary. The risk is that an overly zealous approach will harm drugmakers' revenues and, as a result, stem the flow of new treatments.
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