Enough with the tests already

If I ask my doctor for a test, he will almost always grant my request. He will also ship me off to a specialist if it looks like I have something spooky. Now this is what family dcotors are trained to do.

When I go to a specialist this begins a whole new relationship, mostly involving "I'd like to see you again in six months."

The last time I went to see such a specialist, I said, "Look, I"m not going to sue you. Don't practice defensive medicine with me. I like you, but I'd rather not ever come back here again.

I've calculated that there's about a 75 percent overlap between physical therapy and yoga -- meaning that yoga, which is not covered by insurance, is good enough for most of my aches and pains.

These are some of the reasons our healthcare system is so screwed up. Despite its thousands of pages, Obamacare has nothing to say about doctors' liiability. Most doctors aren't trained in nutrition or exercise or yoga or any of the wellness things. They are trained to spot symptoms and order a drug, a specialist or surgery. Marcus Welby is long dead.

All of this also pushes up costs, which Obamacare intends to deal with by denying you certain types of care. Some bureaucrats in Washington are going to make those decisions. Bad as your insurance company is in saying no, imagine that coming from some committee in Washington.

Today comes yet another example of our current system at work.

Doctors in urology groups that profit from tests for prostate cancer order more of them than doctors who send samples to independent laboratories, according to a study in the journal Health Affairs. 

The study found that doctors' practices that do their own lab work bill the federal Medicare program for analyzing 72% more prostate tissue samples per biopsy while detecting fewer cases of cancer than counterparts who send specimens to outside labs. 

Hiring pathologists boosts revenue for a practice and creates a potential incentive to increase the number of tests ordered, said Jean Mitchell, a Georgetown University economist and author of the study.

Given how many urologists want to biopsy my prostate, I'm going to go out on a limb and say that a) they don't want to get sued, and b) they may be trying to pay for some expensive biopsy equipment they've bought.

Is the medical system actually working?

I frequently write about breakthroughs in medicine and suggest that innovation, not government-run healthcare, is the answer.

There now seems to be some evidence that this is true.

New data show that health spending over the past several years has been normalizing toward the rate of general inflation, rather than growing higher and higher, as had been the case almost continuously since the 1970s, J.D. Kleinke writes in The Wall Street Journal.

This moderation in the growth rate of spending predates the national recession. And it puts the lie to the claim that we need government to put the brakes on an "out-of-control" health-care system. The moderation has been driven by cumulative improvements in medical care and by insurers, and by marketplace disciplines on the demand for medical care. Consumers are finally getting more involved in managing and paying for their own care.

Contrary to the perennial doomsaying, the health-care system is—almost in spite of itself—getting better, Kleinke says.

A generation of breakthrough drugs for chronic disease, mental illness, HIV and cancer were developed in the 1980s and '90s at great cost. Dozens of these drugs—like Zocor for heart disease or Zyprexa for schizophrenia—are now widely available, many in generic form. There are now countless electronic ways of telling patients about them. And health insurers are driven by their own evolving market disciplines to make sure patients start taking them and keep taking them in the cheapest available versions. 

Combine all these new medicines, information channels and business compulsions with the slow, steady transfer of economic responsibility for health care—from corporate and government bureaucrats to consumers and their families—and suddenly health-care starts to look almost like an actual market.

Just in time for the whole thing to get swallowed up by Washington.

Will this happen to your doctor?

A physician in Seattle who calls himself Dr. Bob describes how the profession is changing.

The past year or so has been one of the most challenging in many a season, on a number of fronts. Professionally, the passage of Obamacare has made it abundantly clear that the independent private practitioner is a dying breed, and likely will disappear — with the exception of cash-only, concierge-style arrangements — within the next few years. The administrative burden is crushing — unfunded mandates, such as pay-for-performance, compliance programs, HIPAA, mandated “government certified” EMRs (even though existing, non-certified ones are fully functional), and intrusive, abusive audits by the Feds and third party carriers.  

Such mandates and regulatory excesses place, or will soon place, such an overwhelming burden on the solo physician or small group as to make their continued existence unsustainable, even in the near term — and the full implementation of Obamacare will put roses on their grave. Reimbursements are dropping precipitously (my income dropped about 25% last year), as expenses spiral upward (employee health insurance rates are up 25%; malpractice rates up 15%, etc., etc.). The small business model of solo practice or small medical group is rapidly becoming extinct: its executioner, Big Government and Big Insurance.

And so, big changes are in store: my practice will be sold in the next few months to a large medical group affiliated with a nearby hospital, and I will have as a primary responsibility inpatient hospital care, with a much diminished office practice focusing primarily on my specialty of male infertility and vasectomy reversal. I have decidedly mixed feelings about this change — I anticipated going to my deathbed as a private, solo practitioner, loving the independence and rich patient relationships which this brings. 

But I am weary. After nearly 30 years in private practice, I am not sure which straw broke the camel’s back, but it is most surely broken. It is a weariness born of 14 hour days; of dictating charts and finishing paperwork until 8 or 9 pm each night, after starting the day at 7 am; of endless audits by the insurance industry and Medicare; of the constant threat of litigation; of the crushing burden of one more federal requirement mandated but never recompensed; of a host of ever-expanding administrative burdens having nothing to do with patient care, and everything to do with bureaucratic micromanagement of the profession. And this before we have even begun to see the nightmare which Obamacare will inflict. Camels weren’t designed to carry such a load.

I've started to notice this around here.

The difference in healthcare systems

Older Americans are not quite as healthy as their English counterparts, but do live just as long, if not longer, according to a new study.

Americans aged 55 to 64 and 70 to 80 had higher rates of chronic diseases than same-aged English people, but they died at about the same rate. And Americans aged 65 and older -- while still sicker than their English peers -- actually lived longer than similar-aged people in England.

"If you get sick at older ages, you will die sooner in England than in the United States," study author James P. Smith, PhD, of the nonprofit RAND corporation in Santa Monica, Calif., says in a news release. "It appears that at least in terms of survival at older ages with chronic disease, the medical system in the United States may be better than the system in England."

Americans and their English counterparts were equally likely to die from chronic diseases during the ages of 55 to 64, but Americans tend to live longer with chronic diseases during their 70s.

The researchers speculate that this may be because these same illnesses are more likely to be fatal in England than in America, or that English people may be diagnosed at later stages in their disease, which would result in a higher mortality rate.

"Both of these explanations imply that there is higher-quality medical care in the United States than in England, at least in the sense that these chronic illnesses are less likely to cause death among people living in the United States," Smith says.