Editore"s Note
Tilting at Windmills

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September 3, 2007
By: Kevin Drum

HOUSEKEEPING NOTE....Starting on Monday, I'll be joined on the blog by Shannon Brownlee, author of the upcoming book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. Shannon will be guest blogging for the next week on various medical topics, and hopefully giving us a preview of her book at the same time. Healthcare blogging is one of our regular fixtures here, so this should be fun for everyone. I hope you enjoy it.

Kevin Drum 2:04 AM Permalink | Trackbacks | Comments (24)

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Comments

I guess that, in lieu of actual universal healthcare, the blogging will have to suffice for now.

Posted by: Donald from Hawaii on September 3, 2007 at 2:26 AM | PERMALINK

We are laying bricks in the wall, Donald. I'm always tickled pink when health care comes up. We still have reliable Democrats denouncing "socialized medicine" so information is our ally, and since the powers that be won't spread it, we will.

We are like water. And ask any roofer. Water always wins.

Posted by: Blue Girl, Red State (aka G.C.) on September 3, 2007 at 2:33 AM | PERMALINK

Blue Girl: "We are laying bricks in the wall, Donald."

And hopefully, it'll be just like the end of a certain long-lost Twilight Zone episode from the 1950s, when Gloria Swanson had scheming son-in-law Robert Redford entombed alive behind a newly-laid brick wall in her house, thus avenging her daughter's brutal death at his hands.

Posted by: Donald from Hawaii on September 3, 2007 at 2:46 AM | PERMALINK

Kevin, any chance you could start labeling your posts? You have scores of excellent posts on health care (for example) - but these get buried over time and become difficult to retrieve (or am I missing something?). If you labeled your posts, it would be much easier for us to find them and, in particular, share them with people we are trying to introduce to your blog.

Just a thought...

Posted by: Augustus on September 3, 2007 at 4:51 AM | PERMALINK

I hope you are right, Blue Girl. The U.S. desperately needs universal health care and any asshole who says we can't afford it, need look no further than the $2 billion a week we piss down our leg in Iraq to know that is horseshit.

Posted by: The Conservative Deflator on September 3, 2007 at 6:32 AM | PERMALINK

Whata you mean, toooo much medication?

At least some of the pro wrestlers keep me going.

Posted by: Elvie's Crack Physician in Vegas on September 3, 2007 at 9:13 AM | PERMALINK

So the thesis is that medical corporations guaranteed payment by the federal government overuse lucrative high-tech high-risk procedures to the detriment of their patients?

I don't have a strong opinion one way or the other, but I'd like to point out that a lot of the time patients are aware of the decision. When faced with a poor prognosis a patient will often choose intervention even if a procedure is experimental or they are plainly told that it will reduce their life expectancy (with a low percentage chance of a long term "cure"). So I guess you have to look at long term vs. short term survival rates and come up with some way of quantifying the importance of hope.

A lot of people are dying from intervention. I'm guessing a lot of folks in the poor hospitals wish they were able to.

Posted by: B on September 3, 2007 at 9:14 AM | PERMALINK

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.

Amen. I hate the American rite of passage that seems to suggest that the older we get the more drugs have to be crammed into our medicine cabinets. I especially hate the aggressive and manipulative advertising by pharmaceutical companies that enables that culture.
I'm 47 and have no drugs other than aspirin in my medicine cabinet, so far so good.

Posted by: Del Capslock on September 3, 2007 at 10:10 AM | PERMALINK

I'm a pharmacist's son, and I've worked behind the drugstore counter since I was five years old, so count me in on the over-medication thing. (But it's not all the doctors' fault: a lot of the time the poor buggers are just writing random prescriptions to get neurotic clients out of their damn hair.)

Besides that, I'm Canadian -- which means I ree-eely think you need to copy our insurance system.

We don't have socialized medicine in Canada. If anything it's the States that has socialized medicine, in that you live under the dictatorship of your insurance companies, who rip off roughly 5% of GDP not for *providing* medical care but for carrying out triage, deciding who *doesn't* get medical care.

In Canada medical care is governed the old fashioned way, by the Colleges, i.e. professional associations, by the Provincial and County medical associations, and by the Boards of clinics, hospitals, co-operatives, and dozens of other forms of caregiver organization.

What's different about Canada is that we've abolished the "insurance" function. Like ask yourself, what's to insure? You only insure something that's uncertain, and there's nothing uncertain about health care: nine people out of nine have bodies, and everybody's body needs health care.

So naturally everybody splits the bill, and pays the normal way of paying for things that everybody needs -- through taxes.

The efficiency gains are phenomenal: it costs government roughly 0.5% of the gross to pay bills. Contrast this with the phoney "insurance" method: in the States people pay over 16% of GDP to insure 85% of the people. In Canada, where we live longer than Americans do, we pay about 9.6% of GDP -- of which .5% of that 9.6% is government overhead -- and that pays for everybody, not just some people, which is apparently the American Way.

Posted by: David Lloyd-Jones on September 3, 2007 at 11:29 AM | PERMALINK

The solution to rampant intake of foreign substances is very simple. Allow shamans and hakims and homeopaths to prescribe mantras and prayers and herbs and sugary pills to those who want to medicate themselves for every little physical inconvenience. To make it even more cost effective, make it socially acceptable to consult astrologers to forecast the precise date and time on which a person's ailment will magically disapper as a result of the proper alignment of the stars.

Posted by: gregor on September 3, 2007 at 12:11 PM | PERMALINK

[Trolling Deleted. Is this what passes for amusement for you? how sad that your life sucks so bad your only joy comes from trolling liberal blogs.]

Posted by: mhr on September 3, 2007 at 12:43 PM | PERMALINK

..."Give these guys power and watch them gravitate toward totalitarian rule."

Unlike the current administration, huh?

Posted by: shnooky on September 3, 2007 at 12:50 PM | PERMALINK

And if I don't keep piling on new medications in a vain attempt to control the inert, morbidly obese patient's blood sugar, blood pressure, and cholesterol and if that patient has a heart attack, an amputation, or renal failure, then I get sued. My malpractice insurance won't cover me because I failed to meet standard of care, the patient's family is awarded more than my malpractice limit for "pain and suffering" and then my personal assets are given to the patient. As a physician, I have no pension, so everything that my husband and I have saved for our retirement is gone. I'll keep prescribing the damn pills, thank you.

Posted by: J Bean on September 3, 2007 at 12:51 PM | PERMALINK

The U.S. desperately needs universal health care and any asshole who says we can't afford it, need look no further than the $2 billion a week we piss down our leg in Iraq to know that is horseshit.

If we spent the same per-capita on national health care as Canada does, the cost for the U.S. would be about $23 billion a week. Try again.

Posted by: elmendorf on September 3, 2007 at 2:38 PM | PERMALINK

Um Elmendorf, we're already spending more per capita than Canada.

Posted by: J Bean on September 3, 2007 at 3:16 PM | PERMALINK

J Bean, that was the point.

Even assuming we cut our health care costs in a nationalized system as low as Canada's (averaging around $4,000 US per capita per year last time I checked), the costs to cover the whole U.S. population would still be astronomical. Imagine that number if we assumed the per-capita costs to be what Americans are paying now.

Cut out the entire Iraq War, and the savings that could be applied to a socialized medical care system would be lost in the noise.

Posted by: elmendorf on September 3, 2007 at 6:29 PM | PERMALINK

I guess I'm overmedicated. Six prescription medications, more than a dozen pills a day. But damn if I'm going to listen to someone telling me that's somehow bad. You know what's bad? The fact that my body is fucked up like this. My medicine isn't the problem, my condition is. I won't listen to anybody telling me to sacrifice my quality of life for some medicinal purity. All that does is make you feel more righteous than thou. No thanks.

Posted by: amanda w on September 4, 2007 at 4:44 PM | PERMALINK

Weighing in late but here is my 2002 forecast on Big PhRMA which has become mostly manifest

A likely Health Sector scenario over next 12 months

Major Trouble ahead for Pharmaceutical firms

1)Classical example of how greed and arrogance and the excesses of the free market takes something that is truly miraculous (life saving drugs/vaccines) and moves it to excess which then "backfires" See Teller -"When Technology Bites Back" or Dutton Worse Than The Disease"

2)Direct marketing to consumers on TV is a real debacle- the pharm companies come across as bone-fide drug pushers which they have become!

3)Science will show an increasing number of pharm products do more harm than good. They may be "efficacious" BUT THEY ARE NOT SAFE- grossly underestimated as contributing to cancer for example-see prempro story recently


4)Polypharmacy is running rampant- too many drugs for too many conditions in an individual- will get MUCH WORSE as naive boomers age and take more and more mixed meds

5)Psychotropics, analgesics and sedating antihistamines are contributing to serious safety problems on Americas highways and workplaces and who knows what other errors in judgment by leaders with this stuff swirling around their brains

6)Medications, especially psychotropics and analgesics are migrating in
alarmingly large quantities to illicit market (eg. Oxycotin)


7)Yet politically, denying NEEDED drugs to elderly is hottest political issue going-another one is denying affordable drugs to millions dying of aids especially in Africa. So some populations are UNDERMEDICATED. Many in US are OVERMEDICATED

8)In high density populations there is the issue of ultimate ENVIRONMENTAL FATE in soil and water of human excreted medicines and/or their metabolites

9)Congressional Hearings ahead with tone of Tobacco and Asbestos

Richard A. Lippin, MD
Health Sector forecaster-July 2002

CONGRATULATIONS TO SHANNON BROWNLEE


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