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Showing posts from January, 2010

Why is always in the last place you look: medical expenditures at the end of life

Now this is a rather obvious point to make, but it still bears making. I keep hearing people  shaking their heads over the fact that costs for medical care in the last year of life far outstrip the costs before that time.  In an article published in Health Services Research, based on costs of care over 10 years ago, showed an average yearly cost for Medicare recipients of a bit over $7000, but a cost of over $37,000 for the last year of life.
Now if I knew I was going to die, I certainly wouldn’t want to spend $37,000 receiving boring and unpleasant medical care. But if I knew that the Apple company was going to do so well, I would have bought low.
Of course medical costs are high in the final year of life, because that is the year of life when most people are sickest, and therefore are getting the most amount of medical care. Certainly having discussions with patients about what they want when they get close to the end of their lives will save money.  This will reduce the horrendous …

Rewrite: the senate health care plan

After reading the senate’s health care bill I felt frustrated. Why must it be so long? Why must it be supported only by democrats? Does it really have to be that complex? Couldn’t the important things be gleaned from the rest, resulting in a bill that was less than 2000 pages? To resolve my feelings of frustration, I again took to my keyboard.
If I were queen of the world*, the health care reform bill before congress would be shorter, sweeter and more to the point than the present one, and would be passed by a majority of both political parties. Like the present bill, it would attempt to improve quality, reduce cost, and allow everyone who needs it access to health care. Unlike the present bill, my reform bill would not include measures to improve health behaviors specifically, because that is just too much for a single piece of legislation.
(*Now if I got to be god, instead of just queen of the world, I could make more radical solutions happen, including an affordable single payer or…

Reader's digest version: the health care bill

Yesterday I spent about 5 hours digging through the senate version of the health care bill. It will probably bear significant resemblance to the bill that is finally passed, and since I am eventually going to need to know what is in the bill, I decided to go ahead and read it. It was not short. In fact, it was incredibly long. Many of the 2074 pages consisted of corrections in wording or lengthy descriptions of the formation of various commissions, which I skimmed. Some points were worded so abstrusely that I just couldn't figure out what they were saying, so I did not address them.

I was generally impressed with the time and thought put into the creation of the bill. I must say, though, that when I finally sit back and evaluate the thing, I think it suffers from its ridiculous length and complexity. It has ended up looking like a wish list written by a monstrous consortium of well informed visionaries. If even a portion of it actually ends up being accomplished it will profoundl…

the $25 plan

I would like to make $120,000 a year.  It seems like a reasonable amount to make after becoming good at what I do, and after an expensive and time consuming education, and not entirely out of reason given that the average salary for an internal medicine doctor like myself is $150,000. Despite being well established, busy, and taking call and seeing patients in the hospital, as well as providing various services for the hospital and for a set of group homes for developmentally disabled people, I don’t make anywhere close to that much money.

I would also like to provide high quality care to patients for a reasonable price.  Presently I charge about $160 for an appointment that takes me about 30 minutes, give or take an hour, to complete. That seems kind of steep. The reason I charge so much is that most of what I do, solving problems over the phone, reviewing tests, consulting colleagues, signing my name about a million times a day, is unpaid work.
An average internist takes care of 150…