I really liked John Dorschner's report, "Healthcare reform poses benefits and risks to South Florida economy" in The Miami Herald. It is a shocking that Miami leads the nation in Medicare costs per person. The Dorschner story opens a window on the impact to Miami's economy when health care reform materializes. So far, most of the stories have targeted Medicare fraud, but I'm wondering: is there something in the culture of place that ties together the fact that Miami is both the epicenter of the housing boom and bust and the highest health care costs in the nation? It can't be coincidence.
In the meantime, I strongly recommend an article by Atul Gawande from the June 1 New Yorker, "ANNALS OF MEDICINE: THE COST CONUNDRUM, What a Texas town can teach us about health care." A friend tells me that it is required reading among senior staff at the White House directed by President Obama. The article raises the question of cultural issues around the delivery of medical services in a way that I hadn't considered before.
4 comments:
I'm not surprised that Miami has the highest per person costs for Medicare. It's greed, plain and simple. In the past, if you had a medical condition, a doctor would write you a script for medication, tests, etc, if it was medically necessary. You would go to the hospital for your tests, the pharmacy for your medication, etc. But now, doctors have become one-stop shops offering everything under one roof. (Just look how many medical centers have popped up offering free transportation to the elderly.) So now, the doctor gives you a script, you walk down the hall for your medical test, walk to the next window to get your medications filled, etc. The doctor makes a profit from the visit, the test, and the medications. Profit clouds a doctor's judgment of medical necessity.
Until government cracks down on doctors' self-referals, the medical costs will continue to skyrocket.
Obviously, there are more problems that contribute to high medical costs- bureaucracy, insurance companies, malpractice/tort issues, drug companies, etc. But at the end of the day it boils down to greed- each spoke in the wheel is looking out for themselves, trying to make as much profit as they can.
In Miami, the mindframe "I'm gonna get mine" permeates government and private enterprise. I don't know what the solution is.
What annoys me no end is that doing these things to reduce fraud are things that neither Bush nor Obama are interested in. Bush because he was too lazy and Obama because he wants to tie in the cost savings into his "comprehensive" reform bill so it can support the illusion of lower costs.
There is huge saving to be had in fighting fraud, self referral and the nonsense of Medicare part D non-negotiated medicine prices. Not much more than one pen stroke fixes them but I guess it is too much to ask.
Is it greed or unsustainable economic development. I mean, think about how many doctors there are here. They have to make enough money to support hteir practices. Is there too much competition? I dunno, maybe I am wrong.
One thing is for sure, when we correct the Medicare problem, Miami is screwed. Think of all those dollars leaving the county. No one is really saying it, because it is politically incorrect. I am not advocating for the excesses, but it will be interesting to see how hospitals an clinics deal with it if they start cracking the whip.
what annoys me is the shortsightedness of the dumb-shorted public. it is great to whine about the layout, structure, and administratine permissiveness which allows fraud..but we as a society are"OUT-OF-BULLETS"! TO FUND THESE SOCIAL CHANGES IN HEALTH CARE, ENERGY, JOB CREATIONS..WHO'S GOING TO PAY FOR IT? you have very marginal incomes and little-or-no job security here in florida..and what?!>YOUR ANSWERS ARE TO RAISE FINE LEVIES AND TAXES ON EVERY CITIZEN WHEN THEY CAN ILL-AFFORD THE PRESENT RATES?!WHAT HAPPENS WHEN YOUR WIND INSURANCE GOES UP 10 PERCENT A YEAR, AND PROPERTY TAXES GO UP 50 PERCENT A YEAR..YOU RICH DOCTORS AND LAWYERS ARE GONNA LOVE THAT AS MUCH AS SECURITY GUARD(who, incidentally, can't afford even to go to work to be a deterrant to muggers and rapists!)CITIZENS WHO ARE SEEING ANY DISPOSABLE INCOME OR RETIREMENT(NOW THERE'S A JOKE...ONLY THE BROKERS WILL HAVE YOUR MONEY AT RETIREMENT!) E-VAP-OR-ATE!IT IS JUST NOT INCIDENTAL FRAUD..IT IS FRAUD THAT HAD MORPHED ITSELF INTO THE SYSTEM SO HEARTILY SO AS TO KILL THE PUBLIUC IF YOU TRY TO CUT THE STRUCTURAL CANCER OUT. SAME APPLIES TO OUR BANKING SYSTEM..WAKE UP CITIZENS..WE SOLD THE COW FOR SOME JACK-IN-THE-BEANSTALK BEANS! FOREIGN COMPANIES OWN US, AND WHAT WAS ONCE BLACK-OPS EXTRA MONEY IN NARCOTICS DOLLARS HAS LONG SINCE BEEN THE TRADE BENCHMARK WORLDWIDE..WE DON'T HAVE JUST ONE PROBLEM...WE HAVE A SYSTEMIC FAILURE ON ALL FRONTS!PLEASE DON'T USE YOUR THUMB TO BLOT OUT THE SUN...FOOLISHNESS! I WARNED EVERYONE FROM THE DEA TO THE CIA THAT THIS NARCO THING WOULD EVENTUALLY RUIN THE COUNTRY..ALONG WITH LACK OF REAL SERIOUS CONCERNS ON ALL LEVELS OF SECURITY, TO LACK OF WAGE INCENTIVES, TO OUTRIGHT SALE OF GOODS AND REAL PRODUCT PRODUCTION BEING SHIPPED OVERSEAS. THE SHORT-TERM PROFITS AND PURE-ASS GREED DID THIS COUNTRY IN..AND IF YOU REALLY DUMB-ASS THINK-TANKS KEEP SAYING 9-11 WAS A RADICAL MUSSLIM ATTACK..YOU ARE A TRULY BRAIN-DEAD MASS OF FLESH! someone didn't pay up the world bill, and when violent force of intimidation was used, the response was two towers falling down.the towers were a tragic play, and set up..AMERICA BY THAT TIME WAS ALREADY BANKRUPT..AND HAD VIRTUALLY NO SECURITY. HELL, YOU DISRESPECT SECURITY GUARD(you complain, they get fired, you get no continuity of service..)AND POLICE AND INTELLIGENCE SERVICES HAVE A LEFT HAND THAT DOESN'T KNOW WHAT THE RIGHT HAND WAS DOING. NOW, WHAT WAS YOUR TINY-ASSED, MINISCULE COMPLAINT...?
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