dieseltaylor Posted August 16, 2009 Share Posted August 16, 2009 From the Beeb Texas town's healthcare puzzle By Katty Kay BBC News, McAllen, Texas In the country that reveres the free market, competition is supposed to drive quality up and costs down. But not in healthcare - and not in McAllen, Texas. In the past 15 years, this sleepy town has reinvented itself as a boom place for modern medicine. Wherever you look there are hospitals, clinics, and laboratories. In the same period the cost of healthcare has soared faster here than anywhere else in the country. The 'McAllen problem' McAllen, on average, now spends $14,946 (£9,263) on healthcare for every patient enrolled in the government's Medicare scheme, almost double the national average of $8,304 per Medicare enrollee. Patients in McAllen certainly receive more tests and treatment for their money. Research by the Harvard doctor Atul Gawande for a recent New Yorker article found that critically-ill elderly patients in McAllen received 50% more specialist visits than in another Texan town, El Paso, which is some 800 miles (1,200km) away. Doctors in McAllen ordered 20% more abdominal ultrasounds, 30% more bone density studies and 550% more urine-flow studies to look for prostate problems, Dr Gawande reported. But the extra dollars and extra tests do not appear to translate into better care. Hospitals in El Paso - which has a similar population, but spends just $7,504 per Medicare patient - recently performed better than McAllen hospitals on 23 out of 25 health indicators. Thanks to Dr Gawande's New Yorker article, the crisis in McAllen has even caught the attention of President Obama: the puzzle of why some places spend so much on treatment without providing better healthcare is apparently known in the White House as the "McAllen problem". So what exactly is causing the problem? We spoke to Dr Lester Dyke, a McAllen heart surgeon. He believes the fusion of business and medicine here has gone too far, and that profit rather than patient need drives many decisions. President Barack Obama says the road to reform begins with rewarding doctors and hospitals for quality instead of quantity. He has praised the performance of several non-profit hospitals for providing excellent care at low cost. But at McAllen's newest hospital, staff believe they have an alternative model. The Doctors Hospital at Renaissance makes a profit but is physician-owned. Critics say this creates a conflict of interest and that staff at the hospital are under pressure to increase output by ordering unnecessary tests and referring patients to fellow investors. The hospital rejects such allegations and insists that because doctors, not bureaucrats, run the hospital, decisions are made on a clinical rather than financial basis. State of the art The Doctors Hospital is undeniably impressive. During a tour of the neo-natal intensive care unit we saw Justin. He was born at just 25 weeks gestation and weighed barely more than 1lb (0.45kg). Now, he was sleeping soundly inside an incubator. The latest technology, expert doctors and a high nurse-to-patient ratio helped save Justin's life. It was a story repeated in every part of the hospital we were shown. Patients with expensive private insurance have long expected such standards. Yet at the Doctors Hospital just 16% of patients have private coverage. The remainder are uninsured or on federal programmes for the poor and elderly, so most of the cost of the high standard of care at the hospital is actually being paid by the government. But can America afford to subsidise such high quality care for the poor and uninsured, or should healthcare be rationed? “ We may tell a patient there's no medical need to send out a nurse again. But they'll find a doctor and agency that doesn't care about that ” Tara Sabal Manager, Health Care Unlimited Dr Carlos Cardenas, the chairman of the hospital's board, refuses to consider rationing: "To have the availability of something and not make it available to some would be to say it's OK for you to have it but not for others to have it." I press him on whether America can really afford it. He talks about efficiencies and savings, but concedes: "I don't know the answer... but what we're doing here is a step in the right direction." Doctors and hospitals are only one part of a $2.4tn puzzle. There are huge vested interests in the system - drug companies and private insurers - who want Americans to carry on consuming as much medicine as possible, even though too much medicine can sometimes be harmful. Every year, for example, approximately 100,000 Americans die from complications with surgery, far more than the 40,000 that are killed in car accidents annually. But moves to treat patients away from hospitals and in the home are also open to abuse and sky-rocketing costs. Sweeteners Once again McAllen is an example of excess. We visited McAllen resident Samuel Sanchez. He is recovering from a stroke, so a nurse from homecare agency Health Care Unlimited visits regularly to help with his rehabilitation. Tara Sabal, who helps run the firm, says that in the past decade the number of agencies in the region has exploded. They depend on doctors to refer patients to them - and sometimes offer incentives to secure those referrals. Health Care Unlimited refuses to play the game, but Ms Sabal describes the kind of sweeteners other agencies offer doctors. "Monthly stipends, that range... from $1,000 to $5,000 up. Cars for their wives, private tuition for the children. Lunches at whatever restaurant they want to go to. Anything from material to monetary," she says. Ms Sabal is frustrated by the lack of regulation and oversight. "The government's not coming to those agencies... and saying: 'I want to see how you spend your money.'" The abuse does not stop with referrals, Ms Sabal insists. Patients are not discouraged from demanding more and more treatment because doctors have a financial incentive to sign the prescription. Since almost all patients here are on Medicare, once again the government picks up the bill. "We may tell a patient there's no medical need to send out a nurse again. But they'll find a doctor and agency that doesn't care about that. So the patient gets what they want in the end - but maybe it's not what's best for them." In America, customers are king - and patients have that mindset too. Mention rationing and critics scream "socialised medicine". But what McAllen shows is that more care does not necessarily equal better care. The White House says both suppliers and consumers of healthcare need to learn this lesson. Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/americas/8137085.stm Published: 2009/07/07 08:31:04 GMT © BBC MMIX It does seem to me that healthcare is an open pit in which any civilisation can pour unlimited money. I am not totally sure but my gut feeling is that it is probably a ruinous way to go - probably as useful as military science in not leading to anything productive. When you consider the improved infrastructure/energy resources that would be more beneficial to the US overall it does seem dumb. Healthcare particularly does rile me as man is born to die and delaying it at huge cost seems to be daft economically if "humane". Analogous to us pouring money into clunkers to extend their usefulness. Wasting assets should be recognised as such. Medical science will continue to invent more complicated and expensive ways to deal with even more illnesses. A line needs to be drawn as to what a state can be expected to cover, and what people can spend on their medical hobby. After some thought a cure. Perhaps every citizen is given a notional sum to pay for healthcare - to last them their life. As it is their "money" that they are spending then they will be cautious about wasting it. They will, if sensible, avoid dangerous sports, poor eating habits, unhealthy sexual partners. Once their allotment is up the state has no further aid to give them and they can spend their own savings. Illnesses covered would not include lifestyle choices like plastic surgery, IVF treatment, psychiatric etc. Given the uneducated masses and the scare-mongering to use drugs it would seem advertising should be banned. In any event items bought would be for real cash. The notional state cover would be for emergency treatment/hospital and life prolonging treatment up to the limit. 0 Quote Link to comment Share on other sites More sharing options...
gunnergoz Posted August 16, 2009 Share Posted August 16, 2009 Healthcare is only important to some when they, personally, require it. What other people do with their needs is irrelevant as long as I can get my needs met. Or so goes the logic of the times. 0 Quote Link to comment Share on other sites More sharing options...
-E Posted August 16, 2009 Share Posted August 16, 2009 Healthcare particularly does rile me as man is born to die and delaying it at huge cost seems to be daft economically if "humane". Analogous to us pouring money into clunkers to extend their usefulness. Wasting assets should be recognised as such. That sounds good on paper. ...Until it's YOUR health at stake. (or more to the point... until it's MY health at stake! *grin?*) I always remember the old adage "There are no atheists in a foxhole" which is most applicable to this subject. 0 Quote Link to comment Share on other sites More sharing options...
Stalins Organ Posted August 16, 2009 Share Posted August 16, 2009 Helthcare is like sex and oxygen - only important when you're not getting any. 0 Quote Link to comment Share on other sites More sharing options...
JonS Posted August 17, 2009 Share Posted August 17, 2009 http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true A much deeper article on what's happening in McAllen 0 Quote Link to comment Share on other sites More sharing options...
gunnergoz Posted August 17, 2009 Share Posted August 17, 2009 http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true A much deeper article on what's happening in McAllen Very good read, thank you. 0 Quote Link to comment Share on other sites More sharing options...
dieseltaylor Posted August 17, 2009 Author Share Posted August 17, 2009 That is a cracking article. Makes me even more convinced that people should have a finite amount of cover and that their life choices are relevant. If all men are equal in a democracy for voting, tax laws then having the same medical rights would seem reasonable. Rather like proven with dogs fairness is seen as an important part of being in the pack/society. 0 Quote Link to comment Share on other sites More sharing options...
MeatEtr Posted August 17, 2009 Share Posted August 17, 2009 We're a virus with shoes, that's all we are. 0 Quote Link to comment Share on other sites More sharing options...
Michael Emrys Posted August 17, 2009 Share Posted August 17, 2009 ...their life choices are relevant. I recently had a thought-provoking example of that. I ran into a guy I know a couple of days ago. I hadn't seen him in a year or two, so we were bringing each other up to date. He mentioned that he was doing chemo for pancreatic cancer, and while talking about it, he pulled out a cigarette and lit up. Now Jim is not a bad guy or what I would normally consider stupid, but as he stood there talking about his cancer and puffing away on his ciggy, I had to wonder how much reflection he had done on the contradictions of his life. Next time I see him, I'll ask. Michael 0 Quote Link to comment Share on other sites More sharing options...
Patrocles Posted August 17, 2009 Share Posted August 17, 2009 From the Beeb It does seem to me that healthcare is an open pit in which any civilisation can pour unlimited money. I am not totally sure but my gut feeling is that it is probably a ruinous way to go - probably as useful as military science in not leading to anything productive. When you consider the improved infrastructure/energy resources that would be more beneficial to the US overall it does seem dumb. Healthcare particularly does rile me as man is born to die and delaying it at huge cost seems to be daft economically if "humane". Analogous to us pouring money into clunkers to extend their usefulness. Wasting assets should be recognised as such. Medical science will continue to invent more complicated and expensive ways to deal with even more illnesses. A line needs to be drawn as to what a state can be expected to cover, and what people can spend on their medical hobby. After some thought a cure. Perhaps every citizen is given a notional sum to pay for healthcare - to last them their life. As it is their "money" that they are spending then they will be cautious about wasting it. They will, if sensible, avoid dangerous sports, poor eating habits, unhealthy sexual partners. Once their allotment is up the state has no further aid to give them and they can spend their own savings. Illnesses covered would not include lifestyle choices like plastic surgery, IVF treatment, psychiatric etc. Given the uneducated masses and the scare-mongering to use drugs it would seem advertising should be banned. In any event items bought would be for real cash. The notional state cover would be for emergency treatment/hospital and life prolonging treatment up to the limit. I WANT MY AMERICA BACK! I WANT MY AMERICA BACK! I WANT MY AMERICA BACK! OH SAY CAN YOU SEE, BY THE DAWN'S EARLY LIGHT GOD BLESS AMERICA!! oh...wait a minute...I can't disrupt this text like I do at the townhall meetings! curse you internet!!! 0 Quote Link to comment Share on other sites More sharing options...
dieseltaylor Posted August 17, 2009 Author Share Posted August 17, 2009 : ) He who shouts loudest must be right! Helps to wrap a national flag around you at the same time - make sure it is the right country flag! Any red flag would be a no-no. 0 Quote Link to comment Share on other sites More sharing options...
Bugged Posted August 17, 2009 Share Posted August 17, 2009 Now Jim is not a bad guy or what I would normally consider stupid, but as he stood there talking about his cancer and puffing away on his ciggy, I had to wonder how much reflection he had done on the contradictions of his life. Next time I see him, I'll ask. Michael I imagine that trying to quit smoking at this particular time would add to his stress, maybe even making matters worse for him. I wonder if he's planning to quit once he gets through this crisis. Or maybe he figures the odds are stacked against him, and he may as well enjoy what's left of his life. *shrug* My teen-aged cousin would frequently nag her mom about her smoking habit. My aunt quit smoking when she was diagnosed with Chronic Obstructive Pulmonary Disease at the age of 50. A year and a half later, my teen-aged cousin started smoking. Now that's just crazy! I can't dictate how others live their lives and I certainly wouldn't suggest that they don't deserve proper healthcare just because I don't agree with the choices they've made. But my cousin makes me shake my head in wonder. 0 Quote Link to comment Share on other sites More sharing options...
Michael Emrys Posted August 17, 2009 Share Posted August 17, 2009 I wonder if he's planning to quit once he gets through this crisis. He's not going to "get through" this particular crisis. He's almost 70 years old and he reported that his doctor told him to expect to be on chemo two weeks on and three weeks off for the rest of his life. Or maybe he figures the odds are stacked against him, and he may as well enjoy what's left of his life. *shrug* That may well be. I think—although I can't be sure, obviously—that in the same circumstances I would choose to forego the chemo. Michael 0 Quote Link to comment Share on other sites More sharing options...
dieseltaylor Posted August 17, 2009 Author Share Posted August 17, 2009 I had a retired neighbour who had chemo - probably prolonged his life by less than a couple of years but as it fried his brain a tad and he had very poor memory for current things so his wife had the joy of living with a childlike creature until his death. Chemo side effects are not widely appreciated, http://www.nhs.uk/news/2008/04April/Pages/Chemotherapyseffectsonthebrain.aspx In my opinion the brain is the person so losing that ahead of the body is hugely more painful to the family and friends. She, on the other hand, has survived two rounds of chemo quite well - so far. 0 Quote Link to comment Share on other sites More sharing options...
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