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The facts remain that we have exorbitant spending with no mechanism
currently in place to rein it in.  Important parts of the article to me
are 

1) that we routinely charge "wedding prices" for things that could be
obtained much more cheaply. 
2) that physicicians have lots of incentives to order more tests and few
external disincentives to be spendthrift
3) that technology will continue to spur more expensive tests
4) that those least able to afford costs or stand up on their own behalf
are the most likely to pay the most

Point one is insidious, and changed my life.  When I invented my little
reusable needle pain device, I TRIED to get medical device manufacturers
interested.  All of them said the only way they'd be interested in a pain
relief device was if it were disposable, or if it were hugely expensive. 
That's the name of the game.  Now that I'm slightly on the inside of
medical device sales, I have also discovered that in order to continue
making profits as they did pre-Obamacare limits, big HMOs have instituted
"rebates" that increase their profit margin when they're using a
particular medical device.  Device companies are expected to pay these
insurers some of what the insurers pay BACK, so it appears they are
limiting their profit and operating expenses to 22%.  How ... repugnant.

Completely agree, with your points, Lei Chen-

Also, if everyone has a right to basic healthcare as part of life,
liberty, and pursuit of happiness, then if healthcare can personally
bankrupt you, aren't your rights being violated?  

If we all debate and talk about this,maybe we'll accomplish something.


"Chen, Lei" <[log in to unmask]> writes:
>I know this is quite dangerous, but the tone of piece was overtly
>political and sensational.  Furthermore since my institution (Yale New
>Haven Hospital) was named I thought I would offer a few points on the
>article.
>
>1. Despite the author's many disparaging remarks about Obamacare all the
>egregious examples of exorbitant patient bills would NOT happen after the
>implementation of the plan. 
>
>2. Medicare part D was passed under a Republican president.  
> 
>3. The tort reform argument is specious.  There hasn't been a credible
>effort at tort reform by either party in the past decade.
>
>4. The "solutions" proposed do not really answer the basic question of
>fundamental right to basic health care: do we believe in it; and if we
>do, where is the line that distinguish "basic" and "advanced" levels of
>care.  
>
>5.  Finally the salary argument is plain stupid.  According to his logic
>Obama should certainly make more than Marna Borgstrom (CEO of my
>hospital).  
>
>Sorry about the rant.  The lay press may be talking about it but in my
>opinion this piece is sensational but does not inform.   It stokes
>political fervor but does little to further the discussion the US health
>care system.   
>
>Lei Chen, MD MHS
>
>Associate Professor of Pediatrics
>Director of Research
>Section of Emergency Medicine
>Department of Pediatrics
>Faculty, Global Health Initiative
>Yale University School of Medicine
>________________________________________
>From: Pediatric Emergency Medicine Discussion List
>[[log in to unmask]] on behalf of Gill Winnik
>[[log in to unmask]]
>Sent: Tuesday, February 26, 2013 9:30 AM
>To: [log in to unmask]
>Subject: long but a must read
>
>usually I would not  use the list to point out an article, but this one
>in TIME magazine really rocks, is discussed among lay people everywhere
>and i believe is a must read:
>
>http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/
>
>Giora Winnik MD
>Maimonides Medical Center
>Brooklyn NY
>________________________________________
>
>
>
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Amy Baxter MD
Pediatric Emergency Medicine Associates
404 371-1190


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