Print

Print


Rick, I think you have hit the nail on the head..

Marty
Martin Herman, M.D.

Pediatric Emergency Medicine 
Sacred Heart Children's Hospital
Florida State University, Department of Pediatrics
5153 N. 9th Ave, 6th Floor Nemours Bldg
Pensacola, FL 32504
Ph: 850 416 7658(office)
Email: [log in to unmask] 
CONFIDENTIALITY NOTICE: 
This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege.




 > Date: Sat, 6 Apr 2013 03:30:12 +1300
> From: [log in to unmask]
> Subject: Re: Our Future
> To: [log in to unmask]
> 
> I am sure that there are as many opinions as there are members of this list
> serv, many of which revolving around political philosophy.
> 
> I appreciate the Canadian point of view, particularly those of you who have
> worked both sides of the border.
> 
> I have spent the past 8 months working in New Zealand, which has provided
> me with a unique opportunity to reflect on the US healthcare system. And
> reflect I have.
> 
> At the end of the day, New Zealand (and most other developed countries) has
> better *population based* medical outcomes and covers virtually ALL of its
> citizens. At 60% of the cost.
> 
> How do they do that? Well for one thing, when I walk in to see a patient
> here, the lawyer is not sitting in the back of the room. And for another,
> the expectations of the population are different.
> 
> The lawyers demand perfect care. (Here patients wanted good medical
> care). This is somewhat evidenced by the emphasis in clinical decision
> rules that emphasize near 100% sensitivity with a cost in specificity.
> Catching that last 1% is very expensive. This is Bentley diagnostic care.
> 
> And the US is an incredibly individual-focused nation. So each individual
> wants "everything done". Again, Bentley care.
> 
> These two factors are at odds with the concept of limited resources.
> Attempting to maintain some political neutrality, our current focus is on
> driving down costs. The reality is somewhat different; we simply provide to
> much heath care (e.g. too many admissions for low risk chest pain, too many
> head CTs for minor head trauma). It simply consumes too much of our GDP.
> 
> Ultimately, it is a question of limited resources. And where there are
> limited resources, there is rationing.  We don't like to use the "R" word
> but the reality is that we live in a world of limited resources and our
> national priorities (Canada, the US, New Zealand) determine where those
> resources will be deployed. Some countries ration by waiting lists, some by
> limiting extremely expensive care (e.g. end of life, organ transplantation
> late in life), and some by socioeconomic status (i.e. US in which 15-20% of
> the population is without insurance).
> 
> Which brings me back to my original point, as long as the culture insists
> on perfection (Bentley care) and as long as there are lawyers in the room
> to enforce this mandate, the system will become more and more *
> unsustainable,* both financially (burden on the US economy) and
> socially (distribution of those resources).
> 
> So it seems to me that Canada (not having worked there) and New Zealand
> (currently working there) have medical systems that, while imperfect and
> with visible warts, provide a framework for sustainability. The US does not.
> 
> Rick Place
> 
> I wade into this debate with some trepidation.
> 
> 
> On Fri, Apr 5, 2013 at 1:27 PM, Elin Ringstrom <[log in to unmask]>wrote:
> 
> > Thank you Mike,
> >
> > As a doctor who has worked in both countries, I agree with your points.
> >
> > Elin Ringstrom,MD
> > Mankato, MN
> >
> >
> > On Thu, Apr 4, 2013 at 3:56 PM, Michael Falk <[log in to unmask]
> > >wrote:
> >
> > > Joe,
> > > Having worked on both sides of the border, I have to disagree with your
> > > assessment.  I think that both systems have significant problems and need
> > > major overhauls, but in the long run feel that the Canadian model, or
> > > something along those lines, is far more sustainable and equitable than
> > the
> > > current US system.
> > >
> > > What has evolved in the US is a very poorly designed system that is based
> > > on an outdated concept: that health care can be funded through private
> > > insurers via a system of subsidies and tax breaks to employers.  After
> > > WWII, the US elected to pursue this model and has funded health care this
> > > way, with a variety of "patches" to gloss over huge problems in the
> > system,
> > > ever since.  But no one has serious looked at the original premise and
> > it's
> > > long term viability.  The problem is that health care is getting to
> > > expensive to be paid for in this fashion and no one wants to "pay" for
> > the
> > > differences (or as I say to my residents: Everyone wants a "Bentley", but
> > > they only want to pay for a "Honda").  Added to this is the whole concept
> > > that an "insurance model" is actually appropriate for paying for health
> > > care!!
> > >
> > > I am attaching this excellent article for the Atlantic Monthly that
> > reviews
> > > a lot of this:
> > >
> > >
> > >
> > http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/
> > >
> > > Last point: there is a persistent "myth" down here that there is a "free
> > > market" approach to health care, when in fact the entire system survives
> > on
> > > huge subsidies, both actual and in the form of tax breaks, that really
> > make
> > > it a state-funded system.  We may as well just admit it and deal with the
> > > issue upfront....which is not what we did with "health insurance reform"
> > > because there was certainly NO "health care reform" in the last round!
> > >
> > > Just my 2 cents worth.
> > > Mike Falk, MD
> > > New York, NY.
> > >
> > >
> > > On Thu, Apr 4, 2013 at 2:34 PM, Joe Nemeth, Mr <[log in to unmask]>
> > > wrote:
> > >
> > > > I just returned form a conference and had a chance to chit-chat with
> > some
> > > > American Colleagues about health-care reform. We all found it
> > ironically
> > > > humorous that it seems like we want to flip-flop health-care paradigms.
> > > >
> > > > I will tell you from FIRST hand experience that "socialized" health
> > care
> > > > as we know it up here does not work. Quebec, Canada's second most
> > > populated
> > > > province, is probably the poster-child for how not to implement this
> > type
> > > > of construct.
> > > >
> > > > The ED's (both adult and peds) are saturated due to high input (see:
> > > > functionally nonexistent primary care infrastructure), very inefficient
> > > > although well-meaning throughput (ED'S) and poorly organized, not
> > > > accountable output (the hospital). Add a dash of corruption and it
> > makes
> > > > for the perfect storm.
> > > >
> > > > I think you guys "were" closer to getting it done the right way than we
> > > > are..."were" is the key word.
> > > >
> > > > joe
> > > >
> > > > ---------------------------------------------
> > > > Joe Nemeth MD CCFP (Emergency Medicine)
> > > > Assistant Professor
> > > > Pediatrics, Family Medicine
> > > > Director
> > > > Department of Emergency Medicine
> > > > Montreal General Hospital
> > > > McGill University Health Center
> > > >
> > > >
> > > > ________________________________________
> > > > From: Pediatric Emergency Medicine Discussion List [
> > > > [log in to unmask]] on behalf of Peter Antevy [
> > > > [log in to unmask]]
> > > > Sent: Thursday, April 04, 2013 12:55 PM
> > > > To: [log in to unmask]
> > > > Subject: Re: Our Future
> > > >
> > > > Todd,
> > > >
> > > > I agree with you that with the creation of ACO's the care of the
> > patient
> > > > will be
> > > > driven away from hospitals as a simple function of how reimbursement
> > > > happens.
> > > > I actually agree with your sentiment of capitalizing on this moment in
> > > time
> > > > where there will be a significant shift in the way healthcare is
> > > provided.
> > > >
> > > > Those who don't believe this is a real issue will ultimately be stuck
> > > > having
> > > > their decisions being made for them in the long term.
> > > >
> > > > Peter
> > > >
> > > >  Peter Antevy MD
> > > > Pediatric Emergency Medicine
> > > > Joe DiMaggio Children's Hospital
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > > ________________________________
> > > > From: trzim29 <[log in to unmask]>
> > > > To: [log in to unmask]
> > > > Sent: Thu, April 4, 2013 12:13:14 PM
> > > > Subject: Our Future
> > > >
> > > > How are we positioning ourselves looking toward the very near future
> > with
> > > > ACO
> > > > development and Obamacare?
> > > > More insureds could mean more encounters. BUT, the future is pushing
> > > > healthcare
> > > > away from the hospitals into outpatient settings, ie urgent care,
> > > > immediate care
> > > > outpt. surgery centers etc...
> > > > This could be a real issue for er medicine.
> > > > Either inundation or drying up of patient encounters, depending on
> > which
> > > > actually takes precedence.
> > > > Either way...we are in for it...
> > > > The smart ones will capitalize on this.
> > > > Todd Zimmerman
> > > >
> > > >
> > > >
> > > > Sent from my Verizon Wireless 4G LTE Smartphone
> > > >
> > > > For more information, send mail to [log in to unmask] with
> > the
> > > > message:
> > > > info PED-EM-L
> > > > The URL for the PED-EM-L Web Page is:
> > > >                 http://listserv.brown.edu/ped-em-l.html
> > > >
> > > > For more information, send mail to [log in to unmask] with
> > the
> > > > message: info PED-EM-L
> > > > The URL for the PED-EM-L Web Page is:
> > > >                  http://listserv.brown.edu/ped-em-l.html
> > > >
> > > > For more information, send mail to [log in to unmask] with
> > the
> > > > message: info PED-EM-L
> > > > The URL for the PED-EM-L Web Page is:
> > > >                  http://listserv.brown.edu/ped-em-l.html
> > > >
> > >
> > > For more information, send mail to [log in to unmask] with the
> > > message: info PED-EM-L
> > > The URL for the PED-EM-L Web Page is:
> > >                  http://listserv.brown.edu/ped-em-l.html
> > >
> >
> >
> >
> > --
> > Elin Ringstrom MD
> > Attending Physician
> > Department of Emergency Medicine
> > Immanuel St. Joseph's Hospital - Mayo Health System
> >
> > For more information, send mail to [log in to unmask] with the
> > message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >                  http://listserv.brown.edu/ped-em-l.html
> >
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  http://listserv.brown.edu/ped-em-l.html
 		 	   		  
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html