This is a long article, but I think it's worth slogging through.

I read the entire article -- all 8 pages.

If I lived in Texas and had some medical problem needing a thorough diagnosis and good medical care, I'd make sure I made a trip to McAllen, Texas.

I'd make sure I made a trip to McAllen, Texas.

#2 | Posted by CalifChris

I would not.

From the article:

In fact, the four states with the highest levels of spending Louisiana, Texas, California, and Floridawere near the bottom of the national rankings on the quality of patient care.

I would not.

From the article:

In fact, the four states with the highest levels of spending Louisiana, Texas, California, and Floridawere near the bottom of the national rankings on the quality of patient care.

#3 | Posted by Whatsleft at 2009-05-29 06:47 PM

State-wide, perhaps. I was speaking specifically of McAllen, Texas, which was the town focused on in the article as having excellent medical care.

Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen's five largest hospitals performed worse, on average, than El Paso's. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it's delivering better health care.

Perhaps you should read it again.

WHATSLEFT

Perhaps you should read it again.

Instead of me re-reading the article again, perhaps you should read this critique on Dr. Atul Gwande, the physician/author who wrote this article.

WHATSLEFT

sorry, screwed up the link.

Here it is again --

Chris,

I didn't find the article by Gwande to be either praise or condemnation of a single payer system. The article was merely an observation by Gwande of why healthcare may be so expensive in the U.S., with emphasis on the idea that the costs have been driven up by excessive diagnosis and procedures.

After reading his retort I'm not even sure Himmestein has read Gwande's article. Himmelstein seems to be reacting strongly to things that Gwande never expressed, in the New Yorker article.

I quoted a portion of the article that directly demonstrated that you misunderstood the article, after your statement:

"McAllen, Texas, which was the town focused on in the article as having excellent medical care."

The article clearly tries to make a point that El Paso hospitals provide better health care, even though McAllen spends much more on healthcare, per capita. Care to comment on that?

The only way to cut costs is to cut back on services.

State-wide, perhaps. I was speaking specifically of McAllen, Texas, which was the town focused on in the article as having excellent medical care.

#4 | Posted by CalifChris at 2009-05-

what was that you say??

BETTER IN TEXAS>>.

damn...weve been saying that since before 1836...

The only way to cut costs is to cut back on services.

Again, read the entire article. Pay attention to what Gawande says about the Mayo Clinic and Grand Junction. They increased the quality of the care while lowering costs.

Excessive testing is bad for your health.

WHATSLEFT

RE: your post #8

Give me a chance to really go over your article again (but not now, it'll have to be later on). I did read it in its entirety but read it quickly. I'm not so arrogant or stubborn that if I had misread or misinterpreted its contents I will not admit so afterwards.

I have a real beef with certain medical fees -- Medicare payments to physicians/hospitals being cut back so low that now many physicians no longer even accept new Medicare patients anymore. I'm also adamantly against some physicians now "cherry picking" their patients (though not to say that is what your article advocated).

I am going by my own personal experience. A couple of years ago, my personal physician (of more than 20 years) decided he would join one of those new "concierge" physicians' groups. Everything remained the same for his patients -- same insurance companies accepted, same costs for office visits, etc.) EXCEPT each patient now had to pay my doctor $1800 a year just for the "privilege" of having him continue to be their physician. IOW -- $150 a month "out of pocket" for each one of his patients (as no insurance company or Medicare would cover the cost for this type of physician plan) and if you didn't pay the $1800 yearly fee he would no longer see you as his patient.

My physician told me it was due to Medicare and other health insurance companies not reimbursing him enough money for his medical services and he was working 70 hours week (at age 59) and was tired of it. He said his costs -- malpractice insurance, rent to lease his office, etc. were all going up -- but medical payments reimbursed to him were all going down.

The new MDVIP group he now joined limited him to having only 600 patients a year (down from his 2400 patients he was seeing before he joined MDVIP). With each of those 600 patients now paying him $1800 a year my physician would now make $1,080,000 a year before he even got out of bed in the morning! And the $1,080,000 would be in addition to what he normally made for his usual practice as a physician.

Needless to say, his patients left him in droves but he didn't care as he only needed 600 to stay with him out of the former 2400 he used to treat. I remained with him another 9 months (costing me $1350 for NO extra services than I had been receiving from him for the last 20 years) and then found a new doctor in the same building.

Although, I personally had no real difficulty in finding another physician -- and actually, like my new physician even better -- for my former physician's patients' who were elderly with many of them having difficult and/or complex medical conditions, forcing them to leave and find another doctor because they couldn't pay him an extra $150 every month for the "privilege" of him being their doctor anymore it was quite a hardship.

I personally felt my former physician's decision to be a betrayal of sorts, especially to his patients who had been with him for many years. But I do understand that he could not financially afford it anymore when private insurance companies would decide to reimburse him the least amount possible for his services and Bush had slashed Medicare payments almost in half to doctors and hospitals during the 8 years he was in office. That is not a Bush-bash statement -- it was a fact -- as my physician was the one who told me about it.