Listen to Interview on “Fresh Air” Today, Monday, July 27; Link To Video Interview on Air America Here

Thursday, I did an interview on “Fresh Air” with Terry Gross. They tell me it will air this afternoon ( Monday July 27   Check your NPR radio station.   You should be able to listen to it at http://www.freshair.com   I just learned that audio of the interview will be available, online at 5 p.m. on this link:

http://www.npr.org/templates/story/story.php?storyId=111063048&ft=1&f=13

You may also be interested in a video interview that Andy Fredericks and I did with Sam Ceder on “Air America’s “BreakRoom Live”.  (Andy is the director of the documentary based on my book, Money-Driven Medicine.)  Here’s the link to the video  http://samsedershow.com/  You will need to scroll down the page to find it.  Then fast-forward through the host's introductory remarks until you come to a picture of Seder, Andy and I sitting at a table.

        

18 thoughts on “Listen to Interview on “Fresh Air” Today, Monday, July 27; Link To Video Interview on Air America Here

  1. I think a better way to reward young residents for going into primary care is to make their loan payments tax deductible. With that and increased payments not based on pushing people through, perhaps more will choose primary care.

  2. I just listened to your interview with Terry Gross, and then with Sam Seder. It was one of the most simply stated and informative descriptions of the healthcare issue I’ve come across. Thank you.

  3. I heard you on NPR’s Fresh Air.
    As a currently uninsured “young person”, I wonder whether the proposed health insurance program would include coverage for preventative and therapeutic care modalities that have been proven for thousands of years, such as massage therapy, accupuncture, even yoga and t’ai chi?

  4. Hi Maggie, enjoyed your interview with Terry Gross today.
    Here is a possible solution to drastically lowering health care cost in the USA. It is called, “Free Enterprise Medicine”. NON-USA hospitals and Providers would be allowed to operate within the USA with NO AMA or other legal restrictions on their operations. All Medical & Legal issues would be handled be as if these hospital and service providers were located in their Washington DC embassies.
    mike

  5. I greatly enjoyed your interview, but I would offer one quibble. You state as gospel that 1) We need to train more primary care physicians and 2) Specialization in medicine is negative. I would offer the following counterpoints to those contentions. 1)Training physicians is both an expensive process and a long process. Most health care encounters that are described as “primary care” are handled equally well by midlevel providers (NPs and PAs) with appropriate physician back-up. These providers are much cheaper and quicker to train, and I would argue, follow guidelines as well or better than physicians. Why does it not make more sense to invest finite resources in increasing the supply of these midlevels and reverse the usual ratio of one midlevel per three physicians to three or four midlevels per one physician? I am also unaware of any other field of human endeavor in which the evolution is not toward increased specialization. As the knowledge base inevitably grows, people specialize in order to have a depth of expertise. the concept currently being sold of Marcus Welby as the a cure to our health care woes is fallacious.
    As full disclosure, I am a subspecialist who takes care of about 5 diseases, and I can relate the difficulty in staying current and having the expected depth of knowledge and understanding in those small number of conditions.
    I guess my point is that we need to question certain “truisms” and critically analyze all proposals so that we can improve our health care delivery system and the health of our fellow persons.

  6. Maggie,
    I listened to your interview on Fresh Air tonight and got really excited that someone had finally got it right – you stated that competition in health care had not driven down prices because health care is not a true market economy. Way to go!
    Then to demonstrate the point, you stated that health care consumers could act as good consumers usually because when they need health care they need it immediately and therefore could not shop around for more efficient providers.
    Swing and a miss!
    Health care consumers don’t shop around for more efficient and cost effective providers because they are shielded from the true cost of health care by their medical insurance. How many health care consumers can tell you what the true cost of the last medical procedure they had? If they have insurance, that number is somewhere close to zero.
    You are also accurate about providers over-treating and over-prescribing, but in every other market the consumer is the reasonable check on over-prescribed services. But the consumer doesn’t do their job in the health care market because they have very little economic incentive to be frugal in the health care they buy.
    In fact, what you have is this crazy situation where me and my doctor sit isolated in a room and decide how much of the insurance companies money we will spend! His incentive is to increase billing and decrease risk (defensive medicine) and my incentive is to get the best health care someone else’s money can buy.
    Now I have no love for insurance company’s, but you have to admit that this situation shouldn’t pass the laugh test.
    No matter what solution eventually comes out of congress, I fear it is doomed to outrageous cost overruns similar to today’s system if we do not find a way to align the consumer’s economic self interest with the goals of the overall system. If we don’t do that, then every time my doctor suggests a test, or a drug, or a procedure, I am going to shrug my shoulders and say “Why not, it doesn’t cost me.”
    jte

  7. Ooops! The second paragraph should read…
    Then to demonstrate the point, you stated that health care consumers could _NOT_ act as good consumers…

  8. Patrick, Mike & Lisa,
    Brandon, Bix, Chuck–
    Thank you all for your comments.
    Patrick–Welcome to HealthBeat.
    I agree that Nurse-Practioners and Physician Assistants can do much of the work that primary care physicians do now.
    But primmary care physicians can do much of the work that specialists do.
    We know this, both by looking at Europe (where patients see many more PCPs and many fewer specialists and both outcomes, and patient satisfaction are, by and large better)–and by looking at the best healthcare in the U.S.
    In places like the Mayo Clinic, Geisinger, etc. patients see many fewer specialists.
    Costs are much lower (after adjusting for differences in local prices, and underlying health of the local population.) and qualty i higher.
    When you compare very similiar patients you find that Medicare pays less for patients at the Mayo Clnic–where outocmes, patient satisfaction and physician satisfaction are much higher.
    We also know that in communities where the ratio of primary care docs to specialists is higher, costs are lower–and quality is higher.
    This is not to say that most specialists don’t do a very good job. They do–and they are absolutely essential. . .
    But when a patient is experiencing symptoms and doesn’t know what is wrong with him or her, there can be much to be said for seeing a primary care doctor who will be looking at the whole patient.
    Specialists, quite naturally, see a patient as womeone who has a liver disorder, a
    kideny problem etc. As many specialists say, “Iff you’re a hammer, everything looks like a nail).
    By contrast, at least some primary care docs have been trained to diagnose by listening to and talking to patients — and using “hands on” to diagnose.
    Many doctors complain that today’s med students are just being taught to order tets.
    The don’t knwo how to diagnose.
    These are the reasons why we need to increase the number of primary care docs, family practioners, pediatiricans, ec. (The House bill does this.)
    Mike & Lisa–
    Mike, I’m afrid Lisa is right. We have decades of experience telling us that free enterprise doesn’t solve the problem in heatlhcare.
    We are the only developed nation that has chosen to turn healthcare into a largely unregulated, for-profit enterprise. Overall health in the U.S. than in other develped nations (even if you only look at Caucasions) and outcomes for many disases just are not as good here. (This is all documented in U.S. medical journals.)
    Brandon–
    I suspect universal coverage would cover acupuncture (many private insurers now cover it)
    As for other alternative therapies, this is something that the comparative effectivenes panel that Obama has already funded will be lookinga at–and calling for unbiased head-to-head studies comparing different treatments for particular ailments.
    In many cases, we need more mecical evidence that these treatments work for patients who meet a particular medical profile.
    Bix–
    Welcome to HealthBeat– and thank you for your kind words.
    Chuck–
    We need to atrack more med students coming form low-income failies. Reseach shows that they are much more likely to be willing to go back to low-income areas where thye are needed, and to choose primary care.
    Also we need physicans who reflect the diversity of the patient popuulation. Docs coming form low-income families are in a better positiont to relate to patients coming form low-income rural families and inner city famlies-white as well as black and hispanic.
    Kids comding from low-income families just aren’t going to take on $250,000 in debt. They have no family safety net.
    They need full loan forgiveness–which many reformers are suggesting for students from low-income famlies, regardless of race.

  9. I listened to parts of the interview and found it quite informative, especially about some aspects of the Obama healthcare plan. I liked your take on why Americans have not, at least until now, embraced universal/national health care, namely that most don’t know the facts about the sad state of US healthcare outcomes relative to other countries. I also agree that a hybrid public-private plan probably makes the most sense, in that it provides more choice and increases competition. I also liked the concept of ending the wasteful pay for services model, which encourages over-treatment. I think you should be offered a job in the Obama administration.

  10. Maggie,
    In your FreshAir interview, it sounded like you favor Medicare Advantage plans over Original fee-for-service Medicare. Where I am, we frown on the Medicare Advantage program for several reasons, one of them being the overpayments and another being the privatization of Medicare. Do you think that if payments to Medicare Advantage plans are cut to the same level as Original Medicare, Medicare Advantage plans can compete with Original Medicare?

  11. Stan and Elaine–
    Stan– You are toio kind.
    Welcome to the blog–and thank you.
    Elaine–No, I don’t favor Medicare Advantage. I think it’s a terrible idea.
    We’re overpaying the insurers who offer Advantage, and they are not offering good value for the money.
    I’m quite certain that those overpaymetns will be cut next year.
    I’ll have to listen to the interview again to hear what created the impression that I favor Advantage . . . Rest assured, I do not.
    Thanks for the comment

  12. Your interview with Terry Gross revealed again your blind spot about so-called “insurance”. With all of your research skills and (most of the time) rational conclusions from the evidence, it’s hard to understand how you can believe that “regulation” of the insurance industry will “solve” the basic problems of healthcare in the US caused by privatized financing of basic health coverage. “Insurance”by definition MEANS underwriting. Yet you continue to spread the canard that it’s somehow possible to “regulate” the insurance industry out of their underwriting practices, such as requiring them to sell policies to “all comers”, to prohibit them from cherry-picking the youngest and healthiest “consumers,” and to prohibit them from denying coverage to patients with pre-existing conditions, or else to subsidize them when they make policies unaffordable for people they would not ordinarily cover (the cause of the Medicare Advantage overpayments). I’m not sure whether the CBO estimate even considered the administrative overhead and costs involved with “regulating” and “overseeing” and “monitoring”, but as a federal bureaucrat for 10 years in two different regulatory agencies, I can tell you that it would be prohibitively expensive and not even doable politically. “The government” couldn’t even get a commitment from the insurers not to continue the practice of recission of policies (as Wendell Potter noted, they still have to send the message to Wall Street that they will continue to practice their profit-maximizing and profit-protecting methods). The insurance industry happily recognizes that hell will freeze over before the government will have the financial and competent human resources and political will to “regulate” the basic bread and butter of insurance–underwriting. This is why only (traditional) Medicare works in this country as “health insurance”–there is no underwriting: everybody is covered as soon as they qualify by age or disability and pay the premiums, everybody pays the same premium, and everybody has the same benefits package.

  13. John Earl:
    Your comment is based on a flawed understanding of how health and medical services are delivered.
    What really happens is this:
    A single patient can present with
    complaints and receive different diagnoses from different diagnosticians, and
    the diagnosis will determine what treatment is given. Different radiologists
    read the same x-rays or CT or MRI scans and some diagnose that a disease is
    present and some diagnose that a disease is absent. A university hospital may
    be stellar in providing a particular surgery or high-risk procedure while a
    community hospital may provide that same surgery very poorly and should not
    even be providing high-risk procedures. Even with the same diagnosis,
    different specialists prescribe different treatments depending on their specialty
    and focus. Different regions of the US provide different amounts of various
    procedures even though the health status of their populations is similar.
    Depending on the results of these situations, differences will occur in what
    kind of health services are provided (or not), how much is provided, why it is
    provided (or not), and where it is provided. Of course, the results of these
    decisions impact whether and how much insurers will pay out.
    Patients rely on their doctors’ professional expertise to act as agents on their behalf and can only hope that the medical care being recommended is correct and safe. Research shows that patients trust their doctors implicitly to give them the right care, in a safe and accurate manner; patients even believe that their doctors will tell them when a treatment is not going right or when an error has been made, even though this is largely not true.

  14. Maggie,
    I think essentially we agree, but be careful about turning an association into causation. Many people, me included, would argue that the reason integrated health care delivery systems like Mayo cost less and deliver great care is that their team approach decreases redundancy and improves coordination, thereby decreasing costs and ensuring good outcomes, for the most part. There is also little defensive medicine practiced there which also reduces costs. Simply increasing the number of primary care physicians (notice not providers) does not guarantee those same outcomes.

  15. Patrick–
    I agree that ingegrated delivery system are preferable.
    But we do have pratical evidence that when there are more primary care providiers and fewer specailists, costs are lower and outcomes are at least as good, somtimes better–both in much of Western Europe ( where patients see many more primary care providers and many fewer specialists, and in the U.S. in communities that have managed to reduce cost while lifting quality.
    In these communities the ratio of primary are docs to specialists tends to much higher (I’ll be writing about this) and they are not all working in ACOs . .

  16. ACarroll–
    You need to read the legislation–and news stories about what insurers have already agreed to.
    Insurers will have to provide policies for anyone who applies, regardless of pre-existing conditoins, at the same price that they charge everyone else in the community. Period.
    This is already the case in New York State–where I live. It works.
    In N.Y., as long as you have had been insured in the past, continuously (which shows you didn’t wati until you became sick to apply for insurance) anyone can get insurance, without a physical and without reporting on pre-existing condtions. Everyone pays the same price for the same policy
    The insurance industry has already agreed that as long as we have a mandate that everyone has to buy insurance (rather than waiting until they get sick to apply) everyone will get insurance at the saem price in a given community—and insurance companies cannot turn sick people down, or charge them more.