June 24, 2009
Danbury News Times
Letters Editor
In the June 24 article “President battles insurers over his health plan”, insurers complain that a government health plan would disadvantage them because they would not have a level playing field to operate on.
But insurers should not expect sympathy from patients or doctors. They have accumulated almost monopolistic powers over the past few decades precisely because they “owned” the playing field and made sure that it wasn’t level for anyone besides themselves. It has allowed them to bully doctors and underpay them with a like- it or leave- it approach. And it has allowed them to exploit patients by raising their premiums, while they reduce what they will pay for drugs, testing, and doctors’ visits. This accounts for their tremendous profits and the exorbitant salaries they pay their CEOs.
A government plan would finally inject some real competition into the health care insurance market.
No wonder private insurers are worried!
Ed Volpintesta MD
Friday, June 26, 2009
Younger physicians' idealism drives public health insurance
June 26, 2000
The New York Times
Regarding “ The Prescription From Obama’s Own Doctor” (OP-ED, June 25): It is encouraging to read that the American Medical Student Association strongly supports public health insurance. Often younger physicians’ idealism affords them the ability to envision the future of medicine more clearly than their older colleagues whose vision is often clouded by a timid conformity that impedes progress and perpetuates the errors of the past.
Ed Volpintesta MD
The New York Times
Regarding “ The Prescription From Obama’s Own Doctor” (OP-ED, June 25): It is encouraging to read that the American Medical Student Association strongly supports public health insurance. Often younger physicians’ idealism affords them the ability to envision the future of medicine more clearly than their older colleagues whose vision is often clouded by a timid conformity that impedes progress and perpetuates the errors of the past.
Ed Volpintesta MD
Medicare is not mediocre
June 26, 2009
New York Times
Re “The Only Public Health Plan We Need” (OP-ED, June 25): To suggest that “Medicare is a “mediocre-quality insurer” is wrong. If the goal is to mislead the public with prejudices and misconceptions as do all opponents of public health insurance, why no just call it socialized medicine, a scare-tactic that has halted progress of public health insurance for over fifty years.
Millions of Americans would have undergone bankruptcy if they were not protected by Medicare. I have not seen or heard of any Medicare patients having their cancer treatments denied or their insurance cancelled because of pre-existing conditions something that happens not infrequently with private insurers.
Clearly, Medicare is not mediocre, mercenary, or merciless, common complaints often hurled, as they should be, at private insurers.
Ed Volpintesta MD
New York Times
Re “The Only Public Health Plan We Need” (OP-ED, June 25): To suggest that “Medicare is a “mediocre-quality insurer” is wrong. If the goal is to mislead the public with prejudices and misconceptions as do all opponents of public health insurance, why no just call it socialized medicine, a scare-tactic that has halted progress of public health insurance for over fifty years.
Millions of Americans would have undergone bankruptcy if they were not protected by Medicare. I have not seen or heard of any Medicare patients having their cancer treatments denied or their insurance cancelled because of pre-existing conditions something that happens not infrequently with private insurers.
Clearly, Medicare is not mediocre, mercenary, or merciless, common complaints often hurled, as they should be, at private insurers.
Ed Volpintesta MD
Tuesday, June 9, 2009
Role of defensive medicine as driver of health costs understated
Dr. Atul Gawande wrote an interesting article in the New Yorker. By studying a Texas town with unusually high health care costs, he concluded that the incentives for doctors to be paid separately for each patient and procedure and in some cases fueled by an entrepreneurial spirit were responsible for the unusally high cost of health care there; and how this approach may be responsible for high costs of health care everywhere.
The article was good particularly his suggestions how doctors in their local communities could control health costs but his conclusion that the fear of malpractice threats and defensive medicine did not raise the cost of health care are questionable.
Here is my response to The New Yorker.
June 7, 2009
The New Yorker Magazine
I have difficulty accepting Atul Gawande’s conclusions about defensive medicine (the ordering of more tests than necessary in order to have a good defense in case a malpractice suit is filed) in his June 1 article “The Cost Conundrum”.
He suggests that because Texas’s malpractice laws have a $250,000 cap on pain and suffering, doctors they are not under acute pressure to practice defensive medicine, that is, order more tests than necessary in order to have good defense in case a suit is filed.
He based this on a cardiologist he interviewed who mentioned that malpractice cases had gone down “practically to zero”.
But Texas Liability Trust, the largest liability carrier in Texas reported only a 50% reduction in malpractice suits according to an article published in the September 8 issue of American Medical News, the official newspaper of the American Medical Association.
Even if the number of malpractice cases filed were “practically to zero”, doctors would still practice defensively because undergoing one is a terrible ordeal. No doctor wants to risk malpractice because just one suit, even a frivolous one, has the potential to ruin his or her career.
The fear of malpractice suits is one of the factors that contribute to the high cost of care in Texas as much as it does anywhere and until a more humane method of treating malpractice cases is established—one that does not destroy doctors’ reputations, or cause them unnecessary distress as they wait on tenterhooks waiting for the outcome of a case—doctors will continue to practice defensively.
The solution to the cost conundrum includes reforming the malpractice laws.
Edward J. Volpintesta MD
The article was good particularly his suggestions how doctors in their local communities could control health costs but his conclusion that the fear of malpractice threats and defensive medicine did not raise the cost of health care are questionable.
Here is my response to The New Yorker.
June 7, 2009
The New Yorker Magazine
I have difficulty accepting Atul Gawande’s conclusions about defensive medicine (the ordering of more tests than necessary in order to have a good defense in case a malpractice suit is filed) in his June 1 article “The Cost Conundrum”.
He suggests that because Texas’s malpractice laws have a $250,000 cap on pain and suffering, doctors they are not under acute pressure to practice defensive medicine, that is, order more tests than necessary in order to have good defense in case a suit is filed.
He based this on a cardiologist he interviewed who mentioned that malpractice cases had gone down “practically to zero”.
But Texas Liability Trust, the largest liability carrier in Texas reported only a 50% reduction in malpractice suits according to an article published in the September 8 issue of American Medical News, the official newspaper of the American Medical Association.
Even if the number of malpractice cases filed were “practically to zero”, doctors would still practice defensively because undergoing one is a terrible ordeal. No doctor wants to risk malpractice because just one suit, even a frivolous one, has the potential to ruin his or her career.
The fear of malpractice suits is one of the factors that contribute to the high cost of care in Texas as much as it does anywhere and until a more humane method of treating malpractice cases is established—one that does not destroy doctors’ reputations, or cause them unnecessary distress as they wait on tenterhooks waiting for the outcome of a case—doctors will continue to practice defensively.
The solution to the cost conundrum includes reforming the malpractice laws.
Edward J. Volpintesta MD
Sunday, June 7, 2009
Insurers only partly responsible for primary care shortage
June 7, 2009 YJHM
In the June 7 issue of the Boston Globe, Dr. Stephen J. Bergman wrote an interesting OP-ED piece , “Pitting doctor against doctor” in which he expresses serious concern for the plight of primary care doctors, especially their low compensation rates compared to specialists.
He blames health insurers for their tactic of proposing to pay primary care doctor more by paying specialists less. Pitting doctor against doctor, as he calls this approach is a bad idea. It is a bad idea but there is another side to this argument.
Here is my answer to the editors at the Boston Globe
June 7, 2009
The Boston Globe
In his June 7 OP-ED piece “Pitting doctor against doctor”, Stephen J. Bergman MD is only partly right to put the blame on insurers for the low compensation rates given to primary care doctors.
Leaders of organized medicine have known about the unfair disparity between primary care and the specialties for decades. However most of the twenty-four medical specialties have largely ignored the plight of primary care. The majority of the specialties and their leaders have pursued a policy of protecting their own turfs, so to speak, and have left primary care on its own.
Outnumbered in the political arena, primary care’s approach has been woefully ineffective and their dominant attitude has been one of inurement and desperation more than effective advocacy.
Arguably, the internecine arena that health insurers have instigated may be viewed as a natural evolution of primary care’s fight for survival. Saving primary care is not the responsibility alone of the insurers. It is the responsibility of the entire medical profession.
So far, both have failed.
Ed Volpintesta MD
In the June 7 issue of the Boston Globe, Dr. Stephen J. Bergman wrote an interesting OP-ED piece , “Pitting doctor against doctor” in which he expresses serious concern for the plight of primary care doctors, especially their low compensation rates compared to specialists.
He blames health insurers for their tactic of proposing to pay primary care doctor more by paying specialists less. Pitting doctor against doctor, as he calls this approach is a bad idea. It is a bad idea but there is another side to this argument.
Here is my answer to the editors at the Boston Globe
June 7, 2009
The Boston Globe
In his June 7 OP-ED piece “Pitting doctor against doctor”, Stephen J. Bergman MD is only partly right to put the blame on insurers for the low compensation rates given to primary care doctors.
Leaders of organized medicine have known about the unfair disparity between primary care and the specialties for decades. However most of the twenty-four medical specialties have largely ignored the plight of primary care. The majority of the specialties and their leaders have pursued a policy of protecting their own turfs, so to speak, and have left primary care on its own.
Outnumbered in the political arena, primary care’s approach has been woefully ineffective and their dominant attitude has been one of inurement and desperation more than effective advocacy.
Arguably, the internecine arena that health insurers have instigated may be viewed as a natural evolution of primary care’s fight for survival. Saving primary care is not the responsibility alone of the insurers. It is the responsibility of the entire medical profession.
So far, both have failed.
Ed Volpintesta MD
Sunday, May 10, 2009
Humane care, not rational care
Rational health care can be misconstrued to mean what is economically sensible treatment as opposed to what is humane treatment. Although rational care may be good, it isn't necessarily humane. The objectives of medicine, business, and law are not always aligned harmoniously.
May 10, 2009
News-Times
Danbury, Connecticut 06801
Syndicated columnist Ellen Goodman emphasized in her May 8 article “Rationed health care may be rational” that doctors and patients need to talk about just how much care a terminally ill patient should receive. She also pointed out that doctors don’t talk about death as much as they should because they consider death a failure of their skills.
This is all true but doctors sometimes “over- treat” even when doing so will not change the final outcome for fear that the family might think the doctor was incompetent and maybe even sue him or her for malpractice.
Thus for some doctors doing everything is the safest way to practice even though it is costly and may do nothing to improve a patient’s quality of life. Doing everything is called “defensive medicine” and is so common that it has come to be considered good medicine.
Lawmakers are beginning to understand this terrible dilemma that doctors and patients face. In one sense, it is a result of medicine’s great advances. Kidney dialysis, heart bypass surgery, and new methods of treating cancer for example, give the impression that no disease is incurable. But there are situations when good conversation and less intervention, as Ms. Goodman put it, is best.
In those situations where a prognosis is poor, a good relationship with a personal physician is very helpful. If he has known the patient for some time he probably can help the family and patient arrive at a humane decision. Also, when a prognosis is poor there are usually several doctors involved. Decisions not to over-treat are usually arrived at by not one but several doctors working together. Hospitals also have ethics committees to help doctors and families make difficult decisions.
Perhaps we should be talking not about rationed care but about humane care.
Ed Volpintesta MD
May 10, 2009
News-Times
Danbury, Connecticut 06801
Syndicated columnist Ellen Goodman emphasized in her May 8 article “Rationed health care may be rational” that doctors and patients need to talk about just how much care a terminally ill patient should receive. She also pointed out that doctors don’t talk about death as much as they should because they consider death a failure of their skills.
This is all true but doctors sometimes “over- treat” even when doing so will not change the final outcome for fear that the family might think the doctor was incompetent and maybe even sue him or her for malpractice.
Thus for some doctors doing everything is the safest way to practice even though it is costly and may do nothing to improve a patient’s quality of life. Doing everything is called “defensive medicine” and is so common that it has come to be considered good medicine.
Lawmakers are beginning to understand this terrible dilemma that doctors and patients face. In one sense, it is a result of medicine’s great advances. Kidney dialysis, heart bypass surgery, and new methods of treating cancer for example, give the impression that no disease is incurable. But there are situations when good conversation and less intervention, as Ms. Goodman put it, is best.
In those situations where a prognosis is poor, a good relationship with a personal physician is very helpful. If he has known the patient for some time he probably can help the family and patient arrive at a humane decision. Also, when a prognosis is poor there are usually several doctors involved. Decisions not to over-treat are usually arrived at by not one but several doctors working together. Hospitals also have ethics committees to help doctors and families make difficult decisions.
Perhaps we should be talking not about rationed care but about humane care.
Ed Volpintesta MD
Tuesday, May 5, 2009
Remedies: New Media
"Ever regret being born a girl, or worse, being pregnant with one? Do you have that nagging suspicion that junior's a fairy? Some days, don't you just feel too brown to fit in? For the first time, a new line of miracle Remedies have been developed to address these cultural neuroses. Our products incorporate the latest medical breakthroughs, enhanced by ancient Chinese secrets that comply with the highest standards in numerology, filial piety, and Confucian mythos."E-literature, medical marketing, and folklore collide in Remedies, a work-in-progress by new media artist Monica Ong, who creates narrative spaces that examine cultural anomalies in public health.
http://monicaong.com
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