Letters – Health Care, Used and Overused – NYTimes.com

To the Editor:

Re “In Medicine, the Power of No” (Economic Scene column, April 7):

David Leonhardt is right about the importance of reducing the use of health care services of limited or no value. The surest way to do that is for doctors and patients to build strong, trusting relationships and, then, for doctors to talk straight to their patients about what is best for them given the state of their health and the power of available treatments. Since we go to doctors for their expertise, it is reasonable to expect that we would accept their recommendations.

And there is the rub. Today’s insurers discourage doctors from spending enough time with patients to build those relationships. But, even when they exist, doctors are often reluctant to give “bad news.” And, finally, if patients don’t undergo the latest treatment, doctors lose the income from it, and the hospital will lose the income from the CT scan not ordered.

So, until these conditions change — including the nature of the incentives — those who say “no” are likely to be fairly rare.

Stephen M. Davidson

Boston, April 7, 2010

The writer is a professor at the Boston University School of Management and the author of “Still Broken: Understanding the U.S. Health Care System,” being published this month.

via Letters – Health Care, Used and Overused – NYTimes.com.

What’s Wrong With Me?

I'm trying to figure out what's wrong with me. My new senator, Scott Brown, and his Republican colleagues are telling us that "the American people are angry" about the new health care reform legislation. But even though I am an American born and bred, I'm not angry, and I am trying to figure out what's wrong with me.

Should I be angry that, now, 32 million previously uninsured Americans will be able to get affordable, comprehensive insurance?

Should I be angry that those folks will now have access to modern medical services early in the course of their illness when it will do the most good?

Should I be angry that they will not get as sick as they do now? And that they will not need to use expensive hospital emergency rooms so much anymore?

Should I be angry that now more Americans will have the capacity to develop ongoing relationships with primary care physicians instead of showing up in an emergency room when they can no longer avoid needed care?

Should I be angry that we have a chance in the U. S. now to catch up with the much better health statistics common to most other developed countries - all of which have universal coverage?

Should I be angry that now we have a shot at keeping per capita health care spending rates under control, maybe even approaching the low rates of some of those same countries that already cover all their citizens and get more value for their spending?

Should I be angry that private health insurers will no longer be able to deny coverage to people because of pre-existing conditions?

Or to cancel coverage of people who get sick and need care?

Or to fail to renew coverage for people who, because of illness, actually had to use their health insurance benefits?

Or that employees of small businesses will now be able to get affordable coverage without paying the very high rates associated with small risk pools?

Or, having been schooled in the validity of majority rule, that the Democrats figured out a way to enact this reform with a majority instead of the 3/5 that has become standard procedure in the Senate?

Or, believing that people tend to learn from their mistakes when given another chance, that today's Republicans, most of whose Congressional ancestors voted against Social Security in the 1930s and Medicare in the 1960s, have still not learned to get on the right side of history?

The fact is none of those things makes me angry. So, maybe I am just out of step with the rest of the American people - or at least the ones that Scott Brown and his colleagues are talking to.

I do know one thing that will make me angry. And that is that now that they have passed this historic legislation we so badly need - even though more work remains to be done - I will be angry if the Democrats fail to defend with conviction and enthusiasm their historic achievement. And anyone who doubts the magnitude of the accomplishment should recall that although efforts to reform the health care system have been made regularly from the 1930s onward, before now only Lyndon Johnson has even been able to get the two houses to vote on a bill. The result of his effort was Medicare. It has taken a long time to take this next step. Surely the bill's Congressional supporters, all of whom are Democrats, can persuade their constituents that they did the right thing!

Examining Healthcare: The Industry & Its Policies

Professor Davidson has been a faculty member at Boston University School of Management since 1985. His research interests and areas of expertise include: management of health care organizations, working relationships of managers and physicians, health insurance, health policy, and evaluation of health care programs.

Blog Postings

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  • What's Wrong With Me? (The Huffington Post)
  • The Final Push (The Huffington Post)
  • Insurers v. Hospitals: Another Reason We Need Reform (The Huffington Post)
  • What Should Progressives Do? (The Huffington Post)
  • Still Worth Passing (The Huffington Post)
  • By Revealing Their True Colors, Insurers Eliminate Any Reason to Compromise
  • With Them (The Huffington Post)
  • The Devil is in the Details (The Huffington Post)
  • Free Now To Do the Right Thing (The Huffington Post)
  • Reform with and without the Public Option (The Huffington Post)
  • Why the Public Option Is Critical (The Huffington Post)
  • Paying for Health Care Reform, Part II (The Huffington Post)
  • Paying for Health Care Reform, Part I (The Huffington Post)
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     reuters

  • Free Now To Do the Right Thing (The Great Debate, Reuters.com)
  • A Simple Fix for Healthcare (The Great Debate, Reuters.com)
  • Liberals and Conservatives on Healthcare Reform (The Great Debate, Reuters.com)
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    Other Commentaries and Appearances

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  • Philosophical Differences (Politico)
  • TWIB: The Road to Healthcare Reform (NECN)
  • Breaking through the Healthcare Impasse (Bostonia)
  • Solving the Health Care Reform Puzzle: How to Balance Cost, Access, and Quality (BUniverse)
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    Letters to the Editor

    globenyt

  • Health Reform after Massachusetts (New York Times)
  • The Public Option and Other Choices (New York Times)
  • Doctors' Orders Are Where Costs Escalate (Boston Globe)
  • Are In-store Clinics the Prescription We Need? (Boston Globe)
  • Why Not Insure Children? (New York Times)
  • Cutting Hospital Connections to Cut Costs (New York Times)
  • After the Great Recession (New York Times Magazine)
  • Tugging at Patients' Costs Won't Solve Health System Woes (Boston Globe)
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    Books

  • Still Broken: Understanding the U.S. Healthcare System (forthcoming from Stanford University Press)
  • Building a Healthcare Organization (Beard Books, Inc., 2005, with Janelle Heineke and Marion McCollom)
  • Remaking Medicaid: Managed Care for the Public Good (Jossey-Bass Pub. Co., 1998, with S.A. Somers)
  • The Physician-Manager Alliance: Building the Healthy Health Care Organization (Jossey-Bass Pub. Co., 1996, with Janelle Heineke and Marion McCollum)