• Sound Medicine: A bitter pill to swallow

    Sound Medicine is a radio show produced by the Indiana University School of Medicine and WFYI Public Radio. In the last few years, I’ve become their go-to guy on health policy.

    Recently, the show interviewed Steven Brill. While I recommend you listen to the whole thing, I got to sneak in a question or two, and at 7:20 you can hear me ask what I first posted here a few weeks ago. Specifically, I asked why he didn’t comment on all-payer as a solution, and whether he thinks it might be a good idea. Listen, after the jump!

    Steven Brill, journalist, knows healthcare. Brill’s latest article, ‘Why Medical Bills are Killing Us,’ is the cover story for the March 4, 2013 edition of Time magazine and it’s also the longest story ever to be published in Time. Brill spent months poring over and analyzing medical records, and his findings are fascinating. Many hospitals charge $1.50 for acetaminophen, a generic version of Tylenol, when consumers can buy over 100 of these generic pills for the same price at the drug store. Although $1.50 may not seem very costly, does $15,000 for routine blood work sound high? For cancer patients the cost may be even higher as, many hospitals charge mark-ups in excess of 400% for cancer treatments.

    • Aaron, I listened to your questions about skin in the game. I’d like to refer you and others to a web page of a physician who is treating only those with skin in the game.

      *Take a look at the fee schedule and see what you think.
      *Then take a look at the transparency.
      *This doctor has excellent credentials and likely he has excellent quality
      *He accepts no insurance.
      *When he first opened his clinic he stated that he was treating many Tenncare patients (Tennessee state program/ Medicaid).


      Browse the first http to see his fee schedule and then browse around.

      On the left side of the second http go down to New Clinic Manual where he discusses “How to Start a Third-Party Free Medical Practice”.

      • Concierge medicine is not new. I’ve written about it many times, even at AcademyHealth. Granted, his prices are more reasonable than most, but lots and lots of people would not be able to afford this.

        Regardless, he’s free to practice as he likes. This works for him, and may work for others. It won’t work for many people, though, especially the chronically ill.

        • Aaron, I am not sure how you define concierge medicine, but I call what he does fee for service medicine not concierge medicine which I interpret to mean that an annual fee has been provided to the provider. I leave that term for MDVIP and other similar entities. I have found similar pricing in many fee for service entities that exist today including those mini clinics seen at pharmacies.

          You say: “It won’t work for many people, though, especially the chronically ill.”

          Why not? Where is the proof? I exclude the poor that require financial aid no matter what type of healthcare system exists.

          • Because the chronically ill have fixed medical costs that would blow through savings very quickly.

            • We have to be very careful when we talk about the chronically ill because many times the estimated amount they spend is very overplayed. Let us all understand that a chronic illness can be psoriasis which for most doesn’t require much more than a $10 supply of a steroid cream. Even a more severe chronic illness like diabetes most of the times does not have such high annual costs. Thus only a few of the chronically ill fit into the category you mention. They are important and might even need government assistance, but good policy addresses the majority not the minority.

    • If the chronically ill person is wealthy, then they can afford their fixed costs easily, and there is no policy case for transferring those costs to others.

      If the person is poor, then they will not be paying any significant portion of their costs regardless, and so the system we implement is irrelevant.

      If they are middle-class, then they have the resources to pay the bill, but it would require foregoing expenditures in other categories of life. What is the policy case that a person who has resources but would rather use them for something else, should have their medical costs paid by other people?

      • “What is the policy case that a person who has resources but would rather use them for something else, should have their medical costs paid by other people?”

        Robert, you make a lot of sense, but I wouldn’t hold my breath waiting for an answer. When answers come they are generally wrapped in confusing rhetoric and numbers that obscure rather than promote clarity.Yours is a simple, and intelligent question deserving of a simple answer.

    • This article was incredible and absolutely accurate!

      Bottom Line: Until the Feds allow Medicare to negotiate prices with vendors (pharma, devices, labs, etc) our costs for treating seniors and the disabled is going to bankrupt us with the oncoming of baby boomers who are now beginning Medicare.

      We, the American people are so stupid when it comes to what our Congress allows this industry to do! I am embarressed to say that I work in it and sell a device that may cost 100 bucks (including research, manufacturing costs, overhead) and lists it for almost $5,000.00!

      Needless to say, I am looking for another career because I am embarresed when a well insured patient has to spend over $1,000.00 in out of pocket expenses when their insurance has already paid 80%! It’s a Racket and these companies take advantage of people in dire medical need!

      And I am so sick and tired of hearing surgeons whine about their Medicare Reimbursements while they drive their Aston Martins and take their family to Switzerland to Ski.

      We need a single payer system