Opinion L.A.

Observations and provocations
from The Times' Opinion staff

« Previous Post | Opinion L.A. Home | Next Post »

May 6 buzz: How to stop healthcare costs from going up; the benefit of Superman going global

May 6, 2011 |  1:17 pm

Most viewed and commented: Diagnosis as disease

Are doctors overmedicating their patients, and subsequently raising healthcare costs? That's what H. Gilbert Welch contends. The practicing physician and professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice writes:

You might reasonably wonder: How did we get here? A big part of the story is, of course, money. Whether you are a drug company, a hospital or any other player in system, the easiest way to make more money is to encourage lower thresholds and turn more people into patients. […]

Lawyers get some credit too. While clinicians are sued for failure to diagnose or failure to treat, there are few corresponding penalties for overdiagnosis or overtreatment. Doctors view low thresholds as the safest strategy to avoid a courtroom appearance.

Here's some of the reader reaction:

As a former oncology RN, I saw doctors ordering tests and chemo for patients who were in the final stages of dying and in a coma and cancer was eating the patient from the inside out.  They should have been in hospice care.  They prey on patients and their families with false hope.  If an oncologist isn't pushing chemo, he isn't making money.  I won't even get into the crap I saw in other departments because it's just as bad if not worse like the time a doctor ordered pregnancy tests for a 60 year old woman dying of MS.  I worked in one of SOCAL's "best" hospitals...


As an MD radiologist, Democrat and not a member of the AMA, I see colossal wastes of dollars and resources daily. This article aptly points out that medicine is driven by money. Pharma companies push to legitimize conditions so that patients can feel better about themselves by taking drugs. Patients want their doctors to do "things" to feel that someone is taking their problems seriously and doctors are happy to do things (as that is how they make money).

Unfortunately it is difficult to separate the wheat (what is a significant problem/process worth pursuing and treating) from the chaff (what processes and treatments have little or no change in outcome) That is where the individual and individual responsibility comes in to play. However, so long as we have a third party payment system waste will be rampant. The patients wants it all so long as it is covered with little out of pocket and the doctors are glad to provided it all so long as it is covered.

We need "The Intelligent HSA":

money given to the patient to control and spend or save based upon personal needs and desires, a HDHP safety net for catastrophics, a non-governmental single payer put out to bid and treated like a utility and a "medical coach" for every patient to advise them free of profit motives.

Let the patient decide what is the right diagnostic threshold with their own money

google "theintelligentHSA"


This guy really has no clue of what he is talking about.

Diagnosing based on low thresholds has been driven by a desire to PREVENT costly treatment once a disease progresses. That such early diagnoses SAVES money and SAVES lives is well documented.


Most shared: Losing Superman

Writer Ariel Dorfman imagines what would happen if the Man of Steel renounces his U.S. citizenship:

Superman decided that in an increasingly global world, it was counterproductive for him to be branded as an instrument of U.S. policy. He came from another planet, after all, which gave him a "larger picture." […]

What would happen, for instance, if the Man of Steel, champion of the dispossessed, were to decide that it was his task to close Guantanamo or to use his X-ray vision to expose secret documents that not even Wiki Leaks' Julian Assange has been able to uncover? What if the erstwhile American demigod were to offer his services to China? (Though, thinking it over, he would probably never do anything of the sort, given his enthusiasm for truth and justice).


Killing vs. capturing Osama Bin Laden

John Paul II, saint?

L.A.'s population drop

Cynicism over Osama bin Laden's death

The cost of illegal aliens, firefighters and schools

--Alexandra Le Tellier

Comments ()