Posted on | April 21, 2017 | No Comments
There are 64 million UN “Persons of Concern” in the world.
They are in danger because of climate change.
Climate change creates instability and economic hardship and….
Drought, desertification, crop failure, famine and urban crowding.
All the above lead to human displacement and warfare.
12% (500 million) currently say weather disaster may put them on the move.
Doctors in the Top 5% – Not The Top 1% by Income. Oh, and Canadian doctors make more than U.S. doctors.
Posted on | April 20, 2017 | 2 Comments
What are the average 2017 earnings of U.S. doctors?
Primary Care – $217,000 Specialties – $316,000
What is the salary span for doctors by specialty?
Pediatricians make the least ($202,000), Orthopedists the most ($489,000).
How much have salaries grown in the last six years?
43%, from an average $206,000 in 2011 to an average $294,000 in 2017.
Who made more, salaried or self-employed doctors?
Self-employed. 4% more in Primary Care, and 32% in Specialties.
Do men and women make the same?
No. Men make 17% more than woman. But 22% of women work part-time compared to 11% of men.
Do doctors on the East and West Coast make more than everyone else?
No. Doctors in the North Central states ($317K) and Great Lakes states ($303K) make the most. Northeast doctors ($296K), Western Coast doctors ($290K), and Mid-Atlantic doctors ($282K) rank in the bottom half.
Did the ACA play a role in elevating physician salaries?
Yes. 52% of Primary Care and 38% of Specialists saw a large influx of new patients under Obamacare.
Which physicians, on average, make more – U.S. or Canadian?
Canadian. Their physicians on average earned 9% more than U.S. doctors in 2017.
Would most doctors chose Medicine again if given the chance?
Yes. More than 3/4’s would chose Medicine again.
SOURCE MATERIAL: Medscape Physician Compensation Report, 2017.
Posted on | April 19, 2017 | No Comments
Posted on | April 18, 2017 | 1 Comment
UnitedHealth Group CEO
It has been roughly a month since Americans witnessed that “the health care emperor had no clothes”. For seven long years, the Republican leadership waged an unending and relentless battle to collapse the Affordable Care Act, insisting that Americans in large majorities hated it and that it had to go. But when push came to shove, they discovered that, in large majorities, Americans liked it, as opposed to going back to the health care free market free-for-all.
In pursuing their campaign and sowing their lie, Republicans had no more loyal allies than the health insurance industry. And within that industry, none was more deceptive than UnitedHealth Group Inc. This week the company proudly announced that its first quarter profit had soared upward by 35 percent. This included a hike in profits from insurance sales for the quarter of $2.1 billion on total revenues of roughly $49 billion even though it covered fewer individuals.
UnitedHealth Group Inc. you might recall is the same company that gave Republicans a big lift on November 19, 2015 by alarmingly announcing their intentions to abandon the Obamacare exchanges in 2017. At the time they were covering only a half a million citizens across 34 states and claimed that they would lose $700 million in the coming year. Of course, they were happy to continue with the government’s Medicare Advantage plans which have been a bonanza for them. They’ve signed up over a million new Medicare and Medicaid customers in this quarter alone.
Their CEO Stephen J. Hemsley, whose total annual compensation is in the range of $50 million, solemnly announced at the time that his free market colossal was under siege. He said, “We can’t sustain these losses. We can’t subsidize a market that doesn’t appear at this point to be sustaining itself.” He further predicted a rise in premium costs for the ACA silver plan of 7.5%.
With remarkable coordination, Republican chairman of the United States House Committee on Oversight and Government Reform, Jason Chavetz (R-UT), chimed in that day. He said, “Premiums are up and ultimately, health care is more expensive. The consequences we see from this hastily and poorly conceived legislation were entirely foreseeable and not at all surprising.” The race was on.
But what Chavetz and his fellow Republican leaders could not foresee or conceive at the time was that Donald Trump would be their President and that the American people would demand to know what their exact plan was to replace the coverage they already had.
UnitedHealth Group Inc. on the other hand experienced no regret and little if any blowback. Even though their well coordinated announcements set off an election year fire, and their lobbyists proudly applauded the Republican landslide, there has been no day of reckoning – at least not yet.
Posted on | April 7, 2017 | 1 Comment
Health policy experts generally agree that applying taxes to unhealthy products or behaviors can reliably deliver public health benefits. We have learned from the nation’s battle with tobacco that taxes not only discourage consumption but also provide funding for beneficial programs like public health education. In some states and locales, this approach has been embraced as well in the battle against obesity through the use of soda taxes.
California extended healthy taxation within another domain this week – energy. They successfully approved new taxes on gasoline. That action will likely dampen use of carbon creating fuels, accelerate use of high mileage and electric vehicles, and in funding much needed infrastructure for bridge and road repairs decrease injuries related to motor vehicle accidents.
This latest action signals that California, the world’s 8th largest economy at $2.5 trillion Gross State Product, is not waiting around for Congress or Trump’s America to catch up. They have no interest in facilitating his immigration policies or wasting money building walls. Last week, they took the serious step in the early exploration of a single payer health program that would cover all citizens, including documented and undocumented immigrants. And now, they’ve decided to not wait around for the Administration to follow-through on promises of a “huge “ infrastructure bill.
Why should they? Their economy is nearly the size of Brazil (#7 worldwide), and is fueled by record tourism in the south, premier high-tech leadership in the north, and agriculture throughout. Their governor, Jerry Brown, is experienced, progressive, inventive and committed. He’s a grown-up in every way, and has his priorities straight.
Under his care this week, the legislature approved $5.2 billion in gas taxes and vehicle fees by gaining the required 2/3 majority in both the House and Senate state bodies.
In garnering support, the governor focused on the $130 billion in priority repairs and planned new construction on the books that had been accumulating since the last gas tax hike 23 years ago. Brown’s message was simple. direct, and honest: “The Democratic Party is the party of doing things, and tonight we did something to fix the roads of California.”
As we approach the third month of President Trump’s tenure, two things are clear – chaos is not the same as leadership, and the kind of progress we’re seeing in California can fuel growth, optimism and good health. Other states should follow their example.
Posted on | April 4, 2017 | No Comments
At the end of WWII, Canada and the U.S. realized the necessity of focusing on health care infrastructure. There were of course the hundreds of thousands of physical and mental health casualties streaming into overflowing and over-stressed hospitals. Add to this a significant and growing explosion of chronic diseases fed by soldiers and their families embracing tobacco and alcohol, and feeding an explosion of cardiovascular disease, cancers, and psychiatric diseases codified in the first psychiatric classification system, DSM-1.
The Canadians approached the challenge as a planning exercise and ultimately focused on prevention and universal insurance coverage as their starting points. The U.S. took a different road, embracing private scientific enterprise and liberal amounts of national funding to expand scientific research and hospital bed capacity. Insurance coverage in the U.S. was not simply an after-thought. To many, it was a threat, a slippery slope toward socialized medicine, a Communist plot.
Now, more than a half century later, American health continues to suffer. We have been unable and unwilling to “walk back” these decisions, and continue to insist that American scientific brilliance, industrial might, technologic know-how, and massive medical funding will ultimately seize the day. But evidence to the contrary continues to pile up.
Trump’s attempt to dismantle the ACA and downsize Medicaid expansion has boomeranged to the extent that policy analysts have worked hard to expose the negative impacts that would result from eliminating coverage of vulnerable populations. To make their cases, analysts have been exposing some eye-popping comparisons with our neighbors to the north who are all covered under a single payer system.
Case in point: In the March 14, 2017 issue of Annals of Internal Medicine, authors compared the fate of patients followed by the Canadian Cystic Fibrosis Registry to those in the U.S.Cystic Fibrosis Registry. The study included patients from 42 specialty clinics in Canada and 110 clinics in the U.S. Their choice of disease was interesting because it has been a major target of America’s Medical Industrial Complex.
The disease is genetic and incurable, creating excess production of mucous secretions in multiple organs, but especially in the lungs where infected secretions progressively destroy a child and young adult’s breathing capacity. It effects approximately 1 in 10,000 live births in both countries. Effective treatment involves early diagnosis, hands on percussive treatments to clear the mucus, active family and community involvement, break-through pharmaceuticals, and lung transplants for some.
With America’s scientific and technologic might, one would predict that the U.S. would outperform Canada. But here is the sad truth:
1. Canadians with cystic fibrosis live approximately 10 years longer than their counterparts in the U.S. – 50.9 years vs. 40.6 years.
2. The gap in survival has been growing larger over the past two decades.
3. Canadian patients with the disease are afforded lung transplantation with much greater frequency than in the U.S. – 10.3% vs. 6.5%.
4. The factor most directly associated with morbidity and mortality is lack of insurance coverage. U.S. Medicaid patients with the disease fare substantially better than those without insurance.
5. The adjusted risk of death for a patient with the disease in Canada is 34% lower than in the U.S.
6. The newest pharmaceuticals for cystic fibrosis are substantially less expensive in Canada than in the U.S. where some are priced at $250,000 a year.
The Commonwealth Fund authors David Squires and David Blumenthal recently stated that “In medical terms, we might call uninsurance a “comorbidity”—one unique to the United States among all industrialized nations, and just as deadly as pneumonia or diabetes.”
This battle with Trump over the survival of the Affordable Care Act offers a chance to America to start over on health delivery. Scientific know how can not outperform coverage and prevention. That’s been well established. Kids with cystic fibrosis and many other innocents hang in the balance. This is a fight worth having.
Posted on | April 3, 2017 | No Comments
One of the driving misperceptions about the Canadian health care system is that it is a centrally run and directed delivery system, nationalized from start to finish, top down and authoritarian. That bias, reinforced actively in the U.S., is and has been inaccurate from the start. Understanding this bias could be useful as our nation struggles with the next steps in our own health system evolution.
The Canadian system originated in the province of Saskatchewan, in central Canada. The province had always had a progressive streak and in 1947, in the wake of WW II, launched the first provincial universal hospital insurance plan. The other provinces and territories, as well as the national government, watched the experiment with interest for nearly a decade.
Then in 1957, Canada passed the Hospital Insurance and Diagnostic Services Act which provided 50/50 cost sharing between the federal government and any of 13 provinces and territories that chose to participate in universal coverage of their respective populations.
Seven years later, with all provices and territories voluntarily aboard, Canada’s Royal Commission on Health Services recommended and soon succeeded in launching a comprehensive and universal national health program. Under the system, Canada itself became the sole payer, managing an insurance program universally available to all citizens, including all claims management.
A federal governance body was in charge of standards, but the delivery of care was strictly delegated to the provinces and territories which themselves managed and prioritized annual budgets, and designed their own governance systems.
This commitment to centralized claim management coupled with decentralization and self-determination of budget priorities and delivery of care, now a half century later, continues to define a system which is by no means perfect, but significantly outperforms our own in both quality and cost efficiency.
Our own half century has been tumultuous. But a recent development seems to suggest some desire to start over, and perhaps use the “Saskatchewan Experiment” as a model. I refer to a California bill, SB 562, sponsored by the Califronia Nurses Association. If passed, the state would provide comprehensive medical coverage to all California residents regardless of income or immigration status. There would be no co-pays, no deductibles, no restrictions on provider eligibility.
The plan would not rely on private insurers but would administer claims through a nine-person unpaid board that would be appointed by the California Legislature and the governor. There would also be an appointed health professional and consumer advisory board.
Unlike the small state experience of Vermont (population 620,000), California has nearly 40 million residents, which creates size and scope and diversity to allow for successful risk sharing. As for funding, the state would require a waiver from the federal government to steer Medicare and Medicaid dollars into the state effort. In addition, citizens would pay additional taxes, but they’d no longer have to pay for health insurance themselves.
To many, this sounds like a reach. But a half century ago, so did the “Saskatchewan Experiment”. We should give California a chance. We might like the results.keep looking »