That is what happens when medicine is practiced by employees instead of by free agents.
Who pays the price? The buyers, We, The People. Why? Because a free market is replaced by a corporate marketplace, the medical/pharmaceutical/insurance industrial complex.
The Captain
Meanwhile doctors are on strike in UK asking for better pay.
Would a union give doctors more clout against insurance companies, major hospitals as employers and Medicare?
How do you distinguish a free market from a corporate marketplace?
Of course it would. Whereas being free agents would give them less clout.
I’m sure you are aware of the trustbusters. It’s a fine line between economies of scale and excess power. For example MaBell, AT&T, had captured regulators and used cost plus to make everything as costly as possible to pump up profits, all in the name bogus quality of service (QoS). MaBell had too much power and needed ti be cut to size. Have you noticed how the cost of long distance has fallen since Judge Green presided over the breakup?
The AMA is in the same league as MaBell used to be. What do doctors say to push statins and cardiograms? “It’s the approved procedure.” The last time a doctor tried it on me I asked, “Is it urgent?” Since the answer was, “No, but it’s the approved procedure” my reply was, “Then it’s not happening!”
Patients have been domesticated. Joseph Stiglitz calls it “asymmetries of information.” Good grief, me agreeing with Stiglitz!
The Captain
o o o o o o o o o o o o o o o o o o o o
When my father was diagnosed with cancer there was a lot of disagreement about what to do about it. I’m not going into the details but a medical conference (or whatever it’s called) was organized to discuss it. I asked a friend and trusted cardiologist who treated me for over a quarter of a century to attend the conference. This is what he said to me, “If you wan’t my honest opinion i have to examine your father. At the conference I cannot disagree with the consensus.”
Remember Vioxx? The above mentioned doctor prescribed it for my heart condition.That’s “corporate marketplace.”’
If you place tha AMA on apartment with Ma Bell, where do you place the large corporations that buy up all of the hospitals and dictate wages, salaries and working conditions?
Spell check gave me ‘apartment’ in pace of “on a par with’.
Apart-ment would be good. it’s the joint-ment that’s the problem, too much power.
Definitively a part of the problem. We need the trust busters to get to work. In a democracy it’s the demos that rule. Giant corporations are the equivalent of oligarchy or royalty.
BTW, people who blindly say, “You must obey the law” (see posts above) are also part of the problem. If laws were perfect there would be no need of Congress to enact new laws.
The Captain
That was never an AMA decision. You are conflating standard care with AMA lobbying.
Statins are extremely useful. You only die once. I have no plans on going any time soon.
That is sounding sort of okay…not really but lets ask…
Which practices do the insurers that now control PCP care use to interfere with care? Yes PCP doctors monitor statins but it is often other doctors who prescribe them first. Specialists. Who are not controlled by insurers generally.
Which laws are wrong that need changing in this regard?
What is the monopoly that would be broken up? The AMA is a lobbying group.
Was this before or after the heart attack and stent placement?
If this is an accurate account of the dialogue between you and your doctor (who may well not have been a member of the AMA…a good many aren’t) it’s more a diagnostic of poor communication skills than anything else. Either that or of someone who made his $$$bucks when things did become urgent.
Thankfully, my intervention cardiologist has a better grasp of the science and rationale for treatment and the ability to translate it. Plus it’s now 2023 and thoughtful medical management for those with primary, polygenic familial hypercholesterolemia shows all the signs of nipping ASCVD in the bud… and even reversing it (although I’ll wait for some objective evidence of that before I breathe easier, given my luck) Not so sure about those eating and sitting their way to a voluntary disease state.
And one that represents a very small percentage of practising physicians come to that, if you look at the dues paying membership. Definitely not the standard-of-care controller that folk imagine
Yeah because dad was in the APA not the AMA.
VeeEnn, let them figure that one out.
We were also members of the AAA, a communist plot if ever!
Wow! You’re going to wait until your heart situation becomes urgent before you do anything? Smart. . But it does explain your attitude to climate change - wait until its so bad and so obvious that it is too late to do anything about it.
@bjurasz He will save on his taxes!
@captainccs you are beyond a point where you can get a good doctor. I mean that. Patients get fired if they do not work with the doctor in a reasonable way. Even if not fired doctors give up on patients who wont reasonably understand things.
Well, if the AMA is anything like the BMA and BDA (B for British and D for dental) they’ll be tempting students and residents with favourable membership dues (and the feeling that you’re almost the Real Thing) and hope for repeat subscription by default. In fairness we kept up the subscription to the BMJ for a few years after we came to the US in 1986. Primarily to keep an eye on the political stuff affecting the NHS in Mrs T’s Brave New Britain and the sits. vac…even though any gig you’d want would already be spoken for by the time of advertising, it was also a telling barometer of the impact of the cutbacks that were pretty fierce at the time. Obituaries came next, then a few sundry fun items. A magazine really, rather than a high impact scientific resource.
Well, there you have one reason why ASCVD is still the world #1 killer by a long way. I think it’s still pretty accurate to say today … as it was back in the early 1970s and I was sitting in pathology lectures… that one of the commonest first indications of coronary artery disease is sudden cardiac death. Yep…from that first heart attack!
Boy, knowing what I know now about what is known about the pathogenesis of cardiovascular disease and heart disease specifically, and how behind the standard-of-care times most preventive advice still is, I only wish someone had pushed statins when I first got a heads-up on my “mildly elevated” LDL-C in my 50s. The reassurances I was getting re my “healthy lifestyle” etc were reassuring at the time but, when viewed through a well focused retrospectroscope, could be described pretty accurately as supervised neglect.
Totally wish you had VeeEnn!
In my case the doctors put me on a minor dose of a statin at age 49 because of type II diabetes. Turns out at age 56 I have zero plague. I am now on a minor dose of Crestor and my cholesterol numbers are incredibly good. I am 60 this year.
My chest and legs were checked for plague just before the pandemic. I paid for one of the tests and my insurance for the other. I have that red splotching on my left leg and some on my right leg. My BIL thinks it is related to allergies that can cause leaky vessels. The legs were checked for blockages. I have zero blockages. Totally clean. Not even the calcium deposits in the legs. The PCP and I wanted to see if there were artery problems related plaque blockages.
I have a bit of Venous stasis dermatitis. Losing weight and exercising has been helping. It is not heart related.