1. NIH needs to change funding to be focused on finding cures. It is not doing that now. NIH budget this year alone is $49 BILLION dollars. NIH funds individual researchers who if successful get a patent and then a drug company makes an expensive drug to treat the symptoms. If no patent, no drug company interest then the research findings lie dormant in a huge database wasting the billions of dollars of taxpayer money. There is no priority list of disabling, chronic diseases costing trillions a year for NIH. There is often no published results to help the next researcher. Instead money is thrown across thousands of sites with no coordination to find the final answer, instead ALWAYS "more research is needed." Fund consortiums looking at root causes for cures yet not getting funded. See the 2024 lectures at AlzPi.org and NeuroImmune.org for root causes of dementia, mental illnesses, chronic diseases and fund them instead.
2. Medical schools, oversight agencies should insist on competency. Teach and test updated information on the most misdiagnosed diseases, disabling diseases and costly diseases ROOT CAUSES and stya current. Now outdated information is taught and a flood of basic science concepts is thrown in with no attempt to tell how this is useful for a clinician.
3. Nurses need to use their skills and not be wasting time due to our system of taking the patients meds away. Patients should take their own pills. They do this 99% of their lives. An initial check of what meds they take needs done on arrival as many of the problems patients have is polypharmacy. Then nurses would have the time to be in the rooms to help patients and physicians instead of always passing meds. Med errors are too likely in a hectic, overworked hospital. Nursing home patients would benefit from stopping a lot of their meds.
4. CDC/HHS is outdated in many of their publications and funding There has been millions of dollars wasted just as with NIH. They need to have a priority list of diseases and fund accordingly. Patient advocates need to be given much of the money instead as they will use it wisely.
A question? How many additional deaths was that ceo responsible for, if it was your daughter, your infant baby, mother or grandmother, should businessmen be allowed to take life through their policies while physicians are helpless accomplices?
I would like to see commentators such as yourself discontinue with the perfunctory politically correct virtue signalling of criticizing Brian Thompson's killer. We don't mourn Osama Bin Laden's death. Let's not pretend we care about Thompson's death. He was a scumbag. Plain and simple.
No, intelligent person can state how the addition of business CEO’s to the field of medicine has helped patient care. The million-dollar salaries are taken directly from direct patient care and therefore the CEO must limit, medicine, care and services to protect their salaries.
The goals of CEOs is opposite True Physicians.
1. businessmen take an oath to protect profits ---physicians take an oath to protect patients
2. businessmen take an oath to protect the stockholders ---physicians take an oath to protect the baby holders: parents/grandparents
3. businessmen see numbers --- physicians see patients
4. businessmen try to save money --- physicians try to save lives
Independent Physician Association (IPA)
Recommend - physicians only work 3-4 days for a CEO/Hospital/Insurance company or business-run clinics in order to regain their voice to advocate for patients.
SALARIED PHYSICIANS HAVE NO VOICE, THEIR WORDS MUST BE CLEARED THROUGH THE CEO OR CMO OR MEDICAL DIRECTOR
CEO’s benefit politicians running for a political office.
What about the lives lost caused by the CEO. In all honesty CEO’s run medicine and salaried physicians are voiceless and fearful when it comes to protecting and fighting for patients because their pay check is on the line. The goal of a ceo is to deny and protect their salary.
CEO’s have no role in leading the field of medicine!!!
Physicians return to your first love which are the patients.
My writing is an explanation as to why USA does not have some form of National healthcare system, and why America is alone in this in the entire industrialized Western world. I stated historical fact that the American Medical Association (and physicians) are primarily responsible for our sad situation. Those are my primary contentions and are easily verifiable facts. I was not primarily addressing American physician incomes/salaries in my original writing. However, it is also true that America physicians incomes are greater than that of physician incomes/salaries employed in National healthcare systems, even though such physicians are sill in the top tier of their nation’s earners. In a personal note, I’ve been a licensed healthcare professional for 40+ years and know many “salaried” practicing physicians, none of whom make less than $270, 000 annually and on top of that, most get bonuses for how “efficiently” or cheaply they treat patients (meaning many patients do not get the care they need because the doc wants a bonus). I know their salaries because I see the budgets. I also know many, many physicians whose income is well over $1million/annually. But, it’s in American physician’s nature to poor mouth. As for USA salaries that have come no where close to keeping up with inflation, that’s the situation that applies to the average and low income wage earners, whose salaries have stagnated since the 1970s.
VP this RN appreciates your evidence based analysis of this very complicated and nuanced problem. I am still working at 64 in the outpatient end of life setting and the waste that I see before the patient comes onto service leaves me speechless. I could say a lot more but I will leave it at that.
I nominate Dr Prasad to lead HHS into reform -- it is also clear that it's the entire systemic mess, not just insurance companies, and like cancer, it needs a radical solution...
This is absolutely spot on! I actually work the same insurance company whose CEO was sadly slain… We all know the insurance companies make incredibly high profits and their big wigs on top get paid very well. However I work in the reinsurance sector - specifically I negotiate contracts between ourselves and hospitals in a certain market (like NY for instance) and try to determine how much more $ we’re going to reimburse the hospital (for things like surgeries, er visits, medications used, equipment used for surgeries, ETC) based on a whole range of data and analysis.
These hospitals tend to want double digit increases which is insane! They also have what’s called a “chargemaster”. This is literally a list of everything a hospital can charge an insurance company for (similar to examples I gave above). They can increase the % of dollars they get reimbursed from an insurance company by what ever number they want, without giving any explanation! Sure we try to set limits (or Caps) on how much they can increase that % of dollars we have to reimburse them, but not all hospitals have limits in place.
* As an example, hospital A gets reimbursed $200 million a year in total from our insurance company. Hospital A decides to then increases their charge master by 5%. Just from that alone we now have to pay them $210 million dollars, or $10 million more… No questions asked
I agree with VP re: the fault and brokenness of the entire system. Health care is expensive.
It is not appropriate to treat an 86 y/o person in the same fashion as a 55 y/o person. The ERs docs and hospitalists have become completely overwhelmed by the deluge of people they see everyday, AND they are becoming staffed by APPs to an increasing percentage. . Their current practice is to order tests and scans on everyone. The pressure not to "miss anything" is extreme.
The reason I bring up age of the patient - if we, as a society, cannot come to grips with the fact that we should not treat the extreme elderly in the same way we evaluate and treat younger people, our system is going to "break". We have to educate and bring to public (and medical system) mindset that our approach for the > 85 y/o needs to be a lot more gentle and restrained - and this is APPROPRIATE care, not "withholding " care - than it is for younger people.
The population is aging and the numbers of extreme elderly grow daily. Again, until we as a society acknowledge this fact and change our practices accordingly, the system will break. We need a system of physicians and structure that understands the best way to evaluate and manage elderly patient, essentially a 2-tiered system. This is NOT TO RATION CARE but to provide age-appropriate care. Until we can acknowledge, discuss, and plan for this, our system will remain stressed and extremely expensive.
Yes, I would say in general the American healthcare consumer does have not have an appreciation of the 'Iron Triangle' of medicine, defined as access, cost and quality, and the principle that you can optimize only 2 of the 3 sides of the triangle. As a radiologist, I can attest to the both huge overall growth in imaging demand by the ER and inpatient providers, and also expectation for 24/7 access to said imaging. But health insurance companies in my view do not add any value to any of the 3 sides. In fact, I would say they that they 1)worsen cost, with their high administrative expenses and their need to generate shareholder returns and 2) do not promote improved quality of care, and possibly promote lower quality care, as they tend to cap reimbursements for procedures with no incentives to providers/hospitals for good patient outcomes. Although US patients generally have better access to advanced medical procedures and diagnostics overall than most countries (ie.lower wait times for MRI) that access is not worth the financial price to those who have to foot huge copays and/or deductibles, or having to pay full freight for unexepected 'out of network' services, i.e. 'surprise billing'.
A few very quick fixes would make a huge impact.
1. NIH needs to change funding to be focused on finding cures. It is not doing that now. NIH budget this year alone is $49 BILLION dollars. NIH funds individual researchers who if successful get a patent and then a drug company makes an expensive drug to treat the symptoms. If no patent, no drug company interest then the research findings lie dormant in a huge database wasting the billions of dollars of taxpayer money. There is no priority list of disabling, chronic diseases costing trillions a year for NIH. There is often no published results to help the next researcher. Instead money is thrown across thousands of sites with no coordination to find the final answer, instead ALWAYS "more research is needed." Fund consortiums looking at root causes for cures yet not getting funded. See the 2024 lectures at AlzPi.org and NeuroImmune.org for root causes of dementia, mental illnesses, chronic diseases and fund them instead.
2. Medical schools, oversight agencies should insist on competency. Teach and test updated information on the most misdiagnosed diseases, disabling diseases and costly diseases ROOT CAUSES and stya current. Now outdated information is taught and a flood of basic science concepts is thrown in with no attempt to tell how this is useful for a clinician.
3. Nurses need to use their skills and not be wasting time due to our system of taking the patients meds away. Patients should take their own pills. They do this 99% of their lives. An initial check of what meds they take needs done on arrival as many of the problems patients have is polypharmacy. Then nurses would have the time to be in the rooms to help patients and physicians instead of always passing meds. Med errors are too likely in a hectic, overworked hospital. Nursing home patients would benefit from stopping a lot of their meds.
4. CDC/HHS is outdated in many of their publications and funding There has been millions of dollars wasted just as with NIH. They need to have a priority list of diseases and fund accordingly. Patient advocates need to be given much of the money instead as they will use it wisely.
A question? How many additional deaths was that ceo responsible for, if it was your daughter, your infant baby, mother or grandmother, should businessmen be allowed to take life through their policies while physicians are helpless accomplices?
I would like to see commentators such as yourself discontinue with the perfunctory politically correct virtue signalling of criticizing Brian Thompson's killer. We don't mourn Osama Bin Laden's death. Let's not pretend we care about Thompson's death. He was a scumbag. Plain and simple.
No, intelligent person can state how the addition of business CEO’s to the field of medicine has helped patient care. The million-dollar salaries are taken directly from direct patient care and therefore the CEO must limit, medicine, care and services to protect their salaries.
The goals of CEOs is opposite True Physicians.
1. businessmen take an oath to protect profits ---physicians take an oath to protect patients
2. businessmen take an oath to protect the stockholders ---physicians take an oath to protect the baby holders: parents/grandparents
3. businessmen see numbers --- physicians see patients
4. businessmen try to save money --- physicians try to save lives
Independent Physician Association (IPA)
Recommend - physicians only work 3-4 days for a CEO/Hospital/Insurance company or business-run clinics in order to regain their voice to advocate for patients.
SALARIED PHYSICIANS HAVE NO VOICE, THEIR WORDS MUST BE CLEARED THROUGH THE CEO OR CMO OR MEDICAL DIRECTOR
CEO’s benefit politicians running for a political office.
What about the lives lost caused by the CEO. In all honesty CEO’s run medicine and salaried physicians are voiceless and fearful when it comes to protecting and fighting for patients because their pay check is on the line. The goal of a ceo is to deny and protect their salary.
CEO’s have no role in leading the field of medicine!!!
Physicians return to your first love which are the patients.
My writing is an explanation as to why USA does not have some form of National healthcare system, and why America is alone in this in the entire industrialized Western world. I stated historical fact that the American Medical Association (and physicians) are primarily responsible for our sad situation. Those are my primary contentions and are easily verifiable facts. I was not primarily addressing American physician incomes/salaries in my original writing. However, it is also true that America physicians incomes are greater than that of physician incomes/salaries employed in National healthcare systems, even though such physicians are sill in the top tier of their nation’s earners. In a personal note, I’ve been a licensed healthcare professional for 40+ years and know many “salaried” practicing physicians, none of whom make less than $270, 000 annually and on top of that, most get bonuses for how “efficiently” or cheaply they treat patients (meaning many patients do not get the care they need because the doc wants a bonus). I know their salaries because I see the budgets. I also know many, many physicians whose income is well over $1million/annually. But, it’s in American physician’s nature to poor mouth. As for USA salaries that have come no where close to keeping up with inflation, that’s the situation that applies to the average and low income wage earners, whose salaries have stagnated since the 1970s.
Is MANGIOE a Health Care Revolutionary?
Those of us that oppose the death penalty can't accept assassinations as a solution.
He is a psychotic murderer regardless os what anyone thinks of the victim.
VP this RN appreciates your evidence based analysis of this very complicated and nuanced problem. I am still working at 64 in the outpatient end of life setting and the waste that I see before the patient comes onto service leaves me speechless. I could say a lot more but I will leave it at that.
we have the largest medical library for medical students.
that can train all of Latin America.
or any Spanish speaking student.
I nominate Dr Prasad to lead HHS into reform -- it is also clear that it's the entire systemic mess, not just insurance companies, and like cancer, it needs a radical solution...
Yes the system is broken, but United Healthcare used political bribery to kill the public option.
This is the system they wanted and they had the money and the ethics to make it happen.
https://substack.com/@s0nathan/note/c-80248117
Easy there buddy. Who are you to call me a lunatic?
This is absolutely spot on! I actually work the same insurance company whose CEO was sadly slain… We all know the insurance companies make incredibly high profits and their big wigs on top get paid very well. However I work in the reinsurance sector - specifically I negotiate contracts between ourselves and hospitals in a certain market (like NY for instance) and try to determine how much more $ we’re going to reimburse the hospital (for things like surgeries, er visits, medications used, equipment used for surgeries, ETC) based on a whole range of data and analysis.
These hospitals tend to want double digit increases which is insane! They also have what’s called a “chargemaster”. This is literally a list of everything a hospital can charge an insurance company for (similar to examples I gave above). They can increase the % of dollars they get reimbursed from an insurance company by what ever number they want, without giving any explanation! Sure we try to set limits (or Caps) on how much they can increase that % of dollars we have to reimburse them, but not all hospitals have limits in place.
* As an example, hospital A gets reimbursed $200 million a year in total from our insurance company. Hospital A decides to then increases their charge master by 5%. Just from that alone we now have to pay them $210 million dollars, or $10 million more… No questions asked
They also
I agree with VP re: the fault and brokenness of the entire system. Health care is expensive.
It is not appropriate to treat an 86 y/o person in the same fashion as a 55 y/o person. The ERs docs and hospitalists have become completely overwhelmed by the deluge of people they see everyday, AND they are becoming staffed by APPs to an increasing percentage. . Their current practice is to order tests and scans on everyone. The pressure not to "miss anything" is extreme.
The reason I bring up age of the patient - if we, as a society, cannot come to grips with the fact that we should not treat the extreme elderly in the same way we evaluate and treat younger people, our system is going to "break". We have to educate and bring to public (and medical system) mindset that our approach for the > 85 y/o needs to be a lot more gentle and restrained - and this is APPROPRIATE care, not "withholding " care - than it is for younger people.
The population is aging and the numbers of extreme elderly grow daily. Again, until we as a society acknowledge this fact and change our practices accordingly, the system will break. We need a system of physicians and structure that understands the best way to evaluate and manage elderly patient, essentially a 2-tiered system. This is NOT TO RATION CARE but to provide age-appropriate care. Until we can acknowledge, discuss, and plan for this, our system will remain stressed and extremely expensive.
Yes, I would say in general the American healthcare consumer does have not have an appreciation of the 'Iron Triangle' of medicine, defined as access, cost and quality, and the principle that you can optimize only 2 of the 3 sides of the triangle. As a radiologist, I can attest to the both huge overall growth in imaging demand by the ER and inpatient providers, and also expectation for 24/7 access to said imaging. But health insurance companies in my view do not add any value to any of the 3 sides. In fact, I would say they that they 1)worsen cost, with their high administrative expenses and their need to generate shareholder returns and 2) do not promote improved quality of care, and possibly promote lower quality care, as they tend to cap reimbursements for procedures with no incentives to providers/hospitals for good patient outcomes. Although US patients generally have better access to advanced medical procedures and diagnostics overall than most countries (ie.lower wait times for MRI) that access is not worth the financial price to those who have to foot huge copays and/or deductibles, or having to pay full freight for unexepected 'out of network' services, i.e. 'surprise billing'.