Herman: Is cost = Quality?

Herman, you are always talking about free enterprise and homo economicus.
Of couse, homo faber is the competing model, but let us forget that a moment
since both are 19th century debating points.

You are always taking about how insurance makes costs high. But you never
address the issue of COSTS here. Starr's careful documentation about how
any process of cost containment has been carefully weeded out and killed off
by the AMA is something you do not comment on. Why do you always equate
high cost with high quality?

Can you comment on Starr's documentation below?


The elimination of countervailing power in medical care was a fourth element
in the structural development of professional sovereignty. The state,
corporations, and voluntary associations (such as fraternal societies) might
have exercised countervailing power, but all were kept out of medical care,
or on its margins. Their exclusion meant no organized buyers offset the
market power of physicians. Doctors could then set prices according to what
clients could pay. The absence of countervailing power was also key to the
political influence of the profession. (P. 231).


What is wrong with having organized patients too?

george conklin

In article ,
George Conklin wrote:

>Herman, you are always talking about free enterprise and homo economicus.
>Of couse, homo faber is the competing model, but let us forget that a moment
>since both are 19th century debating points.

>You are always taking about how insurance makes costs high. But you never
>address the issue of COSTS here. Starr's careful documentation about how
>any process of cost containment has been carefully weeded out and killed off
>by the AMA is something you do not comment on. Why do you always equate
>high cost with high quality?

>Can you comment on Starr's documentation below?

>The elimination of countervailing power in medical care was a fourth element
>in the structural development of professional sovereignty. The state,
>corporations, and voluntary associations (such as fraternal societies) might
>have exercised countervailing power, but all were kept out of medical care,
>or on its margins. Their exclusion meant no organized buyers offset the
>market power of physicians. Doctors could then set prices according to what
>clients could pay. The absence of countervailing power was also key to the
>political influence of the profession. (P. 231).

>What is wrong with having organized patients too?

Nothing is wrong with having organized patients. What is
wrong is having employers, trade unions, or government
agencies doing the organizing and running the organizations.

But even more than having organized patients, we need to
make it clear that the patient, and only the patient, can
have the power to make medical decisions, unless public
health is involved, and this does not mean the death rate.

No doctor or administrator should be allowed to order a
patient unless there is danger to others, and the
information must be conveyed to the patient in an
understandable manner, and precisely; far more precisely
than the doctors now have it. We need educated patients
and doctors, who can understand decision making under
uncertainty, and discuss the totality of consequences.

Frankly, most of the present doctors do not know enough
mathematics, probability, and statistics to do this. It
can be done with high school level CONCEPTS, not formulas.





--
This address is for information only. I do not claim that these views
are those of the Statistics Department or of Purdue University.
Herman Rubin, Deptartment of Statistics, Purdue University
hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558

In article ,
Herman Rubin wrote:

>In article ,
>George Conklin wrote:
>>Herman, you are always talking about free enterprise and homo economicus.
>>Of couse, homo faber is the competing model, but let us forget that a moment
>>since both are 19th century debating points.
>
>>You are always taking about how insurance makes costs high. But you never
>>address the issue of COSTS here. Starr's careful documentation about how
>>any process of cost containment has been carefully weeded out and killed off
>>by the AMA is something you do not comment on. Why do you always equate
>>high cost with high quality?
>
>>Can you comment on Starr's documentation below?
>
>
>>The elimination of countervailing power in medical care was a fourth element
>>in the structural development of professional sovereignty. The state,
>>corporations, and voluntary associations (such as fraternal societies) might
>>have exercised countervailing power, but all were kept out of medical care,
>>or on its margins. Their exclusion meant no organized buyers offset the
>>market power of physicians. Doctors could then set prices according to what
>>clients could pay. The absence of countervailing power was also key to the
>>political influence of the profession. (P. 231).
>
>
>>What is wrong with having organized patients too?
>
>Nothing is wrong with having organized patients. What is
>wrong is having employers, trade unions, or government
>agencies doing the organizing and running the organizations.

Oh I see. You are against organized patients despite what you
say. Why cannot fraternal organizations hire a doctor for a flat
rate for its members? Answer: the AMA made it illegal.

You are all for private costs --fee-for-service--but
socialized capital, i.e. charity supplies hospitals, equipment,
labs, and so forth and so on, and then doctors take profits
themselves.

>But even more than having organized patients, we need to
>make it clear that the patient, and only the patient, can
>have the power to make medical decisions, unless public
>health is involved, and this does not mean the death rate.

Of the growth in life expectancy of about 35 years since
1900, 30 of that 35 has come from social improvements such as the
mass transportation of food, public health and so forth, and only
5 from 'medical care,' and most of that was antibiotics, which
physicians can only pass out.

>No doctor or administrator should be allowed to order a
>patient unless there is danger to others, and the
>information must be conveyed to the patient in an
>understandable manner, and precisely; far more precisely
>than the doctors now have it. We need educated patients
>and doctors, who can understand decision making under
>uncertainty, and discuss the totality of consequences.

But you have still neglected the main thrust of Starr's point:
the capital of medical care is socialized, the patients
disorganized, and only fee-for-service is left. This is not
economics Herman. This is pure, raw politics.

>Frankly, most of the present doctors do not know enough
>mathematics, probability, and statistics to do this. It
>can be done with high school level CONCEPTS, not formulas.
>

Customary is what rules the medical world, NOT concepts.



--
George Conklin, Durham, NC: Medicare For All Ages
If HMOs ran the post office, the AMA (American Mail Association)
would declare that getting mail was a privilege, not a right
and 43 million Americans would get no mail delivery.

hrubin@odds.stat.purdue.edu (Herman Rubin) wrote in message news:...

> In article ,
> George Conklin wrote:
> >Herman, you are always talking about free enterprise and homo economicus.
> >Of couse, homo faber is the competing model, but let us forget that a moment
> >since both are 19th century debating points.
>
> >You are always taking about how insurance makes costs high. But you never
> >address the issue of COSTS here. Starr's careful documentation about how
> >any process of cost containment has been carefully weeded out and killed off
> >by the AMA is something you do not comment on. Why do you always equate
> >high cost with high quality?
>
> >Can you comment on Starr's documentation below?
>
>
> >The elimination of countervailing power in medical care was a fourth element
> >in the structural development of professional sovereignty. The state,
> >corporations, and voluntary associations (such as fraternal societies) might
> >have exercised countervailing power, but all were kept out of medical care,
> >or on its margins. Their exclusion meant no organized buyers offset the
> >market power of physicians. Doctors could then set prices according to what
> >clients could pay. The absence of countervailing power was also key to the
> >political influence of the profession. (P. 231).
>
>
> >What is wrong with having organized patients too?
>
> Nothing is wrong with having organized patients. What is
> wrong is having employers, trade unions, or government
> agencies doing the organizing and running the organizations.
>
> But even more than having organized patients, we need to
> make it clear that the patient, and only the patient, can
> have the power to make medical decisions, unless public
> health is involved, and this does not mean the death rate.
>
> No doctor or administrator should be allowed to order a
> patient unless there is danger to others, and the
> information must be conveyed to the patient in an
> understandable manner, and precisely; far more precisely
> than the doctors now have it. We need educated patients
> and doctors, who can understand decision making under
> uncertainty, and discuss the totality of consequences.
>
> Frankly, most of the present doctors do not know enough
> mathematics, probability, and statistics to do this. It
> can be done with high school level CONCEPTS, not formulas.

fantastic

In article <3f1be98c$1_10@news.buzzardnews.com>,
(null) wrote:

>In article ,
>Herman Rubin wrote:
>>In article <3f1bbc3f$1_4@news.buzzardnews.com>,
>>(null) wrote:
>>>In article ,
>>>Herman Rubin wrote:
>>>>In article ,
>>>>George Conklin wrote:
>>>>>Herman, you are always talking about free enterprise and homo economicus.
>>>>>Of couse, homo faber is the competing model, but let us forget that a moment
>>>>>since both are 19th century debating points.

.....................

>>>>Frankly, most of the present doctors do not know enough
>>>>mathematics, probability, and statistics to do this. It
>>>>can be done with high school level CONCEPTS, not formulas.

>>> Customary is what rules the medical world, NOT concepts.

>>And this will be the case as long as even our college
>>graduates only know facts and routine methods. The
>>person who thinks "customary" may be a good surgeon,
>>as long as only skill is required, but will have major
>>problems in recognizing that patients are different.

> Doctors are judged by applying approved treatments. The
>problem is that the research which backs up the approved
>treatments does not take much of any variation by individual into
>account. The information is just not there and that is why
>government needs to put some real money into research and not
>into more and more practice items.

And this will continue to be the case until decision
theoretic approaches are demanded by the patients.

There is a strong movement toward the use of Bayesian
analyses in medicine. It would not take that much
patient pressure to get this in.




--
This address is for information only. I do not claim that these views
are those of the Statistics Department or of Purdue University.
Herman Rubin, Deptartment of Statistics, Purdue University
hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558