Crocodilian

Healthcare 'Debate' Dominated by Shouting and Lobbies

Thank you, author, for the brave and yet rare: "citizens share the blame".

Observing the eruptions of dyspeptic ignorance that pass for "protest" (people simultaneously incensed at the prospect of "Government controlled healthcare" and cuts to their Medicare are apparently unaware of what Medicare is) can lead to despair.

People ought not to have strong opinions about subjects on which they are ignorant. Though the critics have taken up the chant "read the bill", there's no evidence that they've read it, or taken the time and trouble to understand what healthcare finance is about, and why getting more for our healthcare dollar is both possible and necessary.

An intellectually shallow citizenry makes it very difficult, indeed nearly impossible to make good policy on important issues.

Healthcare has seen this before: if one thinks back some years to longterm care, and the popular revolt which lead to senior advocates like Representative Claude Pepper being chased by angry seniors for having had the temerity to give them the guaranty of long term care that they said they wanted . . . very sad.

General Electric’s Virtual Healthcare Economics

You've identified a big but poorly appreciated difference between a "virtual colonoscopy" and a traditional one: one requires millions of dollars of capital investment, and the other doesn't. I might add that while a traditional colonoscopy "belongs" to gastroenterology, a "virtual colonoscopy" (generally)belongs to radiology.

The GE/Siemens virtual colonoscopy "end run" (groan) is part of the political economy of healthcare capital equipment. This is a very high stakes game, but generally invisible-- large amounts of money are spent, to buy things that citizens generally approve of, but through essentially bureacractic and political processes.

So the big vendors have established channels built out, institutional and financing structures to enable radiology buy multi-million dollar equipment. And GE, Siemens and a few other big players have the political heft to get the departments the financing they need, and the political cover that they need for these massive spends.

That's not to say that virtual colonoscopy -- or virtual angiography-- might not be better than the traditional kind, but there are more than medical issues involved. There's cost, there's vendor, and there's departmental/specialty politics as well.

There's more to it than just "convincing the patients" though. Most states require hospitals to jump through hoops before buying expensive equipment like this . . . they must get a "Certificate of Need". It is on this battleground that Siemens and GE fight, getting approvals for their clients from reluctant state bureaucracies (which are all too aware that each new expensive facility is going to add cost). An overview of Certificate of Need laws can be found at:
www.ncsl.org/programs/...