From: hrubin@pop.stat.purdue.edu (Herman Rubin)
Newsgroups: talk.politics.misc,talk.politics.medicine,soc.culture.usa,soc.culture.african.american,sci.med
Subject: Re: Statement of President Clinton on Health Care Reform Task Force
Date: 27 Jan 93 21:50:14 GMT
Organization: Purdue University Statistics Department

In article <1993Jan27.163227.8703@nlm.nih.gov> brandon@caldonia.nlm.nih.gov (Brandon Brylawski) writes:
>timothy@ccu1.aukuni.ac.nz (Tim Bates) writes:

>: If doctors didn't have the support of the government in preserving their
>: monopoly on health, penicillin would be virtually free in medicinal doses
>: available from your local dairy.

>Come, let us be reasonable. The price of medications is set by market and legal
>factors involving pharmaceutical companies;  doctors have no say nor role in what 
>drugs cost, and if you could buy them over the counter they would not cost any
>different. Penicillin, at any rate, is dirt cheap (pennies per pill). Perhaps you
>are arguing that there is no reason to pay a doctor when you should be able to 
>buy medications on your own, when you think you need them. That's an interesting 
>notion, but in my experience very few patients could do so for themselves
>competently. When a patient comes to see me, he is paying me for my expertise; I make
>nothing off of the medications I prescribe. Further, I always try to prescribe
>the cheapest medicine that works well for any condition. If a particular patient's
>problem is well known to me and he merely needs another course of some medicine that
>has worked well for him in the past, or if he needs a refill and there is no reason
>to think that he requires another examination, then I will prescribe over the 
>phone, at no cost to the patient for my service. What system would you prefer?

Penicillin is a poor case, as there are public health issues in developing
penicillin-resistant germs. 

But are you being paid for your expertise?  I have seen the forms by which
"appropriate" fees are calculated; they are based solely on how much time
you spend with the patient, and which procedures you use, and there are 
even limitations on the charge for time.  Do you attempt to explain to a
patient the manifold appropriate procedures, especially for long-term
conditions?  Could you even give a reasonable quantitative probability
assessment, so that the patient can use his/her values to choose between
treatments?  Could you even do this quantitative analysis by questioning
to obtain the patient's utility?  

Can you take into account, in a probabilistic manner, nutritional 
information which is not sufficiently well studied at the present 
time?  Can you take into account the vast variation in nutritional
needs, well established more than 30 years ago?

You should be paid for the quality of your professional advice, with
rates set on the market, with feedback information about the quality
of you advice made available to the patients.  But none of the current
prepaid plans even comes close to this.
-- 
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: (317)494-6054
hrubin@snap.stat.purdue.edu (Internet, bitnet)  
{purdue,pur-ee}!snap.stat!hrubin(UUCP)
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