A reader – Peter Obels (see his blog just added to the blogroll on the left) – has pointed out the old Dutch origin of the word “rant”. He provided two references – Online Etymology Dictionary which has the following definition:
rant – 1598, from Du. randten “talk foolishly, rave,” of unknown origin. Ranters “antinomian sect which arose in England c.1645″ is from 1651; applied 1823 to early Methodists.
And Merriam-Webstr Online
Main Entry: 1rant
Pronunciation: ‘rant
Function: verb
Etymology: obsolete Dutch ranten, randen
Date: 1602
intransitive senses
1 : to talk in a noisy, excited, or declamatory manner
2 : to scold vehemently
transitive senses : to utter in a bombastic declamatory fashion
– rant�er noun
– rant�ing�ly /’ran-ti[ng]-lE/ adverb
Well I guess that describes this blogger quite well!
A new quotation
A colleague at another university clued me to this quotation. It will go over on the right column – because I love the quotation.
There are in fact, four very significant stumbling-blocks in the way of grasping the truth, which every man however learned, can scarcely allow anyone to win a clear title to wisdom, namely, the example of weak and unworthy authority, long standing custom, the unfeeling of the ignorant crowd, and the hiding of our own ignorance while making a display of our apparent knowledge.
Roger Bacon
Read those words carefully, and try to live by them!
The crisis intensifies
Doomsday Scenario for Doctors
In early March the House passed a much-needed tort reform bill, and the Senate now is debating the issue. Unfortunately, even if the Senate passed the bill tomorrow, more than 300 high-risk specialists in the District, mostly obstetricians and gynecologists, still would face a painful decision: Pay an outrageous amount for liability insurance or drop out of the District health care system. If they opt out, the result could be disastrous.
The annual liability insurance premium for these 300 specialists is coming due soon. Last year it was $89,000. This year it is $108,000, which equals about four months’ worth of gross income for these doctors.
Rather than pay this huge sum, some of the 300 doctors may retire early. Others may take their practices elsewhere. Still others may decide to take a chance on going without insurance, which would mean that they would have no admitting privileges at hospitals and could not be preferred providers for health plans.
Any of these alternatives to ponying up $108,000 would mean that D.C. hospitals might lose thousands of patients, which would make it difficult for them to keep their delivery suites open, their trauma centers operational and their operating rooms functional. Hospital beds would go empty, and capacities that once were assets would turn into liabilities.
This story sounds very similar to Rangel’s rant that I cited on Saturday. Increasing malpractice insurance rates do not just impact physicians. Rather the entire health care system is at risk in this crisis.
If enough doctors opt out of the District, health insurance plans might be unable to ensure access to necessary medical services in provider networks as required, and they, too, might not be able to remain in business in the District. Employer health benefit plans also would feel the pinch.
Ironically, doctors who choose to continue practicing in the District might see their premiums go up still more if some of their colleagues give up their D.C. practices. The National Capital Reciprocal Insurance Co. (NCRIC) is the liability insurance company for 90 percent of D.C. doctors. An exodus from the physician ranks could mean an increase in premiums for those remaining, because risk would be spread over the smaller group. Internists, whose $16,000-a-year premiums are recoverable in about two weeks, might find themselves working for several months to pay for insurance.
Further, if NCRIC went bankrupt, as similar companies have in some states, not only would all physicians be uninsured but they also would need to buy insurance to cover risks that had been covered by NCRIC before they could get other liability insurance. “Prior acts coverage” generally costs 150 percent of the annual premium for regular liability insurance; that would translate to $162,000 for obstetricians and gynecologists.
This worst-case scenario may seem extreme, but it is the logical endpoint of a long-emerging crisis. Even if a tort reform bill is passed that covers the District, it almost certainly will not reduce malpractice premiums.
Everyone must understand the unintended consequences of out-of-control malpractice suits. We need real tort reform. I remain pessimistic that we will get that reform in the near future. And the Democrats continue to accept money from the trial lawyers. And the Democrats use the tort lawyer talking points. They are talking us into a health care crisis!!!!!!!!
Medical Weblogs
I have to link to this article. The AMA News interviewed me (and several other medical bloggers) by phone a few weeks ago. The author has done a nice job of understanding the blogosphere and its potential. Welcome to the blogosphere: A brave new world of Web dialogue: A growing number of physicians are sharing their thoughts and opinions on online diaries known as Web logs, or blogs. This article gives some positive publicity to our small (but apparently growing) club of medical bloggers. As I near my first blogging anniversary (May 19th), it seems that we bloggers are impacting both the blogosphere as well as medical thought in general. I hope we do make an impact. Blogging allows us to express our uncensored opinions. We often disagree, and readers often disagree with us. These rants and counter-rants allow readers (and writers) to consider these issues carefully. If we achieve that goal – inducing thinking – then we are a huge success!
Michigan Medicaid drug formulary
State Medicaid programs have the same financial difficulties discussed below in the Medicare rant. A federal court has agreed that Michigan can work to limit drug expenditures. Federal court upholds Michigan Medicaid drug formulary plan
More than a year after Michigan implemented a Medicaid drug formulary in an effort to save money, physicians are still working through kinks in the program, and courts are still reviewing the law to decide whether it’s appropriate.
In the latest court round, the state’s statute came out on top. The U.S. District Court for the District of Columbia in late March upheld the law, which requires physicians to get prior authorization before prescribing Medicaid patients medications that aren’t on the formulary.
But the Pharmaceutical Research and Manufacturers of America and two patient groups in Michigan already have vowed to appeal the decision because they fear that the law will hurt patient care, particularly for Medicaid recipients who are being treated for mental illnesses.
These decisions are necessary. We have limited resources. The states cannot spend moneys that they do not have. Some of these decisions seem painful. Nonetheless, they do seem necessary.
Which antihypertensive should come first?
I have blogged this one silly. This article does summarize the current situation. Hypertensive studies: 2 results Are ACE inhibitors or diuretics more effective? The answer may come soon.
In December, a study of more than 42,000 white and black Americans found that old-fashioned, cheap diuretics — “water pills” — work at least as well and sometimes better than more expensive drugs to treat high blood pressure and certain heart problems. In February, a study of more than 6,000 mostly white Australians came to a different conclusion — that drugs called ACE inhibitors were better than diuretics, although only for men (for unclear reasons).
Now it falls to a committee of experts picked by the National Heart, Lung and Blood Institute in Bethesda, Md., to reconcile the studies and tell America’s 50 million hypertensives what to do. The conclusions are crucial: Hypertension doubles the risk of heart attack and is the leading risk factor for stroke and heart failure. One in four adult Americans has hypertension, which is defined as a reading of 140/90 or higher.
I will not repeat my previous rants on this subject. New readers who are interested can search on ALLHAT and find many rants on this subject.
Money talks
Common sense lives in the Bush Administration. I know that that sentence will give some pause. Others might stop reading. However, after reading this article, you may agree – U.S. Limiting Costs of Drugs for Medicare
In a fundamental change, the Bush administration has begun to weigh cost as a factor in deciding whether Medicare should pay for new drugs and medical procedures.
Most notably, in recent weeks, federal officials have adopted policies to limit what Medicare pays for prescription drugs. These actions, they said, set a significant precedent, illustrating how Medicare will try to control spending if President Bush and Congress agree on a plan to provide more extensive drug benefits to the elderly and the disabled.
The officials said they were not imposing explicit price controls, but stretching federal dollars to ensure that the government would be a prudent purchaser, a goal endorsed by health policy experts.
But drug industry executives have strenuously protested the administration’s actions. The government, they say, lacks the legal authority, the expertise and the clinical data to make such decisions.
“Medicare officials are increasingly injecting questions about cost and cost-effectiveness into decisions about coverage,” said Gordon B. Schatz, a Washington lawyer who specializes in health care issues.
Almost anyone who closely examines potential Medicare expenses would come to the conclusion that Medicare cannot pay indiscriminately. Thus, an intelligent manager would make some decisions based on financial considerations. Examples:
�The federal official in charge of Medicare and Medicaid told doctors last month that they should not prescribe Nexium, a new heartburn drug, saying it was identical to an older drug, Prilosec, which became available in a cheaper generic form in December. The admonition infuriated executives of AstraZeneca, the maker of Nexium and Prilosec, who contend the new drug is superior.
�Medicare refused to pay the full price for a new drug to treat anemia in cancer patients, saying it was “functionally equivalent” to an older drug with a lower price. Amgen, the maker of the new drug, Aranesp, contends that it is more effective than the older drug, Procrit, sold by Johnson & Johnson.
�In deciding whether Medicare should cover a new test for colon cancer, the government said last month that it would analyze the cost-effectiveness of the procedure in detecting cancer among people with no symptoms. The government has rarely been so explicit about considering cost.
Political watchers understand that President Bush comes from a business administration background. He delegates authority, and expects sound decision making. He and his administration do understand the cost implications of political decisions (something the Congress rarely considers). Readers of this blog know my disgust with the entire Nexium promotion in this country – My personal crusade against AstraZeneca – just say no to Nexium . Having this administration convinces me that they will not allow Medicare destroyed unnecessarily.
The Bush administration surprised doctors last month when it bluntly stated its preference for Prilosec over Nexium as a treatment for heartburn.
At a convention of the American Medical Association, Mr. Scully told doctors, “You should be embarrassed if you prescribe Nexium,” because it increases costs with no medical benefits.
“The fact is, Nexium is Prilosec,” Mr. Scully said. “It is the same drug. It is a mirror compound.”
Mr. Scully said he had no problem paying thousands of dollars a year for an innovative drug that saves lives, like Gleevec, for certain types of leukemia and gastrointestinal tumors. But he said, “Nexium is a game that is being played on the people who pay for drugs.”
Will common sense receive its just rewards? I am not certain that common sense will work in political campaigns – the sound bites might not be there. But they have convinced me – actually the New York Times has convinced me – of the administration’s common sense.
