Cell Phones, HMOs and Single-Payer
Dr. Marc answers readers' question every other week. To send a query, click here.
Dear Dr. Marc,
I'm wondering about those omnipresent gizmo's, cellular phones. Don't they transmit in the microwave region of the spectrum? Is putting one next to your head like putting your head in an oven? I thought microwaves, like the sun's ultraviolet radiation, have a frequency high enough to be capable of smashing into our DNA and knocking molecules out of place, leading to mutations with the potential of being carcinogenic.
On the one hand, you see people pressing phones against their heads everywhere you go, so how could it be deadly? On the other hand, you also see people sucking on cancer sticks, cigarettes. They say, if you're worried about brain cancer, just plug a headset into your phone and you'll be fine. But then, you're just holding the phone in your hand, or putting it in your pocket. The phones are so tempting to use, but will we pay a price?
You're not the only one wondering about cellphones. The incidence of brain tumors has increased but no study has yet been able to correlate this with radiation from cellphones. Despite this, I am of the belief that headsets are advantageous, that pressing a cellphone to one's head, as you say, cannot be good for it (for your head I mean). On the other hand, I am not concerned about the headsets - it is hard for me to believe that holding a cellphone in your hand or putting it in your pocket is dangerous - I would expect that process to be on the safe side.
Dear Dr. Marc,
One way of determining how best to manage the costs of delivering health care would be to benchmark the cost structure of a typical provider, perhaps CIGNA and its associated healthcare providers, hospitals, clinics etc. in a city with a counterpart overseas, perhaps Canada or Sweden which presumably have their costs better under control.
Have any such benchmarking studies been done? And, if so, what have they shown about how best to manage health care costs in the United States?
Interesting idea, to track the HMOs in the same way that they track their patients. But I don't think the private payer scheme could be compared directly to one where national health insurance is applied, because of the different cultural and socio-economic differences among these countries. I also don't believe that the HMOs would allow themselves to be subjected to the kind of scrutiny that they themselves engage in routinely. Further, even if we did benchmark their cost structure, how would we get them to change it under our wasteful system of private interest group economics? The numbers would no doubt reveal bureaucratic waste in health care spending and poor organization, a finding that would no more bring in an automatic shift towards National Health Insurance here than it would bring shame to the fat cat lobbyists.
Dear Dr. Marc,
I am presently working for a company engaged in distributing healthcare information to patients. I have seen in detail just how insane the healthcare insurance bureaucracies are, as different states, different companies, different plans, and different accounts all tend to have special conditions attached to their services. Yet, I am constantly told that our healthcare system is the best in the world. I have to take the word of others, for I personally cannot afford medical care. I cannot understand how anyone in their right mind can say that the US private insurance system can be more efficient than a public system. Do you have any observations on that?
I am often told that Canadians flock across the US border to get health care, but I have never been told that by a Canadian. Indeed, I understand that Americans flock to Canada for prescription drugs. Are there any reliable studies to support either claim?
What doubly perplexes me is that I am frequently told that single-payer or publicly funded systems, "just don't work." While there will never be a flawless system of either kind, are there any public health care systems that do work?
In England, NHS is in competition with private healthcare. I see parallels in both the US and British education systems. Those with the greatest wealth get what they need, and everyone else gets to wait in line for underfunded services. If resources were not split between private and public healthcare systems (with either being abolished), do you think that either would be improved, or would it just turn into a different flavor of disaster?
John D. Powers
Perhaps if there weren't the two tiered system in England there would be more consistent quality throughout the NHS. On the other hand, the flexibility under the current system allows more options in terms of available technology. The current U.S. system is clearly inefficient and wasteful, yet might remain so if the government ran it (see Medicare). Universal Health Insurance appeals to me as a concept, but quality is also dependent on who's administering the health care, as well as what type of expertise is being provided. You are right to point out that the cultural expectations in both countries and the sense of entitlement almost automatically leads to wealthy people demanding (and paying for) better service no matter what the system. But regardless of who is or isn't flocking here to get care from across our borders, we still have decent comparative health care throughout much of the US even now. Unfortunately, the insurance company and drug company models for delivering passionless, profittable self-serving health care may well be chipping away at our reputation around the world.
Dear Dr. Marc,
I just read some of your responses on health insurance costs and the profit motive of insurers and pharmaceutical companies. While I agree in part, you are only commenting on one leg of a three-legged stool.
As a conscientious benefits broker with a modest but growing practice, I often have to explain why health care costs are rising. The AMA's vested interests in the status quo are no less profound than Pfizer's/Glaxo/Merck--pick one.
The $200 monthly single rate for the plan design that one of your previous questioners was looking at was probably a bargain. This stuff costs a fortune. Rather than denigrating insurers, it would be instructive for Nation readers to hear from an actuary or underwriter. Here in Massachusetts, where more than ninety percent of the private small group market is held by not-for-profits, "greed" is an insufficient answer to the question.
Jeff Tyrakowski, Vice President for Employee Benefits
Ernst & Company, Quincy, MA
Thanks for the insights. However, I think the main point of the original question was not the cost of the patient's insurance, but of the inadequate coverage it provided her. The AMA does not stand for all doctors, nor does it protect them from the hefty regulations that cramp a physician's abilities to order appropriate tests and treatments. Often, the insurance evaluator is a nurse who lacks the clinical experience of the doctor he or she is evaluating. Would such regulations ever be applied to the insurance and pharmaceutical companies?
Dear Dr. Marc,
How come you respond to every medical question asked of you with a lengthy diatribe against the evils of the healthcare industry and other assorted leftist rants? Is the purpose of your column to dispense medical advice or is it to serve as a platform for your socialist views?
It may surprise you to know that I consider myself neither a socialist, nor even a leftist. My views depend on the issue. Drug Company abuses, corporate agendas, health care injustices, media misinformation, to me these are fastballs down the middle. Ask me if drug company prices should be regulated, I say yes. Ask me if doctors should be regulated further, I say no. Someone wanted me to comment today on whether the veins on the President's nose were a sign of drinking. Of course I ignored the question. Another thing, the purpose of this column is not to dispense medical information. It's difficult to do that without knowing the patient. I refuse to do it. Rather, the idea of this column is to address questions relating to the broad nexus of medicine, health-care, politics and culture in the US today.