On some level, I pity politicians for the way they have to straddle two vastly different worlds.

They spend part of their time in DC, working with highly functional, intelligent, motivated people with agendas (usually hidden). And then they go back to their districts and meet with “the people”. And I don’t mean the average people. I mean the kind of people who come to local political events.

Yesterday I gave a 20 minute presentation about Single Payer to about 20 people as part of a local county DFL series on health care reform. (DFL is Democratic Farm Labor party — Minnesota’s Democrats.) The other speaker was from the Minnesota Medical Association, giving the AMA’s plan for universal coverage.

I was the youngest person in the room by at least a decade. The other presenter just retired as a general surgeon, and was the past-president of the MMA. The moderator was an ED physician from the county medical center (there *is* another health care facility in Rochester).

The audience was mostly Medicare-age folks. As they asked questions in the Q&A time, we learned that one was retired from IBM, another from the state Medicaid office, a third had worked for Mayo in their development office.

And then there was the guy in the back wearing the Star Trek communicator.

His first comment was to point out how the underlying issue was actually ideology about private industry vs government.

Okay, so he has a very insightful comment to make. Despite the Star Trek paraphernalia.

I gave a broad overview of single payer, and didn’t dive into the nitty details (source of tax funds, how it is decided what is covered, etc). The other presenter did give more details, but he had to because the individual mandate with insurance reform is complicated.

When the issue of waiting lines in Canada came up, someone else in the audience pointed out that it was likely propaganda rather than factual. Several other times, members of the audience piped up to answer questions with very knowledgeable statements.

Yes, a crowd in Rochester is not a typical crowd of people. This is one of the most over-educated populations in the country thanks to Mayo and IBM.

Overall, I probably didn’t sell single payer to anyone who didn’t already believe in it. But I did get to use two of my favorite arguments. When someone brought up the “fact” that the government is inefficient, I was ready with both the reality of Medicare vs insurance as well as the student loan industry (where Direct Loans are 10x more efficient than private, government-guaranteed loans).

And I got the biggest laugh out of the audience during a discussion about concerns for underfunding the system. The other presenter said that a single payer system would automatically result in underfunding. I rejoined with “the military has a single-payer, and it does not seem to have any problems with being underfunded.” That line really works in a room full of Democrats.

After hearing the MMA/AMA proposal, it does seem that all of the ideas health care reform are merely different ways to go in the same direction. The AMA plan would require immense amounts of government regulation to ensure that community pricing is fair, that no one is priced out of the market, that the level of benefits is appropriate, that low-income patients aren’t sold high-deductable insurance (essentially relegating them back to being uninsured), etc.

With those kinds of regulations, how long will insurance companies play along until they pull out because the market isn’t profitable? And once you have only two (or one) private insurer left in a market that is heavily regulated, how is that not like a de facto government-run single-payer system?

On the flip side, a single-payer system would in reality be implemented through private insurance companies who are selected by a bidding process. I guess the only difference is whether individuals “choose” their insurance provider, or allow the government to select it for them.

Thanks to Google Reader, I’m able to keep up with an large number of blogs that focus on medical and pharmaceutical topics. Below is a brief tour of the blogs that I find interesting at the moment.

• Hooked: Ethics, Medicine and Pharma is a blog by Howard Brody, extending the topic that he addressed in a book of the same name.
• Health Care Renewal comes from a collections of physicians and others concerned about the concentration of power in medicine. They have many great links to medical issues addressed by the government.
• Movin’ Meat is written by an Emergency Medicine physician who covers his experiences on the front lines, as well as commentary on the political state of health care.
• Over My Med Body comes from Grahamazon, a medical student in California. He is recognized in the blogging community for his excellent posts about his experience becoming a doctor, as well as health care reform. But I know him personally from our college days when we built a bridge in Tennessee on an Alternative Spring Break.
• Panda Bear, MD is another Emergency Medicine physician who currently has a biting post about the pointlessness of drug reps in the ED.
• Pharmalot is one of the newer blogs that I’ve picked up recently. Coming from New Jersey, it covers a large swath of the pharmaceutical industry with 10+ posts per day, ranging from links to news articles to commentary about drug company antics.
• PostScript comes from the Prescription Project, a partner in many of our projects to remove the influence the pharmaceutical industry bias from the practice of physicians.
• Running a Hospital is written by Paul Levy, the President and CEO of Beth Israel Deaconess Medical Center. It’s fascinating to see his perspective as a non-physician, but clearly a fellow traveler in delivering patient-centered care.
• Question Everything has an interest in food, nutrition and physical activity. And also getting fast food out of hospitals.
• Modern Prometheus is an MD/PhD student who is finally coming to the end. He spent time as a leader of the dark side, but there may yet be hope of turning him back.
• And finally, Drug Rep Toys is aptly named. It is nothing more than an inventory of the ridiculous and useless things that drug reps give to physicians in a pathetic (but sadly successful) attempt to curry favor.

From yesterday’s American Health Line

As the U.S. “prepares for the next great debate on its ailing health care system, support is growing for a shift from the traditional employer-based financing to publicly subsidized individual health insurance,” Washington Post columnist David Broder writes in an opinion piece. He cites a report from the Committee for Economic Development to be released this week that will “give a strong push to the idea” by saying “in blunt terms that business can no longer afford to pay the rising costs and lacks the clout to curb the forces that are driving health care inflation.” The report “outlines a two-step solution, aimed at producing a competitive marketplace with broad individual choices,” according to Broder. First, “the federal government would establish independent regional ‘exchanges’ through which individuals would purchase one of many competing private insurance plans,” and second, “every family would receive a fixed-dollar credit, sufficient to pay the premium on the basic, low-cost plan in its region, so it could be insured without cost to the family budget.” (Broder, Washington Post, 10/14).

So satisfying to see that more serious discussion is afoot about moving away from the employer-based system of coverage…here’s to moving toward universal coverage!

It looks like Minnesota may have stumbled upon the most effective way of eliminating drug reps: forbid them from bringing food to doctors. It seems that without food, doctors stop seeing them.

That’s the pattern that showed up when the New York Times looked more into the Minnesota experience. But there’s more:

Since drug companies can no longer offer expensive meals to Minnesota physicians, they are inviting nursing and secretaries to dinners to listen to a pitch delivered by a physician. However, the only person in the room who can actually prescribe the touted drug is the invited speaker (who is earning $500-$2000 for his or her time) … this makes the actual goal of the event ever so clear.

…where we’re holding our National Physicians Alliance board and committees meeting!  We’re in Washington, DC, about 30 of us, deliberating on how to best advocate for our patients and how to best engage physicians on important health issues.  The ideas are flowing, as is the caffeine.  More from DC as we continue to discuss how to build our robust and growing organization!

Sismondo S (2007) Ghost Management: How Much of the Medical Literature Is Shaped Behind the Scenes by the Pharmaceutical Industry? PLoS Med 4(9): e286 doi:10.1371/journal.pmed.0040286

Also see an article an I was involved with during medical school:   Madison Ave. Has Growing Role In the Business of Drug Research
Watch what you read, especially if it is sponsored by industry.