Where your health care dollars go

A Late Dance

The following quotation appeared in a full-page, color advertisement
on page A7 of the 2010-01-05 Washington edition of the New York Times
for the Hospital for Special Surgery
(repeated on 2010-04-27, again on page A7).

“One of our oldest hip patients was 93
and she couldn’t be happier with her new hip.
We can’t always recommend surgery to patients in their nineties,
but the lady in question was in excellent health
and able to dance at her 70th wedding anniversary party.”

The advertisement featured, just above that statement,
a silhouette drawing of a man and a woman dancing,
with the woman bent backward at about a 45 degree angle,
with the man’s arm behind her back to keep her from falling
(There’s a name for that position, of course;
I’m just not enough into dancing to know it).

The introduction to the ad runs as follows:

“Eighty is the new seventy.
Seventy is the new sixty.
Sixty is the new fifty.
Forty is the new thirty …
as the popular new saying goes.

And there’s a lot of truth to it.

The average life expectancy is now 78 years.
If you are already in your mid 60’s
you can expect to live till your 80’s
and more and more people are celebrating the big 100.
(Remember when it was the big 50?)

And our bones and joints are wearing out even faster
due to prolonged energetic lifestyles.”

Of course, the body of the ad consists of
suggesting the advertiser is an ideal place to go
for all the joint reconstruction that seems to go
right along with that extended longevity.

2009-01-21-WP-shoebox-full-medications

Hundreds Visit Medical Tents Seeking Care for Cold Feet and Worse
By David Brown
Washington Post, 2009-01-21

[Reporting on the medical needs at the inauguration of President Obama:]

Marshall Anderson, park ranger and paramedic,
arrived at his first aid tent northeast of the Washington Monument
at 5:30 a.m. yesterday.
His first patient arrived at 5:31.

“She walked in right behind me,” he said at midmorning,
by which time he and his colleagues had seen 17 people.

The first patient, a Maryland woman in her 30s on dialysis,
“was on a shoebox full of medications,”
Anderson recalled.
“She was cold, and she just wasn’t feeling well.”

His advice after a quick assessment:
Go home and watch the inauguration on television.

2010-03-04-Rawlings-Blake

Mayor Released from the Hospital, Blames Coffee
Associated Press, 2010-03-04

BALTIMORE (AP) ―

Baltimore Mayor Stephanie Rawlings-Blake says
drinking too much coffee is likely to blame for her brief hospitalization.
[The mayor was hospitalized for 11 hours.]

Rawlings-Blake woke up early Thursday with chest pains and lightheadedness.
She underwent a series of tests
at the University of Maryland Shock Trauma Center
and was released at 2 p.m.

Rawlings-Blake says her trip to the hospital was precautionary,
and she was given a “100 percent clean bill of health.”
She says the symptoms were triggered by a gastrointestinal problem
and were not stress-related.
The mayor says,
“I just need to slow down my Starbucks habit.”

[One might wonder how much that 11-hour hospitalization cost,
and who paid.
One might also wonder if she had to pay the bill out of her own pocket
if she might have been quite so quick to head for the hospital.
Cf. the Senator Barrasso - President Obama exchange.

As to the cause of her “gastrointestinal problem”, see this.]

2010-03-13-NYT-elderly

Finding the Right Care for the Elderly
By LESLEY ALDERMAN
New York Times, 2010-03-13

Two years ago my father, then 83, became very ill.
Until then, he had been living alone
in a pleasant one-bedroom apartment on the Hudson River,
an hour’s drive from my home in Brooklyn.

After a couple of months in the hospital it became clear that
my dad, Harvey Alderman, could not return to solo living.
He was fragile and forgetful,
and there was no way he could keep track of
the 14 or so pills he had to take each day.

But where would he go — and how would we pay for it?
Could he stay in his apartment if he had regular visits from an aide?
Or should he go to an assisted-living facility
where there would be more services available for him?

So began my family’s crash course in caring for
an aging parent in declining health.

If you’re in this predicament, you know already there is no simple answer.
Older people each have unique medical and emotional needs.
And finances often dictate how far you can go
in creating the ideal situation for them.

That is what Linda Chase, a lawyer in Reston, Va.,
realized after running the numbers on
what it would cost for home care for her mother,
who has dementia and needs round-the-clock attention.

“We couldn’t afford private home-health care,
so the only option for us was
assisted living in a facility with dementia care,”
Ms. Chase said.

...

Ms. Chase found it would cost around $150,000 a year
to hire full-time home caregivers for her mother, Jeanette Chase.
...
A nearby assisted-living facility, on the other hand,
charged $80,000 a year
for a room on a secure floor intended for memory-impaired patients.
And her mother’s long-term care insurance,
which did not cover in-home care,
covered 40 percent of the bill for assisted living.

[I.e., $32,000 a year paid by insurance.

How much money is spent in all keeping alive these people who have dementia?
If families wish to pay to keep their loved ones alive,
that is certainly their prerogative.
But it seems to me that scarce federal funds,
when the combination of the budget deficit and trade deficit
show how much overspending we’ve been doing,
should not be spent to extend indefinitely the life of the elderly in such circumstances.
Take the first example, Mr. Alderman.
He’s taking fourteen pills a day (how much does that cost)
and now his mind is so far gone he cannot even remember to take them?
What’s the point of keeping him alive at public expense?
It almost seems like the only point is
to keep making jobs and profits for the health care industry.
Is American health care now run by a coalition of the needy and the greedy (e.g.)?]

2010-03-15-Harbaugh

Here is a quote from a June 2009 article:

“Roughly 50 percent of people who reach 85 will become demented,
according to studies conducted by
investigators at Rush Medical Center in Chicago.

“By age 100, the number spikes to 60 percent.
Of those who develop dementia,
roughly 60 percent will prove to have Alzheimer’s disease.
It’s predicted that
the current number of patients with Alzheimer’s disease in the United States
is roughly 5 million.
By the year 2050, it will grow to about 30 million,
presenting a significant financial burden to the healthcare system.”

[See also.]

Let’s extrapolate that $80,000 per year care cited in an article above
over a population of five million:
That’s $400 billion per year!
Is that where the Democrat’s long term health care cost is headed?
And the bill will grow proportionately as the number of dementia patients grows.

2010-04-13-Harbaugh

Below is most of a letter recently published in the health section of a newspaper
from a woman telling about her health situation.
(Her name was published, but I see no need to include that here.)

---

A few hours ago my oncologist called and said that
a brain CT scan I had last week showed a new small suspicious spot.
(I cannot have MRIs because I wear a pacemaker.)

She has referred me for consultation to a radiologist
but told me that if radiation is recommended
I could not have it without a biopsy to prove that the spot is malignant.
She is particularly concerned about my having a biopsy
because of my advanced age.
I would think that elastography is designed for
a condition exactly like mine.

---

So let’s see, what are the health problems of this woman?
Heart problems (the pacemaker),
cancer worries (“my oncologist”),
advanced age.
She doesn’t mention them, but many people of an “advanced age”
have replaced various joints (knee, hip, elbow) one or more times.
Also the likelihood of taking literally thousands of dollars of drugs each year,
if for no other reason than because
advertising in various publications aimed at the elderly
convinced her it was a good idea.
And why not?
It’s no cost to her.

My opinion is that these kinds of cases
make a very good argument for limiting the amount that will be spent
(either by the government or by insurance companies)
on people as they get older.

The high level of per-capita healthcare spending on the elderly
is quite a recent phenomenon;
it is just something that has happened,
driven by a combination of the needy and (in part) the greedy.
Why not return to the historical level of spending on them?
The nation certainly prospered with those lower levels of healthcare spending;
to return the nation to fiscal health it seems necessary
to cut its spending on personal health.

2010-04-16-NYT-Genzyme-cost

Genzyme Drug Shortage Leaves Users Feeling Betrayed
By ANDREW POLLACK
New York Times, 2010-04-16

...

[The drugs discussed in this article are]
Cerezyme, for Gaucher disease, and Fabrazyme, used against Fabry disease.

[From Wikipedia:
About 1 in 100 people in the United States
are carriers of the most common type of Gaucher disease,
while the carrier rate among Ashkenazi Jews is 1 in 15.]

Both diseases are rare inherited enzyme deficiencies
that allow fatty substances to build up in the body, damaging organs.
The Genzyme drugs, which are typically given intravenously every two weeks,
provide the missing enzyme for each disease.

...

[T]here are only 1,500 Cerezyme users
and fewer than 1,000 Fabrazyme users in this country....
[T]he drugs are ... expensive —
about $200,000 a year.

...

“My life would have been so different if not for their drug,”
said Linda Rubenstein of Carlisle, Mass.,
who said Cerezyme had allowed her to have a son and a job.

...

2010-04-16-NYT-Cerezyme-cost

Precious Drugs That Come at a Cost Few Can Afford to Meet
By ANDREW POLLACK
New York Times, 2010-04-16

...

Mr. Katz said he had voluntarily taken only half a dose of Cerezyme
because a full dose for someone his size — he weighs 200 pounds —
cost more than $400,000 a year.

...

2010-06-Kiplinger-Lankford-Long-term-health-care

Long-Term Care That Falls Short
Benefits from the government's new program
won't cover the cost of a nursing-home stay.
By Kimberly Lankford
Kiplinger's, 2010-06

...

the actual cost of long-term care ...
currently averages $219 per day in a nursing home,
or $168 for eight hours of care by a home health aide.

[$219/day × 365days/year =~ $80K/year !!

For comparison,
the real disposable per capita income for the United States in 2010
was about $33K in "chained 2005 dollars",
which converts to about $37K in 2010 dollars.]

2010-06-14-NYT-paying-people-to-take-pills

For Forgetful, Cash Helps the Medicine Go Down
By PAM BELLUCK
New York Times, 2010-06-14

[1]
It has long been one of the most vexing causes of America’s skyrocketing health costs: people not taking their medicine.

[2]
One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker.

[3]
Now, a controversial, and seemingly counterintuitive, effort to tackle the problem is gaining ground: paying people money to take medicine or to comply with prescribed treatment. The idea, which is being embraced by doctors, pharmacy companies, insurers and researchers, is that paying modest financial incentives up front can save much larger costs of hospitalization.

...

2010-06-14-NYT-Should-people-be-paid-to-stay-healthy?

Should People Be Paid to Stay Healthy?
By THE EDITORS
New York Times, 2010-06-14

Opinions from:

* James C. Capretta, Ethics and Public Policy Center
* Karen Davenport, Center for American Progress
* Kevin Pho, primary care doctor
* Arthur Caplan, professor of bioethics
* Gary Charness, economist, U.C. Santa Barbara
* Uri Gneezy, economist, U.C. San Diego

2010-07-20-WP-Aizenman-disease-management-program

Insurers tout disease management programs, but critics are wary
By N.C. Aizenman
Washington Post, 2010-07-20

Venante Kotey is a stay-at-home mother in Dumfries. Bridget Hamilton-Roberts is a nurse more than 500 miles away in Atlanta. They’ve never met. But over the past year and a half, Hamilton-Roberts has become critical to Kotey’s health -- all through conversations over the telephone.

The two are part of an innovative disease management program that links patients with caregivers across the country. Every week -- and sometimes every day -- the nurse calls the mom with tips on how to monitor her Type 2 diabetes with blood sugar and lipid tests. She has enrolled Kotey, 35, in free lessons on how to give herself insulin, persuaded her doctor to provide a faster-acting version, and found her a psychiatrist to treat her depression. Hamilton-Roberts has also become a trusted confidante, said Kotey, a person who “really gives me the force to go on. . . . I love Bridget; she is like family.”

These phone-based programs have sparked debate, with critics claiming there is little evidence that they actually work, and proponents -- including many insurance companies -- lauding them as precisely the sort of prevention-oriented approach needed to fix the health-care system. That debate has gained new salience because of a key requirement of the sweeping health-care overhaul enacted by Congress this year.

Starting next year, most health insurance plans will be required to spend 80 to 85 percent of the premiums they collect on medical claims or other activities that improve members’ health. Profits and other costs such as administrative expenses must account for no more than 15 to 20 percent. The Obama administration is drafting regulations that will determine which, if any, disease management programs insurers will be able to count as improving members’ health. Consumer advocates argue that only programs whose effectiveness has been scientifically proven should be included. But insurers warn that if the rules are so strict that most of their disease management programs don’t qualify, they will be forced to curtail or even drop them.

...

Both the possibilities and the limitations of the phone-based alternative offered by OptumHealth were evident during nurse Hamilton-Roberts’s recent call to Kotey.

Kotey was barefoot and in curlers, bouncing a ball to her 4-year-old son in the driveway of her suburban townhouse, when the phone rang.

A former secretary who moved to the United States from Haiti six ago years and still struggles with English, Kotey said that when her doctor first diagnosed her diabetes, she was so overwhelmed she failed to comprehend many of the details. But on this afternoon Kotey rattled off answers to the nurse’s queries with seasoned ease.

“Have you been able to check your blood pressure?” asked Hamilton-Roberts.

“135 over 75,” replied Kotey.

“Do you know what your latest hemoglobin A1C value was?”

“8.2” was the answer. Her A1C level, which measures a diabetic patient’s average blood glucose levels over a prolonged period of time, had dropped one percentage point from two years ago, though it was still above the recommended level of 7 percent.

“We’re very attuned to what’s available to the patient,” said Hamilton-Roberts. “The physician might have been thinking, ‘Oh, I know this patient has financial problems and I know how much these [education] programs cost.’ Well, the physician doesn’t know that the patient has benefits that will cover that.”

Still, for all her progress, Kotey’s blood pressure and blood sugar levels remain stubbornly high. Although she has lost 14 pounds, with 196 pounds on her petite frame, she still has a way to go to reach a healthy weight.

And there are times when personal rapport can’t help Hamilton-Rogers overcome the challenge of communicating by phone.

“I want to ask if I can drink ah-spee-REEN,” said Kotey in her heavy accent at one point, reading the label off a bottle of aspirin pills. “They say he’s good for blood clots.”

“Ah-SPEE-rion?” the nurse responded quizzically. “I’m not familiar with that. . . . Don’t do anything as of yet. . . . These things have to be cleared by your doctor first.”

“Now, what about that aspirin?” Hamilton-Rogers continued, prompting a confused look from her patient. “Are you taking your baby aspirin every day?”

2010-08-20-WP-Kaiser-Tianne-Hill

For the homeless, federal changes promise better access to health care
By Mary Agnes Carey and Andrew Villegas
Kaiser Health News
Washington Post, 2010-08-20

BALTIMORE --

[1]
Homeless and unemployed,
Tianne Hill said she dreads getting mail
at the city shelter on Guilford Avenue where she lives
because it often includes medical bills she can’t pay.

[2]
The 40-year-old former waitress and short-order cook
owes about $6,000 for abdominal surgery.
She’s expecting another bill soon for emergency treatment of a seizure.
And she has other conditions that require expensive care:
asthma, arthritis, anxiety and depression.

[3]
Like many other homeless people, Hill is uninsured and ineligible for Medicaid,
the state-federal program that covers millions of other poor Americans.
But beginning in 2014,
Medicaid greatly expands under the new health-care law
to include adults without children,
who generally have been excluded.

...

[Thanks to the Democrats’ health-care expansion,
not only will Ms. Hill’s health-care expenses be covered in the future,
but there will be no limit on her medical expenses.
In fact, if she fails to take the pills she is told to take,
yet more spending will be done to try and get her to take those pills.
There is literally no limit on the spending that Democrats will do on such people,
no matter how unwilling they are to make the effort to lead a healthy lifestyle.
Remember, the country is already deep in debt and deficit,
even in advance of paying exorbitant and unlimited healthcare expenses.

And what about when, as seems very likely,
she develops various weight-related conditions, such as
diabetes, hypertension, heart disease.
What if her annual health care bill comes to
ten, twenty, thirty, forty, fifty, sixty, seventy, eighty, ninety,
one hundred thousand dollars?
Dialysis alone can run $50K/year.
The sky’s the limit, right Dems?

And just how real are these conditions of “anxiety and depression”?
Isn’t this an ugly junction of the greedy and hypochondriac?]

2011

2011-04-01-NYT-Kolata-dialysis

When Ailments Pile Up, Asking Patients to Rethink Free Dialysis
By GINA KOLATA
New York Times, 2011-04-01

...

An 84-year-old man being treated at a clinic in Elkins, W.Va.,
run by West Virginia University
has been counseled against dialysis.
He has high blood pressure and severe congestive heart failure,
a condition as lethal as terminal cancer.
His heart problems make it hard for him to breathe,
and he is often in the hospital.
In a telephone interview,
the man said he saw friends suffer on dialysis
and always thought he would refuse it.
But he is getting ready to start anyway.
The man, whose name is being withheld to protect his privacy,
says he changed his mind after he “sat and thought about how good life is.”

“What choice do you really have?” he asked.

When Congress established the entitlement to pay for kidney patients
in October 1972,
dialysis and transplants were new procedures
that were not covered by health insurance.
There were horrifying stories —
rich people got dialysis and lived while poor people died.
In Seattle, a committee meted out dialysis by voting on who could get it.
A man who was supporting a family, for example,
took precedence over a single woman.

[Anything wrong with that?]

It also was expected at that time that
fewer than 40 patients per million would need dialysis,
and that most of those patients would be healthy —
except for their failed kidneys — and under age 54.

Now more than 400 people per million start dialysis each year.
More than a third of the patients are 65 or older,
and they account for about 42 percent of the costs.
People over 75 make up the fastest-growing group of dialysis patients.
And most elderly dialysis patients have other serious diseases
like diabetes, heart failure, stroke and even advanced dementia.
[Why on earth would you give expensive, life-extending treatments
to someone suffering from advanced dementia?
Talk about insane!]
One-third of them have four or more chronic conditions.

The federal program, said Dr. Peter S. Aronson,
a professor of nephrology at Yale University’s School of Medicine
“is so emblematic of good intentions misapplied.”

“The question,” Dr. Aronson said, “is how to dial it back.”

Recent studies have found that dialysis does not prolong life
for many elderly people with other serious chronic illnesses.
One study found that the procedure’s main effect
is to increase the chances that
such patients will die in the hospital rather than at home.

Meanwhile, costs are soaring —
end-stage kidney disease will cost the nation
an estimated $40 billion to $50 billion this year [2011].
And doctors are recommending dialysis sooner,
even though recent studies have found that
an early start confers no additional benefit.

Even so, Ms. Armistead said,
when patents are ready to choose “medical management,”
family members often struggle with the decision.

It also can be difficult to make some patients
understand the gravity of their disease or their choices,
said Barbara Weaner, a nurse practitioner at West Virginia University
who works with dialysis patients.

“We live in a country where there is a lot of choice,
where people tend to be afraid of dying
and where palliative treatment is not always recognized as a good alternative,”
Ms. Weaner said.

Her patients at the Elkins clinic illustrate her point.
Those who are old and very sick often have a choice —
they can have “medical management” without dialysis
or they can have dialysis, which might fail to improve their lives.
But for many, the first choice is not acceptable.

One patient, a 78-year-old woman whose name is being withheld,
was not a good candidate for dialysis, her doctors said.
She has complications from diabetes, high blood pressure,
a heart valve problem and severe coronary artery disease.
Her medical problems were so grave that dialysis
was likely to lead to a series of medical interventions —
hospital stays, drugs and doctor visits —
but would not necessarily prolong her life. And her doctors told her that.

But she insisted on dialysis, saying,
“Some life is better than no life.”
In the seven months she has been on dialysis,
she has been hospitalized four times,
including twice for heart surgery.

“I go to dialysis because I want to live,” she said in a telephone interview.
“I want dialysis.”

[Clearly, to me anyhow, this makes the case for rationing.
The country really has better uses for resources than
extending the lives of 80-somethings, let alone 90-somethings.
The obvious immediate need is to reduce the federal deficit.
Here is one way to make a significant contribution to that need.]

2011-08-16-AMAG-medical-compensation-survey

American Medical Group Association's 2011 Medical Group Compensation and Financial Survey
American Medical Group Association, 2011-08-16

...

The AMGA 2011 Medical Group Compensation and Financial Survey gives a complete financial picture of medical group operations in one volume, providing compensation, productivity, and financial operations data from approximately 49,700 healthcare providers throughout the United States, including 124 specialties, 32 other healthcare provider positions, and 28 administrative positions. The data represents responses from 239 medical groups, representing 51,700 providers (55.6% of groups report more than 100 physicians). The survey data includes starting salaries by specialty; medians, means, and percentiles; compensation/productivity ratios; and comparative data from previous surveys, as well as providing analysis by group size and geographic region.

...

A limited number of copies of this year's survey are available for working press. For press copies, contact Tom Flatt at tflatt@amga.org. Surveys are also available for purchase for $325 to AMGA members and $650 to nonmembers. To order, visit www.amga.org or contact Stefan Rozga at (703) 838-0033, ext. 326. Survey data is also available in a subscription-based, interactive, online database. For details, contact Stefan Rozga or visit www.amga.org.

---

Although the full data is not available from the AMGA except under the above conditions,
what purports to be a summary of the data is at http://cejka.force.com/PhysicianCompensation.

The numerical data there, as of 2012-03-16, is:

Specialty Median
Allergy & Immunology $265,592
Anesthesiology $372,750
Cardiac & Thoracic Surgery $532,567
Cardiology $422,921
Colon & Rectal Surgery $379,219
Critical Care Medicine $305,000
Dermatology $386,068
Diagnostic Radiology - Interventional $492,102
Diagnostic Radiology - Non-Interventional $461,250
Emergency Care $285,910
Endocrinology $233,000
Family Medicine $208,658
Family Medicine - with Obstetrics $215,450
Gastroenterology $415,872
General Surgery $367,315
Geriatrics $202,958
Gynecological Oncology $425,218
Gynecology $236,010
Gynecology & Obstetrics $302,638
Hematology & Medical Oncology $325,000
Hospitalist $229,294
Hypertension & Nephrology $259,776
Infectious Disease $225,412
Intensivist $305,464
Internal Medicine $21,950
Neonatology $275,359
Neurological Surgery $625,300
Neurology $246,500
Nuclear Medicine (M.D. only) $313,333
Obstetrics $317,000
Occupational / Environmental Medicine $233,000
Ophthalmology $253,708
Oral Surgery $389,661
Orthopedic Surgery $501,808
Orthopedic Surgery - Hand $476,384
Orthopedic Surgery - Joint Replacement $503,809
Orthopedic Surgery - Pediatrics $435,318
Orthopedic Surgery - Spine $677,158
Orthopedic-Medical $293,873
Otolaryngology $377,430
Pathology (M.D. only) $354,917
Pediatric Allergy $201,720
Pediatric Cardiology $251,058
Pediatric Endocrinology $192,903
Pediatric Gastroenterology $252,310
Pediatric Hematology / Oncology $213,977
Pediatric Infectious Disease $194,126
Pediatric Intensive Care $268,609
Pediatric Nephrology $196,006
Pediatric Neurology $218,230
Pediatric Pulmonary Disease $205,386
Pediatric Surgery $434,714
Pediatrics & Adolescent $213,379
Perinatology $421,832
Physical Medicine & Rehabilitation $248,000
Plastic & Reconstructive Surgery $405,635
Psychiatry $217,169
Psychiatry - Child $212,842
Pulmonary Disease $303,125
Radiation Therapy (M.D. only) $458,333
Reproductive Endocrinology $322,612
Rheumatologic Disease $231,579
Sports Medicine $233,842
Transplant Surgery - Kidney $387,429
Transplant Surgery - Liver $444,194
Trauma Surgery $413,078
Urgent Care $230,239
Urology $413,746
Vascular Surgery $425,173

2011-09-12-Boodman-Elderly-get-too-many-medical-tests

Concern Is Growing That The Elderly Get Too Many Medical Tests
By Sandra G. Boodman
kaiserhealthnew.org/Washington Post, 2011-09-12

[Talk about overconsumption!
And entitlement.]

Every year like clockwork, Anna Peterson has a mammogram. Peterson, who will turn 80 next year, undergoes screening colonoscopies at three- or five-year intervals as recommended by her doctor, although she has never had cancerous polyps that would warrant such frequent testing. Her 83-year-old husband faithfully gets regular PSA tests to check for prostate cancer.

“I just think it’s a good idea,” says Peterson, who considers the frequent tests essential to maintaining the couple’s mostly good health. The Fairfax County resident brushes aside concerns about the downside of their screenings, which exceed what many experts recommend.
“Most older people do what their doctors tell them.
People our age tend to be fairly unquestioning.”

[One wonders how much of this overtesting is due to push by the doctors or
demand by the patients.
I am sure there is some of each.]

But increasingly, questions are being raised about the overtesting of older patients, part of a growing skepticism about the widespread practice of routine screening for cancer and other ailments of people in their 70s, 80s and even 90s.

Critics say there is little evidence of benefit -- and considerable risk -- from common tests for colon, breast and prostate cancer, particularly for those with serious problems such as heart disease or dementia that are more likely to kill them.
Too often these tests, some doctors and researchers say, trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments for slow-growing diseases that may never cause problems, leaving patients worse off than if they had never been tested. In other cases, they say, treatment, rather than extending or improving life, actually reduces its quality in the final months.

“An ounce of prevention can be a ton of trouble,” observed geriatrician Robert Jayes, an associate professor of medicine at George Washington University School of Medicine. “Screening can label someone with a disease they were blissfully unaware of.”

Dartmouth physician Lisa M. Schwartz cites one such case: a healthy 78-year-old man who was left incontinent and impotent by radiation treatments for prostate cancer, a disease that typically grows so slowly that many men die with -- but not of -- it.

2011-10-06-NYT-Kolata-Surgeries-near-end-of-life

Surgery Rate Late in Life Surprises Researchers
By GINA KOLATA
New York Times, 2011-10-06

Surgery is surprisingly common in older people during the last year, month and even week of life, researchers reported Wednesday, a finding that is likely to stoke, but not resolve, the debate over whether medical care is overused and needlessly driving up medical costs.

The most comprehensive examination of operations performed on Medicare recipients in the final year of life found that nationally in 2008, nearly one recipient in three had surgery in the last year of life. Nearly one in five had surgery in the last month of life. Nearly one in 10 had surgery in the last week of life.

...

2011-10-24-NYT-Well-Mammograms

Mammogram’s Role as Savior Is Tested
By TARA PARKER-POPE
New York Times, 2011-10-24

Has the power of the mammogram been oversold?

At a time when medical experts are rethinking screening guidelines
for prostate and cervical cancer,
many doctors say it’s also time to set the record straight about
mammography screening for breast cancer.
While most agree that mammograms have a place in women’s health care,
many doctors say widespread “Pink Ribbon” campaigns and patient testimonials
have imbued the mammogram with a kind of magic it doesn’t have.
Some patients are so committed to annual screenings
they even begin to believe that regular mammograms
actually prevent breast cancer,
said Dr. Susan Love, a prominent women’s health advocate.
And women who skip a mammogram often beat themselves up for it.

...

2012

2012-02-12-WP-doctors-compensation

Success of health reform hinges on hiring 30,000 primary care doctors by 2015
By Sarah Kliff
Washington Post, 2012-02-12

The relevance of the article cited above to this post
is primarily the following informative graphic:]



That on-line graphic contains less information on salaries than is in the print edition.
It would be interesting to know why that is:
Did the providers of the information complain about it being published?
Did the high-salary doctors complain about their salaries being published?
Or another alternative?

In any case, here, typed in by hand, is some of the data in the print edition.
There the salaries are given down to the last dollar,
here I round the salaries to the nearest thousand.
Thus the numbers you see here should be multiplied by one thousand.
At any rate, here is the data from the print edition, modulo my typos:

Median compensation, 2011
Source: American Medical Group Association

Specialty	Compensation in $1K
Orthopedic surgery	502
Radiology	492
Cardiology	423
Gastroenterology	416
Dermatology	386
Anesthesiology	373
General surgery	367
Opthalmology	356
OB/GYN	303
Emergency	286
Psychiatry	217
Family care	209

2012-03-05-WP-Klein-high-health-care-costs-its-all-in-the-pricing

High health-care costs: It’s all in the pricing
by Ezra Klein
Washington Post Sunday Business (Analysis), 2012-03-05