Disqus - Latest Comments for matthewdipaola

Re: http://jamessiminoff.com/post/1487170880

matthewdipaola — Fri, 05 Nov 2010 15:40:06 -0000

I've followed your blog for a while and enjoy a lot of the topics that you bring up. But I think your comparison of the mortgage crisis and free market failure is off base. The mortgage business has been one of the most heavily subsidized areas of our economy. Examples: Fannie Mae, Freddie Mac and mortgage interest deduction on income taxes. All of these are intrusions on a free market and distort that market in one way or another.

So before a claim can be made against the free market, I think it's important to first dissect the market, identify the government influences and then decide if the comparison is even valid. In this case , as well as many that people make, it is not.

Take care

Matthew

Re: http://blog.jayparkinsonmd.com/post/619659393

matthewdipaola — Fri, 21 May 2010 14:12:10 -0000

And you forgot, Obama said he has an iPod but doesn't know how to use it.
http://www.youtube.com/watc...

I can only come to one of two conclusions with that statement:
1. Either he really doesn't know how- and that's sad because it's freaking simple to use OR
2. it's BS dishonest rhetoric meant to make it sound like he is above those "distractions"

Either way it's disappointing

Re: http://blog.jayparkinsonmd.com/post/592634253

matthewdipaola — Wed, 12 May 2010 21:10:34 -0000

Shh, don't tell anyone, they might think there's a conspiracy

Perhaps C-section is more profitable for the hosipital. Maybe therein lies the distinction. And to the extent that MD's are employed by hospitals, this trend might be (subconsciously?) encouraged. A potential conflict of interest and why I am of the mindset that hospital employment is not always in the best interest of patients.

According to my thesis, there can be a good case for fear making the world go around as well...of course one person'e fear = another's dollars

In the end, why can't we just let love make the world go 'round? Jay, let's start with us. (insert feel good music here)

Re: http://blog.jayparkinsonmd.com/post/592634253

matthewdipaola — Wed, 12 May 2010 20:34:12 -0000

Jay, I love you but I have to take exception to your conclusion with this one. My wondeful Ob/gyn wife informs me that births are typically paid on a global type fee schedue, where the entire birth from prenatal to delivery- regardless of whether they got a C- section or vaginal deliver- pays a flat rate. And it often is about $2000 for the whole 10 months of care- egardless of how complicated the pregnancy is. So it is financially more beneficial to do the vaginal delivery as it takes less time/ effort.

I think the real issue is risk. Patients (and lawyers) will accept nothing less than a perfect child at every birth and can hold the Ob/gyn accountable until the child is 18 for any harm incurred. So the simple fact is patient demand + a ravenous medical legal climate = scared as hell Ob/gyns. If there's even a suggestion of fetal distress on the monitors, Ob's are almost forced to take matters into their own hands where at least they have some control in the OR.

This is why no Ob's want to deliver babies anymore. Most Ob's I know (OK I'm biased) are super people who just like the joy of bringing baby's into this world. But most also admit that it is increasingly treacherous and risky in this legal climate.

Re: jay parkinson + md + mph = doctor in brooklyn - I’m very honored to be in the latest issue of...

matthewdipaola — Wed, 11 Nov 2009 12:55:10 -0000

congrats Jay!

Re: jay parkinson + md + mph = doctor in brooklyn - Stolen Medical Data

matthewdipaola — Sat, 17 Oct 2009 11:22:09 -0000

Amen. And thanks for taking the post to the next level.

Re: Matthew DiPaola MD - If We Spend Twice as Much on Health Care As Other Countries, and the Government Pays for Half of Health Care Now....

matthewdipaola — Mon, 12 Oct 2009 07:46:58 -0000

It is a marketing virus which obtains the contacts from your address book and sends out an advertisement.

It is going around. Sorry for any inconvenience.

Take care

Matthew

Re: Matthew DiPaola MD - If We Spend Twice as Much on Health Care As Other Countries, and the Government Pays for Half of Health Care Now....

matthewdipaola — Mon, 12 Oct 2009 06:01:13 -0000

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Re: Malpractice Reform: is a new paradigm needed?

matthewdipaola — Tue, 22 Sep 2009 14:11:56 -0000

There certainly is such a thing as malpractice and patients have every right to sue for it. Perhaps I was too narrow in making it sound like all malpractice was "negilgence." I can see how my phrasing in the last paragraph may have been misleading. i will edit that for clarity to say "malpractice," as negligence is only one form of malpractice.

My aim was to draw the distinction between true malpractice and cases in which the standard of care was followed in every conceivable manner and a bad outcome still occured.

Re: jay parkinson + md + mph = doctor in brooklyn - Get the facts about the stability and security you get from health insurance reform | Health Insurance Reform Reality Check

matthewdipaola — Mon, 10 Aug 2009 17:18:19 -0000

Don't forget Jay, our representatives -through Medicare, Medicaid etc- are part of those profiting from the system. Without these programs they would have no power, no retired constituency to manipulate through votes on Medicare, no more tax dollars feeding their coffers which get vacuumed away into the federal abyss. Where are tomorrow's Medicare dollars? Are these governement officials not villians for not saving this money somewhere instead of placing the unfunded obligation of Medicare, Medicaid (and future health reform) on the backs of our grammar school children.

Obama has a nice narrative and it is cool to be pro Obama and anti Bush. Unfortunately they are not that different from one another. This web site looks more like propaganda to me.

Re: From the comments (re: free markets fixing healthcare):

matthewdipaola — Mon, 10 Aug 2009 09:04:42 -0000

Interesting points. However there are a few things that need clarification. In point 1, I think you are confusing correlation with causation. You imply that mandatory auto insurance laws are the cause of efficient delivery of auto insurance. I don't think that you can prove that this law causes efficieny. How do you know that the industry doesn't operate efficiently in spite of this law? You need to highlight a historical comparison when this law did not exist and show that prices were higher and delivery was poorer to make this claim. See Jay's writings about how the state of Mass.' Mandatory coverage has made healthcare delivey neither more efficient nor less expensive.

You stop short in your analysis of deregulation. You state that insurance companies would skim off of the top. Certainly some would. However this would still leave open wide markets for higher risk patients. I think what you are protesting is the fact that higher risk patients might have to pay higher premiums if price stratification based on risk were more widespread.

As for individual health being a public good, that is a slippery slope. I think you can debate that forever and it really comes down to where you fall on the spectrum of belief in individual liberty vs state control. If individual health is a public good then who truly owns your body? You or the state? Where will you draw the line? Should we all have mandatory weigh ins each week and the heavy among us be forced to run on public treadmills? Also, Correct me if I am wrong, but aren't private firms with a profit motive developing the vaccinations for H1N1?

As for point 2, I would hope that I am not oversimplifying. As a practicing physician I would have hoped that 4 years of med school and 6+ years of advanced residency/ fellowship training would have given me a more complex understanding of the human body. If that's the case, I want my $200,00 and all those years I slaved away back. All kidding aside, I still do not think you have proven your point. You are confusing the complexity of the human body with the complexity of healthcare delivery, an important distinction. While the human body is extraordinarily complex, health delivery will always be subject to the laws of supply and demand. To make your argument effectively you would have to define some point of complexity at which markets break down. That inflection point would have to be translatable to non biological systems as well. You underestimate the degree to which other industries deal with the vague, unknown, risky and uncertain and highlight the durable nature of a computer. What about the internet and Google? How do you define search algorithms? These are not durable goods. Certainly they have enormous public utility- allowing scientists, patients (you name it) to connect and make great advances in the world. The free market effectively distributed the internet and Google to the world- and yet it wasn't owned by the public.

Healthcare is defferent because it as an industry built on the the ethic that all of its consumers should receive the highest level product at every interaction. period. The definition of the "highest level" of care is a continuously moving target and will always be up for some debate. The distribution of the care is healthcare delivery and subject to laws of supply and demand whether we like it or not.

Re: jay parkinson + md + mph = doctor in brooklyn - Why markets can’t cure healthcare - Paul Krugman Blog

matthewdipaola — Mon, 03 Aug 2009 01:50:13 -0000

I completely disagree with Krugman and again believe that his NY Times pulpit and Nobel prize in economics inappropriately legitimaize a weakly argued, soundbite point.

Krugman claims that healthcare is distinctive for 2 reasons: 1) no one knows "when or whether" they may need care (health events can be unpredictable) and 2) healthcare is complicated. He is wrong on both points. In order for his point to ring true, he would have to prove that free markets are incapable of effeciently distributing unpredictable and/or complicated services. Free markets efficiently distribute both unpredictable and complicated services all of the time.

Point 1. Free markets operate extremely efficiently to protect against the unpredictable events of death (life insurance), car accidents (automobile insurance) and fires (homeowners insurance). In each case there is a disincentive for the insurance company to pay- not unlike the case of healthcare. Well manged insurance companies such as Geico, through excellent planning and policy pricing are able to offset claim payouts by prudent float investment and either break even or turn a profit. Such insurance firms provide a solid protective service to countless people daily. Without free markets (and we can argue about how truly "free" some of these markets are) these people would surely be worse off.

Point 2. Free markets efficently allocate complicated goods and services all of the time. The computer industry is an excellent example. I don't know how to create a microchip but i can certainly explain to a competent professional what types of activities for which I would use a computer. And in a free market, an honest, trained salesperson can help guide me to the appropriate computer, at a good price for my needs. The same holds true for medicine. No patient needs to know the nitty gritty distinctions between various stents. They do, however need to be educated and guided appropritely regarding the qualities of that stent that most effect their decsions- "Doctor, how long does stent X last? what are the side effects? what are appropriate alternatives? what quality of life will this provide me? The professional's role is to guide the patient through this complicated desicion process and is their "value added" to the market interaction.

Krugman fails to delineate why healtcare is truly distinctive. Healthcare is distinctive because its practitioners are obligated through professional ethical standards to provide the highest level of care to ALL patients/consumers regardless of age, disease status and ability to pay. Certainly this differs from the flat screen TV market: this would be the equivalent of every TV shopper DESERVING the $5000 48 inch flat screen TV (assuming that the 48 inch was considered the highest quality). And this ethic may indeed raise costs- to the extent that high quality equals high cost. One can argue ad infinitum about what constitutes the "highest level of care." And I think Jay makes good points in his writing that high cost does not ALWAYS equal high quality care.

Krugman's last point about there being no successful free market systems in healthcare is utter nonsense. There has been no such thing as a free market in healthcare in the US since at least 1965 and he woefully ignores any examples prior to this. Government intervention has perverted the free market to the extent that any conclusion about its true workings is impossible to make. This would be like the commisioner of baseball, prior to Jackie Robinson entering Major baseball, saying: "there is no evidence that black players can be successful in the Major Leagues" Rubish.

Milton Friedman, a Nobel prize winning economist with a decisively different take on these issue is worth considering. For a look at why free markets in healthcare must be considered please read Friedman's 2001 article "How to Cure Healthcare."

http://www.hoover.org/publi...

Re: jay parkinson + md + mph = doctor in brooklyn - Health Care Reform and You

matthewdipaola — Mon, 27 Jul 2009 00:37:51 -0000

The entire food and beverage industry should be non profit as well. We will all die rather quickly without food or water and they should therefore be more immediate "rights." And access should be both unrestricted and equal.

Additionally legal counsel should be free and equal for all. A massive governemnt overhaul of the delivery of legal counsel to our citizens is urgent and necessary. We cannot let congress go to recess without it. millions of people lose out on countless settlements and spend more time in jail than they should because of poorly delivered counsel. All counsel should be non profit.

What about funeral homes? Why should anyone make a profit off of death? Isn't that wrong?

I hope you are getting my point. Profit is not the problem. I recently met a new colleague who was originally from Poland. When he was growing up he wanted to be a doctor but his family DISCOURAGED him because the system was so miserable. Under communism (no profits, just "fair" distribution) he said that people had to go to black markets, buy their own antibiotics and syringes and then take them back to the hospitals to treat family members. That is what a system with no profits. My colleague is now here training in the US and praises truly free markets. Freedom is the only answer. The freedom to win and lose with the profit margin as the score card. The key is to create the game so that profits and good care are aligned. We have not done that in the US...yet.

Re: jay parkinson + md + mph = doctor in brooklyn - GOP Rep.: Public Health Care Option "Is Gonna Kill People"

matthewdipaola — Sat, 11 Jul 2009 10:46:02 -0000

I am all for better systems. But I think that before stating that a better system would have prevented MJ form popping too many pills, other hypotheses must be entertained. For instance, were Jackson's team of cronies obtaining scripts for him under their names or on the black market? Were corrupt personal doctors getting paid hefty sums of cash to stay quiet and push a plethora of pills to the King of Pop. I am not sure if any computerized system could have resolved the pathology surrounding Jackson's situation. All good systems must be rooted first in good ethics.