Bad aspects in American health care system

1. Most physicians do not set their own fees. Medicare, Medicaid, and private health plans set these fees, which often have little to do with the costs of doing business.

2. Congress each year sets Medicare fees through a formula called SGR (Sustainable Growth Rate), which this year calls for a 20% reduction in overall physician fees.

3. If SGR were to go through as to proposed, surveys indicate at many at 30% of physicians will not accept new Medicare patients because new Medicare fees will not cover expenses.

4. The next political crisis will be limited access to doctors; this is already occurring in Boston, where waiting times to see doctors are 2 to 3 times the national average for comparable cities.

5. Medicare on average pays 80% of what it costs to provide care: hospitals and doctors make up the difference by negotiating higher payments from the much maligned private plans.

6. An estimated 10% of health costs are due to the practice of “defensive medicine,” whereby doctors order extra tests and procedures in anticipation of defending themselves again future malpractice lawsuits.

7. Passing federal laws permitting patients to enroll in plans and “portability” of plans across state lines would make a public option unnecessary and would render private plans “competitive.”

8. Ending “community ratings,” which force the young to pay the same premiums as older individuals, and reducing “standard benefit plans, “ which often include unnecessary benefits, would reduce premiums for the young and decrease the number of uninsured.

9. The primary care shortage is real and growing because medical students are smart and are not choosing to work twice as long as specialists at 1/2 the pay; doubling Medicare pay for primary office visits would be a good start for relieving the crisis.

10. The surest way to reduce costs is having patients spend more of their own money and making them more responsible for their health, which is the premise of lower-premium health savings accounts and high deductible plans.

Radiological images of Morgagni's Hernia

A 41-year-old woman was evaluated for a 5-month history of dyspnea and cardiac arrhythmia. Chest radiography revealed an enlarged right mediastinum with air content on the right side (Panel A, arrow; and Panel B, lateral view). Thoracic computed tomographic (CT) scans showed a Morgagni's hernia, characterized by an anteromedial diaphragmatic defect, with herniation of the transverse colon and part of the omentum into the thorax (Panels C and D).

CT scans also showed that the bowel contents were compressing the right side of the heart.
Morgagni's hernias are secondary to congenital defects in the anterior diaphragm. The hernia sac frequently contains the transverse colon with the omentum; more rarely, the stomach, small bowel, or liver is involved. The patient's hernia was laparoscopically reduced , and the diaphragmatic defect was repaired with a composite mesh. Postoperatively, the patient's symptoms resolved. Follow-up thoracic CT confirmed the absence of bowel contents in the thorax.