Come Down To My Basement…I’ve Got Candy Down There…
Organized medicine is certainly facing a little bit of a faith crisis. From those they’re supposed to represent come cries that the AMA, specialty and state societies do not do enough for [put individual specialty here]. From the interested public and other interest groups comes cries that the AMA, specialty and state societies move to benefit the physician over the patient.
Throw amongst those pragmatic concerns the intellectual and long held criticism that organized medicine suppresses the supply of physicians and the scope of non-physician practice and is thus inherently anti-free market.
I’ve ignored this topic for long enough considering my considerable involvement in leadership roles within organized medicine and my libertarian leanings.
The clamoring from far right wing free market speakers like the late Noble Laureate above (who I respect considerably, despite the little joke above) and crazy think tanks like the Ludwig von Mises Institute is that the AMA is essentially a guild whose will the government has succumbed to. In a publication titled “100 Years of Medical Robbery” the think tank has this to say about the history of the American Medical Association and its goals:
In the days of its founding AMA was much more open–at its conferences and in its publications–about its real goal: building a government-enforced monopoly for the purpose of dramatically increasing physician incomes. It eventually succeeded, becoming the most formidable labor union on the face of the earth.
To accomplish the twin goals of artificially elevated incomes and worship by patients, AMA formulated a two-pronged strategy for the labor market for physicians. First, use the coercive power of the state to limit the practices of physician competitors such as homeopaths, pharmacists, midwives, nurses, and later, chiropractors. Second, significantly restrict entrance to the profession by restricting the number of approved medical schools in operation and thus the number of students admitted to those approved schools yearly.
The emphasis is my own.
I’ll offer a candid response to this. Through it’s history the AMA appears to have focused largely on improving physician income. Perhaps not as single minded or nefariously as the Ludwig von Mises Institute would have you believe but it remains. And the AMA has had considerable success doing such. The allowance of self goverance that medicine enjoys and the sway it holds over the scope of practice for other providers is incredible. I think there are some real issues of ‘patient safety’ buried in those issues, as the AMA would argue, but it is hard to argue that physician income did not, does not play a role in the AMA’s focus in securing physicians influence over who practices “medicine.”
Organized medicine was responsible for the Flexner Report and continues to hold the greatest sway over the number of physicians this country will (or will not) have by controlling the LCME and ACGME. To argue some conspiracy to suppress the number of medical students (and thus number of future physicians) through these entities is baseless, but it does display how much control organized medicine has wrested for physicians. As does the limiting of the scope of practice of all other medical practitioners. Indeed, that aspect of the AMA’s success (getting state governments to agree to follow their rules on who should be allowed to perform certain procedures or write perscriptions) may be the most marvelous.
It is clear that the ‘thinkers’ and ‘economists’ who criticize the AMA are far removed from the practice of medicine. Some of their rails simply show a lack of understanding of how medicine works. For instance, the article above tries to criticize the AMA’s restriction on who can practice medicine in the name of ‘patient safety’ and ‘quality,’ by saying,
A final challenge to the Lexus standard is the number of accidental deaths occurring in U.S. hospitals every year. Harvard University’s Lucian Leape estimated that there are approximately 120,000 accidental deaths and 1,000,000 injuries in U.S. hospitals every year. To understand what staggering figures these are, imagine a Boeing 777-200 with its maximum of 328 passengers crashing every day for an entire year with no survivors. This would add up to 119,720 deaths, still not as many as are killed through medical error in hospitals every year. UCLA Professor of Medicine Robert Brook, M.D., told the Associated Press, “The bottom line is we have a system that is terribly out of control. It’s really a joke to worry about the occasional plane that goes down when we have thousands of people who are killed in hospitals every year.”
In anycase, the point is there are questionable assertions like this throughout the works of the libertarian thinkers who criticize organized medicine. Despite that, there is some validity to their points. As another Ludwig von Mises paper, “Bring Back The Guild System?” says,
Government regulations on the chiropractic profession, lay midwifery, and on the freedom of nurse practitioners to offer services within their competence, all of which make perfect sense from the point of view of the medical guild that lobbied for them, make no sense at all from the point of view of consumer wishes (as repeatedly expressed in polling data) or from economic considerations. In many cases, such people can provide health services far more cheaply than can licensed physicians (or, in the case of chiropractors, can provide services that licensed physicians do not provide at all), but consumers are prevented from making their own decisions regarding their medical care. Given the logic of the guild structure, no one has the right to be surprised to find that the AMA has put so much effort into undermining its professional opposition.
There is nothing wholly unique about physicians’ efforts towards this. Other professions do the same and also limit their membership through limiting education spots but medicine is certainly one of the most successful at it.
I will accept the blows Milton Friedman lands against the American Medical Association but let me make an argument on why the AMA’s actions are reasonable despite violating the libertarian ideal.
Let us call what the AMA and the rest of organized medicine does a necessary evil. It might not have been through all of its existence granted but today it is. It is because physicians are not playing on a level, free market playing field.
That is the question the thoughtful should be asking; not whether guaranteed access for all can work. Let us be honest, if you goal is improving utilitarian public health measures - life expectancy, infant mortality, time to treatment for diseases, access to care - then a single payer system could work in the United States, provided enough funding. Complaints and nay say against such a system by providers is nonsense and nothing but protection of self interest. There are tradeoffs with such a system, but there are trade offs with any health care system. Look at our current one. If you want to improve what the public would consider ‘health’ then a well funded single payer system would be far superior to our current system, no matter America’s ‘uniqueness’.
But should we do that? The real debate is should the government fund access for those who cannot afford it themselves. Who has such a right?
The Miller Center of Public Affairs tried to do that recently with a panel debate. On the transcript at times the talking heads fall short in defining the debate and staying on course, but it still something worthwhile to look at.
The move towards cost transparency is generally something I support. But there is an argument I will buy that such should be prospective. That’s the line I’m buying with the current lawsuit over Medicare provider data that some consumer groups are waging.
In an unusual statement, the Health and Human Services Department endorsed the objectives of the consumer group that is suing, but said it wanted a higher court to clarify the lower-court rulings.
“We’re caught between court decisions,” said Christina Pearson, a spokeswoman for the department. “There’s conflicting information from different courts, so we’re pushing to get clarity.”
But the government’s legal brief in the case calls for the appeals court to reverse Sullivan’s ruling, leaving the restrictions on the release of data in place.
“I know the government was under a lot of pressure from the AMA in particular, arguing that the government should appeal,” Krughoff said. “Whether that’s the reason the government appealed, I don’t know.”
I’m torn, certainly. It is much easier to speak of the private insured having a ‘right’ to such data than Medicare patients considering what the two groups shoulder in terms of personal costs and responsibility for their health care access.
It is reasonable to imagine that a physician, somewhere out there, participates in Medicare under the understanding that his reimbursement data is shielded from public eyes based on previous court rulings, and would not participate otherwise. Under such a circumstance I think the opening of the Medicare database needs to be solely prospective and not retrospective. That means the data won’t be useful for years and years, I understand that but it is probably the right way to do it.
Several in the medical blogosphere (here and here) have picked up on a front page WSJ story concerning specialist income and shortages.
Probably an overblown story.
But a look at specialist income got me thinking. Is it just me or is diagnostic radiology the specialty most likely to be disappointed over the next couple of decades? When I was writing my previous posts on physician income I started really thinking that radiology may be in for a significant slow down in earnings growth. There are two factors which I think will contribute to disappointing growth in radiologist income:
1) Their rise in income over the past two decades has been precipitous and outpaced the growth in median income of just about every other specialty. And not all of that has been driven by the rise of interventional procedures. Radiology thus, as a specialty, has some of the most to “give back,” if and when physician income growth slows as cost sharing measures.
2) The rise of outsourcing is probably a little overstated but it seems real enough. With rising healthcare costs concerns over international radiologist work (liability issues, etc) may not be enough to prevent the outsourcing trend from speeding up a bit and driving down reimbursement.
This isn’t to make a claim as to the value of radiology or to say that diagnostic radiologists are currently over reimbursed (I don’t think they are). I’m just trying to imagine the future. Radiologists will never be ‘hurting,’ but in my career I think they’ll be doing more work for less dough.
I’m No Radiologist But Something Ain’t Right Here
I have a lot of respect for the ACR and RadPAC’s efforts but diagnostic radiology may not be in a completely defendable position with some of it’s unique aspects as a specialty.
The Bottom Buddy is a device which helps the morbidly obese wipe after using the bathroom. I’ll hold my tongue a bit except to say that it probably says something about the state of and concern for public health in this country. *Sigh*
Brittney Spears underwent a very publicly reported invasion of her privacy during two stays at UCLA affiliated hospitals. As happens with celebrities many hospital employees took a look at her records without a need to.
The trouble is that physicians who did so apparently got off lighter than other employees.
[A]t least 53 UCLA staffers — including 14 physicians — looked at Spears’ medical records on the two occasions, even though they were not treating her, according to statistics from the state and UCLA officials. Eighteen non-doctors resigned, retired or were dismissed after their prying was discovered, according to data provided to The Times by UCLA. No physicians quit or were fired.
“Historically, doctors have been treated in a way that may be more lenient than non-physicians, and we will address that,” said Dr. David Feinberg, chief executive of the UCLA Hospital System.
“We will do everything possible in the future not to be accused of that.”
Watcher’s World goes over some of the reasons that physicians typically get off lighter. One of the reasons is that physicians, in the private world, are not typically employees of a hospital. They simply have priviliges to practice at that hospital and in return for such, that is where their patients get admitted when they need to be in the hospital. In this case however I would imagine that the majority of physicians with priviliges at the hospital are UCLA faculty and salaried employees. Firing them might have been a real possibility.
In anycase, the moral of the story is simple: don’t look at patient’s medical records unless you need to. No duh.
If there’s a bigger single topic discussed in the medical blogosphere than the primary care crisis I’m not sure what it is. It permeates blogs (here and here and here) and the media (here and here and here).
I do believe that the distribution of primary care physicians to specialists in this country is askew but I’ve taken a critical view of some of the claims made by the primary care community. In part there is an argument that the efforts of the organized primary care and the medical blogosphere are merely rhetoric. No one pays attention until there is a ‘crisis’ and the flamboyant and exaggerated claims on the condition of primary care are perhaps merely part of a PR campaign. But in a deeper sense I think that the ‘whining’ coming from primary care is actually contributory to the primary care crisis. I’ve made severalposts to that effect.
I thought what was in order was one summarizing post on the issue, something that might stir up some comments. That’s what I’ve put together here: the four myths of the primary care crisis.
The conclusions I reach are based on what I feel is sound data, but the post is obviously far from comprehensive. If there is data from non-interested parties that I didn’t consider or arguments I’ve ignored then let me know in the comments.
Myth #1:There Is A Worsening Shortage of Primary Care Physicians
I’m just going to flat out say it, the fact that physician bloggers and agenda minded think tanks continue to substitute anecdotal evidence of a shortage as a surrogate for the actual figures is distressing. Take this recently touted article from the WSJ. While I won’t speak to the Massachusetts experience the cited study about a nationwide PCP shortage is flimsy.
One of my biggest pet peeves is that these primary care physician-scientists seem to refuse to characterize the evidence they use in their opinions. I would hope that we can all agree that the HSC Community Tracking Study Physician Survey, cited in the WSJ article, falls short of the best evidence on primary care physician numbers. A 6000 physician sample with nearly less than a 50% response rate. Lovely.
Indeed, the HSC survey is the only original dataset put together by a non-involved entity that I can find that seems to back up a drop in the per capita primary care workforce.
While we have seen a drop in allopathic medical students going into primary care it has more than been offset by IMGs as the GAO says.
From 1995 to 2005 Using AMA and AOA Master Files and HRSA Data
There are probably regional deficiencies in the primary care physician workforce but there are regional shortages for physicians no matter their specialty and it does not speak to a systemic problem facing primary care.
Nor is there good data that demand for primary care will grow with an aging population and cause a shortage. Such predictions by organized primary care are pretty low on the pyramid of evidence. While such a deficit may pan out, trying to predict such (even if you think it is just sooooo obvious a conclusion) is notoriously difficult. Predicting the physician requirements of this nation a decade or more out is essentially impossible. See this IOM report from the mid-nineties on efforts to do such. That’s why the major players over the past decade have flip flopped on whether we need to be graduating fewer or more doctors.
Certainly, even if the above scenario plays out, it would be hard to imagine it as a “crisis.”
I think the best evidence says there is not a general primary care shortage. At least not a new one. As I said, I think we have always needed more primary care physicians in this country but the situation isn’t getting worse. The primary care per capita numbers have been maintained and probably even grown a bit over the decades thanks to an influx of international medical graduates. Let that claim rest in peace.
Myth #2: The RBRVS and RUC Are Responsible For The Primary Care Income Disparity
I’ve posted long and hard on the RBRVS and the AMA’s RUC. I admit that I do not believe that primary care physicians are compensated appropriately and I may even buy that the RUC has not done enough to fix the primary care-specialists income disparity. That being said, the evidence clearly supports that the primary care physician has not done worse versus the specialist since the implementation of the RBRVS.
The RBRVS came into existence in 1992. I think a larger review of income data backs me up but for the sake of this post let me take a couple of examples to highlight the condition of primary care before the RBRVS in 1988 versus today. The data sources are the 1988 Health Care Financing Administration’s PPCIS and the 2007 AMGA Physician Income Survey.
I understand the limitations of comparing these two survey datasets, constructed under two different methodologies by two different groups. For example, below I have to use family medicine income as a surrogate for all of primary care. Even today the major physician income surveys show some wide discrepancies but I do believe that comparing this data gives us at least a general idea that the RBRVS has not screwed the primary care physician. In the end, that is the general point of the myth - the RBRVS and RUC have been bad for primary care. Such doesn’t appear to be the case.
In 1988 all self employed Family Medicine physicians earned a median of $102,500. In 2007 the median Family Medicine physician earned approximately $185,700. That is an increase of 81% in 20 years.
That is better than the orthopedic surgeon (56%), the cardiologist (61%), the anesthesiologist (78%) over the same time frame. There are medical specialties that made off better over that time frame (see radiology) but in general the RBRVS has been progressive for primary care physician income.
Nor, in terms of hours worked, are family practice physicians working more than they did immediately pre-RBRVS.
If you include all primary care physicians the primary care physician earned 65% of what the medical specialists did in 1988 (i.e. the cardiologist, the gastroenterologist, the pulmonologist, etc) and 44% of the average income of all surgical specialists.
No the RBRVS may not have closed the gap in the income disparity completely and/or appropriately but it has made some progress and has not contributed to a worsening of the gap. The income disparity has narrowed since the advent of the RBRVS and the creation of the AMA’s RUC. End of story.
This is my second post on the ethics of organ transplantation today.
The story from the BBC goes like this: a dying 21 year old is an organ donor and the daughter of a mother who needs a kidney transplant. This young woman tries to target her kidney to her mother but instead, upon her death, the organs are allocated based on need.
Rachel Leake, 39, of Bierley, West Yorkshire, was told that her daughter Laura Ashworth’s dying wish to donate her organs could not be honoured.
The 21-year-old’s kidneys and liver went instead to three other patients.
Apparently there was some question as the daughter’s wishes, that she hadn’t expressed them formally. But the executor of the daughters last wishes, even in regards to her organs, should not be the organ donation sharing network…it should be her family. If this is policy then it is unacceptable and even if you cut it merely as a matter of miscommunication this is a really tragic.
Ana Puente was an infant with a liver disorder when her aunt brought her illegally to the U.S. to seek medical care. She underwent two liver transplants at UCLA Medical Center as a child in 1989 and a third in 1998, each paid for by the state.
But when Puente turned 21 last June, she aged out of her state-funded health insurance and was unable to continue treatment at UCLA.
Now this young lady is getting a fourth transplant.
Here are the two arguments made, summed up in a sentence each. For restricting illegal immigrant access to organs,
“All transplants are about rationing,” said Roy Beck, executive director of NumbersUSA
For transplanting illegal immigrants,
“People are people, and when you make an incision in an organ donor, you don’t find little American flags planted on their organs,” [Dr. Michael] Shapiro said.
I’m torn by the issue. There really are two separate issues here and I think, despite some ethicists opinions to the contrary, that I can separate the two. From a bioethical standpoint, I think as long as we’re going to allocate organs through a central sharing process (and notice that I’m a long time supporter of targeted donation and actually a donor’s right to sell their organs) that such should be done on need and independent of citizenship or alien status. But I really don’t think, as in most instances, that tax dollars have any place supporting illegal immigrants.
Sovereignty is important. While their odds are no doubt much worse in their home countries that is where these illegal immigrants should be seeking their organ donations. Or they should be seeking legal immigration into this country.
This legal argument is called pre-emption. After decades of being dismissed by courts, the tactic now appears to be on the verge of success, lawyers for plaintiffs and drug companies say.
The Bush administration has argued strongly in favor of the doctrine, which holds that the F.D.A. is the only agency with enough expertise to regulate drug makers and that its decisions should not be second-guessed by courts. The Supreme Court is to rule on a case next term that could make pre-emption a legal standard for drug cases. The court already ruled in February that many suits against the makers of medical devices like pacemakers are pre-empted.
[…]
In the fall, the Supreme Court will hear a…pre-emption case involving Wyeth, another drug company. Chris Seeger, a plaintiffs’ lawyer who has about 125 Ortho Evra cases, said he expected the court to rule in Wyeth’s favor.
The decision…does not foreclose lawsuits claiming that a device was made improperly, in violation of F.D.A. specifications. Cases may also be brought under state laws that mirror federal rules, as opposed to supplementing them.,
I have mixed opinions on this protection for drug makers. I’ve blogged on many an example of what I think is the naivete of lay juries in pharmaceutical liability cases but I’m certainly not sure that the FDA is in the best position currently to enforce full disclosure on pharmaceutical companies. It certainly is an interesting Supreme Court opinion to keep our eyes open for. If the opinion comes down on the side of big pharma I’m wondering what that might’ve meant for the Vioxx cases if Merck hadn’t settled. Maybe nothing…I have no idea.
If anyone has an informed opinion on whether FDA pre-emption of state laws (so many of the Vioxx cases were filed in federal court) would’ve had any effect on the whole Vioxx mess then please comment.
It’s no surprise that I’m not a fan of Paul Krugman. His dismissal of the potential for market forces to help reform health care is chief amongst my disagreements with his positions. In his most recent column, “Voodoo Health Economics,” he’s up to it again. His starting point is this claim,
Elizabeth Edwards has cancer. John McCain has had cancer in the past. Last weekend, Mrs. Edwards bluntly pointed out that neither of them would be able to get insurance under Mr. McCain’s health care plan.
The absoluteness of that claim might be a little far fetched. Both of these individuals have essentially unlimited financial resources and, at least in Mr. McCain’s case, could probably, with enough searching, pass the underwriting process somewhere and get insurance. Even if that insurance excluded cancer as a pre-existing condition and had extremely high patient side costs it would represent something real. The cancer screening, for these individuals, is the important thing. The poor outcomes for the uninsured with cancer are almost entirely attributable to the advanced stage at which cancer is found in the uninsured not in a lack of funding for the actual cancer care.
Mr. Krugman also brings up this age old claim,
[T]he United States has the most privatized system, with the most market competition — and it also has by far the highest health care costs in the world.
It seems to imply a cause and effect in a vacuum without admitting other contributing factors to the high cost of health care in this country.
I’m not disputing that the United States “runs” one of the least effective health care “systems” in the world but there is obviously more contributing to our comparatively high health care costs. Namely that, independent of access to care, the United States has the least healthy population in the western world (i.e. United States patients cost more on average than patients in any other western country).
And, he also praises the Veterans Health Administration. Such was in vogue recently. But I doubt Mr. Krugman has ever spent much time in a VA hospital. As most medical students I will raise my hand that I have. I’ve also had the privilege of hearing and actually speaking with (apparently former) VA Secretary Nicholson. I think I can speak for many, many medical students who have served at many, many VA hospitals in saying this is an incredibly inefficient system.
And I do mean medical students actually do something at the VA. Public health care generally runs easily whether medical students are there or not. Sometimes we even get in the way. I’m not sure that such can be said about some services at VA hospitals. There are many an example where things would’ve taken days longer to get done if I or another medical student hadn’t been there to do grunt work or make phone calls. The complete disregard for expediency, the often times lack of focus on basic patient safety efforts seems like a system wide problem despite some of the praise the VA system has gotten. With the wars in Iraq and Afghanistan dragging on such is finally getting some focus in the media,
VA hospitals are also receiving a surge of new patients after more than five years of combat. At the sprawling James J. Peters VA Medical Center in the Bronx, N.Y., Spec. Roberto Reyes Jr. lies nearly immobile and unable to talk.
[…]
Maria Mendez, his aunt, complained about the hospital staff. “They fight over who’s going to have to give him a bath — in front of him!” she said. Reyes suffered third-degree burns on his leg when a nurse left him in a shower unattended. He was unable to move himself away from the scalding water. His aunt found out only later, when she saw the burns.
Anecdotes of course but there is good evidence that such problems actually affect patient outcomes.
Measuring comparative outcomes in VA patients is difficult. VA patients are more likely to be homeless, to make far less use of care, to make use of care at a later stage of disease versus Medicare patients and just generally are sicker than their counterparts out in Medicare. That said, when trying to control for these there is some evidence that in several key disease states they do worse versus their Medicare counterparts. For example, heart attacks.
Yet Mr. Krugman extends praise over the system,
As I’ve mentioned in past columns, the Veterans Health Administration is one of the few clear American success stories in the struggle to contain health care costs. Since it was reformed during the Clinton years, the V.A. has used the fact that it’s an integrated system — a system that takes long-term responsibility for its clients’ health — to deliver an impressive combination of high-quality care and low costs. It has also taken the lead in the use of information technology, which has both saved money and reduced medical errors.
Sure enough, Mr. McCain wants to privatize and, in effect, dismantle the V.A. Naturally, this destructive agenda comes wrapped in the flag: “America’s veterans have fought for our freedom,” says the McCain Web site. “We should give them freedom to choose to carry their V.A. dollars to a provider that gives them the timely care at high quality and in the best location.”
That’s a recipe for having healthy veterans drop out of the system, undermining its integrated nature and draining away resources.
Draining away resources? What resources? These veterans aren’t (and rightly so) generally paying for their care. It isn’t like an insurance system where having healthy veterans in the pool subsidizes the sick.
Okay, the points above are, in some part, merely semantics but you have to wonder about the soundness of the rest of his arguments when Mr. Krugman makes examples like those above.
As I type, front page on CNN is a profile piece on a plastic surgeon and several of his patients who are upset he continued to operate while in an alcohol treatment program.
[Dr.] West is an alcoholic, according to a Medical Board of California decision, and a member of the state’s Physician Diversion Program.
The program keeps the doctors’ identities private, so it allowed him to continue to treat patients, even operate on them, while he was secretly getting treatment for his addiction.
[…]
A study by the Federation of State Physician Health Programs found about one percent of all physicians practicing in the United States are in confidential treatment. That’s about 8,000 doctors whose patients may have no idea they are addicts.
A physician doesn’t have to disclose his drug or alcohol troubles and gets to keep practicing on unaware patients. A little shocking at first light. Let me tell you why it isn’t and why I think these confidential treatment programs are extremely important.
These are not programs for physicians who have been caught practicing under the influence, who have made mistakes because they’ve been inebriated. The way I understand it, these are physicians who sought help of their own volition. Physicians without documented professional troubles secondary to substance abuse.
That is an incredibly important point. It is highlighted in this quote from the CMA president,
[T]he California Medical Association, a physicians advocacy group, is fighting to keep the program running, and to keep the names of doctors enrolled confidential.
The association’s president, Joe Dunn, told CNN, “We believe very strongly this is the absolute best way to ensure patient safety. We need to get physicians out of the shadows.”
Dunn believes if the program is shut down in July, doctors will continue to feed their addiction privately and not get help. He argues, “Without a diversion program, no one knows. Patients don’t know. Health professionals who could help don’t know.”
It absolutely positively is the difference between having more physicians out there who are actively abusing substances with patients none the wiser and having physicians out there who are getting treatment for abusing substances with patients none the wiser. I don’t think, when framed appropriately like such, that that is really any choice at all.
This survey of British physicians was published in a British magazine a while back and I only now picked it up. In it a majority of respondants say that some care, apparently especially some operations, should be limited by patients’ age and lifestyles.
Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.
[…]
About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt.
Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money.
One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements.
Tony Calland, chairman of the BMA’s ethics committee, said it would be “outrageous” to limit care on age grounds. Age Concern called the doctors’ views “disgraceful”.
That’s taking voluntary, transparent rationing to a pretty incredible level. When resources are scarce, as in most of medicine, then lifestyle can play a role in who gets what. I have no problem, along with 94% of British doctors in the survey, in saying an alcoholic who is likely to return to drinking shouldn’t be at the top of the liver transplant list.
Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant…
Roger Williams, who carried out the 2002 transplant on the former footballer [George Best,] said doctors could never be sure if an alcoholic would return to drinking, although most would expect a detailed psychological assessment of patients, who would be required to abstain for six months before surgery.
But rationing based on age and some of the other suggestions put up in the survey just elicit a ‘yikes.’ Such transparent, open and flamboyant rationing efforts are inevitable in any limited global budget health care system (i.e. Britain’s socialized NHS).
[Larry] Niven said a good way to help hospitals stem financial losses is to spread rumors in Spanish within the Latino community that emergency rooms are killing patients in order to harvest their organs for transplants.
“The problem [of hospitals going broke] is hugely exaggerated by illegal aliens who aren’t going to pay for anything anyway,” Niven said.
“Do you know how politically incorrect you are?” Pournelle asked.
“I know it may not be possible to use this solution, but it does work,” Niven replied.
I don’t even know how you respond to the stupidity of a comment like this, except just to denounce it as such. Larry Niven simply doesn’t know what he’s talking about…or how to write a novel.
The cost of health care has been and continues to rise dramatically in the United States. But only in the magnitude is the United States alone in the world with such a problem. A New York Times blush points out that,
The United States has long been an unusual study in medical care, with employers assuming much of the cost. Now, though, as the employers say “enough,” calls are deepening for the government to take on more of that role through nationalized health care.
The opposite situation is unfolding in other parts of the world. As long-running national health systems become overburdened, more employers are paying for workers’ supplemental health care costs.
According to the Watson Wyatt survey cited by the NYT piece, India’s employers will spend 30% more this year on health care than they did in 2007. That’s a one year increase. Canadian employers will spend 12% more than last year. Even British employers will spend 8% more than last year.
Granted in some of these countries these are percentage gains on what are relatively small expenses already, but it is still interesting and further circumstantial evidence questioning the sustainability of government run health programs with single budgets.
I did my undergrad work in USC's School of Cinema-Television Cinematic Arts. I have a Bachelors of Fine Arts in Writing for Screen & Television. I loved it, but a future of waiting tables and taking meetings with B-List producers was not for me.
This blog is ostensibly to discuss healthcare policy and maybe educate a few of my fellow medical students. But it will stray into current events, politics, and other science topics when they draw my interest
Other odd notes about me:
I've skied half the resorts on this list (Squaw Valley/Lake Tahoe, Snowbird/Park City, Whistler, Taos, Vail)
I "played" lacrosse in high school and through a club level team in college
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