Demagoguing Against Doctors Using Techniques Developed Demagoguing Oil Companies
We all know the problem with oil companies: They restrict supply to drive up prices to earn profit margins that are nearly a third of those earned by Microsoft while simultaneously keeping prices too low and promoting addiction to oil which produces a lot of CO2 and they never want to reinvest their profits in exploring for new oil so the government needs to restrict drilling in every major prospective US region so the oil companies will be stopped from greedily drilling everywhere and destroying the environment.
Barack Obama seems to be bringing this damned-if-you-do-damned-if-you-don't criticism to the medical industry, and particularly doctors.
On the one hand, he told doctors at the AMA convention yesterday that he was not a fan of tort reform and felt that limits on malpractice cases was a disservice to those who were truly injured.
On the other hand he made this case:
Not long ago, doctors' decisions were rarely questioned. Now they are being blamed for a big part of the wasteful spending in the nation's $2.5 trillion health care system. Studies have shown that as much as 30 cents of the U.S. health care dollar may be going for tests and procedures that are of little or no value to patients.
The Obama administration has cited such findings as evidence that the system is broken. Since doctors are the ones responsible for ordering tests and procedures, health care costs cannot be brought under control unless they change their decision-making habits.
On the third hand, doctors aren't spending enough to address preventable errors:
President Obama himself in his speech cited the "100,000 deaths a year" figure as if it's reliable and well established, as did yesterday's New York Times. And of course it's a figure eagerly spread by the Litigation Lobby. But as Zachary F. Meisel and Jesse M. Pines note in Slate, it's a really, really, really soft number:
...one of the biggest headlines of all was the 1999 Institute of Medicine report To Err Is Human, which announced that up to 98,000 preventable deaths occur each year in U.S. hospitals. Since then, health care improvement organizations such as Leapfrog Group have invested copious resources in reducing preventable errors. But a key issue has been overlooked in this movement: The original estimate -- the 98,000 deaths -- may have been way off. In fact, some of the researchers who conducted the original studies used in the IOM report re-evaluated their data in 2002 and reported that had they used a different calculation method, the number of estimated deaths would have been less than 10 percent of the original. Oops.
dave smith:
If only he and his cronies ran everything, everything would be perfect.
June 16, 2009, 4:25 pmorthodoc:
No problem. Just tell me which "tests and procedures" you'd like for me not to do. Or which patient I shouldn't do them on. I'm assuming that if I do this, I won't get sued if I miss something important....
Maybe we can do "comparative effectiveness research." Because it has never occurred to anyone in the medical field that we should be checking to see what works better, and what doesn't. Thanks, Captain Obvious!
June 16, 2009, 4:47 pmBill:
Thanks for that first paragraph! Brilliant summary!
June 16, 2009, 4:55 pmOh, and you're dead on about my industry, too. The piece that nobody talks about is the government's absolute insistence that all efforts to align the incentives of hospitals and doctors to improve efficiency must be branded as felonious as soon as anyone dreams one up, but only while complaining about inefficiencies in the system.
John Anderson:
Seeing as you just referenced Lucifer's Hammer, couldn't you have used "On the gripping hand" instead?
;)
June 16, 2009, 6:11 pmSam L.:
John, I believe you meant "The Mote In God's Eye", from which phrase the aliens were called Moties. Instapundit would have said "the gripping hand"--he has before.
June 16, 2009, 9:02 pmJames H:
This is all just a bunch of prep to the masses and the compliant media to basically say that the doctors are wasting sooo much money with unnecessary crap, that the government should come in and take over. He knows that the cost of taking over is too high, and so the all-too-familiar solution comes along: rationing. Rationing seems to be the solution to every "problem" from energy to health care.
June 16, 2009, 9:46 pmPops:
Another tactic being employed here is the "good cop, bad cop" routine. Government interference in the medical marketplace has disrupted natural incentives to do the right thing (bad cop), so now government will step in to fix everything (good cop).
Current government interference in the health-care marketplace derives mainly from the tax exemption for employer-provided medical benefits. We might have a chance of getting back to free-market principles and a stable system if employer-provided medical benefits were simply taxed, thus removing much of the incentive for employers to get involved. So here's a novel idea: people spend their own money for visits to the doctor. People spend their own money to buy real insurance to cover catastrophic events. If some people don't have enough money to go to the doctor or to purchase real insurance, it would be better to just give them the money to do so rather than to destroy the entire free market. [To illustrate this last point - when people don't have enough money to buy food, we give them food stamps. We don't nationalize the entire food production and distribution system. Of course if someone from the Chairman Zero administration is reading this, they might get ideas...]
June 17, 2009, 5:49 amJim Collins:
orthodoc
June 17, 2009, 9:04 amLet me ask a question. Why should I have had an EKG and a heart sonogram, when all I came into the ER for was stitches in my leg?
Yes, I am a big guy and quite a bit on the heavy side, but all I needed was 10 stitches in my left leg.
Dan:
The first graph is a brilliant summary of how the oil companies have been hammered by every side of the political spectrum.
June 17, 2009, 10:43 ammishu:
Jim, maybe your blood pressure was through the roof? Would you then suggest that it's not prudent to take the blood pressure of a bleeding person? Just a guess but it seems like you haven't given us all the data.
June 17, 2009, 12:16 pmDr. T:
Obama established a clear behavior pattern early in his presidency.
1. Decide to take over a big chunk of the economy.
2. Make illogical claims and malicious statements about the people or businesses in that part of economy.
3. Make totally absurd claims that the government can run that part of the economy better.
4. Apply illegal restrictions against that part of the economy while simultaneously make illegal government expansions into same.
5. Repeat step 4 until the government has it all.
It worked for commercial banks, Fannie Mae and Freddie Mac, non-bank financial institutions, a financial insurance giant, and two automobile companies. Next on the list are health care insurers and then all health care providers. Who knows what will follow as Obama continues his fascistic and socialistic policies.
June 17, 2009, 3:29 pmDr. T:
Jim Collins asked: "Why should I have had an EKG and a heart sonogram, when all I came into the ER for was stitches in my leg?"
A number of possibilies:
1. Someone thought you had an irregular heart rhythm or a heart murmur.
June 17, 2009, 3:35 pm2. The ER has a (bad) protocol requiring those tests on obese people.
3. The doctor was clueless.
4. ER reimbursement is better for cardiac tests than for stitching.
Jim Collins:
You may be correct that I didn't provide enough information.
First off I'm big (6'-7") 290 lbs., not obese.
Second my blood pressure was excellant, the doctor even commented on that.
I'm more inclined to agree with Dr. T's numbers 2 and 4, add into that that I have excellent health insurance and #4 becomes real valid.
Dr. T's number 2 is the issue here. I am quite willing to believe that it is the main reason. Number 2 is in place to protect the hospital in the event that I keel over walking out of the ER from a totally unrelated health issue.
If my blood pressure was high, if I had a history of heart attacks, if I was having trouble breathing, if I showed any indication of something being abnormal, then I would have no problem with these tests. Something like that saved my Mother's life a few years ago. These tests were done for just two reasons. To protect the hospital and to help the hospital's bottom line.
June 18, 2009, 6:24 amDan Smith MD:
Jim Collins' anectdote provides rationale for eliminating as much as possible the barrier between patients and doctors produced by a faraway insurance company that can be fraudulently charged for unnecessary procedures. Look at Medicare fraud, for example. Medicare may have a low administrative overhead, but it makes fraud a lot easier to perpetrate. I don't excuse the ER for ordering the EKG and Echo. But if Mr. Collins had to pay the charges up front, would they be so eager to perform the tests without explaining why they were necessary?
June 18, 2009, 12:21 pm