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POLICY/POLITICS: New York Times, dogs, pustilent sores, licking of.

After the previous three times, I don’t think I can bear it.  This time David Leonhart has written a NYT article saying that the reason we spend more here is because of American culture. This may be the most moronic sentence of the whole series of articles:

We Americans tend to treat any rejection of a health claim as some conspiracy by insurance companies, the government, doctors and the pharmaceutical industry. In other countries, people have arrived at a better understanding that health care necessarily involves economic triage — that $10,000 spent on quixotic care is $10,000 that can’t be spent more usefully.

We Americans” are somehow are magically controlling the spending, apparently over the objections of  “insurance companies, the government, doctors and the pharmaceutical industry”

He’s supposed to be the economist. Does he have no idea who controls health policy and health care spending in this country?  For chrissake, the government here more or less represents the “insurance companies, the government, doctors and the pharmaceutical industry” and their interest is in spending more, not less. “We Americans” did not get a seat at that table, unless you count patient groups that also have an interest in higher spending and are co-opted by industry. Any high school senior doing a basic political science class  who read the cliff notes on Stigler’s theory of capture can tell you how that works. But apparently you get to miss that class, or Econ 101 if you want to write on health care for the NY Times.

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John Sharpmark richardsonTom LeithJack E. LohmanPeter Recent comment authors
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John Sharp
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So I think we agree that there are multiple factors and not just an “American Attitude” involved. Mostly there are the wrong incentives – for demanding more expensive treatments, ordering unnecessary tests, for raising insurance premiums, for suing, for not making safety a priority. Changing the incentives is the challenge and I think most physicians would rather be paid on the right incentives that just financial or defensive ones. Being paid for outcomes would be the right incentive once we figure out how to do that. Regional differences need to end.

mark richardson
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mark richardson

I have been lurking for a while and wish to gain some insight into the statstics presented by Michael Watson. How accurate are the numbers presented? 190,000 deaths from Hospital related errors and 1.5 million injuries from medication errors. From my own experience most medication errors go unreported and or not recognized. Could these numbers be grossly understated?

Barry Carol
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Barry Carol

Jack,
“Tom, I couldn’t agree with you more that MedMal is a distraction. Insurance companies are increasing premiums because they can, and they need to in order to make up losses in other segments of their market. Malpractice costs have remained at .5% of overall health care spending.”
See comment #10 in this thread for a doctor’s perspective. For the record, comments from “BC” are mine.

Jack E. Lohman
Guest

Tom, I couldn’t agree with you more that MedMal is a distraction. Insurance companies are increasing premiums because they can, and they need to in order to make up losses in other segments of their market. Malpractice costs have remained at .5% of overall health care spending.

Tom Leith
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Tom Leith

First, my thanks go to Michael Townes Watson for proving again that the quality of information found in books isn’t necessarily better than that found on the internet.
Second, the whole MedMal thing is a distraction. Premiums amount to 2% of the spend. We have bigger fish to fry. Like coming up with better insurance contracts regardless of who pays the premium.
t

Jack E. Lohman
Guest

I agree on that Barry. How do the physicians on this thread feel abouth a 3-person panel rather than 12-man jury?

Barry Carol
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Barry Carol

Jack — The shades of grey would be where the specialized courts earn their keep. If I’m a doc going about the daily business of practicing medicine, it would make a huge cultural difference, I believe, if I can be confident that any dispute I become involved in will get an honest, fair and objective hearing by judges with expertise in this area of the law with input from neutral medical experts hired by the court as compared to a slick tongued plaintiff’s lawyer trying a case in a judicial hellhole before an ignorant jury whose emotions can be manipulated… Read more »

Jack E. Lohman
Guest

In this case yes, Barry, because in my view it is black and white. What if it were grey? A light shade of grey or a dark shade?

Barry Carol
Guest
Barry Carol

Jack, I absolutely agree that this decision would fare better under a specialized health court system without juries. In the case of my example, the question for the panel would be: Was the doc’s decision based on sound, reasonable and prudent medical practice which should explicitly include consideration of costs vs benefits from a system standpoint and not just the individual patient standpoint. It also makes a big difference when we are talking about allocating society’s finite resources financed by all taxpayers vs an individual choosing to spend his or her own money. Just because some people can afford to… Read more »

Jack E. Lohman
Guest

I probably would disagree that he would forego the test if a family member was at risk, though he might if he were paying the $1000. But I just don’t know how you are going to set limits under any scenario. Reasonableness to one person is surely different for another (as you and I have found out). But I think this scenario would fare better under a three-physician medmal board as opposed to a 12 man jury. Thus one would have to wonder whether physicians would take more or less chances in their ordering.

Barry Carol
Guest
Barry Carol

Jack, I think you missed part of my point on the culture of defensive medicine, probably, because I didn’t explain it very well. In the case of the MRI where the physician has no financial stake, assume his assessment is that there is only a one in 10,000 chance that the test will show a serious problem (like cancer), and all the other test results will be normal. The test cost $1,000 each. If insurance (or taxpayers) pays for it all, that means we would spend $10 million to catch one cancer early rather than late. The doc knows implicitly… Read more »

Jack E. Lohman
Guest

In the example of a physician ordering an MRI in which he has no financial stake, but doing so “just in case,” I don’t have a problem with that, Barry, because physicians never know until the results come back whether the test he ordered was necessary or not. I only have a problem when physicians set up expensive testing facilities in their clinics and use them as cash cows. There is absolutely zero reason why physicians cannot refer their patients for testing in hospitals and labs in which they have no financial interest. As we’ve discussed before, unnecessary testing is… Read more »

Barry Carol
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Barry Carol

Putting aside the debate between a single payer system, a taxpayer funded premium support or voucher model, and the current employer / Medicare /Medicaid / individual insurance market model with 15% of the population uninsured, there are several issues that impact on the ability of “the system” to reduce utilization. First, our current payment system does, for the most part, reward doing more tests and procedures. However, pay for performance metrics are still not very good, and there are huge parts of medical care that just don’t lend itself to it, at least not yet. I’m afraid that defensive medicine… Read more »

Jack E. Lohman
Guest

Correction: “a qualified three-judge PHYSICIAN panel”

Jack E. Lohman
Guest

Michael, your points are well taken. We need a medical malpractice system that is fair to the patient – but also fair to the physician and society – and I believe that a qualified three-judge panel should replace the unqualified 12-man jury (in medical malpractice cases only) who most often make their decisions on the basis of who’s the best actor rather than who’s right. Barry, I’d believe the defensive medicine argument if it weren’t for the fact that all of these tests done to protect their ass weren’t also profitable as hell. Doctors get paid not only on the… Read more »