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POLICY/QUALITY: Assisted suicide, as rational as can be

In a remarkable front page story, the London Times has an excellent article on why assisted suicide should be legal in any rational country, as it is in Oregon and apparently Switzerland. The story is called Why a retired GP chose to end her life seven years before time and it shows how a determined lucid retired physician from the UK made the right choice for herself, but was forced to travel far from home to do so. Luckily her children supported her through the process, and they present a united front to those who’d interfere in the rights of those who want to make this choice. She wrote more than 100 letters explaining her actions.

On a personal note, my own grandmother made a similar choice and committed suicide when she felt the infirmities of her old age was making her life unbearable. She wrote me a loving letter that I received after her death, but unfortunately society wasn’t ready then to allow her to do it in a more public way, or to let us know it was coming. I wish that I’d had the opportunity with her that the GP’s children had with their mother.

 

POLICY/POLITICS: Ezra Klein skewers the HSA, Joe Paduda skewers the CDHP, with UPDATE

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(This entry bumped up to top because of fun UPDATE)

Apologies for my later start this morning, those of you who follow my knee problems will perhaps be as pleased as I am to know that I spent the weekend snowboarding with apparently no ill effects on it! But it mean that there’s only limited fodder for THCB written over the weekend.

The good news is that while I’ve been slacking, over at Tapped, Ezra Klein skewers the HSA, reminding us that it’s a destruction of the risk pool. I suspect that educating Bush about health care is like the story of David Stockman trying to explain the budget to Reagan, and realizing that he never had a clue about the difference between real and nominal dollars. One of Ezra’s commenters also points out the obvious–that the HSA will do nothing to reform the underlying problems of the system’s cost explosion, and so is by definition a temporary fix.

Last year, when I bought health insurance for my law firm (me, my family, my paralegal and my secretary) I could get coverage with a five hundred dollar annual deductible for $1,900 a month. I looked through all the options and saw that a plan with a $5,000 annual deductible was $1,200 a month. If there was one with a $10,000 deductible it would maybe cost maybe $900 a month (guessing). With health-care inflation running at 8-10% a year that policy with a $10,000 deductible would soon be prohibitively expensive.

Meanwhile over on his Managed Care Matters blog, Joe Paduda skewers the CDHP, with a big assist from Alain Enthoven. Remember kids, the CDHP is the bastard child of a one night stand between a benefits consultant with nothing to sell and a right-wing think tank that can’t do basic math.

CODA: In the transcript of the debate between Enthoven and Reggie Herzlinger on the KaiserNetwork site, Reggie’s comments have all been excised. I wonder whether there’s censorship of some kind here, or whether she was so embarrassed at what she said that she asked for them to be pulled…anyone who knows the truth please get in touch!

UPDATE: Reggie apparently did ask the Kaiser people not to publish her remarks. So was she chicken embarrassed, or was it a bad hair day, or was she selling her schtick to someone else for an exclusive?

TECH/PHYSICIANS: Medtronic helps out whistleblowers, by The Industry Veteran

The Industry Veteran is back on his preferred way to make a buck in health care

Another whistle-blower makes good, this time on the device side of health care manufacturing.  It appears that Medtronic pays spinal surgeons upwards of a half million dollars a year in bogus consulting arrangements (e.g., for eight days of work during the year) if these payees agree to use the benefactor’s products.  What brightens the career prospects for whistleblowers in this suit is the fact that the plaintiff is not a scientist, a physician, a sales rep, an MSL or any of the usual types within either the clinical or the business operations.  The woman here worked as a travel agent for Medtronic, in which capacity she arranged accommodations for the bribed surgeons.  Her duties made her privy to the occasions where the amorality of business managers intersect with the usual conditions of gross immorality and psychopathic narcissism among physicians.  The news here is encouraging.  The day might dawn where the greed-is-good, corporate, fiduciary officers and the my-son-the-genius-doctors will have to fear their own admin assistants, office managers, temps, and maintenance workers.  Well, probably not, but at least the possibility brings a smile.

PHARMA/POLICY/POLITICS/PHYSICIANS: Tierney with some optimism on the DEA’s war on doctors

Writing (unfortunately behind the fire-wall) in the NYT, John Tierney attacks the Republicans as being the Party of Pain. With their attempts to stop the Oregon assisted suicide law, and the relentless attack of the DEA on pain doctors, the Republican conservative Christian establishment that captured the DOJ in 2001 continues to defy rationality. Tierney is hopeful, however, following the Supreme Court’s ruling in Oregon’s favor.

Of course we never needed to engage in this ridiculous vendetta against pain doctors anyway. In his harrowing long and excellent issue brief on the subject Ron Libby at Cato points out that Oxy wasn’t that big a deal anyway

A final problem with the DEA’s claims of an OxyContin epidemic is the agency’s inflated estimate of risk of death. In 2000 physicians wrote 7.1 million prescriptions for oxycodone products without aspirin or Tylenol, 5.8 million of them for OxyContin.55 According to the DEA’s own autopsy data, there were 146 "OxyContin-verified deaths" that year, and 318 "OxyContin-likely deaths," for a total of 464 "OxyContin-related deaths."56 That amounts to a risk of just 0.00008 percent, or eight deaths per 100,000 OxyContin prescriptions 2.5 "verified," and 5.5 "likely-related." Even those figures are calculated only after taking the DEA’s troubling conclusions about causation at face value.

So this is just a classic case of the DEA acting like the drunk looking for his keys under the lamp-post because that’s where the light is. And who suffers? Obviously the doctors in jail or ruined. And it’s not a issue for just a few pain doctors. Libby points out that between one in five and one in three pain doctors has been investigated by the DEA or local authorities. Would you keep doing your job if there was a one in three chance that you’d be investigated, maybe have your assets seized, and possibly be sent to jail for very long time just for doing it?

And why is it being done? Well the DOJ and local police departments get to keep all the money from asset forfeiture. In other words this is essentially theft with patients, doctors and the taxpayer picking up the tab

Tierney hopes that there’ll be a resolution to this:

The Supreme Court’s decision is a victory for patients and their doctors – including, I hope, some of the ones in prison for violating the federal legal theory that has now been rejected by the court. The doctors should go free, and Republicans in the White House and Congress should restrain the drug warriors who locked them up. When this year’s budget is drawn up, it’s the D.E.A.’s turn to feel pain.

These loonatics need to be stopped and whatever my political differences with Tierney and the Cato crowd I applaud them for getting this in the public eye. Unfortunately I think he’s being far too hopeful that any good will come of this given the number of theocratic fascists social conservatives  still in the Administration and heading to the Supreme Court, and the current DOJ attempt to promote laws already overthrown by a (slightly) more liberal Superme Court.

BLOGS/TECH: Bloggers meeting, sadly without me

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A group of tech bloggers are meeting at HIMSS at 8.30 pm on Sunday Feb 12th in San Diego at Hennessy’s Gaslamp pub. Sadly I wont be there as I don’t show up till the next a.m — being too cheap to pay for an extra night in a hotel and having non-refundable tickets and all — but Tim Gee, Neil Versel, Shahid Shah and maybe even MrHISTalk himself should be there.

POLICY: The future of retirement

In this book review of a couple of finance books in the New York Times, Neil Genzlinger is close enough to being right to remind us why we need to figure out the underlying problems in the health care system.

But as far as radical new ideas, the visionary approach would have been the blunt one: forget retirement planning. Hakuna matata. In the future, whether you have $15 million socked away or $1,500, nothing will matter – not food, not shelter, not golf, not active-senior communities – except health care benefits. Medical science, which already offers rebuilt knees and transplanted livers and faces, will soon offer new everything, but at a staggering cost. The Health Care Cabal will issue a one-page retirement plan: “In exchange for all your assets, including your children (and all their future earnings in perpetuity), the H.C.C. agrees to replace your parts as needed, while supplies last.” And everyone will sign it, because here in the have-it-all era, death is simply unacceptable.

THCB: Last call for submissions

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Last call for submissions for the THCB health care reform
competition. Your mandate: solve the health care crisis in 250 words or less.
Be sure to, ahem … read the contest  rules, before submitting your master plan, as it’s clear several of our contestants didn’t.

The grand prize:
potential international superstardom and a guest spot on the Eric Novack show.

POLICY: Joe Paduda explains what’s wrong with Part D’s economics

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While we’ve been focused on what’s wrong with Part D’s implementation, Joe Paduda reminds us all about one of the other problems with Part D. It’s that by it’s nature a voluntary benefit is going to attract adverse selection. In other words, the only people signing up for it so far — and barring the dual eligibles who were involuntarily alloted into it there haven’t been too many, and DSS reports that there won’t be that many more — are the ones with big drug costs. So by definition eventually the plans will start losing money.

For now the PDPs are being covered against that risk, and the very generous taxpayer will make up the difference. But later on the taxpayer may not be so generous (as with Medicare Risk in the late 1990s) at which point the PDPs will start to exit.

This, by the way, is exactly the inverse of the problem with HSAs, where all the healthy people will leave the insurance pool, leaving those behind in a death spiral.

QUALITY/POLICY: Need an Organ? It Helps to Be Rich

Were you looking for this?ABC News reporter Joy Victory found a really juicy angle on the problems of being uninsured. Her article is called  Need an Organ? It Helps to Be Rich. As you might suspect getting on the waiting list for an organ if you’re uninsured is pretty tricky. Entry to the list is controlled by the big medical centers that do transplants. Although everyone is supposed to be viewed independently of means, its totally obvious that if the patient is uninsured the hospital concerned will lose a packet on the procedure. So like every other aspect of care access for the uninsured, their chances of getting access to that list are much lower than those with insurance. And of course it goes without saying that unless they are lucky enough to be in a job offering great insurance — a number which is getting lower every day — they are not going to be able to buy insurance at any affordable price.

But the fun contrast that the article brings up concerns the other end of the transplant pipeline. Nearly 23% of those who’s organs are donated for transplantation were uninsured, who in other circumstances wouldn’t be eligible to accept their own organs! So this is a case where the haves are literally living off the have-nots.

You’d think that the advocates of universal insurance could run with this one a little?

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