WhiteCoat

We’re All Dead …

If you believe Michael Cannon’s article “Universal Coverage Kills” at the National Review Online.

It amuses me when people possessing little knowledge of the inner workings of the practice of medicine write articles as if they are “in the know.” Mr. Cannon’s article is one such work.

I’m not going to pick apart the whole article, but there are several statements Mr. Cannon makes that are either purposely inflammatory or that show a fundamental lack of insight. Contrary to its title, the article talks very little about “universal coverage” but instead tries to incite the public about “never events.” I’m glad he links to a few statistics, but the conclusions he comes up with are flat out wrong.

Mr. Cannon states that

“For more than 40 years, Medicare has provided financial rewards to providers when a patient requires follow-up care following a medical error.”

This is a partial truth, but he’s sensationalizing the whole concept. There are errors such as wrong medications, wrong site surgeries, and wrong type blood transfusions. I’ve stated before that I can’t think of a legitimate reason for some of those things happening. Should practitioners be compensated if they commit those errors? Maybe, maybe not. Errors are a part of any profession. If your mechanic doesn’t fix the rattle in your car, you still have to pay him for his “error” in trying to diagnose the problem. If the restaurant messes up your order, maybe you get comped the meal, but you don’t walk out of the restaurant without paying the check. If your attorney can’t get case filings done on time and requests a continuance, you’re paying him for going to court to get the judge’s permission and your paying for the letter/phone call telling you the status of your case.

The other side of the coin, as I’ve also stated before, is that if people like Mr. Cannon and our beloved government are so sure that all of these “errors” are preventable, then provide all of us overpaid brain dead doctors with a way to prevent the errors, then. Give me some links to those articles, there, Hippocrates. Put up or shut up.

Mr. Cannon also makes the statement that

“Medicare will still reward hospitals for many medical errors, including infections and medication errors ….”

Since when did living organisms that cause infections become a “medical error”? If you get a strep throat are you going to pay the doctors double for your “error”? How about that painful little drip coming from the tip of your woo-hoo? OK, I guess that the clap results from an error in judgment. So you’ll have to pay us triple for that one – once for the medical error and once for the judgment error. How about pneumonia? How about paronychia from chewing your fingernails? For that matter, how about the cavities from the organisms in your mouth? What about influenza? Are all of these infectious processes “medical errors”? I’d like to see how you rationally differentiate post-op infections, c difficile, and UTIs from other compensible “infections.”

Mr. Cannon’s article does propose a solution to all of medicine’s ills, though. Actually, the idea was created by Group Health Cooperative and Kaiser Permanente “more than 60 years ago.” According to Mr. Cannon’s article,

“Doctors and patients who choose those plans tend to like them, and the plans receive high marks for quality, which suggests the financial incentives they use serve patients better.”

He doesn’t really explain what he’s talking about, so I did a little searching.

Mr. Cannon wrote another article here that expounded more on this process.

Drumroll, please … he’s advocating a national HMO.

Yes, HMOs are Michael Cannon’s answer to the healthcare crisis. Pay a flat monthly fee for every patient a physician sees and the physicians are responsible for paying for all of the care that the patient requires. If the patients require more care than the monthly fees, the doctor has to pay for the care out of pocket.

Brilliant.

Do I even need to link to articles on what a colossal failure HMOs have been? Try finding a physician who even takes HMO patients in many parts of the country. Doctors are less happy and see fewer patients. You think it’s tough to get an MRI now? Try getting an expensive test with an HMO. HMOs reward minimalist medicine. The less you do, the more money you make. That’s great if you’re a healthy patient with few medical problems. I have neither the time nor the desire to track them down, but I would like to see some studies on how many chronically ill people are happy with their HMO care.

As I sat here shaking my head at another person perpetuating misinformation to the public, I started thinking about how to explain the concept of a “never event” to a journalist.

If you’re a journalist whose articles don’t follow the rules of proper English, a never event woul mean that you don’t get paid for writing the article. Any article you write in which your editor has to make any correction is uncompensated. You don’t like that idea? Why you miserable incompetent money-grubbing wretch. Taking money from a publisher when you’ve made a mistake?!?!? That borders on unethical. You churl!

Of course, your editor, as a representative of the employer that is paying you money, has an incentive to find errors so that the employer doesn’t have to pay you. Even so, that type of system shouldn’t bother you so much. After all, how hard can it be to follow the rules of English? Those are at least written out in Strunk and White.

Yeah. I can go with that concept.

Mr. Cannon’s article uses the “naked this” like it’s going out of style and has dangling modifiers and sentence fragments galore. Maybe we can start a petition to the National Review and request that they withhold Mr. Cannon’s paycheck this week for all of those literary “never events.”

I propose that they send his paycheck to their local hospital to help it avoid more “medical errors.”

19 Responses to “We’re All Dead …”

  1. HyperAl says:

    Remember Mr. Cannon when your steel balls starts to rust, that’s a never event. You’re on you own…

  2. Kathy says:

    is Mr. Cannon Deborah Peel’s bf?

  3. HyperAl says:

    Hospitals should have a “Quarantine” procedure prior to admission to identify POA. Every single orifice of the patient should be poked and cultured, pts stool, behind the ears, under the fingernails, several hundred skin swabs for every creases and skin fold that can possibly harbor bacteria. List down all the pathogens identified as POA or Present on Admission. That way it’s covered. :)

    Medicine should be legislated by Medical People not Lawyers.

  4. HyperAl says:

    Interesting article on the state of health care in Alaska and how many internist are opting out of MEDICARE.

    http://www.acpinternist.org/archives/2008/10/safety.htm

  5. Marilyn says:

    I was ecstatic when an employment change for my husband also meant ditching our HMO. I struggled for several years with seriously classic thyroid symptoms, but because my labs were “normal” (i.e., a T4 level of .8 with the bottom of range being .8) they tried to push anti-depressants, beta-blockers, diuretics and statins. Funny how they would have paid for all those expensive drugs without a thought. Couldn’t go doctor shopping because of the HMO.

    As my husband and I get closer to retirement age, the scarier the idea that we might have to depend on Medicare. :-P

  6. [...] by GruntDoc on October 23rd, 2008 We’re All Dead … « WhiteCoat Rants If you believe Michael Cannon’s article “Universal Coverage Kills” at the National Review [...]

  7. Dr. Alice says:

    Thanks for the masterful dissection, WhiteCoat. Much more clever than what I managed. :)

  8. adina says:

    I don’t necessarily disagree with a lot of your assessment of of “Never Events.”

    However, you are absolutely incorrect that Michael Cannon favors a national HMO. He is a libertarian who works on health policy for the Cato institute, and opposes any form of government insurance. He favors non-taxable health savings accounts, in which people can use the money to pay for their own insurance and/or medical expenses. He cites Kaiser as an example of a health insurance organization that people might choose, based on the general satisfaction of Kaiser patients and workers (I’m a med student, and have a lot of instructors who’ve worked for Kaiser. Most love it). However, for those who would be unhappy with an HMO like Kaiser, Cannon (from what I’ve read)believes that people should choose whatever insurance they prefer. In fact, he runs a club called the “Anti Universal Health Care Club.”

  9. adina says:

    I love your blog, but I believe you should make the above factual correction in your article.

  10. Debbie says:

    I am a lurker and just wanted you to know that I really enjoy the way your arguments and other posts are so entertaining to read. Thanks for taking the time to blog.

  11. Meghan says:

    I loved your arguments against this guys article. I wanted to leave a comment on his article so bad, but there was no place for this, so I’m glad Whitecoat’s argument is out there :) Also, I would love to actually meet one of these people who “loves” Kaiser. My husband has it, so I can definitely say for a young healthy person like him, it’s wonderful- they have great ideas about prevention and maintenance of health. BUT, and this is a big but, here in so cal anyway, their acute care just absolutely sucks. It’s horrible, I’ve never heard a single person say a good thing about a hospital experience in the Kaiser organization here. Also, there is a good reason, that although they are the highest paying hospital in the area, they are constantly struggling to hire nurses. They cut corners! They don’t treat their basic employees (nurses, CNAs, etc) well at all. I’m constantly nagging my husband to please switch his insurance coverage (he chose it because it’s cheapest), just in case he ever has an appy, or major accident or anything really. Cripe, I remember when he had his wisdom teeth out, I had to drive 12 miles to fill his Rx at the closest Kaiser pharmacy. I know it’s not that far, but I had to pass at least 15 closer pharmacies to get there. Ok, so thats not that big of a deal, but it’s just one of the many things I don’t like about Kaiser. Sorry rant over. Thanks for saying all the things I wanted to Whitecoat

  12. I disagree. I think capitated networks are necessary to save our health care. I wrote about it today. Of course, it’s not a third party system. I am wholly against all third party interference in health care. I think it has destroyed medicine. But what I believe we need is a market based capitated network, independent of all third party interference. Read on…
    We Are All Playing Texas Hold’em On Our PlayStations

    We’ll have to agree to disagree on this one.
    How will patients with multiple chronic illnesses or with catastrophic illnesses fit into a capitated system? Doctors will drop them like Enron stock certificates because they cost more than they contribute to the system.

  13. WhiteCoat says:

    Adina,
    Mr. Cannon’s article states the following:

    It doesn’t have to be this way. More than 60 years ago, markets devised health plans that discourage medical errors by forcing doctors and hospitals to bear the financial costs of all such errors. You know them as plans like Group Health Cooperative and Kaiser Permanente. Doctors and patients who choose those plans tend to like them, and the plans receive high marks for quality, which suggests the financial incentives they use serve patients better.

    If you do a search for terms “doctors pay costs errors kaiser” you’ll get the article I cited in my post.
    Whether Mr. Cannon has this underlying intent to create health savings accounts for everyone (which I personally don’t think is a bad idea), he wrote one article advocating an HMO-like insurance program and his article in the National Review alluded to the same type of program.
    I call ‘em as I see ‘em.
    If you have a different explanation for the type of system he advocates in his National Review article (because he is not specific on what he advocates) and can substantiate it with succinct links (I’m not reading some 50 page white paper), I’d be happy to add an addendum to the bottom of the post.

  14. David says:

    ID folks in hospitals have trouble with health care providers washing hands before seeing patients. Some lines are left in too long causing infections. These are known problems that need to be improved, perhaps with technology.

    Absolutely agree – but infections still occur even when hands are washed and when lines are changed on a timely basis. Should we still be liable if we do everything right and infections still occur?

  15. [...] WhiteCoat writes, “It amuses me when people possessing little knowledge of the inner workings of the practice of medicine write articles as if they are ‘in the know.’ Mr. Cannon’s article is one such work…there are several statements Mr. Cannon makes that are either purposely inflammatory or that show a fundamental lack of insight…I’m glad he links to a few statistics, but the conclusions he comes up with are flat out wrong.” [...]

  16. [...] blogger WhiteCoat was among the many who responded (sometimes angrily) to that oped, and has since responded to my response to those responses.  [...]

  17. [...] the organism that some medical industry pundit wannabes **cough cough** Michael Cannon **cough sniffle** Diane Suchetka **hack snort** claim should never [...]

  18. [...] Canon from the Cato Institute and I had a disagreement about “never events” a few months ago. On those, via private e-mails between us, we agreed to [...]

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