Archive for February, 2009
Friday, February 27th, 2009
I read a couple of recent articles regarding the free emergency medical care available in Canada.
In one, the author’s husband waited five hours to be evaluated for excruciating chest pain and was later diagnosed as having pulmonary emboli. The author stated that her husband’s challenge was to “survive the bureaucratic barriers long enough to benefit from this care.”
In the other, the author noted that so many hospitals were going on “bypass” (where they could divert patients coming to the hospital by ambulance) that ambulances were having difficulty finding a hospital available to take patients. The Canadian government “banned” the ability of hospitals to go on bypass, regardless of the number of patients in the emergency department. Now “critical congestion within ERs has become the norm.”
The author notes that “The problem is not the hospitals – the problem is the system.”
I think we’re kidding ourselves if we believe our emergency medical system will somehow become “better” if health care is nationalized.
Posted in Access to Care, Funding Crisis, Policy | 22 Comments »
Thursday, February 26th, 2009
Reading through a patient’s old records and came across the following entry:
Holy Deep Chill, Batman … taking antibiotics for the flu just might turn you into … into … Mr. Freeze.
Then you might get elected governor of a state and … well … I’ll let you all have fun in the comments section with the conclusions you can draw.
By the way, antibiotics don’t work for viruses … including the influenza virus.
Posted in Funny, Health | 8 Comments »
Wednesday, February 25th, 2009
I wasn’t able to watch President Obama’s speech last evening.
I did read it at Politico.com, though, and I have hope in him that he can pull our country through this giant morass that we are in.
The part of his speech relating to health care is below.
For that same reason, we must also address the crushing cost of health care.
This is a cost that now causes a bankruptcy in America every thirty seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. In the last eight years, premiums have grown four times faster than wages. And in each of these years, one million more Americans have lost their health insurance. It is one of the major reasons why small businesses close their doors and corporations ship jobs overseas. And it’s one of the largest and fastest-growing parts of our budget.
Given these facts, we can no longer afford to put health care reform on hold.
Already, we have done more to advance the cause of health care reform in the last thirty days than we have in the last decade. When it was days old, this Congress passed a law to provide and protect health insurance for eleven million American children whose parents work full-time. Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives. It will launch a new effort to conquer a disease that has touched the life of nearly every American by seeking a cure for cancer in our time. And it makes the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control.
This budget builds on these reforms. It includes an historic commitment to comprehensive health care reform – a down-payment on the principle that we must have quality, affordable health care for every American. It’s a commitment that’s paid for in part by efficiencies in our system that are long overdue. And it’s a step we must take if we hope to bring down our deficit in the years to come.
Now, there will be many different opinions and ideas about how to achieve reform, and that is why I’m bringing together businesses and workers, doctors and health care providers, Democrats and Republicans to begin work on this issue next week.
I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.
The gist of President Obama’s plan is to provide comprehensive health care for everyone (i.e. “open access” to health care) while reigning in costs. We’re going to spend more money to implement electronic medical records, to find a cure for cancer, and to invest in preventative care.
These are all laudable goals, but a system with increased expenses and decreased costs is difficult or impossible to attain without significantly affecting access to care and quality of care.
Want to take a bite out of cancer deaths? The cancer caused by smoking cigarettes kills a quarter of a million people each year. Put a $10 “advance health care tax” on every pack of cigarettes sold to pay for future health care costs. That will cut down dramatically on smoking and will increase funding for future smoking-related cancer cases.
Electronic medical records will help in the administration of health care, but only if the records are universal, complete, and easily accessible. No health care provider is going to spend tens of thousands of dollars to implement an electronic medical records system when there is no unified records system and when the return on the investment amounts to decreased productivity and increased costs. Kevin MD has posted a lot of information on this problem. Read more about his posts here.
The thing about President Obama’s speech that worries me the most goes back to the Engineer’s Triangle.
There is a dynamic tension between quality medical care, timely medical care, and free medical care.
If the government is going to make medical care free or low cost, that leaves two other variables in the equation.
Are we going to settle for free and timely care and take a hit in quality?
Or are we going to get free and quality care that will be difficult to access?
I’m betting on the second option – one in which care in this country will become time-rationed like in every other socialized medical system. It won’t be that you can’t have the medical care, it’s just that you may die waiting to receive it because so many other people are also in line to get the same free care. After all, we only have “limited resources” and we have to contain costs, you know.
Much of the medical care that some take for granted now, such as expensive lifesaving drugs and expensive end-of-life care, will become unavailable.
Not sure how I feel about this one. I think that our nation wastes exorbitant amounts of money on expensive care that has little or no effect on patient outcomes. That money could be put to much better use by providing primary care services to patients who cannot afford and currently have no access to it.
I’m just concerned that the pendulum is going to swing too far in the other direction and that increasing amounts of expensive but reasonable treatment will also be curtailed to cut costs.
Posted in Access to Care, Funding Crisis, News Commentary, Policy | 17 Comments »
Wednesday, February 25th, 2009
 The University of Chicago case is getting a lot of press and is polarizing the people on either side of the argument about Dontae Adams’ care.
Read about it at one of my previous posts, at ShadowFax’s place, over at Kevin’s blog, or at Scalpel’s blog. The Chicago Tribune is getting a lot of play out of the controversy. It has published several articles already and just put up another one last night.
Just by the sheer number of people writing about the topic, you should be able to tell that the outcome of this topic is going to help define how medical care will be provided in the future.
On one side of this issue is Dontae Adams and his mother.
Dontae happened to be in the wrong place at the wrong time. He was bitten in the mouth by a pit bull and had a large cut on his lip. It is obvious that he needed medical care. Dontae’s mother took him to the emergency department at the University of Chicago where she alleges that they began asking her about their insurance soon after they arrived. Dontae’s mom works and he has medical coverage through the Illinois Medicare program.
Stop here for a minute.
If you read through the comment boards at the Chicago Tribune web site, they are rife with people who criticize indigent/uninsured patients who may or may not be citizens of this country for “clogging up the emergency department” by going there for “routine” care. It’s easy to look down on someone is viewed as “abusing the system.”
So let me ask you this: Suppose you lost your job tomorrow and had no insurance. Suppose you had to take a minimum wage job at WalMart to keep food on the table for your kids and you weren’t eligible for health insurance. What would you do for medical care?
If you called a random doctor’s office and told them you needed an appointment for “routine” care and could only pay a small amount of cash, what are the chances that you’d get seen that same day? What are the chances that you’d be seen at all? Our family has good insurance, my daughter needs to see a specialist, and the earliest appointment is 4 months away.
Let’s say you’re living on a fixed income and want to pay for your doctor’s visits in cash. How can you afford to spend well over a hundred dollars for a single doctor’s office visit?
Ah, but there are free clinics all over the place, right? In the rural hospital where I moonlight, the closest free clinic is about 40 miles away and has very strict criteria on who it will treat at no cost. Cook County, IL, where the University of Chicago is located, is in the midst of a budget crunch and has closed down many free clinics. See articles HERE, HERE, and HERE.
There’s also an issue of whether or not the care some people seek in the emergency department is “necessary.” Clearly, much of the care that emergency physicians provide is not “emergent.” But I can say that because I have had eight years of medical training plus all the continuing medical education each year. Going to the emergency department to get an excuse for missing work, or trying to get a three day government-paid babysitter for grandma so you can leave on a trip is one thing, but in general, we have to give the benefit of the doubt to the patients.
Back to Dontae.
According to federal EMTALA laws, patients must receive a medical screening examination when they present to an emergency department seeking care. If an emergency medical condition is found, the condition must be stabilized or the patient must be transferred. If no emergency medical condition exists, the hospital’s duty under EMTALA ends.
From what I’ve read in the newspapers, according to EMTALA, Dontae’s injury was not an “emergency medical condition,” so the University of Chicago did not have a legal duty to treat Dontae once the emergency physicians determined that no emergency medical condition existed.
Now let’s look at things from the other side of the coin: Outside of federal EMTALA laws, what services should hospitals and physicians be “required” to provide?
Some believe that medical providers should be on the hook for everything. Expand EMTALA laws to require that patients receive everything they ask for. We need to provide for all of a patient’s needs. Whether it’s cardiac stents, kidney dialysis, Vicodin prescriptions, Lasik surgery, hair plugs, or a sex change operation, all medical care should be free to everyone. Sound silly? That’s the way our system is headed. If you think that some things should be free, but others should not, then you’re engaging in the same thought process that the University of Chicago used when it discharged Dontae Adams. Where ever you draw the line between free and not free, someone who would have to pay is going to criticize you for your decision.
That “free care” medical system is akin to expecting government to provide services with no one paying income taxes, expecting cities to provide services without anyone paying property taxes, expecting newspapers to run all of your advertisements for free (and to be delivered for free, too), or expecting professional medical societies to stay solvent without charging membership fees.
If we head down the free-for-all route in medicine, then why have insurance? If hospitals are required to provide all services to everyone regardless of the ability to pay, there’s no need to have any insurance. Hospitals can’t refuse care and all we have to do is show up at the front door to have access to the latest and greatest medical technology.
That’s a great idea, except for one problem: Who’s paying for it?
Medical care isn’t cheap. Government reimbursements for medical care are shrinking or nonexistent. New York pays a whopping $17.50 to physicians who provide lifesaving care to patients in the emergency department. California’s whole medical system is in shambles. Very few patients can afford huge medical bills. That leaves the physicians and hospitals holding the bag.
A “provide everything” approach becomes a system where hospitals and doctors are essentially paying for patients to come and receive medical care. That type of system is unsustainable. Providers have gone and will continue to go bankrupt. In addition, the more we lessen the incentive to go into medicine, the less physicians we will have. Who will want to spend twelve years of their life for medical education and take out several hundred thousand dollars in loans just so that they can provide unreimbursed care to anyone that demands it?
Do an internet search about hospital closings. Here’s a list of 50 hospitals that have closed in Illinois since 1980. Here’s another example of a hospital closure this month in Queens, NY. Is the University of Medicine and Dentistry in New Jersey next?
Where do we draw the line between care that must be provided and care that doesn’t have to be provided?
The line is already there. We just have to stop trying to redefine it.
The more we try to force medical providers to provide comprehensive free care for everyone, the closer we get to a system in which fewer and fewer patients have access to any care.
Posted in Access to Care, CMS, Funding Crisis, Health, Insurance, Medicare, Policy | 14 Comments »
Tuesday, February 24th, 2009
We got into an argument with our 5 year old daughter last night about trying the new dish that my wife prepared for dinner.
The dish contained onions and Daughter WhiteCoat didn’t know what they were, so she picked them out of the meal and set them on the side of the plate.
We asked her to try one.
She asked us what they were.
We told her.
She began crying.
“Honey, just try one. That’s all we’re asking. You just might like them.”
She bawled even harder.
“What is wrong with you?”
[Between sniffles] “I heard that they’re bad for your eyes.”
Dinner ended early because we couldn’t stop laughing.
Posted in Random Thoughts | 7 Comments »
Monday, February 23rd, 2009
 It isn’t just the patients who think I’m a bad doctor.
Based on the information from all the pinheads at Medicare’s “HospitalCompare” web site, I’m downright dangerous.
For those who don’t know about Hospital Compare, it is a site where the general public can compare the “quality indicators” for hospitals on measures deemed important by the AHRQ.
I failed to meet a couple of indicators recently, so I received notices from our hospital administration that I am now considered out of compliance with the HospitalCompare guidelines and am bringing down our numbers on the HospitalCompare.gov web site.
In other words, Medicare thinks I’m a bad doctor.
Let me tell you about the patients I screwed up on.
The first patient was a gentleman in his 70′s who started having chest pain at home. He got sweaty, passed out, and hit his head on the concrete floor in his house, causing a nice goose egg on the back of his noggin. When he arrived in the emergency department, he was still having chest pain, so we hooked him up to an EKG and … lo and behold … he was having a myocardial infarction.
According to the quality indicators at “HospitalCompare”, if a patient with a heart attack is going to receive thrombolytics (“clot busters”), the thrombolytics must be given within 30 minutes of the patient’s arrival at the hospital. If a health care provider takes longer than 30 minutes to administer thrombolytics to someone with a heart attack, the government considers that provider to be practicing bad medicine.
Now I’m faced with a choice:
A. Do I give clot busters to someone who sustained a significant head injury (and may be bleeding internally) so that I can look like a “good doctor” to Medicare and HospitalCompare.hhs.gov? If there is bleeding inside his brain, clot buster medications will make the bleeding worse and could kill him.
-OR-
B. Do I perform a CT scan on the patient to make sure that there is no bleeding inside his brain before I give the clot-buster medications? If I do the CT scan, there is no way that we’ll get the results and be able to give the patient thrombolytics within the 30 minute window.
If I choose “A,” the hospital stays in the upper echelon of facilities that meet HospitalCompare.hhs.gov‘s guidelines. Doesn’t matter if the patient dies – according to Medicare, “We’re Number ONE!”
If I choose “B” I’m doing what is right for the patient, but our hospital will look bad and HospitalCompare.hhs.gov will plaster it all over the internet that our hospital doesn’t follow Medicare’s rigid and sometimes life-threatening guidelines.
I chose “B.”
According to HospitalCompare.hhs.gov, my decision made me a bad doctor.
The second patient was an elderly lady who came to the hospital with leg pain and weakness. She was in a lot of pain. We did some testing and she ended up having a blown disc in her back that was pressing on a nerve root. She was admitted and had surgery. Five days after she was admitted, she ended up having a heart attack while she was recuperating on the medical floor.
According to the quality indicators at “HospitalCompare”, if a patient has a heart attack and does not have contraindications to receiving aspirin or beta blockers, the patient must receive aspirin and beta blockers within 24 hours of their arrival in the hospital.
The brainiacs at Medicare who run this HospitalCompare site expect that I put on my Amazing Kreskin glasses, bust out the crystal ball, and predict with 100% certainty which patients I admit will later have a heart attack while in the hospital. A patient might get admitted for an infected hangnail. If the patient later has a heart attack and I didn’t give aspirin and beta blockers or document a contraindication to those medications, CMS considers me a bad doctor.
(Note: The “beta blocker on arrival” metric has since been dropped from the list of current measures – the first of several indicators that CMS apparently is admitting it was wrong about. However, the aspirin on arrival metric still exists and is calculated in the same retrospective fashion)
By looking out for my patients and by failing to be a prophet, I’m a bad doctor.
So be it.
Add these to the reasons why so many doctors and nurses are getting fed up and leaving medicine … at a time when more doctors and nurses are needed to care for sick Americans.
If you believe all of the information on the HospitalCompare.hhs.gov web site, you deserve what happens to you.
Maybe you’ll get lucky and have a “good” doctor who treats your heart attack and head injury the “right way”.
Posted in CMS, Medicare | 38 Comments »
Friday, February 20th, 2009
I had three different patients infer that I was a bad doctor in one day. I’m starting to get a complex.
Oh well, at least none of them spoke in Baby Talk.
First was a patient who was 16 years old who had an aphthous ulcer (“canker sore”) in her mouth. Looks painful. Try Anbesol. Oh, the Anbesol didn’t work? Use Tincture of Benzoin to cover the ulcers and they aren’t as painful. What’s that? You need a note for missing school for the past 4 days?
“OK, what should I write as the medical reason that you weren’t able to make it to school?”
[With the eye roll] “Because I’ve been crying my eyes out in pain for 4 straight days, duh.”
“Unfortunately, I can’t write ‘crying your eyes out’ as an excuse for missing school.”
Mom and painstricken teen glanced at each other.
Then mom gathered up their things and said “Come on, honey, we’ll go to Metro Satellite Hospital and get a note. The doctors are better over there, anyway.”
Then was the mom who brought her child in after being bitten by a dog. The child had a small cut of about 1 cm on the side of his face that needed closing. The mom made it clear on several occasions that she “was studying to be a nurse.”
Before I even said “hello,” the mom said “I want him put out for this and I want a plastic surgeon to close this wound.”
“I don’t think you’ll find anyone willing to take the risk of putting your son under general anesthesia to repair a half-inch cut on his cheek. I’ll go call the plastic surgeon to see if he is available to fix it, though.”
Grandmother was in the room when I came back. I told her that the plastic surgeon was unable to come to the hospital that evening, but that he would see her son in his office in the morning and would close the wound then.
“How is he going to put him to sleep in a doctor’s office?” the mom asked.
“He isn’t,” I told her.
Grandmother chimes in “they’re just not doing these things here because they aren’t qualified.”
They left the ED and called administration to complain about me later in the day.
Finally was the man in his 70′s who had been falling … for 3 years. He had seen multiple neurologists and had been evaluated multiple times for the same symptoms. Because all doctors are dimwits who earn their money by testing and not by diagnosing, there was no official reason why the patient continued to fall. His latest round of radiation (CT scans) and laboratory testing were performed two weeks prior and showed nothing. Several doctors had recommended that he use a walker … which he refused to do. He also refused to go to a nursing home.
The patient fell again that evening, so his wife brought him in to be evaluated by me for the 27th “second opinion” of the cause of the patient’s falls.
I didn’t find anything different from the exams documented on him previously, and I didn’t see the need to engage in insanity by ordering another round of radiation and blood tests, so I told the patient and his wife that I planned to send him home.
“I want him admitted for a couple of days,” she stated matter-of-factly.
“OK, what is it that we’re going to do for him while he’s in the hospital?” I asked.
“Just watch him so he doesn’t fall.”
“You said he fell because he wasn’t using his walker. You want him admitted so the nurses can make sure he uses his walker?”
“I want him admitted anyway.”
“What’s going to happen after a ‘couple of days’ in the hospital?”
“I want him admitted.”
“If he wants to go to a nursing home, we can try to admit him to satisfy Medicare’s rules. However, you’ll have to sign a form stating you’re aware that Medicare might not pay for the hospitalization and that you will agree to pay for the stay yourself if Medicare does not do so. Or, he can stay on our extended care facility at a reduced rate if you’d like.”
She scowled at me and said “You’re not a very good doctor.”
The specter of a monetary outlay for one’s medical care had an effect on her desires, though. She took her husband back home, warning me that “he better not fall again” as the nurse wheeled the patient out to the car.
Sorry, lady.
Maybe you can form a support group with Canker Sore Girl and Gramma Dog Bite.
Posted in Patient Encounters | 34 Comments »
Thursday, February 19th, 2009
I shook my head as I read the article “Medial misdiagnosis: The right to treat patients unfairly” by Nikki Weingartner.
I agree with the author. Medical misdiagnosis undoubtedly exists. The problem with her article is that it raises an issue, creates critiques that are unwarranted, and then proposes no solution.
She briefly mentions the training that physicians must go through in order to get their MD degree so that they can “brandish their pride and prejudice,” and, in some cases “boast[] an undertone of arrogance.” Then she states that professionals who are paid, on average, $150,000 per year are paid not to find a correct diagnosis, but rather to “perform exams, assess symptoms, write prescriptions, … and, if necessary, perform surgery.”
If you want to criticize physician salaries, read this article by Mike Royko first.
And there is a saying in medicine that “surgeons heal by cutting.” You just take your tirade a little too far.
Ms. Weingartner criticizes physicians for missing a case of lymphoma when a woman complained of night sweats, then in the same paragraph, she states that lab errors “give physicians a tool to proceed with sometimes deadly consequences.” Lymphoma can’t be diagnosed without lab tests, ma’am. Which should we choose?
Then she discusses how the symptoms of TIA, panic attacks, heart attacks, cerebral aneurysms, and status migrainosis can apparently all be similar, warning that “to mistake one for another could prove fatal.”
Obviously Ms. Weingartner must have the inside track on how to be 100% accurate in diagnosing vague symptoms. You’ve blown our cover. Now everyone knows that I and most other doctors are just overpaid dimwits. So give it up. Tell me how to diagnose TIAs, panic attacks, heart attacks, cerebral aneurysms, and “status migrainosis” with 100% accuracy in each and every case. Save us from ourselves.
I agree with you on one point: Doctors can do better. But we can’t do better by being forced to see more patients in a shorter amount of time with less reimbursements.
The New York Times article you quoted has a quote from Mark McClellan: “You get what you pay for … and we ought to be paying for better quality.”
Your article makes it appear that you are one of the many people in this country who demand perfection from an inexact science.
How much are you willing to pay for it?
Posted in News Commentary | 8 Comments »
Wednesday, February 18th, 2009
 If you haven’t learned yet, I can’t stand cell phones.
Yes, they have their place in society. But when people gab on them 24/7 and get arthritis in their thumbs from texting, the cell phones are being misused. Talking on a cell phone when I’m in a room is cause for me to leave immediately and see several other patients before I return. If you’re well enough to be gabbing on your cell phone, your severity of illness scale just dropped precipitously.
And … you’re cruising for a bruising if you call it the “Emergency Room” instead of the “Emergency Department” around me. Just ask Nurse K.
So here’s pet peeve #3 of mine:
A mother brought an 8 month old child into the Emergency Department last night with a cough and a fever of 103.8. Now the temperature is up there, but the kid looked OK. We had also seen about 6 other kids that day suffering from the same symptoms and they all had negative workups.
The grandmother was tagging behind mom and baby. And she just happened to be fluent in Baby Talk.
Baby talk to me is like fingernails on a chalkboard. No, it’s worse than fingernails on a chalk board. Literally, my BP shoots up about 50 mmHg when I hear it. If I’m ever in a full arrest, just talk baby talk in my ears. You won’t need the defibrillator. I’ll jump off the bed and go postal on you. My kids know that if I ever even see this Sesame Street “Baby Bear” character on the TV or on the computer, they’ll be grounded … for life.
As I walk into the patient’s room, I hear grandma saying “Ooooh my dood wittwle beeby. We’re donna make you awwwww bettew.”
Her emphasis on the “awwww” sent chills down my spine. In fact, it is giving me a visceral reaction right now as I type it.
“What’s the problem tonight?” I ask.
Grandma blurts out “Our wittwle duy isn’t feewin vewwy good. He had a fevew.”
I grit my teeth and think to myself “I’m sorry, Mrs. Fudd … I didn’t understand you.”
Instead, I ask “So how high was his fever?”
“It was vewwy vawwwy high.”
“Excuse me?” I said as I cocked my head to the side and squinted.
The mom interrupted. “It was 103 at home.”
So I examined him and we did the routine screening stuff … just to make sure.
Everything came back normal and it appeared to be another one of the viral fevers we had seen that night. I gave everyone the discussion about how the “fever isn’t the enemy”, gave them the proper dosing for Motrin, and had them follow up with their pediatrician in a day or two.
A few hours later, we heard an ambulance call go out for a febrile infant.
Shortly afterwards, the same little boy comes rolling by on the ambulance stretcher with mom walking briskly right behind them.
I followed them into the room as mom explained that grandma called the ambulance because the temperature hadn’t gone down and grandma was afraid that the baby would have a seizure.
Grandma came up to the security desk and started ringing the bell like it was the close of trading for the stock market. The security guard let her back without asking anyone.
She ran back searching for Baby Bear’s room, and I could see her through a crack in the curtains as she zeroed in on the paramedics walking out of the room. She busted into the room asking if “everything was alright.”
“Yes, she appears fine,” I told her.
Then she did it.
The Trifecta.
She gets on her cell phone while I’m listening to the kid’s chest and loudly says “We’re back in the emergency room with the baby. I’ll call you when I know more.” Then she gets down in the baby’s face and says “Dis time the dowctor is dunna take bettew cawe of you.”
I thought my damn head was going to explode.
“Ma’am, you’re going to have to wait out in the waiting room. When the emergency department is busy like this, it’s our policy to limit patients to one visitor at a time.”
“But …”
“I’m sorry … but mom is here with him.”
She walked out in a huff.
After she left, the baby’s mom looked at me and said “I know what you’re thinking. She bothers me sometimes, too.”
I gave mom half a smile and a blank stare.
I was still recovering from the spinal shock of that whole Trifecta thing.
Posted in Patient Encounters | 19 Comments »
|
|
Obama’s Speech – Healthcare Reform
Wednesday, February 25th, 2009I wasn’t able to watch President Obama’s speech last evening.
I did read it at Politico.com, though, and I have hope in him that he can pull our country through this giant morass that we are in.
The part of his speech relating to health care is below.
The gist of President Obama’s plan is to provide comprehensive health care for everyone (i.e. “open access” to health care) while reigning in costs. We’re going to spend more money to implement electronic medical records, to find a cure for cancer, and to invest in preventative care.
These are all laudable goals, but a system with increased expenses and decreased costs is difficult or impossible to attain without significantly affecting access to care and quality of care.
Want to take a bite out of cancer deaths? The cancer caused by smoking cigarettes kills a quarter of a million people each year. Put a $10 “advance health care tax” on every pack of cigarettes sold to pay for future health care costs. That will cut down dramatically on smoking and will increase funding for future smoking-related cancer cases.
Electronic medical records will help in the administration of health care, but only if the records are universal, complete, and easily accessible. No health care provider is going to spend tens of thousands of dollars to implement an electronic medical records system when there is no unified records system and when the return on the investment amounts to decreased productivity and increased costs. Kevin MD has posted a lot of information on this problem. Read more about his posts here.
The thing about President Obama’s speech that worries me the most goes back to the Engineer’s Triangle.
There is a dynamic tension between quality medical care, timely medical care, and free medical care.
If the government is going to make medical care free or low cost, that leaves two other variables in the equation.
Are we going to settle for free and timely care and take a hit in quality?
Or are we going to get free and quality care that will be difficult to access?
I’m betting on the second option – one in which care in this country will become time-rationed like in every other socialized medical system. It won’t be that you can’t have the medical care, it’s just that you may die waiting to receive it because so many other people are also in line to get the same free care. After all, we only have “limited resources” and we have to contain costs, you know.
Much of the medical care that some take for granted now, such as expensive lifesaving drugs and expensive end-of-life care, will become unavailable.
Not sure how I feel about this one. I think that our nation wastes exorbitant amounts of money on expensive care that has little or no effect on patient outcomes. That money could be put to much better use by providing primary care services to patients who cannot afford and currently have no access to it.
I’m just concerned that the pendulum is going to swing too far in the other direction and that increasing amounts of expensive but reasonable treatment will also be curtailed to cut costs.
Posted in Access to Care, Funding Crisis, News Commentary, Policy | 17 Comments »