Comments on: Healthcare Update 10-17-2009

By: 75 years of hospital records

75 years of hospital records — Mon, 02 Nov 2009 14:50:46 +0000

[...] Tampa: “When medical malpractice lawyer Michael J. Trentalange asked St. Joseph’s Hospital for every ‘adverse incident’ report made since the hospital opened in 1934, the hospital pushed back hard. In July, the hospital sued him, and Trentalange sued right back, the Web site Health News Florida reported.” (AP/Sarasota Herald Tribune via White Coat). [...]

By: DensityDuck

DensityDuck — Wed, 21 Oct 2009 15:58:08 +0000

Maybe the issue is not that people go to the ED for silly stuff, but that the GP’s office hourse are 9 AM to 4:30 PM. If I want to go see a GP, I have to take half the day off work. Thank God I’m in a profession where I can do that, but what about someone who works the day shift at McDonald’s?

I really doubt that people are going to the ED just to hang out. They’re going there because THEY DON’T HAVE ANOTHER TREATMENT OPTION. Why don’t hospitals have a “non-emergency 24-hour outpatient clinic”?

By: Max Kennerly

Max Kennerly — Mon, 19 Oct 2009 16:00:05 +0000

Your business model isn’t viable under free-market medicine. Chop out Medicare, Medicaid, and government subsidies and your hospital and ED need to cut back drastically, probably to the point that they can’t continue 24-hour coverage, particularly not for specialized services like trauma.

IMHO, that’s uncivilized. Civilized nations provide emergency care to every citizen who needs it.

But that’s beside the point: more importantly, whatever the merits of free-market rationing, it’s incompatible with the will of the voters. They want health care to be more accessible. They don’t want health care to be rationed the same way that Prada shoes are rationed.

As such, you need to tangle with the reality that “free market medicine” won’t be a reality.

In that reality, what kind of rationing do you propose? The author of that article suggests rationing unnecessary ED care; that’s all well and good, but it won’t make much of dent on the GDP, making it a cute, but meaningless, gesture.

By: Matt

Matt — Mon, 19 Oct 2009 14:21:57 +0000

And when do you think physicians will stop viewing medicine as a commodity and start pricing their own services accordingly?

By: Matt

Matt — Mon, 19 Oct 2009 14:15:02 +0000

So what are you physicians, the ones on the front lines who will be affected the most, doing to change the future you describe, and presumably do not want?

By: WhiteCoat

WhiteCoat — Mon, 19 Oct 2009 14:07:53 +0000

Any time that you tell a patient “no” or that outside forces make a test or treatment undesirable for a patient, care has been rationed.
We already are rationing care. The only thing that will change is how the care is rationed.
I have always been an advocate of free market medicine. I’m happy to see patients for whatever complaints they have. The problem (to borrow Happy Hospitalist’s maxim) is that “FREE = MORE”. You can’t apply free market rules if federal law forces you to provide your product at little or no cost. When half (or more) of your patients pay you 10% or less of your charges for providing care, the business model becomes unsustainable.
Goes back to my ELRALA post.
Rationing is occurring and will continue to occur. Just a matter of what type of rationing we will accept. Time rationed? You can’t have your surgery for another 18 months. You can’t see an endocrinologist for 10 months. Quality rationed? You have to go through 6 months of therapy before you get an MRI of your neck. Cost rationed? Insurance will only pay for a generic version of the medication you need – if you still want the medicine your doctor prescribed, it will cost you $400/month.
If we want to remain a bunch of cigarette-smoking, drunk driving, drug using, X-Box addicted, overeating lard-butted couch potatoes who then complain because no one can give us a pill to make everything better, we’re going to see the whole landscape change.
Look at how few graduating physicians are willing to go into primary care medicine. Government overregulation has made the specialty increasingly undesirable.
Quality care will soon be rationed by availability regardless of the price people are willing to pay. In some regions of the US, you can’t find a doctor to take care of you.
Some day people will stop viewing medical care as a commodity.

By: Max Kennerly

Max Kennerly — Mon, 19 Oct 2009 11:38:34 +0000

Unnecessary care probably does drive up costs to some extent, though eliminating it is unlikely to suddenly make health care a much smaller component of GDP. Though annoying to you folks, lame ER visits simply aren’t that big a component of health care costs.

The bigger problem with his argument is that it is, in essence, a plea for health care rationing, which seems to be the worst fear of most physicians.

So, should we ration care or not?

By: WhiteCoat

WhiteCoat — Mon, 19 Oct 2009 04:05:38 +0000

Left a note before, but apparently it was deleted somehow.
Thanks for the link. Nice article. I posted it above.

By: Max Kennerly

Max Kennerly — Mon, 19 Oct 2009 03:08:03 +0000

Philip Howard is right: >99% of all medical malpractice is caused by lawyers.

Wait, what?

By: Max Kennerly

Max Kennerly — Mon, 19 Oct 2009 03:06:48 +0000

Keep in mind: 100% of those attorney’s fees were due to the defendant, which first discriminated against the plaintiff and second refused to settle it.

It’s Obama’s fault that it took four years of bruising litigation to get the bank to admit it discriminated against the plaintiff and compensate her? Please.