Is it fair to ask a patient to pay $6 for emergency medical care? Or are patients entitled to free medical care whenever they need it? That’s the question Australian government officials are currently grappling with.
As the Australian health care unfolds, there are two lessons for Americans — one political and one philosophical.
I discuss how government-mandated electronic medical records are hampering doctors’ ability to practice and resulting in medical errors. I also discuss 4 concrete steps patients can take to protect themselves.
I didn’t mention this in the Forbes piece, but there was a terrific drawing in the Journal of the American Medical Association from a couple of years ago by a 7-year old girl depicting her recent doctor visit. Even young children understand the effect of electronic medical records on their care:
No one was more surprised than the physician himself. The drawing was unmistakable. It showed the artist — a 7-year-old girl — on the examining table. Her older sister was seated nearby in a chair, as was her mother, cradling her baby sister. The doctor sat staring at the computer, his back to the patient — and everyone else. All were smiling. The picture was carefully drawn with beautiful colors and details, and you couldn’t miss the message…
Do you trust your doctor? Most patients assume their doctor is working in their best medical interests whenever he or she orders a diagnostic test or recommends a particular treatment. Customers might wonder whether an unscrupulous auto mechanic is being truthful when he recommends a brake job or a new transmission. But most patients trust that their doctor isn’t recommending unnecessary surgeries merely to line his pockets.
The vast majority of doctors take their ethical responsibilities very seriously. Prior to ObamaCare, only a relatively few “bad apples” have chosen to compromise their professional ethics for financial gain. However, ObamaCare creates new ethical conflicts for doctors. We’ll examine some common physician conflicts of interest before and after ObamaCare, and discuss how patients can best protect themselves…
Prior to ObamaCare, physicians faced perverse incentives for overtreatment. Physicians might also be tempted to pad their income through inappropriate self-referral or business relationships such as “physician owned distributorships”.
After ObamaCare, physicians will face perverse incentives for undertreatment, especially with “bundled payments” and government “appropriate use criteria”. The new “narrow networks” required by many ObamaCare exchange plans will exacerbate these issues:
To cut costs, many ObamaCare exchange plans also require “narrow networks” of providers, where patients may only receive treatment from a short list of approved hospitals and doctors. President Obama has repeatedly promised, “If you like your doctor, you can keep your doctor,” but many patients are learning the hard way that this isn’t true.
Such “narrow networks” also mean that many doctors will lose long-standing relationships with patients they’ve seen for years. Instead, doctors will be increasingly reliant on the government-run exchanges for new patients. This will create a powerful incentive for physicians to adhere to any treatment guidelines mandated by the government or by government-approved insurance plans.
I also discuss several ways patients can protect themselves from these old and new physician conflicts of interest.
My basic theme is that we need to legalize real “catastrophic-only” insurance, free of government mandates. More broadly, instead of debating which new government entitlements to create, we should be vigorously debating which freedoms to restore.
Here is the opening:
The President has proposed a one-year “fix” to deal with the political fallout from his broken promise (or lie), “If you like your insurance plan, you will keep it.” Now it’s, “If you like your plan, you can keep it until after the 2014 mid-term elections. Maybe.”
But the problems with ObamaCare go much deeper than cancelled insurance. As surprising as it sounds, most Americans never had real health insurance to begin with — and were not allowed to by law. And the only cure for our current health insurance mess is to legalize real health insurance…
I discuss the history of how we got into our current mess and some concrete free-market reforms that would move us in the right direction. These include:
1. Eliminate the tax disparity between employer-provided health insurance and individually-purchased health insurance.
2. Eliminate all mandated benefits. Insurers should be free to offer to willing consumers inexpensive policies covering only catastrophic accidents and illnesses.
3. Allow insurers to sell policies across state lines.
Eliminate the tax disparity between employer-provided health insurance and individually-purchased health insurance. This would uncouple health insurance from employment and restore a level playing field to the individual insurance market. Individuals could then purchase policies that they kept even when they changed jobs (just as they already do with their car and homeowners insurance).
Eliminate all mandated benefits. Insurers should be free to offer to willing consumers inexpensive policies covering only catastrophic accidents and illnesses. Insurers would remain free to offer richer policies that covered varying levels of elective procedures (but cost correspondingly more). Customers could purchase whatever levels of coverage they wished from willing insurers based on their own individual needs and circumstances.
Allow insurers to sell policies across state lines. State mandates create 50 separate state markets rather than a single national market. A family insurance plan costing $3,000 in Wisconsin might cost $10,000 in New Jersey because of state regulatory barriers. Allowing interstate competition would quickly drive down prices and help many working families on a tight budget.
I hope Congress can discuss and debate these ideas as a way to truly fix our health care system.
My basic theme is that we must protect the freedoms necessary for the advancement of medical technology.
I start with a pair of vignettes:
How much has American medicine changed in the past 30 years?
Let’s turn the clock back to 1983. A middle-aged man, Dan, is crossing the street on a busy midday Monday. An inattentive driver runs a red light and plows into Dan at 45 mph, sending him flying across the pavement. Bystanders immediately call for help. An ambulance rushes Dan to the nearest hospital. In the ER, the doctors can’t stabilize his falling blood pressure. They prep him for emergency surgery. The trauma surgeon tries desperately to stop the internal bleeding from his badly fractured pelvis but is unsuccessful. Dan dies on the operating table.
The surgeon gives Dan’s wife the sad news: “I’m sorry, but your husband’s injuries were too severe. We did everything we could. But we weren’t able to save him.”
Fast forward to 2013. Dan’s now-grown son Don suffers the same accident. But within minutes of his arrival in the ER, he’s sent for a rapid trauma body CT scan that shows the extent of the pelvic fractures — and more importantly, shows two badly torn blood vessels that can’t be easily reached with surgery.
An interventional radiologist inserts a catheter into the femoral artery in Don’s right leg. Watching live on the fluoroscopy screen, the radiologist skillfully guides the catheter through the various twists and turns of the arterial system and positions it at the first of the two “bleeders.” From within the blood vessel, he injects specially designed “microcoils” into the torn artery and stops the bleeding. He then guides the catheter to the second bleeder and repeats the procedure. Don’s blood pressure recovers. The surgeons now have time to repair Don’s pelvic fractures and other internal injuries.
The surgeons give Don’s wife the good news: “Your husband’s injuries were pretty bad. But we were able to fix everything. He’ll still have to go through recovery and physical therapy. But he should be back to normal in six months”…
Update #1: A great example of medical innovation coming from unexpected places was this 11/14/2013 New York Times article describing how an Argentinian car mechanic saw a Youtube video on how to extract a stuck cork from a wine bottle and realized it could also be used to help extract babies stuck in the birth canal.
His idea will be manufactured by Becton, Dickinson and Company and has already undergone initial successful safety testing in humans. It could save the lives of many babies in Third World countries and also reduce the need for Caesarean section in industralized countries. (Via Gus Van Horn.)
Update #2: For those interested in the real-life technology used in the fictional scenario I discussed, here’s a nice medical slideshow from UCLA interventional radiologist Dr. Justin McWilliams, “Life-saving Embolizations: Trauma and GI bleeding“.
The basic theme: Don’t piss on my back and tell me it’s raining.
Here is the opening:
Many years ago, the writer Ayn Rand noticed a curious kind of backpedalling from the political Left. First, they’d claim that socialism would provide enough shoes for the whole world. But when economic reality caught up with them, and they failed to deliver on their promises, they’d turn around and claim that going barefoot was superior to wearing shoes. In modern parlance, those broken promises weren’t a bug, but a feature!
In the past few weeks, we’ve seen precisely this pattern coming from defenders of ObamaCare. For example…
The federal government wants to reduce the number of Americans diagnosed each year with cancer. But not by better preventive care or healthier living. Instead, the government wants to redefine the term “cancer” so that fewer conditions qualify as a true cancer. What does this mean for ordinary Americans — and should we be concerned?…
I discuss the reasons behind the proposed redefinition, why it could matter from a political (as well as medical) standpoint, and implications for patients and doctors.
The first article of this series described how the ObamaCare law is fueling the rise of government-controlled Big Medicine. This second article will take a closer look at how Big Medicine will control how what medical care patients can receive.
I discuss how government controls over health spending will lead to controls on the health care you may be able to receive. These controls interpose the government between the doctor and the patient, endangering the doctor-patient relationship.