Public Health & Policy

Stossel on health care

Taking a view against universal insurance:

Anyway, insurance is a terrible way to pay for things. It burdens us with paperwork, invites cheating and, worst of all, creates a moral hazard that distorts incentives. It raises costs by insulating consumers from medicine’s real prices.

Suppose you had grocery insurance. With your employer paying 80 percent of the bill, you would fill the cart with lobster and filet mignon. Everything …

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Texas, liability caps, and the influx of physicians

Maybe Florida can learn something:

Texas today is licensing an average of 400 more doctors per year than before reform. The Texas Medical Board expects a record 4,100 new applications for physician licenses this year — 38 percent more than last year, which was the previous record!

The number of medical specialists is growing rapidly. Since reform, Texas has gained 146 obstetricians, 127 orthopaedic surgeons and …

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How NY state law will prevent universal HIV testing

Again, problems can be traced down to the reimbursement system:

Dr. Frieden and others argue that doctors cannot or will not take the time to take all the steps required by New York law to test their patients. “They have a huge number of things that they’re supposed to cover,” he said, while pressure from insurers to see more patients means that “they’re scrunching down to seven or eight …

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A controversial new head of the Canadian Medical Association

He makes no qualms about a two-tiered system in Canada:

In the past, he has compared Canada’s medicare system to that of North Korea. He’s also said that the universal nature of Canada’s medicare system is fundamentally unfair and that those Canadians who are better off should have to pay privately.

At his Cambie Surgery Centre in Vancouver, he services medicare patients. But he also openly lets those who …

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How liability is barrier for disaster physicians

There is sensible talk about including disaster physicians in the Federal Tort Claims Act:

Another option might be to waive medical liability altogether for doctors who treat disaster victims, she said. A similar policy was included in a medical tort reform bill that died in the senate earlier this year, which would have insulated doctors from liability for treating indigent patients.

However, Crawley was skeptical whether a …

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News flash: Defensive medicine exists

The Lancet writes about what doctors already know (if someone can e-mail me the full-text article, I’d appreciate it):

The pressure on doctors from the malpractice liability system in the United States, Australia and United Kingdom may be limiting the quality of care they provide.

The common law tort system allows patients to collect when a doctor is careless or causes injury. Daniel P. Kessler, Ph.D., Professor of …

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The wonders of a universal EHR

It’s funny that we’re re-inventing the wheel, when a great EHR is functioning well at the VA:

The centerpiece of that culture is VistA, the VA’s much praised electronic medical-records system. Every office visit, prescription, and medical procedure is recorded in its database, allowing doctors and nurses to update themselves on a patient’s status with just a few keystrokes. In 1995, patient records at VA hospitals were available at …

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Why single-payer won’t work

From an editorial this past weekend:

A single-payer system would guarantee that health-care services need to be rationed to control costs. Affluent Americans would buy access to health-care services that would be out of reach to lower-income Americans. Reimbursements to providers will decrease because the government is controlling the purse strings, causing fewer physicians to practice and the quality of care to decline. Our tax burden will grow and both …

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Frist on the ER crisis

It all starts with liability reform:

To begin with, we must fix the broken medical liability system that drives doctors out of emergency room practice, increases costs, and contributes to wait times. Some opportunistic trial lawyers, quite simply, have converted our litigation system into a lottery that damages medical care for almost everyone. We should also build more community health centers to provide free or inexpensive care for the uninsured, …

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Health courts debated in the Senate

This is one plausible solution to malpractice reform that I’ve always supported. Dr. Charles writes more on a bill introducing health courts:

Our lawsuit culture is disgusting. Anyone who stands up to do anything of consequence in our society is at risk of being sued for it. Teachers, policemen, doctors, coaches, ministers – we’re generally trying to make the world a better place, but we’re all living in fear, …

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San Francisco unveils a universal healthcare plan

It’s based on employer mandates:

San Francisco, eager to put its own stamp on the health care debate, unveiled an ambitious plan Tuesday that would make it the first city in the nation to provide every uninsured resident with access to medical services.

When rolled out next year, the city’s 82,000 uninsured residents would become eligible for a wide array of benefits, regardless of employment or immigration status. The …

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"Jurors are poorly equipped to evaluate complicated medical care on its merits"

Makes sense:

A local attorney recently offered his opinion that health care tort reform is not needed. He appealed to the emotion of the reader with sad stories about alleged victims of medical malpractice.

Too often, it is the telling of a sad story, rather than actual malpractice, that plaintiff’s attorneys leverage to the financial gain of their clients and, of course, themselves.

Jurors are poorly equipped to …

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Obvious news of the day: ERs are overwhelmed

Yes, ERs are in crisis. A favorite topic here. A major part of the problem can be traced to poor primary care access and “defensive medicine”. Let me elaborate:

1) Lack of access
Lack of primary care incentives for medical students and providers = dwindling primary care access = patients going to the ER for “routine” or non-emergent care = ER overcrowding = eventual collapse. Simple.
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I love how the media is making David Studdert look like an idiot

I was reading this piece in the Boston Globe about a new malpractice proposal. Of course, Studdert’s malpractice findings are trotted out:

A study released by the Harvard School of Public Health earlier this month found that about 40 percent of the medical malpractice cases filed in the United States are groundless. Many of the lawsuits analyzed contained no evidence that a medical error was committed or that the …

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"How much does it cost?"

USA Today tries to get a straight answer and finds that it’s nearly impossible. The reason is because of the insurance companies:

USA TODAY’s story on the difficulties consumers encounter in getting information on health care prices leaves the impression that doctors are unwilling to disclose their prices. In truth, a typical doctor might have 20 or more prices for the same procedure “” because each insurer …

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Feedback on NEJM’s recent malpractice study

Some feedback on the recent NEJM study which showed that 40 percent of malpractice lawsuits were baseless, and 54 percent of compensation went to the lawyers.

The lead study author (who is a lawyer) concluded “[that the] malpractice system that is stricken with frivolous litigation are overblown”. To be honest, a 40 percent baseless lawsuit rate was much higher than I expected. If anything, the study …

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Matthew Holt is sad about the obsession with malpractice

He laments:

People, malpractice is one percent of the dollars, and it’s about 17th on the list of major health care problems and issues we face in this country! It’s the abortion issue of health care – polarizing way way beyond it’s importance.

Deal with it. With 40 percent of malpractice cases being baseless, there is certainly reason for the obsession with malpractice. When physicians let the …

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