The Moral Healthcare Blog – Page 27 – Healthcare, health policy, cognitive science. , and the path to Universal Healthcare..

Down the Insurance Rabbit Hole – NYTimes.com

Down the Insurance Rabbit Hole – NYTimes.com:

Justice Antonin Scalia subsequently expressed skepticism about forcing the young to buy insurance: “When they think they have a substantial risk of incurring high medical bills, they’ll buy insurance, like the rest of us.”

May the justices please meet my sister-in-law. On Feb. 8, she was a healthy 32-year-old, who was seven and a half months pregnant with her first baby. On Feb. 9, she was a quadriplegic, paralyzed from the chest down by a car accident that damaged her spine. Miraculously, the baby, born by emergency C-section, is healthy.

Were the Obama health care reforms already in place, my brother and sister-in-law’s situation — insurance-wise and financially — would be far less dire.

But, if Republicans have their way, even this is in danger, from Matther Yglesias via Slate:

“I’m not concerned with the very poor. We have a safety net there,” Romney told CNN. “If it needs repair, I’ll fix it.”

There’s a certain logic to that position. Except that if you read Romney’s policy agenda what he appears to think about the social safety net for the poor is that it should be drastically curtailed. He proposes the following five points:

Immediately cut nonsecurity discretionary spending by 5 percent.

Reform and restructure Medicaid as block grant to states.

Align wages and benefits of government workers with market rates.

Reduce federal workforce by 10 percent via attrition.

Undertake fundamental restructuring of government programs and services.

In other words he wants to cut the safety net, cut the health care part of the safety net, muck around with the federal workforce, and then cut the non-health care part of the safety net. To further clarify, he states that he “will immediately move to cut spending and cap it at 20 percent of GDP” while increasing defense spending. Which is to say he wants to cut social safety net spending. What’s more “as spending comes under control, he will pursue further cuts that would allow caps to be set even lower so as to guarantee future fiscal stability,” thus cutting social safety net spending even further.

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Medical Progress Today: A Two-Year Look Back at PPACA – Why it’s Dangerous to Our Health

A Two-Year Look Back at PPACA – Why it’s Dangerous to Our Health
So bad it’s good! This amazing piece, apparently from the Department of Obtusity at the Manhattan Institute, takes a stab at criticizing PPACA. Big fail. Trying to finish up my semester here, so I will try to get back to this soon and deconstruct it, but I needed to leave a bookmark to remind me to do it. Enjoy.

How Dr. Emanuel and others think it is the responsibility of the taxpayer to pay for industry errors is beyond comprehension. If this was a pharmaceutical error, or medical device error, my guess is that the CEO of the offending companies would be hauled before Congress and affected families and patients would be called to testify against them – just like Congress did with Toyota.

Aha! Maybe that’s it. Maybe the issue is that these hospitals have a designation of “not-for-profit.” So in some people’s distorted view of the world, maybe they can do no wrong, and for-profit business enterprises can do no right. If this line of thinking is out there, then no amount of regulation will make us safe.

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Guest column: End is near for independent oncology, cardiology practices | Green Bay Press Gazette | greenbaypressgazette.com

Guest column: End is near for independent oncology, cardiology practices | Green Bay Press Gazette | greenbaypressgazette.com:

Cardiologists and oncologists now struggle to generate enough medical revenue to cover their costs to run the practice and pay physician salaries. “Pay the physicians less,” you say? Well, the problem is that the shortage of physicians is so severe that the price to bring a cardiologist or oncologist in is set at a market rate. If you underpay your own physicians, they leave to go to someone who will pay them the market rate; then you have no one to treat your patients.

It is estimated that by the end of 2012, 80 percent of all cardiologists will be employed by or leased to hospitals. Yes, it’s the end of the small independent cardiology and oncology practice and it’s happening right before our eyes.

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Broccoli – Doctors for America

Broccoli – Doctors for America:

The health care market is unlike any other market because health care costs are unpredictable and are not meaningfully bounded on the upside. Break an arm and your costs could be in thousands of dollars. Have a heart attack and you’re in the tens of thousands of dollars. Get cancer and you could enter the hundreds of thousands of dollars category. There’s no way to prepare for such illnesses and their costs. That’s why health insurance exists, to smooth out these costs over a lifetime and to pool our resources to help those with catastrophic costs to pay for them. The purpose of mandating the purchase of health insurance is to have everyone pay into a system that they will eventually use. Equating broccoli and health insurance is specious and a sign of bad faith on the part of those making that argument. As far as I know, nobody has died because they couldn’t get their hands on some broccoli.

When broccoli is 1/6th of the economy of the nation, give me a holler. Maybe then it should be regulated.

In the meantime, what we are hearing is a deliberately misleading meme about ‘limiting principles,” AKA, “where do we draw the line?” My answer is that we don’t draw the line at health care, a fundamental human need that now accounts for one sixth of all economic activity in the US. This is clearly NOT where to draw the line. We can argue about where TO draw the line when the Federal Government tries to mandate burial insurance or some other completely random pseudo-analogy thought up by Fox News and fellow travelers.

News Analysis – With or Without Health Reform, We Pay for Others’ Bad Habits – NYTimes.com

News Analysis – With or Without Health Reform, We Pay for Others’ Bad Habits – NYTimes.com:

As a cardiology fellow, I once took care of a young man with severe congestive heart failure. We were supposed to start him on a blood thinner early in his hospitalization, but it got overlooked. Fed up with the delays in getting his blood sufficiently thinned, he left the hospital against medical advice. He said he had to go home to care for his toddler.

He came to the clinic a week later looking very embarrassed. He had left without prescriptions, so he had been taking no medications since he left, leaving him short of breath. To compound the problem, he had been eating cold cuts, cheap and readily available, which made his condition even worse. But the attending physician refused to give him prescriptions. She said that he had to go to a walk-in clinic. She said he had to learn personal responsibility.

Healthy living should be encouraged, but punishing patients who make poor health choices clearly oversimplifies a very complex issue. We should be focusing on public health campaigns: encouraging exercise, smoking cessation and so on. Of course, this will require a change in how we live, how we plan our communities.

“It’s the context of people’s lives that determines their health,” said a World Health Organization report on health disparities. “So blaming individuals for poor health or crediting them for good health is inappropriate.”

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Taking Responsibility for Death – NYTimes.com

Taking Responsibility for Death – NYTimes.com:

My mother drew up her directives in the 1980s, when she was a volunteer in the critical care lounge of her local hospital. She once watched, appalled, as an adult daughter threw a coffeepot at her brother for suggesting that their comatose mother’s respirator be turned off. Because the siblings could not agree and the patient had no living will, she was kept hooked up to machines for another two weeks at a cost (then) of nearly $80,000 to Medicare and $20,000 to her family — even though her doctors agreed there was no hope.

The worst imaginable horror for my mother was that she might be kept alive by expensive and painful procedures when she no longer had a functioning brain. She was equally horrified by the idea of family fights around her deathbed. “I don’t want one of you throwing a coffeepot at the other,” she told us in a half-joking, half-serious fashion.

There is a clear contradiction between the value that American society places on personal choice and Americans’ reluctance to make their own decisions, insofar as possible, about the care they will receive as death nears. Obviously, no one likes to think about sickness and death. But the politicization of end-of-life planning and its entwinement with religion-based culture wars provide extra, irrational obstacles to thinking ahead when it matters most.

As someone over 65, I do not consider it my duty to die for the convenience of society. I do consider it my duty, to myself and younger generations, to follow the example my mother set by doing everything in my power to ensure that I will never be the object of medical intervention that cannot restore my life but can only prolong a costly living death.

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Contra David Brooks on ObamaCare – Blog of the Century

Contra David Brooks on ObamaCare – Blog of the Century:

This last point highlights aspects of political economy which Brooks prefers to ignore. He writes that there is no way planners can know]”how Congress will undermine any painful cuts the executive branch does make.” Brooks finds this a powerful insight regarding (say) single payer. The very same point applies to his own preferred solution: the extremely complicated and politicized mechanisms required for premium support. The firms which operate Medicare Advantage serve the healthiest segment of retirees with little apparent savings to show for it. Indeed these firms have been able to lobby Congress for wasteful additional subsidies beyond those required in traditional Medicare.

Brooks is right to worry our health system’s administrative complexities and its political vulnerabilities to special-interest lobbying. He’s wrong to believe that a centralized approach to health policy created either problem. He’s also wrong to believe that health reform has made these problems worse. He might ponder, for example, why so many privileged interests from the insurance industry on down dislike or oppose the new law, and are so keen to destroy measures such as the Independent Payment Advisory Board.

As Paul Starr notes in his essential Remedy and Reaction, our overly fragmented, overly incremental approach to politics is the real culprit here. It makes our resulting health policies too complex, too costly, too vulnerable to special interest pleading.

Hamilton and his friends created an amazing political system which served us well for 200 years. That system does not always serve us well today.

Well said. I like to think of the scene in Animal House (when they walk out and say they’re not going to listen to anyone badmouth the US of A) whenever I hear someone argue that we cannot match the quality and efficiency of our European cousins, particularly those in Germany and France. Consider that they are having serious debates about how they are spending too much – while covering everyone and getting better results with no waiting times, mind you – when they are spending a third to half less of their GDP on health care than we are!

Finally, listening to the SCOTUS today, the catastrophic illness and ER visits kept coming up as the talking points about the need for insurance. As anyone in health care knows, the other key to having access is to PREVENT catastrophes and ER visits and maintain health and reduce costs for everyone!