Category Archives: Ethics

Be careful what you wish for.  This cuts both ways.

The incidental economist notes: (Austin Frakt)

If one wants to address the problems in health insurance markets and/or to get providers to accept payment reforms, the mandate–or something like it–is the political price. Yes, it’s about money. What else?

Put it this way, if one wants to retain a private market-based health insurance system (which ours largely is), it takes a mandate. Reject the mandate without replacement with a similar mechanism and the whole thing unravels, not just as a matter of health economics (adverse selection) but as a matter of politics.

Medicynical Note:  We’ve created the most dysfuntional, expensive healthcare non-system in the world.  Yes we’re number one.

Employer sponsored health care is a mess.  Employers don’t have to provide their employees health care–in many instances they can’t afford to provide it; “contractors” are not employees and don’t qualify for employer provided benefits;  if you get sick and can’t work, you lose your insurance.  Remarkable.

Our health care costs are twice that of many other industrialized countries and thousands more per capita/year.  We have 50 million uninsured and have a “system” that encourages “free” use of the most inefficient, most expensive health care provider in the country–emergency rooms.

We all pay.

Bloomberg has an interesting article on the limited medical benefit of spinal fusion to patients–but big financial benefits to doctors, medical practices and suppliers (Medtronic). The article documents at least the appearance of, if not actual, conflicts of interest; high costs $135,000 for the surgery (yes on one patient); $800,000/year incomes for the orthopedists–three times that of pediatricians.

The possibility that many of these and other surgeries are needless has gotten little attention in the debate over U.S. health care costs, which rose 6 percent last year to $2.47 trillion. Unnecessary surgeries cost at least $150 billion a year, according to John Birkmeyer, director of the Center for Healthcare Outcomes & Policy at the University of Michigan.

“It’s amazing how much evidence there is that fusions don’t work, yet surgeons do them anyway,” said Sohail Mirza, a spine surgeon who chairs the Department of Orthopaedics at Dartmouth Medical School in Hanover, New Hampshire. “The only one who isn’t benefitting from the equation is the patient.”

There’s lots to this article including evidence that fusion is no better than physical therapy for disc related pain in several studies–only a 47% success rate for surgery in one U.S. study;  high complication rates for surgery;  direct payments from the medical supplier (Medtronic) in the form of royalties and consulting fees to doctors (as high as $440,000/year to an individual doctor and 1.75 million to a practice in Minneapolis).

Medicynical note: Not a pretty picture of American medicine. Costly, open conflicts of interest, use of aggressive expensive unproven procedures over more conservative approaches–with the same or worse outcomes.  Is it any wonder that our costs are one and half to two times that of other industrialized countries.

The “free market” encourages entrepreneurs to find ways to take advantage of markets, sometimes that leads to better outcomes and more efficiency but in medicine it seems to encourage waste, high cost and over-utilization.

The Washington Times presents a tortured argument against promoting more efficient care in the most expensive health care non-system in the world.

Think of it, a centralized, federal database tracking your every visit to a health care provider – where you went, who you saw, what was diagnosed and what care was provided. Chilling.  Medicynical note: as if private insurers oversight that  controls and limits treatment given is less intrusive, or as if the data will have patient identifiers.

The Times takes issue with the notion of efficiency in health care.  To them, apparently,   spending 50% more per capita on health care than any other nation in the world and 17% of GDP, and increasing yearly, is acceptable:

There is no telling what metrics will be used to define the efficiencies, but it is clear who will bear the brunt of these decisions. Those suffering the infirmities of age, surely, and also the physically and mentally disabled, whose health costs are great and whose ability to work productively in the future are low. And how will premature babies fare under the utilitarian gaze of Washington’s health efficiency experts? Will our severely wounded warriors be forced to forgo treatments and therapies based on their inability to be as productive as they once might have been? And will the love between a parent and child have a column on the health bureaucrats’ spreadsheets?

The Times then goes on to compare cost efficacy measures with the nazis.

Medicynical note: Nothing surprising here. Until we show some will to control  costs our non-system caring for an aging increasingly health care needy population will continue to spend our nation’s wealth.

Our republican friends have been amazingly quiet about their solutions. Their “free market” rhetoric leads one to assume they would put an increasingly large burden of expense on individuals–their form of individual mandate. They would then let the costs of health care assure economic rationing. For those who can’t afford care, I suppose their solution for patients is that of 18th century France and will let them eat cake.

Conflicts of interest affect outcomes as noted in this article on “new hips.”

Wright paid tens of thousands of dollars to a foundation Keggi helps run and gave him a trip to a conference in the Bahamas. Keggi recommended the ceramic device over the kinds of implants used in 97 percent of cases.

The ceramic joint made by Wright Medical Group Inc. shattered, leading to an infection and four more surgeries that left Hirschbeck permanently sidelined.

And costs:

The companies increased doctor compensation for 2008 to about $300 million, according to the data compiled by Bloomberg from reports posted on the device makers’ websites. Fees for 2008 were delivered in 2009, the surgeons say.

More on costs:

The financial ties between device makers and surgeons help explain why health-care costs in the U.S. rose at 2.5 times the rate of inflation in the past 10 years and account for a sixth of the economy. The $300 million works out to $300 for each of the 1 million hips and knees implanted in Americans in 2008.

In the U.S. in 2010, the average price of a primary artificial hip was $7,200, more than four times the $1,600 in Germany, says Melissa Hussey, a senior analyst on the orthopedic team at Millennium Research Group, based in Toronto. In Germany and other countries, she says, sales representatives have restricted access to surgeons.

Medicynical Note: So much for the “free market” system. Without regulation and limits companies will work endlessly to manipulate markets to their financial benefit. Are we fools or what?