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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Friday, August 21, 2009

Now for something complety different-we should spend more on health care

"We are not spending enough of health care" is the point made by economist Mark Perry (economist at the University of Michigan) and the WSJ. See here for Dr. Perry's blog and see here for the WSJ article by Craig Karpel.

Here are some snippets:

The 2.4 trillion spent on health care in the United States is not buried in the ground but paid to other Americans.One man's cost is another man's stream of income. This is a basic economic fact that we take for granted in every area except in health care. I believe Uwe Rheinhardt asked the question "Why is it good when someone buys a car but bad when they buy medicine?" I guess part of the answer maybe because so much of the latter is paid for by the government.

In the midst of what some have labeled "the great recession" while hundred of thousands of jobs were lost the health care section actually added jobs to the tune of 19,000 in July 2009.

About 400,000 non US residents came to the US for health care in 2008.

Economists Robert E. Hall and Charles Jones wrote the following in a 2007 article that examined the "optimal health care spending" in the U.S." (my bolding)

"Viewed from every angle, our results support the proposition that both historical and future increases in the health spending share are desirable. . . . [W]e believe it likely that maximizing social welfare in the United States will require the development of institutions that are consistent with spending 30 percent or more of GDP on health by the middle of the century."
( quote is from the WSJ article, I don't have the original citation)

Tuesday, August 18, 2009

Ambiguity in Legislative language in HR 3200 may be there for a reason

Everyone with any interest in the proposed health care legislation should go here to read DrRich's latest blog entry in which he tell us what the ambiguity in the house bill is really all about.

I have blogged briefly before on the ambiguity and cognitively impenetrable nature of HR 3200 and suggested that is was not due to ineptitude of the authors of the bill and their inability to clearly put in words what they were proposing. As DrRich points out it is ambiguous for a reason.

The reason is that the lack of meaning will be supplied by the rule making processes of the various government agencies and this will be an unending process as opposed to a one time rule setting.

Ambiguity is a topic that has been discussed from time to time in the law journals. See here for a recent article from the Stanford Law Review.

Legal scholars talk about the willful insertion of ambiguous language into statutes as opposed to the inadvertent insertion of ambiguity. The first category sometimes is used to effect a compromise between opposing factions of a legislative body.In other cases the lack of clarity leads to interpretation (or more accurately definition) by an administrative or regulatory agency which could be the real reason for the ambiguity at least in some instances.

If a proposed statute is so ambiguous that its meaning cannot be determined by careful reading of the statutory language then public support or public denunciation of the proposal will likely turn on the rhetorical expertise and the persuasive power of the opponents to fabricate catch phrases and sell them to the public.

In regard to house bill 3200 DrRich's point is that no one knows what the specific effects of passage will be because as written the bill is without operational meaning and that will be supplied by government technocrats after the bill is passed and signed into law.

Here is how Dr.Rich summarizes it:

"This is legislation designed to create a legal framework under which huge cadres of unelected, politically-appointed policy mavens and bureaucrats will determine - by publishing hundreds of thousands of pages of regulations, rules, and guidelines - what our new healthcare system will look like. And until those regulations and guidelines are actually created - and this “creation” will be a never-ending process rather than an act - anybody claiming to know the precise nature of our new healthcare system under HR 3200 is engaging in one of the following: lying, projecting one’s own wishful thinking, or extrapolating on the perceived behaviors and beliefs of those who (one surmises) will finally get to make up all the rules."

I can't say it any better than that.

Friday, August 14, 2009

Who benefits from the world class ambiguity of section 1233 of House Health Care bill ?

Does section 1233 ( of the current version of the House bill dealing with Health Care "reform") make end of life counseling mandatory or voluntary or does the section's multi-layered and seemingly un-dissectable ambiguity enable the Secretary of HHS to determine what it "really means"?

Dr.RW discusses aspects of this general issue here quoting two sources with significant insight content from Kathleen Parker and Wesley Smith. Smith's quote is particularly noteworthy;

The bill might not create punishments [ in regard to quality measurement that the Secretary may enact concerning physicians who fail to counsel] , but the regulations that would be created in the shadows outside the direct democratic process could.

So the question arises is the bill written is such a way as no one really knows what it means which in turn raises the question "Are the bill's authors (whoever they are) merely bad at statute composition and are unable to clearly delineate what is to become law or is the ambiguity really quite artfully, purposely inserted so that HHS technocrats can do pretty much what they want"?

In another posting Dr. RW offers this comment:

Although a good palliative care service can save an institution money its focus is on what's best for the individual patient. Sometimes those goals are in conflict, sometimes not, but an excellent palliative care team will manage the conflict appropriately by putting the individual patient first, no matter the impact on the medical commons. When an end of life counseling provision is part of a bill with a clear agenda to control costs some degree of skepticism is appropriate.

How many other sections of the House bill suffer (or benefit) from this same type of opaque wording?

Thursday, August 06, 2009

One more time, so how is the Massachusetts health care plan working?

Here is one view offered by one of my favorite economists, Arnold Kling. Some proponents of certain elements of the administration's health care reform plan ( really the Democrats House of Representatives plan) amazingly claim that the plan for Mass-care is working just fine and would serve well as an example of what should be done on a national level

As Kling explains: ( the italics were added by me):

So, the reform is "working" by mandating a shift in compensation from take-home pay to health insurance ( i.e forcing employers to offer insurance) and by draining money from the Federal taxpayers ( yes, the federal government is bailing them out)

In sum, the plan costs much more than projected, waiting times for physician appointments have skyrocketed, and the Federal Government is having to help pay for it . Who will pay for the cost overruns if and when a similar plan is put into place for the entire country?