Adalja on Medicare and End-Of-Life Care

Dr. Amesh Adalja has a new column up at Forbes: "Medicare Has Chained Us Together, Reliant On End-Of-Life Government Rationing".

A few excerpts from his piece:

As 25-30% of Medicare spending occurs in the last year of life, end of life care has become a rising issue in health care policy debates. End of life scenarios often place the ICU physician in the position of persuading designated surrogates of the patient to—after consulting the patient’s living will and stated wishes—withdraw care and allow the patient to succumb to their illness...

The growing fiscal burden of the program, not surprisingly, raises concerns regarding the costs and efficacy of the treatments paid for by Medicare. End of life care often takes place in ICUs and employs expensive state-of-the-art technology. Yet, in certain contexts, these advanced therapies are unable to alter the course of illness. Family members of gravely ill patients may have religious, financial, or other reasons to continue care and when an unseen 3rd party is responsible for the bill, costs of care are not a factor...

It is the increasingly socialized atmosphere of medicine that has created this scenario that puts physicians in a financial stewardship position creating a conflict with their role as an advocate for their patients. In any system where government pays for end-of-life health care, it will inevitably have to decide who receives it or not. In a free market, in which individuals control their own health care spending, individuals make these decisions for themselves... 

But you should read the full text.

Medicaid Time Bomb

Michael Tanner discusses how, "ObamaCare created a Medicaid time bomb" (NY Post, 12/7/2013).

Wolf on Other ObamaCare Lies

Dr. Milton Wolf has a new OpEd in the Washington Times, "The President’s other Obamacare lies".

The controversy over ordinary Americans losing their health insurance is just the tip of the iceberg.  Some of the other issues he discusses is people losing their doctors, raising taxes, and transparency.

Read the full text for more details.

And if you want more information on his run for the US Senate (or wish to donate to his campaign), check out his website.

Adalja Blog: Tracking Zebra

Dr. Amesh Adalja has a new blog, Tracking Zebra, covering "Infectious disease, politics, healthcare, Pittsburgh, and related topics".

I've learned a lot about the growing danger of antibiotic resistant bacteria from his Twitter feed as well.

Coming Next: "Doc Shock"

After the "rate shock", will come the "doc shock".  Get ready for arguments that "narrower networks" and less choice over doctors will be good for you.

From Megan McArdle: "'Doc Shock' On Deck in Obamacare Wars". 

(Link via Matthew Bowdish.)

Inappropriate "Appropriateness"

Dr. Wes Fisher asks a good question, "What happened to doctors serving as advocates for their patients?"

In particular, he notes how doctors are being increasingly expected to adhere to externally imposed "appropriateness" criteria for treating patients -- which may or may not be what's actually right for the individual patient.

Of course, guidelines and criteria can be helpful adjuncts to experienced clinical judgment. But they cannot replace that judgment.  The issue will become increasingly important as physician payments (or penalties) are increasingly linked to how whether or not a physician adheres to (or strays from) those criteria.

In the worst case, these criteria create a serious conflict of interest for the physician -- will doctors do what's right for their patients?  Or will they adhere to the criteria, even at the patient's expense?

Current Legal Challenges to ObamaCare

The 12/2/2013 New York Times has a round-up of, "A New Wave of Challenges to Health Law".

Two of the key issues include:

* The subsidies for people purchasing insurance through federal exchanges
* Religious freedom questions

Benjamin Rush Institute Debate on Markets and Health Care, Dec 4

The Benjamin Rush Institute will be hosting a debate tomorrow (Wednesday, December 4) on Kenneth Arrow's ideas of uncertainty as applied to health economics.  The set of panelists looks very impressive!

Here is their announcement:

Debate: "50 Years of Uncertainty: Are markets unsuitable for healthcare?"

In celebration of the 50th anniversary of Kenneth Arrow's highly influential article "Uncertainty and the Welfare Economics of Medical Care," the Benjamin Rush Institute chapter of UTHSCSA School of Medicine is sponsoring a debate on whether or not healthcare is sufficiently different from other industries that it requires a significant role for government to correct intrinsic "market failures."

When: Wednesday, December 4th, 2013 6:00 - 8:00 PM

Where: University of Texas Health Science Center at San Antonio School of Medicine
Pestana Lecture Hall 3.104A, 7703 Floyd Curl Drive, San Antonio, Texas 78229

Who:

Avik Roy, graduate from Yale School of Medicine; Senior Fellow, Manhattan Institute, Forbes columnist
Dr. William Sage, MD/JD, Vice Provost for Health Affairs, University of Texas at Austin
Dr. Mark Pauly, PhD, Professor of Health Care Management; Professor Business Economics and Health Policy, Wharton School of University of Pennsylvania
Dr. Samuel Richardson, PhD, Assist. Professor of Public Affairs, LBJ School of Public Affairs

Local audience members can RSVP here.

For out-of-town folks BRI says, "Regretfully, the planned live-streaming will not be available. A video recording will be posted on the website as soon as possible."

More background information on the topic from BRI:

Fifty years ago in 1963, Kenneth Arrow wrote what became a landmark article in health economics, “Uncertainty and the Welfare Economics of Medical Care.”

Arrow’s analysis is deeply imbedded in the economic theory of welfare economics — which in turn is built upon the belief that it is possible to determine a socially optimal allocation of resources — frequently along the lines of Pareto optimality – and anything short of that optimal state is a “market failure.” Arrow contends that the lack of optimality in healthcare, and the market failures which lead to it, emanate from variant forms of uncertainty, manifesting as problems of risk, insurance and imperfect information.  He discusses ways that society attempts to circumvent market failures through the use of non-market institutions, such as government, professionalism, nonprofit status, and trust.

Arrow’s article quickly became required reading for anyone studying the economics of healthcare — and even today, his ideas continue to influence scholarly and popular dialogue. Anyone with a serious interest in tackling healthcare reform needs to be familiar with Arrow’s analyses, in particualr, the problems of adverse selection in insurance, and of asymmetric information, both in matters of insurance and in doctor-patient relationships.

To celebrate Arrow’s contribution to healthcare economics, the Benjamin Rush Institute is hosting a debate. We have gathered an exciting panel of scholars who are well versed in Arrow’s work. Dr. Sage edited and Dr. Pauly contributed to a compilation of essays on the 40th anniversary, Uncertain Times: Kenneth Arrow and the Changing Economics of Health Care. Avik Roy has written several op-eds critiquing the use of Arrow to justify government interventions.