Friday, January 30, 2009

Concierge Physicians Fight Back

In response to the recent attempt by the state of Maryland to regulate concierge physicians as a form of insurance, the Society for Innovative Medical Practice Design (SIMPD) -- the national organization that represents concierge doctors -- has started to fight back.

Dr. Steve Knope has the scoop.

Patients have the right to seek medical care and physicians have the right to offer it on terms they find mutually acceptable. Both sides win they this freedom of contract is respected and protected by the government. It's good to see physicians defending their rights and their patients' rights.

Thursday, January 29, 2009

Rhoads: What Administrative Savings?

Jared Rhoads of the Lucidicus Project has written another OpEd, which I am reposting here with his permission. His topic is the myth of administrative savings under government-run "single payer" systems:
What Administrative Savings?
January 17, 2009 by Jared M. Rhoads

Many people seeking national healthcare reform -- particularly those on the political left -- believe that the United States should adopt a single-payer insurance system, similar to that of Canada's. Proponents say that single-payer systems achieve lower per capita healthcare expenditures because they eliminate "wasteful and unnecessary" business practices such as advertising and screening of new applicants, and that this lowers administrative costs. By empowering the government to pay all health insurance claims, they say, we could simplify paperwork, standardize billing procedures, and consolidate many other activities entailed in processing claims. In other words, if we would just leave the business of health insurance to the government, we could get the same great care we have always had, except at a much lower cost.

But do single-payer systems really achieve lower expenditures through operational efficiency, or is something else going on in this picture?

At first glance, the argument regarding administrative costs may seem plausible. After all, businesses are always trying to reduce costs by building economies of scale, so what could be more economical than having one payer for the entire nation? And statistics do show that per capital spending on healthcare is lower in many countries with single-payer systems. For example, in 2005, Americans on average spent $6,401 on healthcare, versus $3,326 for Canadians -- a difference of over three thousand dollars per person per year.

What pundits and politicians fail to disclose, however, is that the reduction in administrative costs by and large does not account for this difference. In fact, it doesn't even account for most of the difference. According to an article in the New England Journal of Medicine, administrative costs totaled an estimated $1,059 per person annually in the United States versus just $307 per person in Canada.[1] That's a difference of just $752, or about 23 percent of the difference. So where does the rest of the alleged savings come from?

In effect, Canada's relatively low per capita rate of expenditure comes not from reducing paperwork, but from using the financial grip of the government to withhold care.

Consider how the Canadian system works. Canada uses a global budget system in which government officials dictate to hospitals how much they will be allowed to spend in a given year. Looking at variables such as patient volume, supply costs, and inflation, they come up with a projection -- i.e. a wild guess -- for how much it will cost to treat all of the patients who come for care. Each hospital receives a lump-sum payment (or is put on a schedule of recurring payments), an amount of money that must last until the next round of guessing and granting.

When the money runs out, as it predictably does each time, care slows to a crawl. In order to defer or reduced costs, hospitals put patients on long waiting lists or substitute lower quality services (e.g. giving x-rays or ultrasounds in lieu of higher-resolution but more expensive MRI scans). In short, if you are a patient in Canada and need an expensive procedure, you had better hope that the facility is either early in its budget cycle and therefore still awash in money, or that it has deprived enough other patients the services that they need so there is still a ration left for you.

One of the most the perverse things about any socialized system of healthcare, including Canada's, is that the less the system does for its patients, the better its financial performance looks on paper. For instance, if a hospital withholds care from a patient long enough, the patient may give up and travel over the border to get their diagnostic test, surgery, or other procedure done elsewhere. In terms of the hospital's pocketbook (and therefore also the nation's pocketbook), this scenario goes down as an unseen and unaccounted-for personal expense, not an expenditure. Or, perhaps the patient on a six-month waiting list for hip surgery simply dies while waiting. In that scenario, there is no cost to the system at all.

Whatever the case, national expenditure figures of single-payer systems can be set as low as government officials desire, because what ultimately determines how much care patients receive is what the government is willing to fund -- not how much patients want to spend or how much their physicians recommend they spend. (And even if patients wanted to pay out of their pocket for faster or better care by their own doctor, in many cases it is illegal to do so.) Quality and access to care can always be sacrificed to create the illusion of a government-run system that is low-cost and efficient because they are much more difficult to measure and compare.

The notion of administrative efficiency as the primary source of savings is nothing but a shabby cover story to hide the rationing inherent in a single-payer system. Most people wouldn't trust (or allow) a government official to set a budget for what they spend on dry cleaning in a year, yet with a little rhetoric and some confusing statistics, they are willing to hand over control of their own healthcare. Rather than emulating our neighbors to the north and instituting a top-down, centralized system in which the government makes decisions about how much care each person should get, Americans ought to demand the freedom to pay for as many or as few services as they desire, and to keep for themselves whatever they do not spend.


1 Woolhandler, Campbell, and Himmelstein. "Costs of Health Care Administration in the United States and Canada" N Engl J Med 2003;349(25):2461.

Wednesday, January 28, 2009

Goodman: Market Forces Work

John Goodman discusses how medical markets can actually work, citing a number of positive examples including:
Cosmetic and LASIK surgery
Laboratory testing
Retail health clinics
Concierge medicine
Medical tourism
The common element is that when patients control their health spending, they rationally choose to seek the greatest value for their dollar. The result is decreasing costs and increasing quality, as we expect in the free market.

For more information, see the blog post and the full paper by Devon Herrick, "Health Care Entrepreneurs: The Changing Nature of Providers".

These economic arguments work especially well when combined with the moral arguments for free market health care -- namely that patients have the right to seek health care and physicians have the right to provide it in terms that they find mutually agreeable.

Tuesday, January 27, 2009

Hunt: How I Got My New Hip

Allison Hunt explains what she had to do to get her new artificial hip in the Canadian medical system:

A few interesting points:

(1) Her waiting time for the initial appointment to see the orthopedic surgeon was 10 months. Then her waiting time for the surgery itself would have been another 18 months had she not taken matters into her own hands.

(2) She had no qualms about doing what she needed to do to "jump the queue". At some implicit level, most people realize that it's right to seek to improve one's health and life -- i.e., that pursuing one's self-interest is good.

(3) She also explicitly recognized that what she was doing was "cheating the system". However, she doesn't ever quite come out and say that the system was morally wrong. Instead, her final remarks sound like a form of moral rationalization for her actions. It's therefore unclear to me whether she personally thinks her actions were right and the system was wrong, or the other way around. This highlights the importance of explicit discussion of the morality (or lack thereof) of government-run health care.

(4) This sort of "queue jumping" happens all the time in Canada. Lee Kurisko, a physician who has practiced in both Canada and the US calls this the "deep dark secret" of Canadian medicine.

(Thanks to Paul Lemke for the video link.)

Monday, January 26, 2009

Daily: It's Not Wrong to Put a Price on Health

Stella Daily has written an excellent commentary responding to the recent New York Times article, "Putting A Price on Compassion".

I am reposting her piece here in its entirety, with her permission:
It's not wrong to put a price on health

In yesterday's New York Times, Pauline Chen lamented our growing comfort with the role of money in medicine. She refers to healthcare as "the gift of life," which cannot be reduced to a mere commodity that can be quantified and analyzed. And she cites the example of a man suing his estranged wife for either the return of the kidney he donated to her or $1.5 million as evidence that medicine has become too commoditized, saying that there "should have been outrage over putting a dollar value on human life." Is she right?

It's telling that Ms. Chen calls healthcare "the gift of life." Throughout the whole article, the tone is: Healthcare is getting easier to assess and quantify in monetary terms, and that's a bad thing. She would prefer "compassionate care" and "patient-centered partnerships." The implication is clear: Altruism needs to play a bigger role in medicine. Thus, healthcare is not a trade between individuals to mutual benefit, but "the gift of life."

But bringing altruism into medicine harms patients rather than helping them. If we allowed people to buy and sell organs in this country, we would see the supply of available organs increase; is it more "compassionate" to allow thousands of patients to die waiting for an organ, just to keep money out of the equation? If we go toward a freer market in medicine, rather than move in the direction of price controls and government mandates for lower payments to doctors, more bright young people will want to go to medical school; is it "compassionate" to create a shortage of doctors, or to tell someone who has spent many years in extensive postgraduate training that he doesn't deserve to make money just because people need his services?

It's true that quantifying the cost-effectiveness of healthcare has caused dissatisfaction in some ways: The insurance company decides that your doctor's time is worth a lower amount this year than last year, so he shortens the length of a visit and sends you off feeling as though you were rushed through the appointment. Your policy raises the copay for prescription drugs, so your asthma medication costs more, but delivers you no more value than it did when you were paying less. And so on and so forth.

But such examples do not prove that altruism is the solution. They only illustrate the problem with trying to pretend that healthcare has no monetary cost. When patients have to pay for their own care, they become cost-conscious: They evaluate for themselves whether it's worth it to pay more money for a doctor who has more time to spend with each patient, or whether the cost savings is worth a quick visit with less time to discuss medical issues. When a third party is introduced, the patient is insulated from the true cost of care. He starts to want the best of everything, regardless of how much it costs -- because his insurance company is covering the cost. The insurance company, on the other hand, wants to reduce costs as much as possible, even if it means that some patients are dissatisfied with their care. Thus, instead of mutual trade to mutual benefit, we get a system nobody is happy with.

Doctors, medical researchers, and pharmaceutical company executives do not work for the benefit of others. They work because of the pleasure they get from tackling the problems of human disease -- and because of the financial rewards they stand to gain. And nobody can be expected to donate an organ to a stranger out of brother-love alone. The fact that there's money in medicine is not a sad fact to be lamented -- it's the reason that we can enjoy good care.
If you liked her piece, check out her blog ReasonPharm.

Friday, January 23, 2009

More Regulation = Higher Prices

More regulation of insurance companies in Colorado is causing premiums to go up.

Here's the latest example.

(Via Brian Schwartz.)

Thursday, January 22, 2009

More Trouble With Medicare "Never Events"

Dr. Kevin Pho discusses more problems and unintended consequences caused by the new Medicare "never event" rules in his January 15, 2009 OpEd in USA Today, "Medicare's Mistake". Here's an excerpt:
...Where Medicare goes wrong, however, is by extending the no-pay rules to include "reasonably preventable" complications. These currently include patient falls and hospital-acquired infections.

...When a hospitalized patient develops an infection, for instance, it can be difficult to determine whether the fault lies with the medical staff or with a predisposed condition. This is a crucial distinction because Medicare will punish the former scenario but pay in the latter.

Hospitals might be motivated to order tests, without clear medical symptoms, to show that any infection caught from within its walls was already pre-existing.

The American Medical Association shares this concern, saying that the aggressive expansion of no-pay events can "drive up costs by requiring more tests upon admission."

Furthermore, some institutions could decide not to admit or perform elective procedures on high-risk patients, particularly the elderly, out of fear of being denied payment for complications it cannot prevent.

Robert Wachter, professor of medicine at the University of California-San Francisco and an authority on hospital medicine and patient safety, cautions that the rapid expansion of the no-pay idea looks like a "cost-cutting effort clothed in the garb of patient safety" that is "nowhere near ready for prime time."
In other words, government controls to save money will end up costing more money in the long run, because doctors and hospitals will practice to suit the external incentives created by regulation rather than according to what's in the patients' genuine medical interests.

These sorts of unintended consequences will become the norm if we adopt any form of government-run universal health care.

Wednesday, January 21, 2009

CT Looking To Repeat MA Mistakes

The January 16, 2009 New York Times reports on Connecticut's attempt to implement "universal health care" despite the failure of a similar program in neighboring Massachusetts. This proposal has the support of the Connecticut Medical Society.

As Dr. Evan Madianos notes, they must believe that reality doesn't cross state lines.

Tuesday, January 20, 2009

The Value of Innovation in Health Care

Grace-Marie Turner of the Galen Institute has a new article on "The Value of Innovation in Health Care". It's well worth reading the entire piece.

One point that can never be emphasized enough is that innovation comes from the free exercise of the rational mind. The human mind requires freedom to function. That is why men need the freedom to think and the freedom to act according to their best judgment. Only force can stop the mind from functioning, which is why the initiation of force is anti-life.

When government protects individuals from the initiation of force, it protects individual rights and promotes life. In contrast, when government initiates force against honest citizens, it stifles the human mind, and thus prevents exactly the sort of life-fostering innovation that Grace-Marie Turner describes.

That is the real evil of government-run medicine. By smothering the mind, it smothers life itself.

(Disclaimer: Although Turner's piece portrays the Bush administration in a favorable light, this post should not be construed as any kind of endorsement of Bush-era policies. President Bush has been anything but a principled defender of free markets or individual rights.)

Saturday, January 17, 2009

Hsieh LTE in NCBR

From Brian Schwartz, I learned that the Northern Colorado Business Report published one of my LTEs recently as well:
Kefalas readies comprehensive health-care bill

Every country with a single-payer system saves money by rationing and waiting lists. You can save a lot of money by forcing women to wait months for their chemotherapy for their newly diagnosed breast cancer. You can save money by limiting the numbers of cardiac surgeries per year. This is commonplace in Canada. But the patients pay the ultimate price. Do we really want this in America?

Paul Hsieh, MD

Freedom and Individual Rights in Medicine (FIRM)
(I'm not sure of the exact date, so I'll attribute it to 1/16/2009.)

Friday, January 16, 2009

Knope On Forbes Article

Dr. Steve Knope sent me these additional comments on the recent Forbes article on concierge medicine, "Should You Dump Your Primary Care Physician?"

I am reproducing them here with his gracious permission:
First, the title Forbes selected carries a very interesting message: "Should You Dump Your Primary Care Doctor?" It would seem that Forbes is effectively calling concierge medicine the "gold standard" by which readers should judge their own primary care doctor. If your doctor doesn't measure up -- if you don't have adequate access to and time with your doctor -- perhaps you should consider "dumping" him and paying for better care. This is a far cry from the uniformed criticism that was levied against concierge doctors in the early stages of this movement. It would appear that people are beginning to get the idea that doctors cannot provide excellent medical care without the time to do so.

Second, the comments from Joseph Heyman of the AMA are revealing in their ignorance and represent nothing more than political rhetoric:
"...[H]e says, physicians 'should provide the same quality of care to all patients regardless of the model of care in which they are practicing.'"
Really? Let's examine this statement from the chairman of the Board of Trustees of the AMA. Doctors should somehow provide the same level of care in a traditional, third-party practice (in a 7 minute visit) that a concierge doctor provides to his patients in a 30 minute visit. And just how does a physician do this, Dr. Heyman? The corollary of this statement is already recorded in the AMA position statement on concierge medicine: There is nothing intrinsically unethical about concierge medicine, they say, provided that doctors do not advertise concierge medicine as somehow better than the standard, fast-food medical model.

When is the AMA going to stop spewing this political nonsense and start telling the truth? If I didn't think spending more time with a patient was better care, I wouldn't do it. Most concierge doctors take excellent care of about 600 patients. This is plenty. Suggesting that a doctor can do the same job while taking care of 3,000 patients is nonsense. It is clearly refuted by a large body of literature, which shows that primary care doctors do not have the time to adequately address the needs of their patients, much less address their preventative care, which is now being touted by the nationalized healthcare advocates as a part of our needed "reform."
Thank you, Dr. Knope, for standing up for your right to practice in a free market on your terms, for your patients' best interests, according to your medical conscience, free from government interference.

Thursday, January 15, 2009

Knope Featured on Forbes

Forbes has an article discussing concierge medicine in detail. When physicians and patients are able contract in the free market, the result is vastly improved patient care as well as physicians who love their jobs because they can practice according to their medical consciences.

Learn more at, "Should You Dump Your Primary Care Physician?"

Dr. Steve Knope is one of the featured physicians in this article.

Wednesday, January 14, 2009

How To Protect Yourself Against ObamaCare

Dr. Steve Knope gives some good advice on how patients can partially protect themselves from ObamaCare and the inevitable rationing. Here's an excerpt:
My advice: Maintain your private medical care if at all possible. If you are relatively healthy, look into a high-deductible health insurance plan linked to a Health Savings Account (HSA). Start putting money away in that HSA for a rainy day. Find a "concierge physician" or doctor with whom you can establish a direct financial relationship; someone who will act as your medical advocate in a system that is broken and will only get worse. You get what you pay for and medicine today is no different.

All indications are that there will be attempts to ram a national healthcare program through Congress early in the Obama administration. They will create a false sense of urgency, just as they did with the "financial bailout" of our economy. No time to study the issue; this must be done or the society will collapse! Tom Daschle has studied Hillary Clinton's failed national healthcare attempt and he does not want to make the same mistakes she made. He was just quoted in the WSJ as saying that the new Congress needs to act quickly. "We need to be on the offense. This time around, lawmakers cannot try to address every detail when it comes to legislation. Details kill." [Secretary-nominee of Health and Human Services Tom]Daschle said.

"Details kill?" "Lawmakers cannot try to address every detail?" We are just going to guarantee medical coverage for every American on the backs of the American taxpayer and we don't have time to discuss the details of how it will work or how it will be paid for? Every good lawyer I've ever retained has reminded me that the devil is in the details! It looks like we are in for a devil-of-a-new program.
Read the whole thing.

Of course the best way to protect yourself from the dangers of government-run universal health care is to stop it in the first place. So let your friends, family members, co-workers, and elected officials know that you don't want it! After all, it's your life that's at stake...

Tuesday, January 13, 2009

Citation in Washington Examiner

The January 11, 2009 Washington Examiner has quoted me in their editorial on the dangers of universal health care. Here is the opening:
Universal coverage? First, look at the disaster in Massachusetts
By Examiner Editorial -- 1/11/09

To much fanfare from both right and left in 2006, Massachusetts became the first state in the nation to require all residents to buy health insurance. A new state health insurance clearinghouse was created, with taxpayers subsidizing those who couldn't afford to buy coverage. Then Gov. Mitt Romney, a Republican, promised that "every uninsured citizen in Massachusetts will soon have affordable health insurance." Yet just two years later, Romney's much-heralded "solution" -- touted by many as the model for a national program -- has become an embarrassing flop.

Just a year after the universal coverage law passed, The New York Times reported, state insurers were already jacking up rates to twice the national average. According to Dr. Paul Hsieh, a physician and founding member of Freedom and Individual Rights in Medicine, 43 mandatory benefits -- including those that many people did not want or need, such as in vitro fertilization -- raised the costs of coverage for Massachusetts residents by as much as 56 percent, depending upon an individual's income status. So much for "affordable" health care...
Read the rest here.

Their OpEd quoted extensively from my article in the Fall 2008 issue of The Objective Standard, "Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America".

The same issue also includes an excellent OpEd by Sally Pipes, "Obama-Daschle 'reform' will cripple American health care".

I'm deeply grateful to the Examiner for publicizing this issue and to Craig Biddle for encouraging me to write the original TOS article.

Update: The OpEd also appeared in the San Francisco Examiner.

Monday, January 12, 2009

CAHI on Mandatory Insurance

The Council for Affordable Health Insurance has just issued a short two-page paper entitled, "Should the Government Force You To Buy Health Insurance?"

It includes some useful economic data as well as some pretty damning criticisms of the Massachusetts mandatory insurance plan.

The CAHI is a little more sympathetic to the Swiss system of mandatory insurance that I would be. The Swiss system still violates individuals' right to contract, although the subsequent bad economic effects have not (yet) hit Switzerland as hard as Massachusetts.

But overall, the CAHI piece is informative and well worth reading!

Friday, January 9, 2009

Rhoads: On Preventative Medicine

Jared Rhoads, director of the Lucidus Project, has written another OpEd on the government's flawed push to promote preventative medicine. It is reposted here with his kind permission:
On preventive medicine
by Jared M. Rhoads (December 16, 2008)

With expectations for major healthcare reform on the rise, members of Congress are pushing for comprehensive measures for increasing the use and funding of preventive medicine. Senators Tom Harkin (D-Iowa) and Chris Dodd (D-Conn), for example, want to put more prevention programs in place because prevention is "smart economics in addition to good public policy."[1]

Actually, this type of prevention has nothing to do with economics, and it has no place in any proper discussion of public policy.

Practicing good prevention is a thoroughly personal responsibility. Signing up for a mammogram, having a colonoscopy, or keeping on schedule with dental exams are all part of what it means to be a rational, self-interested adult. The same is true of exercising, eating well, managing stress, and countless other measures. Sure, scientific differences of opinion exist over which of these is most important and why. But is this simple advice really so abstruse as to require government officials to instruct us how to manage our own bodies?

Whether in the domain of health, lawn care, or backgammon, the fact that such-and-such an action is "smart" is not a sufficient reason for it to be required, subsidized, paid for in full, or in any other way made the business of the government. Dodd's claim that preventive medicine is good economics and good policy makes, at best, a pseudo-logical connection. If it is proper for government to oversee and involve itself in the care of each man's health, then it is smart to economize over the long term with preventive programs today. The form of this argument holds, but where on earth did he get his premise from?

What Dodd and his colleagues fail to grasp is that government is not a plaything for do-gooders to improve society in whatever ways they believe is good -- regardless of whether such interventions make economic sense. We all know what Dodd means: an ounce of prevention is worth a pound of cure. But while that maxim is wise in the realm of personal conduct, it is irrelevant to public policy.

Why? Because the sole purpose of government is to protect individual rights. Whose rights are being violated if John Q. Smith does not get, does not want, or cannot afford, a prostate cancer screening? The answer is that nobody's rights are being violated -- not Smith's rights, not his neighbor's, and not anyone else's -- so no government-backed remedy is in order. There is, however, a violation of rights if citizens are taxed to pay for each other's services; or if certain preventive measures are made compulsory (or "highly incentivized"); or if insurance premiums are manipulated through selective tax incentives; or if further licensing requirements are introduced to mandate the teaching of preventive medicine in medical schools. Each of these is a distinct possibility given the proposals currently being discussed.

Legislators may have the power, but they do not have the right, to intervene with healthcare or any other industry. Nothing they can do can make such involvement right. Put another way, legislators do not tell us what rights we have; rights tell us what legislators can (and cannot) do.

If preventive healthcare is as economically advantageous as proponents claim, then let people form free associations with like-minded individuals and purchase -- or forgo -- healthcare services as they choose. No programs, no personal fitness czar, no "public-private partnerships", no "Universal HealthMart." Just individuals living as they see fit, and managing the natural risks and rewards of their own behavior. Now that would be smart public policy.


[1] Adofo, A. Congressional Quarterly Healthbeat, December 10 2008

Thursday, January 8, 2009

Parker on the Federal Health Board

Dr. Richard Parker explains why the proposed new "Federal Health Board" will be hazardous to your health:
The "Federal Health Board:" Another Scheme to Ration Healthcare

Tom Daschle, President-elect Obama's nominee for Secretary of Health and Human Services, has big plans for healthcare. Mr. Daschle has proposed a new "Federal Health Board," an agency that would have unprecedented powers over the healthcare industry. This new federal board would essentially determine by government fiat what doctors can and cannot do to treat their patients. This represents not only a vast increase in government regulations, but the virtual elimination of healthcare decisions at the point of service, and the specter of government bureaucrats making life and death decisions over physicians and patients.

Never mind what you and your physician think is the best course of treatment, the "Federal Health Board" in Washington will make all those decisions for you...
Read the rest here.

The moral is the practical.

Wednesday, January 7, 2009

Hsieh OpEd in Christian Science Monitor

I'm pleased to report that the January 7, 2009 edition of the Christian Science Monitor has published my latest OpEd on health care entitled, "Universal healthcare and the waistline police".

My theme is that adopting government-run universal healthcare will lead to a "nanny state on steroids" deeply antithetical to core American principles of individual freedom and responsibility.

Here is the opening:
Universal healthcare and the waistline police

Imagine a country where the government regularly checks the waistlines of citizens over age 40. Anyone deemed too fat would be required to undergo diet counseling. Those who fail to lose sufficient weight could face further "reeducation" and their communities subject to stiff fines.

Is this some nightmarish dystopia?

No, this is contemporary Japan.

The Japanese government argues that it must regulate citizens' lifestyles because it is paying their health costs. This highlights one of the greatly underappreciated dangers of "universal healthcare." Any government that attempts to guarantee healthcare must also control its costs. The inevitable next step will be to seek to control citizens' health and their behavior. Hence, Americans should beware that if we adopt universal healthcare, we also risk creating a "nanny state on steroids" antithetical to core American principles...
Read the rest here.

(I would also like to extend my deepest thanks to Diana Hsieh, Ari Armstrong, and Brian Schwartz for their many helpful suggestions when proofreading earlier drafts of this piece.)

Tuesday, January 6, 2009

Maryland Moves Against Concierge Medicine

The December 20, 2008 Baltimore Sun reports on a proposal by the Maryland insurance commissioner to regulate concierge physicians as a form of insurance.

Fortunately, Greg Scandlen has been raising a stink about this. And so has Marc Kilmer.

And the January 2, 2009 Baltimore Sun also printed my LTE opposing this unjust intrusion of government against the rights of patients and physicians to contract for their mutual benefit.

But as Dr. Steve Knope explains, the Maryland physicians gave up the fight too quickly.

If Maryland patients want to preserve this option for themselves, they need to speak up now.

Monday, January 5, 2009

Thomas on Charity and Rights

Retired surgeon Dr. David Thomas has posted some thoughts on charity, medical care, and rights on his blog. The following is an excerpt from his post, "Can There Be A Right to Medical Care?":
...When I was in medical school, there was no insurance. People got care. Doctors charged and received payment with a direct doctor-patient relationship that was mutually sustainable and satisfactory, medically and financially. Poor people received care through the dedication and compassion of the doctor and community.

I was taught, "Save the widow the farm." That is, when Farmer Joe comes in with a lung cancer, one might encourage him to undergo extensive, expensive surgery that would require that the farm be mortgaged. However, the results were dismal. After Joe’s death, the widow frequently was unable to pay the mortgage and lost the farm.

Instead, one could explain the situation with compassion and frankness and Farmer Joe and his wife, using the same frugality and value system by which they had otherwise lived, would accept the reality of the situation, a reality that bespoke a meager chance of benefit that was not appropriately affordable. Joe's plight would be alleviated by all palliative means medicine had to offer. This rational, realistic decision was the norm. Indulgence in futile care to the point of threatening the whole system was not a problem.

Some patients would be wealthy, and with a full understanding, decide to take the slim chance of cure, paying for their treatment out of pocket, getting the "best money could buy." Frequently, they would leave money in their will to help the hospital meet the expenses of the care given to the poor.

Patients who received charity care knew that the doctor was doing it without pay, out of compassion. That had an added healing effect on the illness and the patient had the ennobling experience of gratitude. The physician sensed fulfillment of the underlying reasons that called him to an honorable, healing profession, a reward greater than money. Thus, the patient and the physician derived a mutual benefit.

The intrusion of government as the provider for the poor came at a great price. The politician arrogated the role of being the source of care. He gave the poor a warrant for medical care through Medicaid and instilled an attitude in the patient of having a right to it. This deprived the patient of any sense of being a recipient of personal compassion and the physician of feeling appreciated. The patient was told that the medical bill had been paid by the government. The physician actually received a pittance on the bill. So the mutual benefit of patient gratitude and physician fulfillment was replaced by the patient feeling entitlement and the physician feeling exploited.
Dr. Thomas has written much more, and I may post additional excerpts in the future. Here's the link to the whole piece.

Thursday, January 1, 2009

Happy New Year!

Because of the holiday, there will be no posting until January 5, 2009. Happy New Year!