Deliberate Waiting in the UK

The 9/4/2001 Telegraph reports that the UK National Health Service (NHS) deliberately keeps patients waiting longer than necessary even though hospitals could see them sooner in order to lower patient expectations.

The NHS also keeps patients on the waiting lists longer than necessary in order to save money and/or shift the costs into future budget cycles.

As always, UK patients have theoretical "coverage". But that's not the same as actual medical care.

(Via @sonodoc99)

Ralston: Ready to Inform on Your Doctor?

In the 9/1/2011 Orange County Register, Richard Ralston of AFCM asks, "Ready to inform on your doctor?" He notes, "Government wants that, and already has doctors informing on patients".

Government-mandated electronic medical records will be a big part of tracking both patients and physicians.

And this proposed National Patient ID Card could make it much easier for the government to control what care patients may receive, and what kinds of treatments doctors can offer, all in the name of tracking and encouraging "provider savings". (Via @aapsonline.)

Health care in 2014 could become eerily similar to life in 1984, but with better technology on the government's side...

Open Letter to Apple: My iPad and My Hip Fracture

Dear Apple:

I've been a happy iPad2 owner since March 2011, but I never fully appreciated its value until I recently broke my hip in a bad fall and required subsequent hospitalization.

I am a physician, so I had already been using my iPad for my work, reading PDFs of medical articles, communicating with my colleagues via e-mail, etc. But when I broke my hip in an accident a few days ago, the iPad became my lifeline to the outside world:

Because I had my iPad with me at the time of the accident, I was able to immediately notify my friends and family of what had happened once I arrived in the ER.

In the ER, the iPad also helped keep my spirits up as I checked e-mail, followed my friends on Twitter and Facebook, and followed the regular world news. When my orthopedic surgeon presented my treatment options to me, he also e-mailed me some relevant medical literature in the form of PDF files which I could digest at my own pace on the iPad. And of course, I was also able to perform Google searches on my various surgery options, the complication rates, postoperative care requirements, etc.

Because of the specific nature of my fracture, I had to choose between two treatment options, each with its own pros and cons. I found it enormously helpful to be able to gather the relevant medical information literally "at my fingertips". Because of the iPad, I was able to more quickly make an informed treatment decision that I was comfortable with.

I did briefly leave my iPad with my wife during the surgery itself, but she gave it back to me immediately after the surgery. Other than that, it did not leave my side while in the hospital.

While in the hospital after my surgery, I used the iPad to read eBooks, check my e-mail, surf the internet, and keep up my regular blogging. It was a real morale booster to be able to continue as much of my regular online routine as possible, despite my impaired physical condition.

My wife also had her own iPad with her while I was hospitalized, which allowed her to update our friends and family in real time on my condition, as well as keep her occupied while I was asleep or in surgery.

And now that I'm at home recovering, my iPad is still at my side!

For someone such as myself with limited physical mobility, the iPad2 with its light weight and long battery life was perfect. A laptop computer simply would not have worked while in the hospital. The iPad was literally an emotional, medical, and physical lifeline for me during a difficult time in my life.

I know Apple has been in the news lately because of Steve Jobs' decision to step down as CEO. I just wanted to take this opportunity to publicly thank Mr. Jobs and Apple for creating such a wonderful, life-enhancing product.

In your advertisements, Apple has touted the iPad as "magical" and "revolutionary". To that, I would add the term "life-saver".

-- Paul Hsieh, MD

[Crossposted from GeekPress.]

The Battle In The States

The 8/25/2011 Washington Times reports, "Rebellion by states could be hazardous to health care overhaul".

(As the article notes, it's unclear that any state-level initiatives could override federal-level provisions of ObamaCare without consent of Congress and the President. But the state-level actions are an interesting reflection of popular political sentiment.)

In the 8/25/2011 Orange County Register, John Graham notes "Health insurers in states' cross hairs".

When state governments can accept (or reject) requested insurance rate increases, it turns the nominally-private health insurance companies into a variant of "public" utilities. Yet when it suits them, the states can shift the blame for increases on the insurers for political purposes.

Wolf and Scherz Double Treat

Two of my favorite physician-writers both published good OpEds recently:

Dr. Milton Wolf, Washington Times, "I'm exactly what's wrong with Barack Obama's America", 9/2/2011.

Ayn Rand once identified "the sanction of the victim" as the method by which bad guys kept exploiting the good guys:

The "sanction of the victim" is the willingness of the good to suffer at the hands of the evil, to accept the role of sacrificial victim for the "sin" of creating values.

It's nice to see some value-producing Americans decide to start withdrawing that sanction!

Hal Scherz of D4PC, Physicians News, 9/2011, "Doctors Will Remain A Target Until They Wake Up".

Let's hope American doctors (and patients) heed his warnings before it's too late.

Drug Shortages

A couple of analyses of drug shortages:

"Preventive Care, Obamacare Style", Robert Goldberg, AmSpec, 8/24/2011.

"The Perils of Price Control", Richard Epstein, Hoover Institution, 8/30/2011.

Hsieh PJM OpEd: How ObamaCare Plays Games with Your Life

My latest is now up at PajamasMedia: "How ObamaCare Plays Games with Your Life".

My theme is that under ObamaCare, people will succeed through cronyism, pull, and "gaming the system". In contrast, doctors who adopt the old fashioned approach of working for their patients' best medical interests will be punished for their virtues.

Here is the opening:

Whenever Congress attempts to "reform" the tax system by passing new laws, they inevitably create new winners and losers. But one group always wins -- the consultants and special interest groups best able to "game" the system to their advantage. The same is happening now with Obama's health care "reform," except this time the stakes won't just be money, but Americans' lives...

I also discuss Dr. Stewart Segal's related concept of the "ACO leper".

Will you be an "ACO leper" under the new system?

Wolf On Prosperity

Dr. Milton Wolf has a new WashTimes OpEd, "Prosperity starts with Americans, not Uncle Sam".

Although it's not directly related to health care, it's a good overview of some key points on free-market economics.

Given that the recent earthquake and hurricane have spurred more popular awareness of the "broken window fallacy", Dr. Wolf's piece is a nice contribution to this public discussion.

Related video:

You Won't Keep Your Current Insurance

In the 8/25/2011 Washington Examiner, Byron York warns Americans, "Plan to keep your health plan? Don't count on it".

In particular, he describes how government incentives will lead employers to drop their current coverage. In turn, this will push many Americans into government-sanctioned and government-subsidized plans which will foster more dependency on the government.

Once that happens, the only question is how long before the system turns into an explicit "single payer" plan.

Admin Note: Sporadic Blogging

FYI, blogging here may be a bit sporadic due to some personal medical issues. (I do have a few pre-scheduled posts that should be appearing over the next few days.

In the meantime, take a look at David Catron's latest in today's AmSpec, "Why Perry Can Beat Obama and Romney Can't".

The point-by-point comparison is interesting. (Disclaimer: I don't agree with Perry on a variety of issues but he's clearly better than Romney on health care.)

Quick Links: Candidates, Addiction, SCOTUS

Kaiser Health News summarizes, "GOP Presidential Hopefuls: Where They Stand On Health Care".

Dr. Alieta Eck of AAPS discusses how too many doctors and patients are, "Addicted to Government".

Jennifer Rubin discusses how quickly (or slowly) the US Supreme Court will decide to review ObamaCare at, "What about the Obamacare litigation?" (Via David Catron.)

Admin Note: DNS Problems Being Fixed

Some people have been having trouble accessing links to the FIRM blog and the main website.

Diana has tracked down the problem to some bad DNS data. That has already been fixed, although it may take a couple of days for the updated DNS information to propagate.

Thanks, Diana, for figuring this out! And thank you all for alerting us to the problem!

Do Not Disturb The Nurses

According to the 8/27/2011 UK Daily Mail, patients are upset at nurses wearing "Do Not Disturb" uniforms while administering medications:

A row has broken out over a hospital trust's decision to give nurses 'Do Not Disturb' uniforms to wear during routine ward duties to prevent patients from speaking to them.

When nurses are wearing the bright red tabards, patients have to address any concerns to care assistants, who do not have clinical qualifications.

The hospital says interruptions, such as patients asking questions about toilets and meal times, stop nurses from doing their jobs properly and could lead to patients being given the wrong medication.

(Read the full text of "Do Not Disturb: Fury over nurses' uniforms that ban patients from trying to speak to them".)

This is an interesting way of rationing care, by limiting when and how patients can interact with caregivers. It's not as overt as, say, capping the numbers of surgeries a hospital will perform each week or how many cardiology appointments patients can get in a year. But the hospital is still sending an implicit signal, "Don't expect too much from us".

(Via @MatthewBowdish.)

Quick Links: Government, Stagnation, Controls

Dr. Hal Scherz of Doc4PatientCare has a new OpEd at Fox News, "Think the Government Handled the Financial Crisis Badly? Just Wait, Because Health Care Is Next". He explains why, "'Stealth' rationing of care to Medicare patients is imminent."

Chief Executive reports, "Health Care Reform Keeping 72 Percent of CEOs from Hiring". (Via D4PC.)

As ObamaCare leads to greater consolidation of providers (including doctors selling their practices to hospital chains), Medscape Medical News notes, "Hospital-Employed Physicians May Drive Up Costs".

Of course, the supporters of government-run medicine will simply use this an excuse to impose yet more cost controls to "fix" the problems created by earlier government controls. (Via @MatthewBowdish.)

Thank You, Steve Jobs

This isn't directly related to health care, but American Thinker just published my short piece: "Thank You, Steve Jobs".

He became wealthy offering value for value. In the end, we and his customers (and his employees and the people who wrote iPad apps, etc.) all won. This is why free market capitalism is a wonderful, moral system.

On a related note, Glenn Reynolds of Instapundit has a nice interview with former BB&T CEO John Allison on how the government caused the financial crisis and why capitalism is the only moral economic system:

Waiting to Find a Family Doctor in Canada

In the 8/22/2011 Globe and Mail, Gloria Galloway reports on the "The soul-destroying search for a family doctor".

Basically, it took her years to find a primary care doctor who would accept her. And now she has a doctor, she will of course still have to deal with any waiting lists for complex care such as surgical procedures or MRI scans.

Again, "coverage" does not equal actual medical care...

(Via Carpe Diem and Kelly V.)

Wolf on Corporate Welfare

Although it's not directly related to health care, Dr. Milton Wolf has a nice new OpEd out in the 8/23/2011 Washington Times, "Energy Obamanomics: No green jobs and plenty of red ink".

The money quote:

It's time for downgraded America to demand that every business pay its own bills. Mr. Obama would like to end what he calls subsidies to oil companies. Fine. Let’s apply that evenly to all energy companies. In fact, let's apply it to all companies in America. No more bailouts, subsidies, targeted tax breaks, selective tariffs, mandates to purchase certain products or any other form of corporate welfare.

(Read the full text of "Energy Obamanomics: No green jobs and plenty of red ink".)

As a supporter of free markets, I am neither pro-business or pro-labor or pro-[any particular sector of business]. Instead, I am pro-capitalism, which means all economic enterprises should be free to compete for customers without special government handicaps -- or special favors. The only thing the government should do is to prevent the use of force or fraud, but otherwise get out of the way of the honest entrepreneurs who create value. The resultant economic boom could help make America great again!

Catron: Professor Obama Holds Forth on the Mandate

President Obama continues to insist that the individual mandate in ObamaCare is constitutional. In his latest AmSpec piece, David Catron rebuts those argument at, "Professor Obama Holds Forth on the Mandate".

In particular, Catron discusses the misanalogies to state-level requirements that drivers purchase automobile insurance and the claim the prior precedent supports the individual mandate.

(Read the full text of "Professor Obama Holds Forth on the Mandate".)

Massachusetts Update

The 8/16/2011 Washington Times reports that "Health coverage, rates rise in Massachusetts".

Although MA residents have theoretical "coverage", that does not necessarily mean they get actual medical care. Furthremore, "health care premiums continued to outpace inflation by rising an average of 5 percent to 10 percent each year".

The article notes that this will soon become a problem at the national level:

Reforming health care in Massachusetts -- and the challenges that came with it -- foreshadowed President Obama's health care initiative, which he signed into law last year. The Affordable Care Act closely mirrors Mr. Romney's overhaul, leaving in place the employer-coverage model but expanding subsidized coverage.

Both laws include mandates on individuals to purchase health insurance or pay a fine, and on businesses to offer insurance, though they exempt small firms. Both establish insurance exchanges that offer subsidized coverage to low-income individuals and families and ban insurance companies from rejecting individuals with pre-existing conditions.

Now, both plans face questions over how to pay for their reforms over the coming decades.

In Massachusetts, that problem is already acute...

The MA plan also relies heavily on expanding government-subsidized health programs such as MassHealth ("which includes Medicaid and the State Children's Health Insurance Program"). One of Romney's former health policy advisors acknowledges that this "does create problems for sustainability".

The article also noted that, "An extra $5.6 billion in Medicaid funding through the federal stimulus bill helped to pay for the program over the past two-plus years. As of this year, though, that assistance is gone."

In other words, the MA plan was kept partially afloat by the taxpayers of the other 49 states. But under the national ObamaCare plan, who will bail out the United States? I wouldn't count on Germany or China being eager to foot the bill!

(Read the full text of "Health coverage, rates rise in Massachusetts".)

For more information on how ObamaCare will harm the US economy, see this piece by US Rep. Darrell Issa (R-CA), "Health care law will deepen deficit".

How to Stop Doctors From "Going Galt"

Up to 40% of doctors have said they would retire early and/or quit clinical medicine due to ObamaCare.

But because of the recent stock market crash, many physicians now say "they will work longer until retirement because personal savings had been gutted or had not grown as rapidly as anticipated".

I have to give President Obama credit for this one -- downgrading the US economy is certainly one way to stop physicians from "going Galt". It all makes perfect sense now!