Hsieh Forbes OpEd: What The US Can Learn From the Australian Health Care Debate

My latest OpEd is now up at Forbes: "What The US Can Learn From the Australian Health Care Debate".

Here is the opening:

Is it fair to ask a patient to pay $6 for emergency medical care? Or are patients entitled to free medical care whenever they need it? That's the question Australian government officials are currently grappling with.

As the Australian health care unfolds, there are two lessons for Americans -- one political and one philosophical.

For more details, read the full text of "What The US Can Learn From the Australian Health Care Debate".

(And thanks to WhiteCoat's Call Room for the link to one of the Australian news stories on this topic!)

Young Invincibles Killing Obamacare?

Megan McArdle argues that, "Young Invincibles Are Killing Obamacare".

She notes that more young, healthy people (who are necessary for the system to work) are signing up.  But not enough.

The 10 Types of ER Patients

Slate has a pretty good article on "The 10 Types of ER Patients: If you fall into one of these categories, here’s how to improve your care".

Armstrong on Problems With Prescription Drug Monitoring

Ari Armstrong discusses how, "Prescription drug monitoring punishes the responsible for the sake of the irresponsible". (Greely Tribune, 3/12/2014).

Here's the opening of his piece:

Prescription drug abuse is a serious problem, sometimes a fatal one. But the answer is not for the government to monitor and harass people who suffer from devastating pain -- and make it harder for them to manage their pain -- in a misguided attempt to save drug abusers from themselves. Unfortunately, that is precisely the effect of House Bill 1283, sponsored by Rep. Beth McCann of Denver...

Light Posting

I realize my blogging has been pretty light lately. This current semi-hiatus will likely continue through the rest of the week due to external obligations.

 I hope to be back in action next week!

Catron: Drug Rationing for Seniors Begins

In the 2/24/2014 American Spectator, David Catron notes that, "Drug Rationing for Seniors Begins".

The latest restrictions for Medicare patients is alarming both the political Left and the political Right.  What the government giveth, the government can taketh away.

(This should be a warning for those advocating "Medicare for all".)

Hsieh Forbes OpEd: Can You Trust What's In Your Electronic Medical Record?

My latest Forbes piece is now up: "Can You Trust What's In Your Electronic Medical Record?"

I discuss how government-mandated electronic medical records are hampering doctors' ability to practice and resulting in medical errors. I also discuss 4 concrete steps patients can take to protect themselves.

I didn't mention this in the Forbes piece, but there was a terrific drawing in the Journal of the American Medical Association from a couple of years ago by a 7-year old girl depicting her recent doctor visit:

No one was more surprised than the physician himself. The drawing was unmistakable. It showed the artist—a 7-year-old girl—on the examining table. Her older sister was seated nearby in a chair, as was her mother, cradling her baby sister. The doctor sat staring at the computer, his back to the patient—and everyone else. All were smiling. The picture was carefully drawn with beautiful colors and details, and you couldn't miss the message...

Even young children understand the effect of electronic medical records on their care.

(Note: There is some overlap in material with my earlier PJ Media piece, "The Eyes of Big Medicine: Electronic Medical Records".  But most of the content -- and the emphasis -- in this latest piece is new.)

Pharmacy Innovation

An promising innovation reported by Wired: "A Drug-Dealing Robot That Upends the Pharmacy Model".

Food Police

Ernest Istook describes how ObamaCare is now unleashing the food police. (Via Ari Armstrong.)

Narrow Networks

Patients are starting to feel the pinch from ObamaCare's "narrow networks".  Two recent stories:

Los Angeles Times: "Obamacare enrollees hit snags at doctor's offices"
(2/4/2014)

Megan McArdle: "'Doc Shock' Reaches the Masses" (2/6/2014)

These narrow networks will also have a less-obvious effect on doctors, as I noted in my recent Forbes piece on the new ethical pressures on physicians caused by ObamaCare:

To cut costs, many ObamaCare exchange plans also require “narrow networks” of providers, where patients may only receive treatment from a short list of approved hospitals and doctors. President Obama has repeatedly promised, “If you like your doctor, you can keep your doctor,” but many patients are learning the hard way that this isn’t true.

Such “narrow networks” also mean that many doctors will lose long-standing relationships with patients they’ve seen for years. Instead, doctors will be increasingly reliant on the government-run exchanges for new patients. This will create a powerful incentive for physicians to adhere to any treatment guidelines mandated by the government or by government-approved insurance plans.

Megan McArdle predicts that political pressures will cause insurers to loosen these narrow networks.  But then patients will have to pay higher premiums, instead.  Either way, patients will be paying some unpleasant price for this form of "universal" health care.

Adalja on Government and Cigarettes

Dr. Amesh Adalja has a new OpEd in Forbes, "Are Controls on Cigarette Smoking A Rationing of Liberty?"

I liked how he notes both that the government overstepping its proper bounds in restricting cigarette use, but also how the government promotes tobacco production (and implicitly consumption) through farm subsidies.  And of course, these tobacco subsidies have bipartisan support.

The government is not our friend nor our protector.

For more, read the full text of "Are Controls on Cigarette Smoking A Rationing of Liberty?"

Amerling on Physician Independence

Dr. Richard Amerling of the AAPS recently gave a short talk on how he came to write the "Physician Declaration of Independence".



Here's the text of the "Physician Declaration of Independence".

(Note: There are some important issues on which I disagree with AAPS, such as abortion rights.  But they make many excellent points about the current state-sanctioned 3rd party payor system as well as the broader issue of government seeking control over doctors.)

Quick Links: HealthTap, Concierge Practices

Darren Dahl interviews Ron Gutman: "How I Disrupted the Health Care Industry" (via @seven2521).

Pittsburgh Tribune: "Doctors flock to concierge practices" (via @AmeshAA)

Hsieh Forbes OpEd: How ObamaCare Creates Ethical Conflicts For Physicians

Forbes has published my latest OpEd, "How ObamaCare Creates Ethical Conflicts For Physicians And How Patients Can Protect Themselves".

Here is the opening:

Do you trust your doctor? Most patients assume their doctor is working in their best medical interests whenever he or she orders a diagnostic test or recommends a particular treatment. Customers might wonder whether an unscrupulous auto mechanic is being truthful when he recommends a brake job or a new transmission. But most patients trust that their doctor isn’t recommending unnecessary surgeries merely to line his pockets.

The vast majority of doctors take their ethical responsibilities very seriously. Prior to ObamaCare, only a relatively few “bad apples” have chosen to compromise their professional ethics for financial gain. However, ObamaCare creates new ethical conflicts for doctors. We’ll examine some common physician conflicts of interest before and after ObamaCare, and discuss how patients can best protect themselves...

Prior to ObamaCare, physicians faced perverse incentives for overtreatment. Physicians might also be tempted to pad their income through inappropriate self-referral or business relationships such as "physician owned distributorships".

After ObamaCare, physicians will face perverse incentives for undertreatment, especially with "bundled payments" and government "appropriate use criteria".  The new "narrow networks" required by many ObamaCare exchange plans will exacerbate these issues:

To cut costs, many ObamaCare exchange plans also require “narrow networks” of providers, where patients may only receive treatment from a short list of approved hospitals and doctors. President Obama has repeatedly promised, “If you like your doctor, you can keep your doctor,” but many patients are learning the hard way that this isn’t true.

Such “narrow networks” also mean that many doctors will lose long-standing relationships with patients they’ve seen for years. Instead, doctors will be increasingly reliant on the government-run exchanges for new patients. This will create a powerful incentive for physicians to adhere to any treatment guidelines mandated by the government or by government-approved insurance plans.

I also discuss several ways patients can protect themselves from these old and new physician conflicts of interest.

For more details, see the full text of "How ObamaCare Creates Ethical Conflicts For Physicians And How Patients Can Protect Themselves".

Medical Malpractice and 3-Way Sex

As a change of pace from health policy, here's an excerpt from a recent Medscape article by Michael J. Sacopulos, JD, "5 Unexpected Ways You Could Get Sued":

Patient Not Warned to Avoid Physical Exertion; Dies During Threesome

A Lawrenceville, Georgia, jury awarded $3 million to the estate of William Martinez. Mr. Martinez was 31 years old in 2009, when he entered his cardiologist's office. There he complained of chest pain that radiated into his arm.

His cardiologist found that Mr. Martinez was at "high risk" of having coronary disease and ordered a nuclear test to be performed. The test was scheduled to take place 8 days after Mr. Martinez' initial appointment with his cardiologist. The cardiologist alleges that Mr. Martinez was instructed to avoid exertional activity until after the nuclear stress test was completed. The family of Mr. Martinez argues that no such instruction was given.

The day before his nuclear stress test, Mr. Martinez apparently engaged in some "exertional activity." In fact, Mr. Martinez engaged in a threesome with a woman who was not his wife as well as a male friend. During this encounter, Mr. Martinez died.

His family members then proceeded to bring a medical malpractice claim against his cardiologist and the cardiologist's practice. Presumably the family's thought was if William Martinez had been properly instructed to avoid high-risk activities, he certainly would have complied.

The family initially brought a claim for $5 million dollars, but this claim was reduced by a finding that Martinez was 40% liable for his own death. Note the mathematics: One would assume that engaging in a 3-way activity would make him one-third liable for his own damages, but apparently there were facts not known to me that increased his liability to 40%.

In August 2011, the New England Journal of Medicine reported that cardiologists are the physicians most frequently named in medical malpractice actions. In fact, cardiologists in the United States have a roughly 1 in 5 chance of being sued in any given year. Based on the Martinez case, you can see how these statistics can actually be true. The cardiologist's attorney indicates that an appeal will be taken. For now, we will all have to wait to see how the appellant court system of Georgia reacts to this case.

Lesson learned: Document every instruction. 

PJ Media: Federalizing Medical Conversations?

I have a short new blog post up at PJ Media, "Federalizing Medical Conversations?"

In it, I ask the question:

Will the federal government be taking a closer look at conversations between doctors and patients, in the name of protecting privacy? Here is an excerpt from a recent e-mail sent by a hospital administrator to physicians I know...

Click through to read the whole thing.

Canadian Surgeons and Patients End Runs Outside The System

The Calgary Herald reports, "Have scalpel, will travel: Alberta surgeons operate abroad to bypass wait times".

More Canadian doctors are practicing outside the country's borders (e.g., in the Caribbean) to provide patients with faster, better service.

In this case, a Canadian woman chose to have her knee surgery by a Canadian doctor in the Caribbean with only a 2-week wait (rather than a 7 month wait in the government socialized system).

This was after she got a private MRI scan (rather than waiting 8 months for a government-approved MRI scan.)

The article notes it's not merely the "super rich" exercising this option, but also many ordinary people who don't wish to wait.  In the case, the patient was totally reliant on her husband to get around, requiring pain medications that made her woozy.  For her, spending money to receive faster medical care made perfect sense.

This two-tiered system may be the future of American health care in a few years.

Dr. Milton Wolf Announces ‘PatientCare’

Dr. Milton Wolf (candidate for US Senate from Kansas) has published his 17-page alternative to ObamaCare.

I agree with many of his great ideas, and his plan would be a good start in moving us in the right direction.  Here's the direct link to the PDF.

Dr. Sotos' Model

The Pittsburgh Tribune has a nice profile of Dr. Peter Sotos in their article, "Walk-ins, cash discount set East Franklin surgeon apart".

Patients willing to pay cash receive good, timely, and affordable care. This is just one example of how health care can work when patients and physicians contract directly, without intermediaries such as the government or insurance companies.

(Via Dr. Amesh Adalja.)

Catron on Medicare and "Single Payer"

At the American Spectator, David Catron reminds us that we already have a "single payer" system for a large portion of the US population in the form of Medicare.  And BTW, it's also one of the most dysfunctional parts of our current health system.

In particular, he notes that:

* The Medicare system is economically unsustainable
* More physicians are declining to accept Medicare patients
* The government tracks intimate personal and health information on Medicare patients
* "Medicare patients have worse outcomes than patients with private health care insurance"

For more details on why we shouldn't move towards a "Medicare-for-all" system, read the full text of his piece, "Single Payer: We’ve Been There, Done That".