Tuesday, November 16, 2004
Would Specter Be Bad News For Tort Reformers?
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There's (another) good reason for physicians to take an interest in who is appointed Chair of the Senate Judiciary Committee--his record suggests Specter would be bad for tort reform.
"" A brief look at Mr. Specter's record makes that clear. In May of 1995, weeks into the new Republican majority, Mr. Specter tried to derail a product-liability reform bill. He voted against limits on attorney fees for medical liability suits and against limiting punitive damages to three times economic damages (not a hard cap, since economic damages would not be capped).
"Mr. Specter also voted against an amendment to limit non-economic damages to $500,000 and against another to protect OB/GYNs from being sued for problems they didn't cause. Mr. Specter also voted against the final bill. " --Washington Times"
More at NotSpecter.com.
[Via Overlawyered ]
Monday, November 15, 2004
Family Presence--A Really, Really Bad Idea
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There's a movement gaining steam to allow family members of very ill patients to watch resuscitation efforts by the medical team. This Fox News article states: "Better access to information and witnessing for themselves the measures taken, they argue, often help survivors through the grieving process."
I couldn't disagree more. As an anesthesiologist, I frequently find myself in situations where family members want to be present--at cesarean sections, at surgery for their children, etc. I just don't see how being present to witness the invasiveness of a modern 'code' is 'more holistic patient care.' We cram tubes down people throats, stick them with big needles to gain venous access, shock them with lots of electricity. During all of this they are often naked, sometimes vomit and, unfortunately, don't survive a majority of the time. Plus there's frequently chaos. The person 'running the code' is usually a medicine resident whose crisis management skills are, um, developing, shall we say?
Really, really bad idea.
Wednesday, November 10, 2004
Many People Won't Do What They're Told
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The New York Academy of Medicine: News & Publications: Terrorism Response Plans Will Not Protect Many Americans, New Academy Study Finds:
""Called Redefining Readiness: Terrorism Planning Through the Eyes of the Public and funded by the W. K. Kellogg Foundation, this year-long study gave the American people their first opportunity to describe how they would react to two kinds of terrorist attacks: a smallpox outbreak and a dirty bomb explosion. The rigorous study involved in-depth conversations with government and private-sector planners, 14 group discussions with diverse community residents around the country, and a telephone survey of 2,545 randomly selected adults in the continental United States. ""
Bottom Line: only about 40% would actually do as they are told and go to a smallpox vaccination center for fear of a) catching the illness form the crowds there and b) concern over side effects. The public would do worse in dealing with a dirty-bomb (radiation) attack.
[Via The Atlantic Monthly]
Shortage of 200,000 Doctors Predicted in US by 2020
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Annals of Internal Medicine (free): Weighing the Evidence for Expanding Physician Supply
"Summary: "Taken together, this body of information indicates that physician shortages are emerging and that they will probably worsen over the next 2 decades. By 2020 or 2025, the deficit could be as great as 200 000 physicians—20% of the needed workforce..."
...[snip]...
"... the data, forecasts, and signals discussed earlier indicate that physician shortages are upon us and are likely to worsen over time. The picture that emerges is uncomplicated and unambiguous. In simple numeric terms, the number of physicians is no longer keeping up with population growth. The ability to fully service the population is further compromised by the increasing complexity of the care that physicians provide and the decreasing time commitment that many physicians are willing to make. These limitations collide with economic trends that predict a growing demand for physician services. Recruiters, medical leaders, and patients are already experiencing these shortages, and colleagues in other English-speaking countries see a situation in the United States that is all too familiar to them.""
Missing from the article is any mention of 'malpractice', 'tort reform', or 'liability reform'. These issues do effect how long someone chooses to practice and where. If one believes that there's a physician shortage coming, states would be wise to become 'friendlier' to physicians by enacting tort reform in order to insure they remain a viable choice for physicians looking for a place to practice. Of course, Pennsylvania won't be among them, at least not while Ed [trial lawyer] Rendell is governor, as he's already been quoted as saying that malpractice reform is "the next governor's problem."
[Via Medscape]
Thursday, October 28, 2004
NEJM: Health Care Coverage and Drug Costs — The Candidates Speak Out
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The editors asked President George W. Bush and Senator John F. Kerry to respond to two questions regarding health care in the United States. Free full text.
Wednesday, October 27, 2004
Four Myths About Social Security
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Four myths about social security:
- The Pension Myth
- The Transition Cost Myth
- The Baby Boomer Myth
- The Medicare Myth
[Via Marginal Revolution]
Is Kerry Proposing Government Health Care?
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Medpundit opines:
""Any plan that expands Medicaid to include over 50% of the population - which is what the Kerry plan does - is a plan that involves government take-over of the healthcare system. There's just no getting around it.UPDATE: People are asking, "where does Kerry say he's going to put over 50% of the population on Medicaid?" His healthcare plan calls for expanding Medicaid coverage to children families that make up to 300% of the federal poverty level. According to the 2004 Federal Poverty Guidelines, 300% of the federal poverty level for a family of four would be a yearly income of $56,500. And according to the U.S. Census Bureau, the median yearly income in 2003 for family households was $53,991. Assuming that the average family is a family of four, that means that over 50% of families would qualify for Medicaid. And believe me, employers won't foot the bill for healthcare insurance when they know their employees can get Medicaid. So a large segment of the population will be shifted to Medicaid, and that's a government healthcare program.""
Sunday, October 24, 2004
All about Kerry's health-care plan
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Nicole Griffin: Kerry, Healthcare, and Unmitigated Disaster
[Via The Shape of Days]
Medical Care Gets Outsourced, Too
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Washington Post: Surgeries, Side Trips for 'Medical Tourists'
Affordable Care at India's Private Hospitals Draws Growing Number of Foreigners:
""Taking his cue from cost-cutting U.S. businesses, Staab last month flew about 7,500 miles to the Indian capital, where doctors at the Escorts Heart Institute & Research Centre -- a sleek aluminum-colored building across the street from a bicycle-rickshaw stand -- replaced his balky heart valve with one harvested from a pig. Total bill: about $10,000, including round-trip airfare and a planned side trip to the Taj Mahal.""
[Via Digital Claudio...]
Saturday, October 23, 2004
Heal the Law, Then Health Care
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I'm reading more about Expert Medical Courts. Although my initial reaction is to avoid the creation of a new expert medical court beurocracy, I'm beginning to see the necessity of it.
Heal the Law, Then Health Care
Troyen A. Brennan and Philip K. Howard
The Washington Post, January 25, 2004
""What's missing from the current debate is any discussion of how the legal system should work in health care. Law is not some sort of sacred mandate but a tool to serve the common good. Asking how law can best serve health care leads to an unavoidable conclusion: A system of justice must be created that makes deliberate judgments -- reliable for patients and providers alike -- with improved patient care as the primary goal.""
Thursday, October 21, 2004
NEJM -- Bankrolling Stem-Cell Research with California Dollars
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NEJM--Bankrolling Stem-Cell Research with California Dollarscontains a very informative passage about how stem cells are obtained:
""What is at issue here is that the derivation of an embryonic stem-cell line requires the dissection and culturing of about 30 cells from the core of a blastocyst, a microscopic early-stage embryo comprising fewer than 200 cells. The derivation process kills the embryo, even as the stem cells persist and propagate. The embryos themselves are obtained from in vitro fertilization (IVF) clinics, where excess embryos are typically produced in the course of assisted-fertility procedures. An estimated 400,000 IVF embryos are currently in frozen storage and will eventually be discarded, except for those that are donated, with informed consent, for use in research. Some religious conservatives and opponents of abortion have taken a firm stance on what seems to be tenuous, ultimately unsustainable moral, ethical, or logical ground: acquiescence to the discarding of excess IVF embryos, coupled with rigid opposition to the use of embryos for biomedical research.""
The same issue contains another article titled Embryonic Stem-Cell Research — The Case for Federal Funding. Both are available free (kudos to NEJM for this).
NEJM: Financing Medicare in the Next Administration
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Financing Medicare in the Next Administration (free full text)
" "Because of its size and political impact, Medicare will rank high on the domestic policy agenda of any incoming administration. When that administration assumes office in January 2005, Medicare will account for more than 13 percent of total federal expenditures; the only larger domestic program will be Social Security, which will account for 21 percent.1 By fiscal year 2007, with the phase-in of the prescription-drug benefit, Medicare's share of federal spending will increase to almost 16 percent. In short, the new administration will find the scope of any new initiatives limited by the needs of the Medicare behemoth." "
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Oct Dec
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