Well, regulars knew that at least one person would have something to say about my last post. It was Lee, of course. Lee comments on everything, usually multiple times. This would make for a lively forum if not for the fact that all of us know what Lee is going to say before he says it. He’s going to give you the standard radical libertarian line, regardless of the subject.
You see, the Lexington Medical Center folks are counting on reactions such as Lee‘s. That’s what they were counting on from the Legislature — ""Aw, gee, who are we to say no to somebody who wants to set up an open-heart center?"
Libertarians think the market works the same way with health care as with selling soda pop.
There are a lot of folks in America who think like Lee. That’s why we pay more in this country for health care than folks in other developed countries do, and we get worse health outcomes.
The fact that a surgical team has to do hundreds of such procedures to be good at it is meaningless to Lee. He’d rather see every hospital in the state take on open-heart if they want to (and since it is a big money-maker, they’ll want to), so that NOBODY can get a bypass from a facility that knows what it’s doing, and we’ll all have to pay for all that duplicative investment.
He actually thinks that the average person is a hard-nosed, discriminating consumer of health care. He thinks that if the average person is told by his physician that a bypass might keep him alive, he’s going to ask how much it costs, and then comparison-shop.
Har-de-har.
Folks, do you realize that one of the arguments LMC has been making in favor of opening this cash cow is that patients are NOT informed? It’s actually one of their better points.
In discussion with some docs who support the proposal, I’ve pointed out that I live almost right behind LMC, and have to pass it to go to any other hospital. So if I cut myself and need some stitches, I go to LMC. Or if I need major abdominal surgery, as I did in 1993, I go to LMC. But if I think I’m having a heart attack, I’m going to Providence (and would even when LMC gets its way on the heart center). And if I have cancer, I’m going to consult the folks who practice at Richland.
I said those things to a Lexington doc just a few days ago, and his response was, "Well, yeah, that’s because you’re an informed patient." His point was that most people aren’t. They’ll just stop at the first emergency room they get to. Good point — except that if you follow that logic to its natural conclusion, every hospital with an ER should be allowed to do open-heart, whether they ever get the chance to get good at it or not.
So much for the invisible hand.
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Good post, Brad. Thanks for expressing my frustrations at Lee’s posts, so I don’t have to. Heaven help us all if people with his ideology ever get into government. Bad government is better than none at all.
Though I suppose you are going to say we’ve got too many radical libertarians already influencing government, or actually in it.
You read my mind, Herb.
Brad, you must be aware that within the medical community it is unheard of to run ads for the public to see how much medical care costs. Why is that?
Hi,
You seem to be quite health conscious.
I had been searching for a place where only relevant information about the subject could be found. No irrelevant information, no irrelevant URLs.
I guess you must be also hunting for something similar.
Well, I have some good news for you.
I have made a website where you can find all your health related information.
You may term it as “health search engine” .
Its called http://www.medicow.com
I am sure you will be happy to know about it.
You can search for any topic related to health, fitness and other topics related to health & I am sure that you will find information on it.
If you find any problems, Drop in a comment, & i shall look into it
Thanks
What makes liberals, especially those with no education in medicine or economics, believe most people to be incapable of rational, enlightened decisions in their own self-interest, in need of having their lives dictated by uneducated liberals?
One of the common slogans of those favoring socialist medicine is that the laws of economics don’t apply to medical care, that it is some sort of unique universe of product and services, though they can never explain what the differences are, much less why they think so.
I guess I fall into the “radical libertarian” camp because I don’t believe it is the right of the government to tell a hospital what type of care it can provide.
Brad, your premise that somehow opening a new heart center will lead to lower quality outcomes is a real stretch. Following that logic, one would assume:
a) Those patients who went to Providence when IT first opened its heart center were basically guinea pigs, right? How was it different for them?
b) Those doctors who would be performing procedures at the LMC would be neophytes basically winging it as they learn on the job. I hardly think that would be the case. More likely, LMC would bring in experienced surgeons to lead the transition.
I’m also fairly certain that there would be some standard of expertise and training required. Do you really think the LMC lawyers would take on the risk of complex heart surgeries if the rate of potential lawsuits was higher than normal?
c) That the doctors and surgeons at Providence (and other heart centers) would basically “horde” information related to new techniques, methods, diagnoses. I’m of the opinion that doctors tend to be more interested in the greater good. However maybe the hospital administrators might be more “libertarian” in their view by viewing LMC as a competitor for their profit center
and, as a result, causing worse outcomes for patients who might not go to their hospital.
Having spent many hours in waiting rooms, hospital rooms, and emergency rooms while dealing with my parent’s recent health issues, I am all for ANYTHING that can be done to improve the access to and the efficiency of the delivery of healthcare.
The best heart surgeons in the area are severely overbooked… maybe having more state-of-the-art heart centers locally will convince more of the better ones to move to the area.
Getting back to your obvious disgust with the libertarian philosophy, maybe you could enlighten us with those aspects of government where you believe the government does things right and efficiently? From my perspective, I’d give the following grades:
Elem Educ. : C-
Higher Ed : B+
Roads/Hwy : B-
State Parks : A-
Libraries : A
Police : B+
Fire : A
DMV : C-
Social Svc : C-
Public Health: C
Zoning : D-
Cronyism : A
Kickbacks : A
It is because I am an evangelical Christian, and not because I am a “liberal” (whatever that is), that I do not trust human nature. For short introduction to where I am coming from:
1) Human nature is fallen, and naive trust in it is misplaced. All things being equal, we can depend on human nature to normally do what helps itself, at the cost of others. There are notable exceptions, for the most part transformed by a combination of higher ideals (the Law of God, reflected to various degrees in various societies, some of it innate, some of it revealed religion), and the continued work of the Spirit of God, who causes people of faith to seek for something higher that we know ought to be there. So we have a messy situation. But I never want to be naive about myself, or anybody else.
2) One of the institutions that God raised up was human government, in order to curb the innate greed and self-seeking nature of human beings (Genesis 9, Matt. 22, Romans 13). He watches over the boundaries of all the nations, and He has been known (according to the tenents of revealed religion), to use government in a harsh way to punish people who deserve it. Not that we don’t all deserve it to some extent, but that is another subject.
3) Neither Republicans or Democrats are fundamentally more righteous than one another. Both will generally be scoundrels, unless some of the above factors enter in. Those on the “left” (if I may stoop to using some very general and useless labels myself) will give out entitlements in an futile effort, because they think man will improve if we are nice to them; those on the “right” think that people will do the right thing if we just leave them alone. Let the market have its way, and people too. We had enough experience with the J. P. Morgans of history that I can’t believe some people can still swallow that.
Never ask a would-be theologian to give a short answer to a question. Not well thought out, nor worked through (no time for that, but it’s my general thought at this time. Scripture is ultimately my authority, and not books on economics, as useful as they may be. For one thing, Scripture conforms more to reality.
I might add that, one of the hopeful aspects is that once in awhile one person with a few faithful followers stands up for what is right, and braves hell and high water to work for change, with some degree of balance (though movers and shakers are seldom well-balanced, that is true). Brad may be one of those; I hope so. He’s using the means that he has to work for change, as small as it may seem. I don’t know if the “Unparty” will work. I hope so. It’s worth a try? Like somebody with a little balanced view of human nature?
Of course, time and context have a lot to do with movers and shakers, e.g. Winston Churchill. Oh well, I’m rambling, obviously.
Herb, the problem is determination of what is “right”. The founders struggled with this and came up with the Constitution and the Bill of Rights. That is our official compass toward what is “right”. Without it, we would all be subject to the whim of whomever was running the show at the time. So, I always try to bounce proposals off of that remarkable document while evaluating. The medical equipment and services issue is really complex. In this case, as in most, they are dealing with a fast changing domain. Catheterizations are actually a common type of medical procedure now. It’s not quite relegated to outpatient yet, but probably getting there. I am usually immediately skeptical when a controlling group wants to control the free market interactions. To me this is just as much a form of price control as it is an attempt to optimize services. By price control I mean intentionally propping the price up real high.
What does the American government do best? Based on all the countries that I visited while in the military, I would have to say that public works and power is done best by the US. The developing world would be wise to copy our super highway system and our electrical grid system for starters. Having potable, clean water straight from the tap is unheard of in many countries around the globe, yet we take it for granted. Our system for traffic lights, emergency lanes, wide durable highways, safe and large buildings, parking lots, lighting, dependable telephones, and emergency services is first rate, especially when considering the size and scope of the US.
I have faith in the concept of government as long as it is democratic and it preserves and protects the unalienable rights of the people. Also, government should promote the well being of the people.
Most of our problems are definitely solvable through democratic means. As I’ve said many times before, the form of capitalism we are using creates bad divisions of labor in complex society, and it guarantees egregious levels of wealth inequality. We can make better divisions of labor through democracy with deductive thinking and planning. We can solve the wealth inequality problem by using progressive taxation and tax credits. We need to overhaul the entire consumer credit industry. The healthcare system is in part failing because of a corporate bureaucracy. It’s hard to believe, but private insurance companies all have different policies and procedures with different payable amounts and different allowables with different codings. The healthcare industry is an administrative nightmare, and it takes an army of administrative workers just to process claims. The entire system is set up to initially deny payment or to reduce coverage for consumers. We need one, efficient system for billing and coding health insurance claims.
Nothing we do however will work unless we believe that other people are just as valuable as we are. God saw that man was worth saving, so he sent Jesus into the world. Jesus said to love God with your heart, soul, and mind, and to love your brother as yourself. We can serve God by serving man, and our system should be set up so that people in their everyday lives (at work) can serve others in an ethical way. We need to be industrious and willing to do work for the sake of ourselves and others.
Going back a bit, to answer Lee, I can’t speak for “liberals” in terms of why they might “believe most people to be incapable of rational, enlightened decisions in their own self-interest.”
But I can tell you why I believe it — because it’s true. Ask a few doctors about it.
I don’t know how much experience you have with physicians and health care (your comments indicate your knowledge in this area is pretty limited; perhaps that’s why you try so hard to pin the “ignorant” label on others), but I have a lot more than I would like to have.
If you DO have experience with docs, then you may have noticed how many of them talk to you as though you were an idiot. I’ve run into that a lot; it causes me to move on to other doctors. But I understand why the less perceptive ones act that way — they are accustomed to treating people who know NOTHING about their condition or their health overall. You ever read those pamphlets about various conditions they have in doctors’s offices? They’re supposedly aimed at adults, but are written on a childish level. Why do you suppose that is?
This is not so much to say people are stupid; it’s to say that relatively few people understand even the basics of medicine.
It’s really ironic that you will accuse me of not knowing enough about medicine to comment, but you assume the average person on the street is fully capable of making informed life-and-death decisions at any time.
Anybody besides me see the inconsistency there?
Mark, you’re back! Where have you been? We need you to balance out some of these posts.
And Dave, is the free market necessarily “right”? Given my skepticism about human nature, I would expect that it would exploit the weak, in the interests of those who have the most power to get what they want. I can’t go as far as Mark wants to (if I understand Mark), because I don’t have a world full of Christians to begin with. Which probably wouldn’t solve anything, anyway. It’s a good thing our country’s documents weren’t just drawn up by evangelical Christians. We’re better off when we’re suffering a bit, otherwise, we get insufferable. Remarkable combination of history that brought about our Bill of Rights, really.
But we still have the problem of hermeneutics, i.e., interpretation of the documents. So I’m back where I started. Oh well, it’s fun to ramble.
How much experience do I have with physicians and health care? I hold degrees in economics, and have designed medical information systems used by private practices and all the hospitals in Columbia and every other major city in the US, as well as some of the equipment in those hospitals, and some of the insurance systems for the US military.
Economic theory assumes that the average person on the street is better informed to make decisions about his life than someone who never met them, whether it is a hospital administrator, or just some politician or newspaper editor. Any other assumption is based on a set of really ridiculous assumptions about some men having god-like powers.
Herb, no offense, but you have the sound of an ELCA person. That is a pretty active church with respect to social causes, do you know if they have ever come out with a position on for-profit medicine? Sorry if I pegged you wrong, I know some Lutherans get uptight about that.
With regard to Lexington, it is no surprise to see someone trying the end run around DHEC they have. Disappointing, yes, surprising, no, so I guess I agree with Brad.
My history as a medical consumer is different than some discussed here, as my main focus is ensuring the care of a loved one who can’t manage this on their own. I would like to be the kind of educated medical consumer Lee describes, but find the information I have access to is limited. Are malpractice databases publicly available in SC yet? Where did you go, Brad, to learn that the abdominal work was better at Lexington but cardiac emergency better elsewhere?
Uncle Elmer, no I am not ELCA, but I feel honored that you pegged me there. I spent a two-year stint, 1985-87, as a guest pastor in the Bavarian Lutheran Church, and learned a lot, I think, from the evangelical wing with which I mostly associated. Before and after that, I was pretty much in a variety of denominations, including the Lutheran Church of Wuerttembuerg, and the United Church of Hessen-Nassau, but also Baptists, Methodists, and Evangelical Free. But sometimes my Southern Baptist (Texas) roots definitely come through. Now I am in exile as a Presbyterian. Not sure how I got there.
Luther is one of my heros, but even more so Melanchthon.
But I still have a lot to learn about both of them.
All of which to say that I don’t know what the ELCA has said about health care, but it would be interesting to find out. I’m snowed under in other research right now, but let me know if you find out anything, and I’ll do the same.
The outcomes of surgeons are tracked in national databases, so other surgeons can learn what works best in what diagnostic scenario, and why. When you get into areas of experimental treatments or techniques, expect to go to a research hospital that is a leader in that field. When the development of a new treatment or technique has been prefected, more people in other cities will learn how to do it, and some will become very good at it, despite the fact that they are in Columbia instead of Sloan Kettering or Johns Hopkins.
Lee,
Market forces don’t apply to medicine well because you don’t shop for heart attack care like you do for a truck.
I ordered my truck and waited 2 months for it. It was built over a thousand miles away and delivered to me.
Time and geography had very little influence on my decsion to buy a truck (and they don’t in many of our purchases these days). But they do matter in medicine. If you are having a heart attack, EMS regulations generally dictate that you are taken to the closest facility with an ER so you have no choice as to where you go. For more elective care,what matters most to patients is having physicians they can trust and who are competent. Price, which drives most other economic sectors, is much farther down the list in medical care.
When it comes to building hospitals, relying on the market alone hurts the poor. In states that have no certificate of need restrictions, private “specialty” hospital are being built for cardiology, orthopedics, and womens care. These hopitals generally take only private insurance and have no ERs so they skim affluent, insured patients away from community hospitals like Richland. With less revenue the community hospitals cut services and can no longer attract the best MDs.
The market is no panacea for health care (or education, for that matter)
You don’t shop for a heart attack any more than you shop for an engine failure in your truck. The smart person knows in advance where to take his truck or himself, for repair. The responsible person has taken measures to reduce the risk of such events, bu t has made arrangements in advance to pay for the repairs.
The rest of the world wants to act like children, and have Big Sister take care of them and pay the bill.