Tuesday, September 15, 2009

"Because health-care resources are assumed to be fixed..."

by the Sandwichman

From an op-ed by Rupert Darwall in the Wall Street Journal today:
"The case for ObamaCare, as with the NHS, rests on what might be termed the "lump of health care" fallacy."


TheTrucker said...

Actually, "the case for 'Obamacare'" rests firmly on reigning in the "waste" that is the private insurance sector. Current proposals and debates have little to do with the actual provisioning of health care. The Republicans are portraying that Obama is changing the actual health care system and snuffing Grandma. But the facts keep getting in their way.

Suffern AC said...

So, if I follow this right, the U.S. needs to continue to be the only market based health care system to support the speedy development and distribution of health care technology. For we are the only country that has figured out that the more you spend on health care, the more there is to spend on everything else? And if, say, nothing is done, we can continue our preferred trend of spending more and more for health care, which will spark more innovations by companies trying to meet the demand. There seems to be no limit to this expansion as more demand creates more health care. Eventually, we will live forever thanks to the capacity of market based approaches to spur innovation. Although in the real world, we may not have a pot to piss in, we will spend our immortality peeing in cups and handing them to doctors and asking them if they might do us one better...that and probably farming.

Shag from Brookline said...

Here's a question or two to ask your physician:

"Describe the defensive medicine you practice in your treatment of me that is based upon your medical malpractice concerns? What would your treatment be if you had no medical malpractice concerns?"

As for Darwall, he might ask his physician to check out his lumps.

Jack said...

Undoubtedly it would save a great deal of money if physicians did not have to confront the possibility of medical malpractice.
This problem would be resolved if there was no occurence of medical malpractice. But so long as instruments are left inside surgical patients and the wrong hip is replaced or the wrong medication is prescribed and administered we will have a need to compensate those that suffer the injury and discipline those who are careless or incompetent.

Unfortunately malpractice in medicine can be devastating to the injured party. There has to be some system, if not torts, to respond to injurious practice. Have you any suggestions? The key to resolving difficult problems is to be just as quick with the solution as you are with the criticism.

run75441 said...

The amount of money saved by eliminating all Medical malpraqctice suits would be a drop in the proverbial 2 $trillion healthcare bucket. You are wasting your time if you believe this will corral rising healthcare costs.

As far as defensive healthcare practice? How about doctors practicing (done you like that term "practicing," when do they quit practicing?) whatever the standards will bare in a region. One study in Florida found the percentage to be ~ 5-7% until such time as managed healthcare was installed and then it dropped to ~2-4%. Still not the pot-of-gold at the end of the rainbow.

Back to Medical Malpractice lawsuits, far more case of malpractice exist than what actually makes the courts. Why is that? Because most people don't sue and attorneys refuse to sue for a misdiagnosed burst appendix worth 1 month of salary. When you look at the average award in 1991, it was ~$285,000 which grew to ~$480,000in 2005. Adjusted for inflation that $480,000 drops to $260,000. To ad to the fun, most states cap awards for pain and suffering at $250,000 to $500,000.

The number of lawsuits went from ~16,000 in 1991 to ~14,000 in 2005. ^ something per 100,000 to 4 something per 100,000. Time to find a new poster child for rising healthcare costs.

http://www.press.uchicago.edu/Misc/Chicago/036480.html “The Medical Malpractice Myth,” Tom Baker

http://www.citizen.org/documents/NPDB%20Report_Final.pdf “The Medical Tort Reform Debate” Public Citizen 2007


run75441 said...


Guess we need to start charging for the passage of our medical technology and knowledge out of the country to other countries. Maybe if would solve the defict?

"the "lump of health care" fallacy. But in a market-based system triggering one person's contractual rights to health care does not invalidate someone else's health policy. Instead, increased demand for health care incentivizes new drugs, new therapies and better ways of delivering health care. Government-administered systems are so slow and clumsy that they turn the lump of health-care fallacy into a reality."

So we have Britain who has issues with healthcare, the quickness of it, and the ingenuity as compared to the US which has 46 million uninsured with 30 million of the 46million who can not afford it. So that is our lump of labor fallacy? He hasn't made his case by using the US as an example and furthermore, no matter how slow it is and how long one may have to wait in a cue, more people are still coverd by percenatge than in the US. A rapid diffuser of techniques does not provide healthcare to the constituency.

Tom Hickey said...

According to Henry C. K. Liu, "the correct way to look at medical expenses is to see it as investment rather than consumption. The same principle applies to education. Cutting cost is a dead-end solution for these sectors."

While the Obama administration seems to be buying into the lump fallacy, conservative views are generally based on the assumption that health care is a luxury good. Both miss the point.

If the US wants the 21st century to be the American Century instead of seeing the torch passed to Asia, we had better get the investment thing right with respect to public investment in infrastructure in relation to private consumption of goods and services.

The US has just gone in for at least a trillion to prop up the private banking system, with guarantees amounting to much more. Are health care and education any less essential to a vibrant and competitive economy than finance? The US spends more than the rest of the world combined on defense. Is defense productive -- assuming it not for an imperial purpose?

There's something wrong with the priorities here, and the problem seems to lie in conflating policy with neoliberal economics. Needed: a new vision for America.

Shag from Brookline said...


My questions may have suggested that I am in favor of limitations on malpractice suits. I am not. I've been practicing law in the Boston area since 1954 and during that time only two or three potential medical malpractice cases came across my desk, none of which I took on. Here in MA there are certain limitations, controls on such claims that seem to weed out all but the egregious cases. I agree that the types of malpractice you outline should be compensable. But I continue to read about defensive medicine being practiced as increasing the costs of medical care. My questions are aimed at finding out from physicians what defensive medicine they are practicing that they otherwise would not. In other words, I seek a quantification of such costs from the horses' mouths.

Jack said...

It strikes me as difficult to be able to obtain honest reports from physicians regarding the defensive aspects of care which will enable the investigator to distinguish between defensive tactics aimed at liability protection vs similar tactics aimed at good investigative/cautionary medicine. The physician will be in the position of having to make that differentiation unless the researcher is clever enough to devise a technique that will adequately distinguish between the two defensive strategies.

It may be that self-defensive practice serves the patient well and is not by definition wasteful.
Fail to make an early discovery of an illness, its cause or some form of dysfunction and the patient may then be subjected to later efforts that are either not adequate by that point or far more costly over all. A thorny issue for sure. I'd venture to guess that those who decry the wastefulness of some medical efforts would cry loud and long if and when denied such efforts for their own sakes. The Congress people in general have a level of gall not to be matched else where as they argue the cost of health care and receive on of the costliest health insurance packages for them selves and family. I'd suggest that the simplest answer to the health care finance debate is for all people to be eligible for either Medicare or the Federal Employees Health Benefits Program, which looks pretty darn good to me,

Kaleberg said...

Doesn't "op-ed in the Wall Street Journal" mean "incorrect"? I buy the Journal and read the editorials to get investment ideas. I just read their advice and do the opposite. My subscription has paid for itself a thousand fold.