The American Spectator

Reader Mail

Barr Knuckled

5.14.08 @ 12:01AM

(Page 3 of 4)

There is an irony with colleges campuses attitude towards guns and drugs. A student can't carry a gun for personal protection, but it's perfectly ok
to carry a syringe and needle for a afternoon fix.
-- Melvin Leppla
Jacksonville, North Carolina

GREAT IDEA, IF YOU LIKE DEATH
Re: Michael F. Cannon & Alain C. Enthoven's Life-Saving Insurers:

The ideas in the article definitely would work to contain costs of health care.

If, for example, a patient is admitted with meningitis and develops a brain abscess as a complication, then stipulating no neurosurgeon can be paid for managing the brain abscess will reduce the costs of caring for that patient. Quickly. If, alternatively, the complication is a severe allergic reaction to the antibiotic chosen, resulting in a respiratory arrest, stipulating that no anesthesioligist nor intensivist can be paid for managing the respiratory arrest will reduce the cost of caring for that patient even more rapidly.

Kudos to Cannon and Enthoven for insuring lower costs.
-- Drew Sullivan
San Jose, California

While I think Mr. Cannon makes valid points in his essay, Medicare and the other providers have "gotten away with murder" when reimbursing health care providers for care rendered. Current reimbursement for elective gall bladder surgery is $400 and includes all preop care and post op care for three months. If that patient needs anything else done in that three month period, it is NOT reimbursable to the health care provider. If that same patient decides he or she does not like the scar, they can and do sue. A recent case resulted in a $40,000 verdict for the plaintiff.

Now, you tell me how a potentially life-saving procedure such as removal of a gall bladder can allow $400 and a scar, which never killed anyone, can pay the attorney a percentage of $40,000!! Therein lies "the rub." A health care system that collects billions, pays out very little, and continually grows in size, ever adding new members ot the workforce. I have often thought that those in the system who shoot down claims get paid far more than the doctors who provide the care. Don't bother checking sources with friends in the system. Just ask the doctors who provide the care.

Additionally, maybe you can explain in an upcoming article why a doctor has to pay for any and all errors, harmful or not, when I cannot remember the last time a lawyer got sued for losing a case. They lose 50% of them, so to my way of thinking, someone must have screwed up. Oh well, jail for life because my lawyer screwed up. I find that much more egregious than simply taking the wrong drug, which most of the time causes no harm at all.
-- Robert Mandraccia, MD
Plastic Surgeon
Bonita Springs, Florida

Michael Cannon's and Alain Enthoven's piece regarding the decision of several insurers as well as Medicare to stop reimbursing hospitals and physicians for preventable mistakes does not address the serious flaws in this proposal; it also contains a number of misconceptions. Chief among these is that Insurers can distinguish between a preventable infection or one an event that is inherent in the risks associated with serious illness. There are some adverse events which are clearly culpable errors (leaving behind surgical instruments) and probably should not be reimbursed. Such events are very rare however, and I doubt that these are the real targets. The real targets are more common events, that while measures can be taken to lower their incidence, such measures are not necessarily effective, may have their own risks and may occur anyway regardless of measures taken to prevent them. For example, Cannon and Enthoven cite the development of pressure ulcers as one of the "preventable complications" that will not be reimbursed. This complication, however, will occur in a subset of debilitated patients regardless of preventative measures. For example, while there are recommendations that bed bound patients should be turned every 2 hours, a study that compared turning patients every two hours with turning them every 4 hours showed no difference in pressure ulcer development. Moreover one study of a particular special foam mattress used to prevent pressure ulcers did reduce pressure ulcers.

From an incidence of 64% to 24 %, but even in the treatment group almost 1/4 of the patients developed pressure ulcers. The point is that a certain unavoidable incidence of pressure sores will develop and require treatment. How to prevent this is not fully understood and may be impossible. Failure to reimburse for these events will financially injure hospitals, which in turn will drive hospitals to cut costs in undesirable ways.

I would wager a fair amount of money that one secondary consequence will be for hospitals to push patients out of the hospital even earlier. Another might be to reduce the number of nurses employed (since personnel costs make up a large fraction of total costs), from another point of view some complications that insurers have chosen to target will drive medical decisions in a direction in which some risks which are potentially greater will be accepted to avoid risks for events that the insurers will choose to not reimburse. Example, Medicare has decided not to reimburse hospitals for infections related to placement of a special kind of vascular catheter placed in large vein deep within the body. This kind of device can be necessary to care for patients who are severely ill in an intensive care unit and can become infected. One way to lower the risk of infection is to choose a site that is associated with a lower risk of infection. This site is often a large vein under the collarbone. The down side of this site is that it also is the site associated with the greatest risk of injury to the lung or bleeding into the chest cavity! A typical critical care physician would weigh the risks of all the available sites in a given patient and choose the one which is overall best in that situation (accepting some risks and avoiding others based on the clinical scenario). Medicare is driving clinicians to accept some risks as "more acceptable" regardless of the specific situation. This is clearly nonsense.

The real problem with all this is that medicine is far too complex for a group of policy wonks whether in the bowels of the Center for Medicare Services or the Cato institute to set policy, and decide what to pay for. It would be far better to get the government out of the health insurance business and create a system where consumers shop not just for health care providers but among a number of different insurance plans, while maximizing the freedom for health care providers to decide what insurance plans to accept payment from.

In that kind of system the decisions of millions of consumers and providers will maximize efficiency far better than anything dreamed up by the health care policy "experts," many of whom have no idea of the actual logistics of caring for the seriously ill.
-- Michael DePietro, MD
Newark, Delaware

AN IMPOSSIBILITY
Re: Reader letters (under "Obama the Only Way") in Reader Mail's Old New Politics:

If Mr. Farahat wants to see America take an "even handed approach" to the Middle East, he needs to realize that it is an impossibility when dealing with Hamas. Hamas is now, and has always been, a terrorist group and an election win does not change that fact. It is Hamas that was founded to make war upon and bring about the destruction of Israel, and for America to deal with them as anything other than a terrorist organization gives them unwarranted legitimacy in the world community. If we deal with them in an "evenhanded" manner, who's next...Al Qaeda?

Letter to the Editor

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