SWCAMBORNE

This just about expresses my concern about the government taking a larger role in the healthcare system.

One of the critiques of ObamaCare has been its proposal to use review panels to allocate medical resources to areas where the payoff would be best.  On a micro scale this used to be called triage and it makes perfect sense.  In Viet Nam when incoming wounded were overwhelming the medical staff on duty at the hospital where I worked triage decisions were routinely made about where to allocate the very limited resources.  Both those who would likely live without help and those who would likely die with help were forced to wait while those who would likely only live with help were treated.

I spent some time in the Emergency Rooms at Huntington Hospital and two different Kaiser hospitals this week helping my Father-in-Law through his latest crisis so I had lots of time to think about review panels, triage and allocation of resources.  In fact I also had enough time to read The Hidden Symbol, Dan Brown’s (author of The DaVinci Code) latest thriller.  I agree with President Obama that it is a bad allocation of resources to give a new hip ($40,000) to a ninety year old with a bad heart but I also agree with Obama’s critics that I don’t want “death panels” to be deciding if I get to live.  BTW by calling the “review panels” “death panels” the critics won this one on the name.  Think “homeless” vs “bums” we help homeless people we didn’t help bums.

I’m not sure that we will get to review panels and I’m not sure if they can work unless the incentives to providers, receivers and allocators of medical services change significantly.   For instance in the current model: If Medicare is paying, who at Kaiser would benefit from not putting another stent in a ninety year old bedridden man?  How would the man or his heirs benefit from not having it since the stent is free?  And what allocator would be able to defend withholding the stent against a crying grandchild on CNN?

We will need to change the incentive to all of these groups before any progress can be made toward controlling medical costs.  But don’t lose heart (we have stents for that),  I have devised the ultimate triage test and I will share it with you. (By clicking on the read the rest of this entry button I agree that Simon is writing what follows as a thought provoking joke and that without training I will not try to apply the test to real world situations) Read the rest of this entry »

I got this joke from my friend Wally G:

This is something to think seriously about.    Will I Live to see 80?
I recently picked a new primary care doctor.  After two visits and exhaustive Lab tests, he said I was doing ‘fairly well’ for my age. (I just turned 60.)
A little concerned about that comment, I couldn’t resist asking him, ‘Do you think I’ll live to be 80?’
He asked, ‘Do you smoke tobacco, or drink beer or wine, indulge in chocolate or coffee?’
‘Oh no,’ I replied.  ‘I’m not doing drugs, either!’
Then he asked, ‘Do you eat rib-eye steaks and barbecued ribs?
I said, ‘Not much…. my former doctor said that all red meat is very unhealthy!’
‘Do you spend a lot of time in the sun, like playing golf, sailing, hiking, or bicycling?’ He asked.
No, I don’t,’ I said.
He asked, ‘Do you gamble, drive fast cars, or have a lot of sex?’
‘No,’ I said.

He looked at me and said…  ‘Then, why do you even give a shit?

When I was in the army many of my fellow enlisted men kept “short-timer calendars.”  When you went under 100 days until you got out of the army (or Vietnam) you could call yourself a “two digit midget.”  Well time have changed and the much anticipated event now is getting to the Medicare Buffet.  Today I broke the thousand day barrier.  In 999 days I will be eligible for the National Health plan.  I am a “three digit midget.”

On the day my friend Peter turned 65 he had knee replacement surgery.  I’m already starting a list of my own.  In 1993 P. J. O’Rourke said “If you think health care is expensive now, wait until you see what it costs when it’s free.” He was right.

The countdown timer on the upper right of my blog should be a warning to all of the people who are trying to finance more free health-care.  We can’t afford free.  Peter’s knee and my allergies and 30 million more maladies are coming at you.

One of the arguments about health care reform is that if the government pays they will ration what is available.  This is certainly the case in the UK as this story in the October 8th Daily Mail shows:

The NHS is the UK’s National Health Service and they are not going to allow doctors to prescribe a new drug for Rheumatoid Arthritis because it is to expensive.  Will that happen here?  It already does to some extent.  But the bigger problem is that if drug developers can’t make money investment will dry up and development will stop.  On the other hand if we don’t change the way we are paying for health care now we will go bankrupt.  My post about Medicare finances.