Thursday, July 30, 2009

New Plan

How about this for health care: We "forb[id] doctors to advertise, to sell drugs, or to own a financial interest in any lab or machinery they used to perform tests." We also make the maximization of profit a violation of the profession's ethics.

Sounds draconian right? But this guy interviews a doctor that reminds us, that's just the way it used to be.



patsbrother said...

Real question: I can understand how allowing physicians to advertise, sell drugs, or own equipment can lead to higher prices and unnecessary tests and procedures. (I don't know enough to say that is actually a major problem, but conceptually I understand.) What I don't understand is how any of that would lead to a different outcome in the situation described at the beginning of the column cited. Can someone explain that to me?

Commentary: I would have no problem with a rule that forbade physicians from selling drugs. I would have a problem with the other two. How would a new doctor in private practice gain clients if he was unable to advertise? I suspect that the current rule (or the needed rule) focuses on the KIND of advertisements used, as in the legal field. (There are many different rules on how a lawyer may advertise, for example.) I also would have a problem with a rule that forbade doctors from owning their own equipment. I suspect the old rule had something to do with equipment that performed collateral tests to the ones performed by the physician himself or herself. I can not fathom the logic of a rule that would suggest that a physician could not own the same equipment on which he or she relies.

I also understand at least one rationale for why doctors perhaps should not own their own hospitals, as it might give the doctors a perverse incentive to recommend overnight stays or treamtments they would not otherwise recommend. However, I think the column cited woefully fails to address exactly how Goldfarb (a case about price-fixing) had anything to do with the problems it mentions. (None of which directly involve price-fixing.)

patsbrother said...

As an aside, I will also mention that this column succumbs to an unfortunate tick regarding the law that frequently annoys me.

The column's title is "Did Warren Burger Create the Health Care Mess?" The body of the column includes the phrase "...Chief Justice Warren Burger concluded that..."

Both are correct, but only in the narrowest sense of the word "correct."

It should read: "Did the SUPREME COURT Create the Health Care Mess" and "...the whole damn COURT concluded that..."

Not only did Chief Justice Burger write the majority opinion -- a/k/a, "the opinion of THE COURT" -- but he wrote the majority opinion of a UNANIMOUS Court.

Since the time of John Marshall, the Supreme Court has eschewed the English tick of having each justice write his or her own opinion, which required people to sift through copious amounts of dreary legal writing to find some semblance of what the damn outcome of the case was. Excluding the rare fluke where a majority of the Court simply cannot agree on anything, the Supreme Court of the United States has a majority opinion to which a majority of the justices sign, and that opinion becomes THE LAW. It helps immensely to know what the outcome was, you see, and does provide somewhat more guidance than the old rule did concerning what legal rules other courts must now apply.

If only Chief Justice Burger concluded something, then his opinion would read "Chief Justice Burger, CONCURRING," "Chief Justice Burger, DISSENTING," or some variant thereof.

What the column SHOULD have stated was "...writing for the Court, Chief Justice Warren Burger stated that..."

Small point, unnecessary rant. I know. Let's move on...

patsbrother said... someone going to attempt to answer my question?

I assure you, it was a real one.

Cousin Pat from Georgia said...

The situation: someone dies at a doctor owned, specialty hospital because no one there knew where the proper emergency equipment was or how to use it. The hospital had to call 911 and have the patient attended by paramedics who knew emergency proceedure.

The answer boils down the misplaced organization managment and priorities. When you create for-profit organizations, you attempt to cut "costs" and maximize profits. You make risk/benefit analyses on what equipment to have around, what specialties and experience your staff should have and what training to put them through.

Many times, the costs cut are on practices that have low return on investment, so more money can be spent on high return on investment priorities.

What I think happened in this case, the specialty hospital appeared to have an unprepared staff ill equipped to deal with emergency/crisis situations. More experienced & trained staff = more money. Crisis prevention & response training = more money. Proper equipment in the proper place = more money. All of these are costs that cut into profit, because crises probably aren't usual occurances at this specialty hospital. The risk is that an emergency won't happen and the specialty hospital won't get sued for much. The benefit is maximized profits.

On the reverse, I'd bet this specialty hospital spends plenty in advertising.

patsbrother said...

Your answer doesn't ring true to me. But thanks for at least attempting one.