Wednesday, February 12, 2014

An Economic Conundrum

Is our outsized health care system an economic plus or minus?

The conventional wisdom, which I have tended to accept, is that our unusually costly system places an undue financial burden on government, makes our industry less competitive internationally and unnecessarily consumes resources that would otherwise be devoted to something else.  Thus, the economy would benefit if we spent less on health care.

In contrast to that, columnist Benjamin Applebaum argues in the February 9 Sunday New York Times that during the last two years the health care system has been a drag on the economy because it has grown more slowly than the economy as a whole (Will Saving on Health Care Hurt the Economy?).

He also points out that “The health care sector has repeatedly helped to pull the economy from recession in recent decades….”   Certainly, it seems likely that unemployment during the recent recession would have been higher if it were not for the large number of people employed in health care, which is largely recession-proof. 

The stubbornness of unemployment, attributed in large part to globalization of the labor market and information technology, poses the question of whether in the foreseeable future there will be enough jobs to employ all our unskilled and semi-skilled people.  Health care employs a lot of them.  Maybe that is a good thing.

Applebaum’s column ends by quoting Harvard School of Public Health Economist Katherine Baiker who favors a more efficient health care system.  She said “….for a given outcome, if you could get it with fewer resources, that would be better for everyone.  You could get more health.  You could get more stuff.”

Well, maybe.  But then again, maybe not.

Sunday, February 09, 2014

Malpractice Prevention

For years I have been of the opinion that the problem with medical malpractice was that there was too much of it and that prevention efforts would be more effective as a remedy than attempts to reform the legal system.

I now sense a slight movement in my direction.  The January issue of Health Affairs featured several articles on the subject.  The introductory column by founding editor John Inglehart reported that the designers of Obamacare considered including medical malpractice reform but decided that the political risks involved in getting in between the personal injury bar and the medical profession were too great.  They punted by including an appropriation of $25 million to fund a search for new approaches to medical liability and demonstrations of evidence-based patient safety programs.

Judging from the articles, most of the effort has been focused in the area known as Communication-and-Resolution.  Under this approach, medical errors are reported to the patient as soon as they become known and compensation offered for damages.  This is in contrast to past practices of sitting tight and fighting the matter out in court.

One article dealt with “safe harbor” legislation, which limits liability if the physician can demonstrate that “designated guidelines” have been followed.  In other words, if there is an established protocol for a procedure and it has been followed, the legal liability for adverse results will be reduced.  The authors doubted that the “safe harbor” approach would have much effect on malpractice settlements but speculated that following protocols could improve patient safety and, thereby, the number of adverse events leading to malpractice claims.

Prevention may not yet be popular but perhaps some people are starting to think about it.

Friday, February 07, 2014

The Logic of Obamacare

Here is the logic of Obamacare as best I can figure it out:



Opponents of Obamacare apparently do not accept this logic.  It would be interesting to know what logic they would put in its place.


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