Position Briefs

Wednesday, October 21, 2009

A couple more ideas on health care...

I wanted to add a few ideas to the health care proposal I laid out before. The first two have to deal with malpractice. Malpractice is a big part of health care costs and, because of the surplus of lawyers in this country, it really doesn't act in any ways that bring us better care. And, according to the theory of macroeconomics, if you can lower the cost of production, holding the price steady, you can increase supply. And THAT would help us achieve better care. So here are a couple of areas we could address.

The first is anything stemming from a decision or recommendation or test interpretation that your doctor gives you. The kind of "you DO have cancer / you DON'T have cancer" kind of thing. As part of the plan I've laid out, I would automatically cover SECOND OPINIONS. So if you have a lump, and he says, "it's not cancer," there would then be four possibilities.

1) you accept that information, and he's right.
2) you accept that information, and he's wrong.
3) you get a second opinion and the second doc reaches the same conclusion
4) you get a second opinion and the second doc reaches a different conclusion

In case (1), no problem. In case (2), because you waived the second opinion that you were entitled to, in doing so you are also waiving your right to sue for anything resulting form that information. In case (3) you have confirmation, but they could still BOTH be wrong. Guess what? STILL can't sue. Why? State of the Art. If two (or more) doctors reach the same conclusion - WITHOUT CONSULTING WITH EACH OTHER (obviously) that this would fall under the category of "technology just isn't advanced enough" or "you had a really weird case." Sucks to be you, BUT: It's not the doctor's fault! Your medical expenses from here out are covered anyway, and in absence of entitlement to punitive damages, what are you going to sue for? If you end up in case FOUR, well... time to start asking QUESTIONS, and being part of the process of deciding what the right option is for you: 'Wait and see' or 'Play it safe, but risk the more invasive option.' Depending on the possible risks, you may choose one way or the other, but you have to OWN your choice - can't sue - so ASK QUESTIONS. Find out if one doctors tends to follow one philosophy or the other, find out which one suits your own, after all: the final decision belongs with the PATIENT.

And for anyone who thinks this would put a huge strain on the system, I don't think it would. Most of the things we hear from the doctor we just accept. I don't need a second opinon for a broken arm, or antihistamines for allergies or stitches for a laceration. And if two sets of eyes is what I need to feel at ease about that suspicious lump? Then so be it. Get a second. (In case (4) I'd even cover a THIRD.) Knowing they can't be sued merely for giving an opinion, more Doctors would be likely to GIVE one. So the supply issue will mostly fix itself.

The other major areas for malpractice is mistakes and negligence. Now right of the bat, I want to say that the burden of proof for this would be a lot higher. One of the things that a patient accepts when s/he goes under the knife is the very real possibility that they'll stay there. We usually take for granted that nothing will happen, but every patient must be informed of the chances of death or other complications when they decide to go through with a procedure. (Remember the philosophy that drove the first section? Same thing applies here: You take your chances!) So the mere presence of a dead body DOES NOT entitle someone to some money. And remember: all subsequent medical expenses are covered anyway, so there's no need to sue for that. Unless it's something as obvious as "he left an instrument inside you when he stitched you up" chances are, it's just one of those things that happen. Not everyone can be saved. BUT...

What do you do about BAD DOCTORS? Well, part of Obama's plan that I really like is the requirement for electronic records. I'd take this a step farther a keep records of all of the procedures that a Doctor performs, along with any preexisting complicating factors in the patient and the outcome. To keep it simple, each outcome would be given a 1-5 rating. Something like...

5) No complications, full recovery.
4) Minor complications, full recovery after treatment.
3) Serious complications or only partial recovery.
2) Serious complications, with lifelong or chronic issues
1) Fatality

And in doing this, you can compare any given doctor's performance against the industry standard. In really simple terms, if the "average" for triple-bypass surgery is 4.5 and you've got a doctor who's been a 2.5 for, say, two years now, the answer is NOT to simply pay off patents anyway. The answer is: STOP HIM FROM PERFORMING TRIPLE BYPASSES! He could still practice medicine, but not that procedure. Only maybe only that procedure in a supporting role. And when stripped of the "why's" and "what happened's" you end up with an objective score that the doctor's can't conspire among themselves to fix or hide. (As many suspect happens when a hospital investigates an incident on it's own.)

Now... if it CAN be determined that something went fantastically wrong: they amputated the wrong leg, for example, or sewed up a retractor inside of you, then YES, you can still be compensated - but by the SYSTEM. And the SYSTEM will determine on it's own how to handle the DOCTOR.

We need to get rid of this "us versus them" mentality that we have right now. It doesn't help us, and it doesn't improve our care.

I've got some other ideas about 'tort,' but I'll save those for a later post. Let me know what you think!

No comments:

Post a Comment