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Implications of A Civil Right To Healthcare

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In his previous post, DrRich used a combination of history, logic, and sleight of hand to convince even his most conservative readers that healthcare is indeed a right.

To summarize that erudite posting: The BOSS rule says it’s a right, so it’s a right – as long as we’re talking about a civil (or legal) right, and not about a natural (or inalienable) right.

A civil right is granted, more or less arbitrarily, by a government or a society, to some group of individuals, usually to redress a past grievance, or to attempt to achieve equality in outcomes, or for some other form of social justice. Civil rights almost invariably require a second group of individuals to sacrifice something of their own in order to satisfy the civil rights granted to the first group. So the granting of civil rights (as opposed to natural rights) will often be seen by at least some as being inherently oppressive, but if used appropriately civil rights can be very good for the furtherance of a stable and civil society. (As DrRich has pointed out, even our Founders – the great purveyors of natural rights – explicitly understood the importance of well-designed civil rights.) Civil rights, at least ideally, advance the virtue of justice, just as their creators claim. Read more »

*This blog post was originally published at The Covert Rationing Blog*

The Most Overlooked Factor In Healthcare Reform: State versus Federal Regulation of Insurance

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For months, Congress has been debating health care reform proposals that would have the effect of dealing a heavy blow to the system of state-by-state insurance regulation.  State governments have stood by, silently.  I’ve been wondering (here, here and here) when the states would start to raise objections.

Slowly, it’s starting to happen.  What has been a mostly overlooked factor in the health care reform debate may end up being one of the most important.

In fourteen states, legislators are trying to pass constitutional amendments that would ban health insurance mandates.  Meanwhile, a bi-partisan group of governors are objecting to provisions of the Baucus plan that would leave the cost of expanding Medicaid to the states (by contrast, the House bill provides federal money for this).  It’s an emerging trend that may reflect growing unease in state governments. Read more »

*This blog post was originally published at See First Blog*

Personal Responsibility, Healthcare Reform, And Going With Our Guts

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This post appears on the Hastings Center’s Values and Health Reform Connection, a new group blog on American values and why they matter in health reform.

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Values come from the gut, not the mind, and the gut is not a sophisticated thinker about the nuances of alternative policy options.

—Jim Sabin, MD Essay: Responsibility

I’m going to do something “radical” here in the spirit of Dr. Sabin’s opening quote – and speak from my gut on the topic of responsibility.

In my opinion, it’s human nature to shirk responsibility, and our current society is a great facilitator of that natural urge. The more wealthy and technologically comfortable we become, the fewer responsibilities we have (in terms of securing basic needs), and the more empowered we are to indulge our inner narcissism. Until we accept that we all have this selfish tendency, we’ll continue to point at others and engage in a blame game that keeps us all very much in the dark about what’s really going on. Read more »

How Should We Define Medical Malpractice?

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Ezra kindly responds to my post from Friday with a more reasoned stance than “just don’t commit malpractice.” His response, however, boils down to two main theses:

  1. Frivolous Lawsuits are not as common as generally thought, and
  2. Standardization can reduce the opportunity for error and thus decrease the frequency of medical malpractice suits.

Well, yes, but I’m not sure that addresses the typical physician’s complaints regarding the current med-mal system.

For example, the “frivolous” moniker is a pretty ambiguous term, especially to doctors’ loose understanding of legal terminology. To a physician, a “frivolous” case is one in which there was no error — where the standard of care was met, but perhaps the outcome was bad. Or to put it another way, doctors tend to feel that when they are vindicated in court, it’s prima facie evidence that the case was frivolous. This conviction is bolstered by the little-recognized fact that physicians win the vast majority of cases that actually go to trial, and the vast majority of claims filed do not result in a financial settlement. Read more »

*This blog post was originally published at Movin' Meat*

How To Reform Healthcare From Its Foundation Up

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When you build a house, you begin with the foundation. The same holds true for the U.S. health care system. The President and Congress are scrambling to put up a reform structure that would have a better chance to succeed if the cinderblocks and joists were in place. No health care system in our country can develop adequately unless supported by validated information, policies and procedures based upon accurate data related to its most important features, and updated continuously. While there are agencies and institutions that can answer some of our questions, a comprehensive assessment is lacking. We should learn much more – the sooner, the better. Conflicted entities cannot be relied upon for objectivity, so if the government would like to increase its role in health care, creating a method for objectifying the rationale for change is the correct place to start. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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