October 16th, 2009 by DrRich in Better Health Network, Health Policy, Opinion
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DrRich’s conviction that covert rationing is the engine that drives many (if not most) of the bizarre behaviors we see in the American healthcare system leads him to take positions on certain contentious issues that do not endear him to either his progressive or his conservative friends.
One of these issues is malpractice liability reform.
DrRich wrote about this some time ago (here and here), and as a result managed to alienate more than a few of his readers, especially the ones who are doctors. So if he were smart, DrRich would leave it alone. (After all, a lot of readers have long since forgotten precisely why they do not like DrRich, and merely harbor toward him a vague sense of unease and distrust. This, DrRich finds, he can live with.)
But a couple of things prompt DrRich to take up this topic once again. Read more »
*This blog post was originally published at The Covert Rationing Blog*
October 2nd, 2009 by Dr. Val Jones in News
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I was reading my daily MedPage Today news, when I came across this amusing example of regulatory unintended consequences. As we all know, pharmaceutical companies are not allowed to promote off-label uses of their medications – doing so is punishable with billions of dollars in fines (just ask Pfizer). But a new set of rules created by the FDA’s Risk Evaluation and Mitigation Strategies (REMS) program essentially requires Allergan to provide safety information about off-label uses of the drug — uses that are illegal for them to discuss.
So Allergan has to file a law suit to resolve the issue of being required (by the government) to do something the government considers criminal.
And the winner is?
Lawyers!
September 16th, 2009 by DrWes in Better Health Network, Opinion
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This week, like many doctors in primary care, I was sent a request by the Social Security to provide “medical evidence” that one of my patients was disabled so they could collect Social Security benefits. As part of that request, I was asked to provide evidence since June 6th, 2007, that my patient qualified for disability on the basis of “alleged” diagnosis of “Heart Disease.”
I was asked to send “copies of records or a narrative report including diagnosis, medical history, laboratory findings, treatment and response to treatment.” Beyond this, I also had to include physical and emotional impairment assessments and a functional assessment of their ability to sit, stand, walk, lift carry, handle objects, hear, speak, travel, and wash their car, view films, and eat bon bons (well, kind of).
And for this copying, writing, mailing, collating what might I see from the government to compensate my time? Well, if I attach this invoice that requires a Federal Employee Identification Number filed through form W-9 available at www.irs.gov (yes, Virginia, this compensation is taxed), I might receive…
…drum roll, please…
… twenty dollars.
Now looking up the lowest paygrade of Social Security worker’s annual compensation of $29,726 and accounting for the 13 vacation days, 13 paid sick leave days, and 10 federal holidays they get paid, I estimate the least expensive Social Security employee makes a bit more than $16.50 an hour.
If we assume that the paperwork they just asked for takes about 2 hours collectively of office staff and doctor time, I think it’s clear that doctors’ payment for this service provided on behalf of our patients is substantially less than what the Social Security administration pays their own staff.
I wonder what else the government has in store for us.
-Wes
*This blog post was originally published at Dr. Wes*
September 9th, 2009 by KevinMD in Better Health Network, Health Policy, Opinion
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Blame motivated reasoning.
Newsweek’s Sharon Begley writes about the phenomenon, which goes a long way why the myth about “death panels” continues to persist in the health reform conversation. She cites the work of sociologist Steve Hoffman, who explains: “Rather than search rationally for information that either confirms or disconfirms a particular belief, people actually seek out information that confirms what they already believe.”
And with a growing majority obtaining their news through pundit-tinged lens, such as from FOX News on the right and MSNBC on the left, there’s always fodder to confirm pre-existing beliefs.
Ms. Begley goes on to suggest that cognitive dissonance is also in play:
This theory holds that when people are presented with information that contradicts preexisting beliefs, they try to relieve the cognitive tension one way or another. They process and respond to information defensively, for instance: their belief challenged by fact, they ignore the latter. They also accept and seek out confirming information but ignore, discredit the source of, or argue against contrary information.
This is seen often in those who believe there is a link between vaccine and autism, despite convincing evidence to the contrary.
And with information freely available on the internet and on the 24-hour cable news cycle, there are endless opportunities to confirm, rather than challenge, one’s beliefs.
*This blog post was originally published at KevinMD.com*
