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In discussing the nation’s health care system, “broken” is the most common descriptive term.  Almost all stakeholders seem to agree on the adjective.  Not Mr. Tevi Troy, writing recently for the Weekly Standard.

Health Care Reform Can be a Stimulus

I have argued that a major overhaul of health care would be a significant stimulus to the economy by leveling the competitive playing field for both employers and workers – those currently working, those out of work and those working on the margins.  In the long term, it would free up capital, both the monetary kind and the human kind, for more productive investments.

It does not surprise me that Congress might see things differently.  The major health care provisions in the stimulus package that will be approved by the Senate have very little to do with stimulus and everything to do with safety net.  Support for state Medicaid programs and provisions related to COBRA.  There are two small provisions in the package that do attempt to push the reform agenda a tiny fraction of an inch.

There is a provision in both House and Senate versions of the bill for for further development of electronic medical records and there is money for “comparative effectiveness research”.

These are hardly earth shaking provisions, unless you are listening to the likes of Mr. Tevi Troy.  To Mr. Troy and his ilk, these measures are the Ft. Sumter of the liberal war on the US health care system.

What planet to these people live on?

Electronic Medical Records

The Institute of Medicine has demonstrated that tens of thousands people die each year from prescription errors, many of which could be avoided with legible prescriptions.  One sure way to improve that simple process would be a script printed by a computer.  Errors could be avoided if doctors knew what other drugs the patient was taking.  That information can be provided by an electronic medical record.

Yet Mr. Troy and other right wing fear mongers describes the stimulus as a “threat to American health care.”

But as Dr. David Brailer points out in a Health Affairs blog post, the stimulus for electronic medical records will only be successful if it focuses less on the technology and more on the organizational and human impediments to its widespread adoption.

Effectiveness Research

Likewise, the defenders of the broken status quo react even more vociferously to the “comparative effectiveness research” calling it a “federal infrastructure that could be used as a tool for government rationing.”

Again according to the Institute for Medicine, one hundred thousand people a year die from hospital acquired infections.  Only 50% of people receive care in accordance with recognized best medical practice.  And yet research on the effectiveness of medical treatments is a threat?

I used to work for the Pennsylvania Health Care Cost Containment Council (PHC4), a state agency on the leading edge of public reporting on the outcomes of health care.  The PHC4 has demonstrated repeatedly that there are wide unexplained variations in the quality of care and in the practice of care.

The United States pays more for health care than any other country in the world.  And not just a little bit more.  We spend almost fifty percent more than the next most expensive country – Switzerland.  We pay more in taxes for health care than countries with tax supported health care systems and yet almost 90 million people had some period during 2006-2007 when they went without health insurance.  The United States does not rank among the top twenty nations in life expectancy or infant mortality.  This should be an embarrassment.

Investments to improve the delivery of care are long overdue.

Yet if the reactions of the out-of-touch to these modest patches to the status quo are a gauge, we are in for a noisy debate when real reform gets center stage.

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Patients, administrators, and family members of victims aired their reflections about medical errors in a video on the on-line New York Times this week (November 25, 2008).  They all lamented that if only doctors and hospitals could own up to their mistakes, there just may be fewer lawsuits.

Two stories I listened to more than ten years ago underline that theme.  A friend, a lawyer representing a medical provider, shared with me his concern about his client that he would be defending at trial that week.  He had advised his client to settle because the evidence against his client was strong and he was not optimistic.

The patient had acquired an infection while in the hospital.  The evidence was incontrovertible and the patient had died.  But the patient was old and infirm and had little time left and even less quality time.  The infection may have hastened the inevitable but it also made the end needlessly painful for both the patient and the patient’s family.

The family asked only that the hospital not bill them for the extended six month hospital stay caused by the infection.  If the hospital agreed they would not sue. The hospital could not admit to a mistake and, as a result, appeared headed for a judgment that would cost the hospital several times the hospital stay.

The second story was from woman I met while waiting for jury duty.  It seems that during stomach surgery her doctor had perforated her stomach and he did not discover it before she was stitched back up.  The stomach acids caused havoc on her intestines.  I asked her if she had sued her doctor.  Oh no, she was quick to reply.  The doctor was so distraught about the mistake.  She could not do that to him.  He had paid for all her medical expenses since the incident several years earlier.  In addition, he only operated on one patient after that accident, resigning from his surgical practice, but not from his medical practice.

Two stories, two very different responses form the blundering providers resulting in two very opposite victim reactions, and two very different litigation results.