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Tag Archives: Policy

More Evidence That Tort Reform Works

This article from the Dallas Business Journal, quotes the Texas College of Emergency Physicians as stating that the number of emergency physicians increased in 76 Texas counties since tort reform passed in that state six years ago. Almost all of the counties experiencing growth in emergency physicians were previously partially or fully “underserved” for emergency care. In addition, the article states that 22 rural counties which previously had no emergency physicians now have “ER-type assistance” since tort reform was passed. I won’t fall into the logical fallacy of “post hoc, ergo proper hoc” (“after therefore because of” – i.e. just because the sun comes up after the rooster crows doesn’t mean that the rooster caused the sun to rise), but I do believe it is more than a coincidence that an increase in emergency physician coverage can be added to the list of so many positive changes that have occurred in Texas since tort reform was passed in that state.

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Does Refusing to Hire Smokers Amount to "Discrimination"?

The Los Angeles Times Health Blog posted an article about how increasing numbers of employers are refusing to hire people who smoke. Happy Hospitalist should have a field day with this one, given his previous thoughts on cigarettes. One company cited in the article doesn’t hire smokers, fires workers if they smoke during their non-work time, and even fires workers if their spouses smoke. Researchers studying the growing trend stated that firing workers because they smoke was “not appropriate” and that “widespread adoption of such policies may make smokers nearly unemployable, cause them to lose their health insurance and affect their health and that of their families.” News flash … smoking already does affect the ability of people to obtain health insurance and already does affect the health of patients and their families. Is there something about this concept that requires further study? Smoking decreases productivity while workers go on “smoking breaks,” increases health care costs for employers who provide health insurance, and may affect a company’s image if customers repeatedly witness a gaggle of employees outside puffing away at the “butt hut.” If it is OK to fire workers for having drugs or alcohol in their systems – even though they are not using these substances at work – why shouldn’t employers be able to include cigarettes as well? The authors note that smoking is a powerful addiction, but if people can’t get a job, they won’t have the money to purchase cigarettes and the problem will eventually take care of itself. Right now, employment is a buyer’s market. There are more applicants than there are jobs, so employers can be choosy. In the future, if employers with rigid requirements are unable to find enough employees, they may need to relax their standards. So is cigarette smoking another “right” that we need to add to the list, or are we just increasing the “nanny state” effect by micromanaging everyone’s lives? [wp_campaign_2]

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More on Defensive Medicine

It seems that my post on defensive medicine in the emergency department struck a raw nerve with several people. Many thanks to Walter at Overlawyered.com for his link and I also appreciate “obvioustroll” linking the post on Reddit.com. Got a lot of interest from both sites and think that it meaningfully adds to the discussion. I answered a couple of questions on other sites, but thought it would be beneficial to flesh out some of the counterarguments used by those who either believe that “defensive medicine” is a good thing or that “defensive medicine” doesn’t really exist. I also wanted to expose some common misperceptions and disinformation spread by those who take those positions. We’ll start with the responses at Overlawyered.com. I left a long response there and you can go read it if you like, but I’ll include a couple of highlights below. Matt, who is an attorney, was the first one to comment, stating that a standard of “‘probably’ doesn’t cut it — and shouldn’t.” He then proceeds to give several examples of why “probably” shouldn’t “cut it” in his mind. If you took your car in for soft brakes, and your mechanic told you he didn’t actually check them, but they “probably” wouldn’t fail, you wouldn’t accept it. If you’re having electrical issues at your house, you wouldn’t put up with your electrician saying that he really didn’t check all the possibilities, but your house “probably” wouldn’t burn down. You wouldn’t let your lawyer get away with telling you he hadn’t really looked into all the facts or the law, but you “probably” won’t get in too much trouble for whatever you’re concerned about. My reply was that his analogies hold no water. I responded: The implication that, like the mechanic and the “soft brakes,” I “didn’t actually check” the patients is silly. A correct analogy would be “I checked your brakes and there is still a half inch of pad left on the brakes. They’re ‘probably’ good for another 12 months. I can run them through a $2000 machine to give us a better idea of when they’ll fail, if you’d like. Oh, you demand the test or your lawyer will sue me for ‘$7.24 million‘ if the brakes don’t last 12 months? In that case, sure.” Then I vetted his other examples. Is it the standard of electrical care for the electrician to rip out all of the wiring in your house “just to make sure” that there won’t be a fire? That’s what you’re implying. It might cost you or your home insurer tens of thousands of dollars, but otherwise, how can you be “sure” that a mouse didn’t eat through the wire right next to some insulation? Oh, and I love your example about lawyers. Is it the standard of legal care to research each issue at law in each of the fifty states before creating a brief for a client? Perhaps laws in other states don’t have binding authority, but the added persuasive authority *might* be the difference between winning and losing a case. How much legal malpractice are you committing by failing to include other state rulings in writing *your* briefs? Not so funny when you have to live by your own illogical assertions, is it? A second commenter named “VMS” then stated Matt is 100% correct and White Coat has developed “GOMER (get out of my emergency room) syndrome which he should cure before he gets into trouble. The physician must eliminate everything on the differential diagnosis by perfoming a risk-benefit analysis. I responded: VMS creates the novel concept that ...

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Atta Boy

Michael Canon from the Cato Institute and I had a disagreement about “never events” a few months ago. On those, via private e-mails between us, we agreed to disagree. Relaxing for an hour or so, I perused several blogs and clicked over the Cato Health Blog site. There I found an article by Mr. Canon that dropped my jaw. Literally. “Coordinated Care Requires Free Markets.” Free market competition between doctors and between hospitals. Let consumers control the money involving their health care (i.e. “make consumers responsible”). Lessen state licensing regulatory hurdles. Sounds vaguely … familiar. Well put, Mr. Canon. Well put.

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Health Care Reform Survey Proves A Point

A new survey of 1,628 adults by the Kaiser Family Foundation puts the brakes on the notion that the desire for health reform is … well … universal. Overall, healthcare reform ranks third on Americans’ priority list for the new administration – behind improving the economy and fighting terrorism, but ahead of reducing the budget deficit, improving schools, and dealing with Iraq. There is general agreement on issues such as providing universal coverage, limiting administrative expenses of insurers, and getting rid of exclusions for pre-existing conditions. But public opinion changes when people learn about the effects of their decisions. For example, 71% of people favor Obama’s idea to require employers to provide health insurance to their workers, but support drops to only 29% when told that the plan may involve employers laying off workers. Two thirds of people also thought it was a good idea to require all Americans to have health insurance … until they found out that some people would be forced to purchase insurance that was too expensive or something they didn’t want. Support for that idea suddenly dropped to 19%. Nearly 2/3 of people would be less likely to support a plan that increased their own costs and less than half of those polled were willing to pay higher insurance premiums or taxes to help cover the uninsured. Instead, 70% of those polled wanted to increase taxes for those earning more than $250,000 per year. In summary, it seems that most people in the survey want “The best health care someone else can pay for.” Got a news flash for all those who were surveyed: The concept isn’t flying now and it won’t fly in the future. If you’re expecting to get better medical care at a lower cost, you’re kidding yourselves. If we aren’t careful about our choices, we might get neither.

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