Blog #8

"Health Care for a Changing Work Force"

In today's world, many Americans don't have jobs in the traditional sense. In fact, around 42 million people in the US work as an independent contractor, freelancer, etc. A major problem with this is that these 42 million people are outcasts from the traditional system of benefits, such as health care, that provide economic security to Americans.

Someone who has recognized this major problem early and has acted on it was Sara Horowitz, the founder of the Freelancers Union. In the early 1990s, she recognized that the number of people turning to independent work was on the rise and that there was no institution to represent these people in a meaningful way. Horowitz had the idea to create an organization to bring freelancers together so they could wield their power in the marketplace and in the political arena. She saw that she could attract a large membership if she could figure out how to provide health insurance at lower cost.

Health insurance companies don’t have much love for freelancers. They prefer to serve large groups because it’s easier to deal with one corporate benefits manager than a multitude of individuals. Horowitz got the idea of grouping freelancers in New York State so they could purchase their health insurance together and get the premium insurance at lower cost. Today, the Freelancers Insurance Company, which is wholly owned by the Freelancers Union, has revenues of roughly $100 million and covers 25,000 independent workers and their family members in New York State.

We as a nation need to take this idea and expand on it so we could cover the entire population with premium health insurance at a reasonable cost.

Blog #7

A major dilemma in the health care system is how patients rate their overall experience at the hospital.  To my surprise, Alabama has the best overall hospitals in the nation when it comes to patient’s ratings.  Patients in Alabama rated high the most in the nation at 70 percent and only rated the hospitals 9 percent of the time at the low rating.  Also to my surprise, three of the biggest states are amongst the worst in overall hospitals in the nation when it comes to patient’s ratings.  Florida, New York, and California rate amongst the lowest in high ratings and the highest in low rating.  New York patients rated their hospitals high only 55 percent of the time and low 14 percent of the time.  Florida patients rated their hospitals high only 57 percent of the time and rated low, a pathetic 16 percent of the time.  California is a little better than New York and Florida, but still very bad with only 60 percent high ratings and 12 percent low ratings.

I found this case study important because we as a nation spend so much money on health care, but still don’t get high overall quality care from our hospitals according to us.  It is absolutely pathetic that the state with the highest high overall rating is only at 70 percent.  70 percent high rating should be at worse, the low of the range for high ratings, not the high of the range.  No one in this country should feel that their overall treatment at a hospital was low, yet every state had at least 7 percent of its patients rate their treatment low.  Nevada really needs to get their act together, having 20 percent of its patients rate their treatment a six or below.  How does a nation with so much technology and advances in health care do so poorly in treating patients?

In conclusion, hospitals around the nation do a pretty poor job treating patients according to the way patients have rated the hospitals overall.  Health care is one of the biggest expenditures in the nation and we have all this technology, yet we still rate our hospitals so poorly.  We as a country need to figure out how to improve conditions in health care so every state has a high rating of at least 85 percent and no state has a rating of six or below. 

Module 6

Since I've been doing research on the debate topic, lets make the blog this week about my debate topic.  My debate topic was "members of professional staffs should be exempted from patient cae situation in which they have conscientious objections." I was told to do the negative, which was fine by me since I actually agree with it. 

Most physicians practicing today were trained to be patient advocates. They have been taught that a physician’s duty is to rally resources for the patient’s benefit. Conscientious objection goes against what physicians have been taught to do. A doctors’conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources, which requires a reasonable conception of the patient’s good and the patient’s informed desires. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. Doctors should not offer partial medical services or partially discharge their obligations to care for their patients.
Doctors have to take a Hippocratic Oath to become doctors.  With this oath, they have sworn to be patient advocates and help their patients in any legal way.  This is why I have a problem with conscientious objection.  If you don’t want to perform certain surgeries or prescribe some type of medicine, then don’t be in that area of medicine or in medicine in general.  A cop can’t just not be physical with someone or use their gun when people are in danger, because they have a conscientious objection about violence.  So a doctor shouldn’t be able to not do certain procedures or prescribe certain drugs because they think it is morally wrong or their religious beliefs.

module 5

This weeks blog is about the ethical decision of treatment when considering the cost of treatment.  The article I read was "The Value of Life: Is It Ethical to Consider the Cost of Treatment in Medical Decision Making?" by Margaret R. McLean from the Santa Clara University website.  The money elephant has caused many of us to consider whether or not there is a dollar limit to the value of human life. Is there a point when it is simply too expensive to keep heart pumping and lungs breathing? Is it ever right to consider the cost of medical intervention—even life-saving intervention—in our decisions about how aggressively to treat a patient?  The article really just brought up the topic and the questions that come with it, it didn't take any stance on the subject.

I personally have no problem with someone not having life saving treatment or any other type of treatment to save their family from the financial burden health care brings.  It's the persons life, let them live it (or in this case, not live it) the way they want.  I completely understand not wanting an expensive surgery that can only help you live for a short time when the bills will keep coming well after you're gone.

Module #4

The article, "Playing Politics with the Doctor–Patient Relationship," was published today in The New England Journal of Medicine.  It talks about a bill that has recently been passed in Arizona that basically allows doctors to LIE to their patient.  This bill gives a doctor the right to withhold information about the health of a fetus. The doctor cannot be sued for malpractice if he or she thinks that revealing these findings might influence a woman to have an abortion. In addition, once the child is born, no lawsuits can be filed regarding the child's disability.  Apparently, the medical professionals in Arizona have not come out to protest this bill like they have done in the past with other doctor-patient relationship issues.

I don't understand how this bill got passed, it doesn't seem legal in any sense of the law.  This bill violates so many ethical issues when it comes to doctor-patient relationships and the right women have to know what is happening with their body.  I feel that this bill will be brought up in front of the Supreme Court eventually and be deemed unconstitutional.

Module 3

This weeks reading was about managed care and the ethical issues it faces.  Managed care has been growing over the past 30 years and is now a major factor in the delivery of health care in the United States.  According to the United States National Library of Medicine, the term "managed care" encompasses programs intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases.  The ethical issue with managed care is that physicians and patients feel that managed care prevents the physicians from doing all they can to help treat the patient because of cost prevention.

This issue reminds me of what I wrote about in my blog last week, waste avoidance.  Waste in U.S. health care, defined more broadly as spending on interventions that do not benefit patients, actually amounts to at least 30% of the budge and is a major driver of cost increases.  Waste avoidance is a newer ethical issue compared to managed care but it also prevents physicians from doing absolutely everything they can for the patient do to cast savings.  Maybe if hospitals can other health care centers can optimize both managed care and waste avoidance, the cost of health care will go down, instead of continuing to rise

From an Ethics of Rationing to an Ethics of Waste Avoidance

The New England Journal of Medicine has recently published an article entitled, "From an Ethics of Rationing to an Ethics of Waste Avoidance," by Howard Brody, M.D., Ph.D.  The article talks about how in medicine, people are focusing on the ethical dilemma of waste avoidance these days.  The facts that have recently overtaken this ethical discussion show that waste in U.S. health care, defined more broadly as spending on interventions that do not benefit patients, actually amounts to a much larger sum — at least 30% of the budget — and that this waste is a major driver of cost increases.  The two principal ethical arguments for waste avoidance are first, that we should not deprive any patient of useful medical services, even if they're expensive, so long as money is being wasted on useless interventions, and second, that useless tests and treatments cause harm. Treatments that won't help patients can cause complications. Diagnostic tests that won't help patients produce false positive results that in turn lead to more tests and complications. Primum non nocere becomes the strongest argument for eliminating nonbeneficial medicine.

This ethical decision is hard for physicians because they are supposed to do whatever they can to help out their patients, even though this might lead to waste.  If the doctor believes that the treatment might help the patient even if its a tiny percent, its hard for them to say no to it, especially since the patient will probably want the treatment also because they would like to get better.  I have no problem with this type of waste, but I do have a huge problem with doctors who order usless tests and treatments to increase their bank account.  Since waste is currently 30% of our health budget, maybe if we can get rid of the waste we could save enough money to permit both universal coverage and future cost control.

Week 1 Blog

Our reading this week was an overview of ethics and some helpful questions you can ask yourself when trying to make an ethical decision.  Ethics is huge when it comes to the healthcare industry and the workers in this industry have to deal with major ethical decisions/dilemmas.  It is also a big deal in business, which is my field of study.

One thing that really stuck out to me in the reading was the fifth principle  that can be used to help healthcare executives determine an ethical course of action, which was Utilitarian benefits:  Never take any action that does not result in greater good than harm in your healthcare facility.  This principle reminded me of an episode of House, where the team was diagnosing an evil dictator from Africa, who has commited genocide and was planning on continuing it.  In the end, Dr. Chase decided to make the utilitarian decision and kill the dictator for the greater good of the world and help save those innocent people the dictator was going to kill.  I know that actually murdering someone for the greater good of the world isn't what the principle meant, but it was a utilitarian decision.  Even though murdering someone is unmoral and unethical, I had no problem with Dr. Chase's decision.

I am going to save the twelve questions for examing the ethics of a business decision, because I know in the future I will be needing it as I will be in the business world.