Failed Industries: the Opportunity Costs of Bail-Outs

We've heard a lot about saving jobs by providing financial CPR to the Big 3 auto manufacturers recently. I won't discuss American auto industries' management incompetence or even whether consumers' car purchases represent a national investment or merely a gigantic wasteful prepaid expense. But I do want to ask: what are the opportunity costs of sinking money into an old-technology industry which cannot manage itself?

I spent this past weekend in San Francisco at the 50th Annual meeting of the American Society of Hematology (ASH), immersed in basic science, current life-science research and development, and the ultimate application of exquisite scientific discipline and research to patient care. The atmosphere was vibrant; the weekend extraordinary. When I joined ASH in 1978 (I am now "emeritus"), it was an organization of about 1400 physicians, basic scientists and researchers. Now, it has a membership of 16,000 with more than 20,000 persons from around the world attending the annual meeting. The discoveries described at these meeting, and the cross-fertilization as experienced scientific researchers, trainees, physicians and other persons concerned with hematology learned from each other and interacted, will revolutionize medical care in coming decades. Hematology has moved from the "black box" era (when we gave drugs without really knowing how they worked), to understanding many of the basic mechanisms of cellular function and disease not just at the chromosomal or genetic level, but at the molecular level.

The money we use to prop up our moribund American auto industry's "yesterday's technology", will not be available to fund scientific medical research which will pay significant dividends, not only through prolongation of life, health and alleviation of suffering, but through financial return on investment. Those missing dollars will not help to keep America scientifically pre-eminent. Failure to fund life sciences research will inhibit new systems of effective patient care.

America should consider its opportunity costs when it commits resources to bail out failed industries. Let's support scientific research and medical technologies which give us a return on our investment, provide significant high-paying employment and opportunity, and harness the brain-power of our country, rather than boost horsepower under the hood.

Let's Not Be Stupid About Health Care Reform

In the mid-1990s, after presenting a talk about the HIV-Infected Health Care Worker at the Tenth World Congress on Medical Law, in Jerusalem, Israel, I met with three medical directors of what would have been Israeli equivalents of three large American HMOs. Each of these men were serious, committed, knowledgeable and depressed about the status of organized health care for which he had responsibility. In each case, the influences of poor lay business management, ethnicity mixed with religion and politics, and budgetary shortfalls created a wasteful system which met none of the reasonable standards to which these directors were committed. They said that the care their organizations provided was substandard.

There is a lesson from this experience. When I recently proposed a health system for all Americans with a single independent federal payer, I also proposed a federal health corps competing with traditional HMO and insurance health care systems because I understood that unless a new health care system had competitive safety valves, it would fail. Unless there is a single responsible "inspector general" for the quality and availability of care for all Americans covered by our health system, patients will suffer. Unless there is a real downside to providing unnecessarily expensive, inaccessible, inappropriately limited preventive care, diagnostic testing, therapy for illness and a full range of appropriate pharmaceutical (and other) products and services, mediocrity will prevail here, too. And unless we construct an ethical and moral framework for our health system, we will have not done our job.

Listen hard to President-elect Obama's health care plans. If they don't incorporate a consensus on American ethical and moral health care standards, the influences of poor business management, ethnicity mixed with religion and politics, and budgetary shortfalls will creat a wasteful system which does not meet our families' needs. We need change, not the old system in new clothes.

Worth Checking Out

For worthwhile information concerning health care costs, see:

http://www.nchc.org/facts/cost.shtml

What's Threatening Our Healthcare System?

No, it's not an epidemic or an earthquake or another hurricane Katrina. It's health care cost inflation, which in 2007 (the year before the US government really started to run the Treasury's money printing presses overtime at full speed) was about twice the general inflation rate. The Medicare population is a prime inflation victim, as its members observed when their Federal Medicare premium and private (i.e., AARP) Medigap premiums increases wiped out their Social Security inflation adjustments robbing resources from food, clothing, shelter and donut hole prescriptions.

The health care inflation rate, at 6.9% was double the general inflation rate; employers paid an increase of 6.1% for health insurance benefits with typical insurance family insurance premiums of about $12,000 per. Our bill for all health care products and services is heading towards 3 trillion dollars.

As our citizens, in increasing numbers, age and become ill, the cost of their care will be reflected in health care inflation. As new technologies, pharmaceuticals and advanced biologic products are introduced, their costs will be reflected in health care inflation. And as the numbers of those needing expensive new services increase, insurers and other intermediaries will elbow their way up to the trough to demand their share of resources as a reward for their roles in "managing" health care.

When resources are devoured by wasteful programs and unnecessary bureaucracies, food, mortgages, education, defense, transportation will be shortchanged. That will not be sustainable.

This Thanksgiving, let us be grateful for our country's world leadership, the affirmative role it plays in our lives, our ability to meaningfully participate in government, prosperity (for many), and the opportunities Americans enjoy to enjoy freedom of thought, action and religion. And let us resolve to provide appropriate health care to all Americans in a kind, humane, efficient system which alleviates pain and suffering and extends valuable life.

Something Was A Little Strange

Medical school hadn't officially started: we were being oriented with cheerleader speeches from faculty and a memorable talk the by the student body president who told it the way it was, ending with the thought that nowhere in the medical school catalog was there any statement that we would be treated fairly.

That afternoon, as we gathered quietly in an auditorium, the student to my left introduced himself as "Sam" (not his real name). And then, as inkblot patterns flashed on the white screen in rapid succession, he whispered an offer to help me with the inkblot interpretations because he had a lot of experience with inkblots. I ignored him.

A few weeks later we had become intense experienced students, soaking up new words, concepts and information. Neuroanatomy was difficult, the exam notorious, and each person's semester grade depended on correct identification of the brain structures in which our instructor had inserted small numbered pin-flags. But there was a problem - at the front of the line named "Sam." As he came to each test specimen, he systematically removed each flag, replacing it within an inch of its original site. Bedlam ensued. Somehow, Sam escaped without being physically assaulted.

A week later, "Sam" didn't show up for class. The next day we learned that he had murdered his mother-in-law. The details were supplied by a national magazine a few days later. The informal consensus was that at least no-one would move the little numbered exam identification flag

HIV and Male Healthcare Workers

At New York's Downstate Medical School, one of the pathology professors delighted in asking students what US persons were (in recent times) most likely to die of smallpox. His answer, hospital laundry workers, was my introduction to health care workers as victims of work-transmitted diseases.

When researching my chapter concerning HIV infected health care workers in Clark, Boardman, Callaghan's "Health Law Practice Guide," I was puzzled by the lack of evidence of widespread transmission of HIV to health care workers. There were a few lawsuits by individuals who claimed to have contracted HIV infection during the course of their duties, but they were relatively uncommon and there were confounding factors: was the appearance of HIV transmitted from a patient, or the result of lifestype exposure?

As noted in Kaisernetwork.org Daily HIV/AIDS Report , the CDC has published a study in the American Journal of Industrial Medicine suggesting that male health care workers face a more than twofold risk of dying from HIV/AIDS related causes, as well as other bloodborne diseases (Hepatitis B and C). Female nurses were at lower risk of dying from HIV - related causes than women who did not work in health care.

So, we are back to the old questions: is it private personal lifestyle or decreased immunity or increased risk of work-related infection which accounts for these findings. Because there are confounding issues, such as workers' compensation insurance payments and employer liability payments which may be at play, it will take a large, well funded and staffed, and deep study to figure this one out.

Final Regulation to implement and enforce the Patient Safety and Quality Improvement Act of 2005

http://edocket.access.gpo.gov/2008/pdf/E8-27475.pdf

The final regulation to implement and enforce the Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) has been published in the Federal Register today. In April 2006, Secretary Leavitt delegated to OCR the authority to implement and enforce the confidentiality protections of the Patient Safety Act in conjunction with the Agency for Healthcare Research and Quality (AHRQ), which is responsible for administration of the Patient Safety Organization (PSO) requirements. On February 12, of this year, AHRQ and OCR published the proposed regulation for public comment. On October 8, of this year, AHRQ and OCR published interim guidance to permit AHRQ to begin listing PSOs prior to the effective date of the final regulation. On January 19, 2009, the final regulation will be effective and supersede the interim guidance.



The final regulation establishes the procedures and requirements for the listing and operation of PSOs, as well as the privilege and confidentiality protection for patient safety work product. The final rule makes several modifications to the proposed rule, in particular adding new requirements for PSOs and clarifying how information is collected to allow efficiencies in provider operations when collecting similar information for different purposes.



OCR’s enforcement responsibility includes the imposition of a civil money penalty for a knowing or reckless impermissible disclosure of patient safety work product. A civil money penalty may be imposed in an amount up to $10,000 for each violation.



The Patient Safety Act recognizes certain provisions of the HIPAA Privacy Rule are implicated by covered entity providers seeking the protections of the Patient Safety Act. The preamble to the final regulation describes how the HIPAA Privacy Rule disclosure permissions operate in conjunction with the patient safety disclosure permissions.



You may review the final regulation in the Federal Register (http://edocket.access.gpo.gov/2008/pdf/E8-27475.pdf).