Pliny's Confusion

I was talking to some people about healthcare reform the other day and I ended up asking them a couple of questions:

1): Did they think it was ok for MD's to publish research while being payed by pharma companies?

Answer - resoundingly - absolutely not!

Why, I asked? It's an obvious conflict of interest, was the general reason.

Follow-up question 1a): Is it a problem when you have a conflict of interest in medicine?

Well, DUH! was the gist of the responses.

1b): So how is a private insurance company whose financial performance is governed by limiting their payouts from client fees, not a conflict of interest too?


Ok let's move on.

2: How is a private insurance bureaucrat determining the services you receive better than a governmental employee?

GD Commie!

Pliny is confused...


Jared said...

If the pharma company payment is disclosed in the research, I think it should be acceptable, but ONLY if it is basic research with tissue cultures or animal models.

As for medical insurance companies, well, I have a rather low respect for someone who makes more money by preventing someone from getting medical treatment for financial reasons.

Individuals disinterested in any form of monetary gain should be making decisions of the necessity of medical treatment. (read: salaried persons without any consequences for approving or denying a claim)

Harvey said...

It is obvious that most people do not see that the decision making as to what medical care, how much of it, and when and where it may be made available is already in the hands of "bureaucrats", paid by the insurance providers to "ration" that care. My patients have largely believed that it was up to me, in conjunction with their primary care providers, to decide these things on their behalf. As I am sure you are all too well aware, Pliny, nothing could be farther from the truth! Moreover, the recent debacle in which the hard rightists have been able to convince the public that even allowing government funding for end-of-life counselling somehow equates with patients having even less control over their own health care decisions (let alone "death panels"!!!) demonstrates the lengths to which some Americans are willing to continue to support "big business" (Health Care Insurers, in this case) over some more equitable means of providing a level playing field for all of us. Jred's commnet regarding what sort of person should be in charge of these decisions is right on! It should be obvious that anyone who sees any personal benefit from how or when they may take part in these decisions should not be allowed to be in such a position.
In the best of all worlds, the decisions as to what may constitute "best" care should be made among the patient, his/her physician(s), concerned family members where appropriate, and, possibly, social work. The decisions as to how this may be paid for should be made by an appropriately qualified and duly appointed government employee, whose recompense does not depend in nay way upon how much money he/she can avoid paying.

Michael Lockridge said...

I think Harvey is right in expressing the ideal structure, at least in a very broad sense. Unfortunately, the decision making process in establishing and building the structure of the new system will be (at least in part)made by self interested persons.

I cannot help but think that the end result will be inflexible, difficult to manage, and expensive. Is there any government system that is not so?

The most efficient system would be managed by a health care dictator. The most caring system would be managed by mom. The reality will be somewhere in the middle (depending on how much of a dictator mom might be) and just another inefficient service we have to put up with.

I am not a cynic. I am a frustrated idealist. >.<

Harvey said...

Unfortunately, this is not the best of all worlds. Tere will always be some degree of disconnect between the ideals we strive for and what any government can achieve. It is my opinion, however, that any move towards more universal healthcare availability to our citizens, especially those who are unable to get such coverage through their own efforts will be better than what we have now, even though this will probably mean that I will pay more taxes and will receive less remuneration as a physician. I am by no means an ultraliberal, but in this matter, after forty years in the trenches and seeing first hand how often our present system fall seriously short, I simply cannot accept that thr USA cannot find a way to do better.