The reason most conspiracy theories fail the giggle test is that they require implausible levels of venality and cooperation on the part of the conspirators. An illustrative example of this can be found in Dr. Rich’s theory on why cardiac arrest patients purportedly don’t receive defibrillation as quickly in hospitals as they get it in public places.
But, unfortunately, there is a big and fundamental difference between the business interests of hospitals, and those of other institutions in which cardiac arrest is relatively likely to occur.
When I first read this passage, I thought Dr. Rich was kidding. Surely, I thought, he’s not seriously implying that hospitals deliberately keep inefficient or slow systems in place in the hope of weeding out expensive cardiac patients. Unfortunately, that is precisely what he is saying:
In a casino, saving the life of a customer is good for business … The healthcare system, on the other hand, thinks differently about people who are prone to cardiac arrest … their sudden death today will save the system countless dollars tomorrow.
Can anyone really be so wacky as to think that hospital administrators sit around board rooms trying to figure out ways to facilitate more “sudden deaths” in order “save countless dollars”? I have spent 20 years in hospital finance, and I have never met a single administrator to whom such an idea would even occur.
Moreover, such a policy would require the tacit cooperation of the medical staff. Does anyone really believe that the medical staff at a community hospital would go along with such a thing? It’s hard enough to get their cooperation on sensible policies (like signing their charts in a timely manner).
Like most conspiracy theories, this one doesn’t pass the giggle test.
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Our biggest donor to our hospital (for which most of the hospital was named) gave money after being saved from certain death from cardiac arrest by our staff. Oddly enough, most survivors tend to appreciate having their lives saved. They may not necessarily donate money, but they mention our hospital in the same story as the miraculous against-the-odds recovery from certain death.
Posted 06 Jan 2008 at 4:12 pm ¶You are correct. It indeed would be wacky for me to suggest that hospital administrators (and/or medical staff) sit around plotting how to make certain that people who have cardiac arrests in their institutions will be sure to complete the process (that is, to die). And while in retrospect I can see why you might surmise that I was suggesting a conspiracy in my post (a mistake for which I accept responsibility), I in fact am doing no such thing. Indeed, I am cynical enough to believe that effective conspiracies - anything more complicated than, say, cheating at bridge, - are generally impossible.
So let me be clear. The general disinterest displayed within the healthcare system toward the problem of preventing sudden death (which I have described at length in my book, Fixing American Healthcare, and have commented upon several times on my blog) is not a conspiracy at all.
It’s just that preventing many of the 300,000 sudden deaths that occur each year in the United States, while entirely feasible with existing technology, would be very expensive, and there is no incentive to drive the healthcare system to do so. (Sudden death, as I’ve explained elsewhere, for several reasons is a boon to society’s financial health.) And since there is no constituency for sudden death (as there is for breast cancer and cerebral palsy, for instance), nobody is forcing the healthcare system to focus on this issue.
So, what with all the well-known and sundry crises that hospital administrators and their medical staffs must face each day, the “problem” of poor response times to cardiac arrests in hospitals simply does not appear above the radar. This is not a conspiracy. It’s simple human nature.
My point, while apparently imperfectly made, was to call attention to the irony. Owners of casinos have noticed a clear incentive for preventing sudden death among their customers, and this realization has led to their adoption of readily available technology (AEDs), which in turn, has led to casinos becoming possibly the “safest” place for you to have your cardiac arrest. In contrast, people who run hospitals (institutions that exist for the express purpose of staving off death) have not availed themselves of this readily available technology. Instead, they seem content to rely on byzantine bureaucratic processes (that, once again, were not designed by evil cabals, but instead evolved, like all bureaucratic processes), so that first responders can often do little more than dial the phone and wait for the officially designated, properly credentialed individual to arrive and then operate the unnecessarily complex hospital defibrillator.
So there’s no conspiracy here, and I apologize for misleading you on that point. There’s no conspiracy - just a deep-seated disinterest in addressing the subject. It is a disinterest that will remain unless somebody forces the issue, or unless utter embarrassment requires a change. I am sorry that my small effort at fomenting such embarrassment has fallen flat, at least here.
DrRich
Posted 06 Jan 2008 at 6:06 pm ¶http://CovertRationingBlog.com
“Our biggest donor to our hospital (for which most of the hospital was named) gave money after being saved from certain death from cardiac arrest by our staff.”
We have a similar story at my institution, K. We’re about to build a state-of-the-art facility on some very pricey land that one of our patients donated to us after our ER crew snatched him out of the clutches of the Grim Reaper.
Posted 06 Jan 2008 at 7:55 pm ¶You are, of course, missing dr rich’s point. Are there readily available AEDs in your facility? I have worked in 8 hospitals and not one had readily available AEDs?????? not a conspiracy, but one of the side effects of profit driven medicine, the financial risk is greater than the financial advantage, if the cafeteria crew works an AED and the patient dies, the lawyers and court ask, why was the cook trying to revive this patient in the hospital!!!! major law suit, but if you don’t have an AED, and the “the officially designated, properly credentialed individual” arrives, albeit too late, the legal systme says, “they did all they could do”.
Posted 07 Jan 2008 at 7:21 am ¶In tangental reply to drmatt, I saw (again) a TV commercial for a lawyer who specialized in medical malpractice. This particular shark implied rather strongly that if a medical procedure didn’t come out the way YOU wanted it to, he would “clean the clock of the doofus doctor who did it to you,” to the tune of millions of $$$$$.
Must give a MD the warm and fuzzies seeing such an ad on TV. (sarcasm)
Posted 07 Jan 2008 at 3:53 pm ¶Talk about having a target on your back! No wonder MDs do heavy duty defensive medicine….
I actually know doctors who refuse to treat lawyers. It is sad.
Posted 08 Jan 2008 at 10:50 am ¶drmatt -
The financial advantage of not having AEDs in the hospital is not driven primarily by profit, but by cost of litigation, as demonstrated by your example. (admittedly costs figure into the profit in the end, but you discount the effect of litigation aversion).
Do you believe, that if there were no finanical intertest in medicine, that the whole endeavor was gov’t sponsored in such a way that the hospital could stay open regardless of volume or severity of patients, thet it could then afford a major lawsuit, it’s defense, and subsequent increase in liability insurance premiums? or are you advocating immunity against torts in such a system?
Posted 08 Jan 2008 at 2:01 pm ¶Torts being not punitive (as in criminal law), if you have a health system that you paid for through taxes, then had a medical law suit, you could’t really sue for medical bills because you wouldn’t have any, the health care was paid for. In the case of wrongfull death you would still be paying (and loss of limb or ability to work) but the overall payments out would drop drastically, physical therapy, medical restoration, medications would all have been paid for by the govt, which means there is nothing for you to recoup.
Posted 08 Jan 2008 at 4:48 pm ¶Not addressing litigation aversion is not the same as discounting it, I was simply explaing to Catron where drrich was going with his point.
In any case your point on liability in a single payor system is moot, the cost of liability would drop almost immediately, substaintially and it would sustain.
Except that in your example, the claim would not be for medical bills, physical therapy or other medical or ancillary treatment. It would be for wrongful death. If it is moot, I guess you are suggesting immunity, because you are claiming that the hospital could not be sued if the chef failed to resucitate the patient.
Posted 08 Jan 2008 at 6:53 pm ¶Moot, by definition means an arguable point, so no implication of immunity. The constitution protects the right to sue anybody for anything. What I am saying is the cost of liability would actualy be less and would play a much smaller role in decisions like, “should we have AED through out the hospital”.
Posted 09 Jan 2008 at 6:28 am ¶But WHY would the cost of liability be less? The items you mentioned, medical care, bills, therapy, etc, are irrelevant to a dead patient. Does a single payer system impose limits on jury awards for the wrongful death?
Posted 09 Jan 2008 at 10:28 am ¶Liability overall would be less, when you talk about the cost of anything you consider it’s overall costs, not just the one time variable expenses. I imagine in a single payor system there would be a limit on what was paid out, likely a standard across the country (which would be more fair, one persons arm is no more valuable than onther persone) this would lower liability even more, insurance companies love predictable, also, why go to court when you know what you have to pay, further decreasing court and attorney costs. Imagine, instead of giving 1/3 of the award to the lawyer you get to keep it all, and you wont have to wait years to get it.
Posted 09 Jan 2008 at 11:12 am ¶Now you are dreaming. I suppose the enire legal system (and the right to sue anyone) will have to be revamped in your utopia.
Posted 09 Jan 2008 at 12:33 pm ¶Why is it that when the nuances of an debate come to light you resort to generalizations? I never, not in a single post, made any reference to a utopia? and where in there did I say anything about not suing or being able to sue? You should invest in a “mind stretcher” and learn to pay attention to details.
“Imagination is more important that knowlege” Albert Einstien
Posted 09 Jan 2008 at 1:37 pm ¶Yes - I generalized. Let me be specific:
You first said
“The constitution protects the right to sue anybody for anything.”
Then you said:
“I imagine in a single payor system there would be a limit on what was paid out…”
and
“Imagine, instead of giving 1/3 of the award to the lawyer you get to keep it all, and you wont have to wait years to get it.”
Which is it? These are not side effects of a single payor system. They are substantive changes to the legal system, and apparently put lawyers into a new model of payment wherein they do not work on contingency, but are paid by someone other than the plaintiff or defendant. And how can you honestly say that your right to sue for anything is protected if the government limits what you can sue for?
Ok, it’s not a utopia, but it is a fantasy. Have fun!
Posted 09 Jan 2008 at 4:21 pm ¶Ok, caps on liability pay outs are not a new concept, it doesn’t change the right to sue, thus does not change the constitution. Additionally, pay outs become a matter of precident in many cases, that is where “settling out of court” comes from, the insurance companies see a losing case, they know “about” how much they will lose for and pay it without the court and legal fees. So, if, over time the payout for certain things became standard because you were dealing with the same entity in every suit, who in thier right mind would split that with a lawyer and go through a long legal process? Your near acuity is clearly 20/20 but you seem to have difficulty with forsight.
I see no changes in the legal system here, nice try though.
and you are right, fantasy, a boy can dream can’t he?
Posted 10 Jan 2008 at 6:42 am ¶Drmatt you said, “I have worked in 8 hospitals and not one had readily available AEDs”.
Where are the AEDs located in most hospitals?
So, since they are not readily available what would you guess their response time is to a cardiac event?
Posted 29 Apr 2008 at 11:28 am ¶Post a Comment