Medicare Makes Things Worse
I’m sure you have all heard that preventable medical errors kill . . . well, no one seems to agree. 30,000 patients a year. 100,000. While I believe that these numbers are exaggerated—and not all of the errors are preventable—it’s a serious problem that hospitals, ever fearful of the lawsuit, are working on. My mother’s hospital just implemented an extremely complex computer system to make sure prescriptions, diagnoses and provider notes are available and legible to everyone. (And has been posted on this blog, these problems are worse in socialized systems).
Well there’s never a problem that our semi-socialized medical insurance system can’t step in and make worse.
In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.
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Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.
But as Orac at Scienceblogs points out (and I can confirm), not all of these “errors” are preventable. Bedsores can occur even with the most attentive care. Foley catheters run right into your bladder (ask Lee). They are a highway for infection. Falls happen when you’re treating a bunch of old people. This isn’t greedy doctors. This is reality.
There’s more. Over on my own blog, I’ve been tinkering with a post titled “Ten Things I Wish I Everyone Knew About Healthcare” and #1 is that Medicine is a much art as science. We all have this image in our heads that doctors take our symptoms, look them up in a great big book and get a diagnosis. If they screw up, it’s because they’re stupid or evil or both.
But that’s not the case. Symptoms can be ambiguous or indeterminate. Medical treatment is a prognosis, not a guarantee. At some level, all providers have to go on instinct. And sometimes your gut instinct is wrong. It’s not malpractice (well, sometimes it is). It’s not evil “for profit” greed. It’s the danger of living in a lump of flesh that doesn’t always make it clear what’s wrong with it.
Why am I mentioning this? Orac (always trust a blogger who takes his name from Blake’s 7) gets to the heart of the matter:
Of course, the problem with these regulations is that they are not designed to improve patient care, the justifications of Medicare notwithstanding. That’s just the P.R. In reality, these regulations are primarily intended to save money. That’s their primary purpose. The only thing of which we can be certain in assessing the likely effect of these new regulations is that the law of unintended consequences will be obeyed. For example, in the cause of decreasing falls, it’s not hard to guess that some hospitals may start using more physical restraints or sedatives for demented patients with a tendency to wander. In the case of central venous catheter-related infections, the risk of infection increases with time that the catheter is in place; the only way to reduce it is to remove the catheter and place a new one at a new site. Changing catheters more frequently will (1) cost more money, because it’s a surgical procedure that can be billed for, and (2) potentially expose the patient to more complications, such as bleeding or a collapsed lung, from more frequent catheter placement/replacement. Changing a catheter over a wire is useless for preventing infection, and frequently changing it to a new site has a price, as do the newer antibiotic-impregnated catheters, which also lower infection rates.
Prepare to be checked in for a bellyache in case it’s appendicitis. Or to get blasted with antibiotics to prevent post-op infection. Or to get handfuls of Prozac in case you’re depressed. Hell, the medical consequences may dwarf the financial ones.
Again, you want these dolts handling all healthcare? An evil for-profit insurance company understands that a pound of prevention is not worth an ounce of cure. The government doesn’t. And we’re going to pay.
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