Archive for May, 2008

Error 404

Tuesday, May 13th, 2008

I have to disagree with Cato. The shift of insurance companies to refuse to pay for “medical errors” is a good idea in principle but likely to be horrid idea in practice.

First, many of the things called medical errors and not medical errors at all. Post-operative infections are a perfect example. When you cut people open, a certain number of them are going to get post-op infections. This isn’t “error”. This is reality. Bedsores are the same way. They happen, no matter how diligent you are.

Often times, medical errors are just misjudgements. Early symptoms of illness are sometimes unclear and doctors have to go on intuition. If that intuition is wrong, is that a medical error? Let’s say, for example, that a patient comes in with flu-like symptoms but they really have inhalation anthrax. If you’d caught this rare disease early, a simple antibiotic course would have handled it. But now the patient is in the ICU.

Who is going to judge whether something is an error or not? Ten to one it won’t be a practicing physician. And the record of insurers — especially Medicare — in judging medical cases is abysmal. My first experience with Medicare was when they refused to pay for removing a patient’s bowel obstruction because it was “medically unnecessary”. I hate the idea of giving those idiots the power to decide what was an error and what wasn’t.

Second, I suspect this will mainly provide excuses for many insurers to simply refuse to pay. If a patient has complications, they will simply refuse to pay for it, claiming it’s the result of a medical error, even when it clearly isn’t.

Third, I love this quote:

Imagine remodeling your kitchen and paying the contractor extra to fix your garage door because he backed his truck into it. When Medicare and private insurers reward medical errors this way, Americans pay higher taxes and insurance premiums to cover the costs of other people’s mistakes.

If it’s a matter of someone cutting off the wrong leg or something, I would agree. But there are better examples. If my mechanic replaces my alternator and it turns out that it was the battery that was broken, I still have to pay for both fixes. I have frequently had to pay mechanics to repair things they broke — mostly because it’s hard to prove that they broke it.

Fourth, what I most fear is the creation of perverse incentives. When I worked in the field, we would treat a breast lump by doing a biopsy, having it analyzed while the patient was on the table and then, if necessary, doing a mastectomy. Medicare refused to pay for the biopsy. Their logic was “you removed the whole breast; why should we pay you for removing part?” This encouraged doctors to do the biopsy, send the patient home and then bring them back later for modified radical.

I suspect the medical error thing will have the same happy result. Unscrupulous hospitals will sends patients home so that they can claim that a post-op infection or bedsore was the patient’s own fault.

This “no error pay” policy sounds good. And I would support it if it stuck to obvious things like giving the wrong medicine or cutting off the wrong foot. But I suspect this is a backdoor way for the insurance companies to cut payments to doctors. And in the end, the improvement in both cost and health will be small. (I also suspect that this would not actually save any money — it would just increase the amount of healthcare people consume.)

It will, of course, have the usual results of having accountants dictate medical practice. Procedures will get more expensive. Because if the hospital is going to have to foot the bill for every post-op infection, bedsore or fall, they’ll just charge you for it from the very beginning.

I’ll close with my usual theme: the human body is not like car; it doesn’t always give clear signals of what’s wrong; it doesn’t always respond in expected ways; and it frequently goes wrong for no clear reason at all. People who rant and fulminate about “medical errors” often forget this.

In the end, I fear this is a titanic deck chair thing. The disconnect between patient and physician is at the heart of our health insurance woes. What this is doing is getting the insurance company — and Medicare — more involved. That’s not necessarily a good thing.

Update: I e-mailed the above to Michael Cannon. His response was that he mostly agreed. Having third parties trying to influence medical decisions is not necessarily a good thing.

Schooling

Monday, May 12th, 2008

Jack Kelley attacks Obama on his claim that “it is not weakness, but wisdom to talk not just to our friends, but to our enemies, like Roosevelt did, and Kennedy did, and Truman did.”, claiming Obama is ignorant of history.

Actually, it’s Kelly who misses the point. Kelly goes on about how Kennedy’s meetings with Kruschev showed a weakness. Of course, his ability to talk to the Soviets was what prevented a nuclear holocaust during the Missile Crisis.

Then there are the swipes that Truman didn’t negotiate with Imperial Japan or the Soviets. No, he didn’t. But he did meet with Middle East leaders when deciding to support Israel. And Ike succeeded him by negotiating the end of the Korean War.

As for Roosevelt, I too wasn’t clear on which one Obama was talking about.

Kelly doesn’t seem to understand that there’s a difference between meeting with a nation that is hostile to you and meeting with one which with whom you are actively engaged in war. But, I’m getting used to those subtleties going over the heads of “conservatives” these days.

Weekend Linkorama

Saturday, May 10th, 2008
  • Numbers in the Dark on gun control. I’m used to the gun-grabbers playing fast and loose with the facts, but it’s getting ridiculous.
  • Is Raoul really reforming Cuba? Some doubts.
  • Pure brilliance from Peggy Noonan on Hillary’s refusal to face reality.
  • Man, I hate the sugar companies. They are the biggest reason I could never be in Congress. The first thing I’d do is call in some of the sugar fat cats, show them a picture of a starving kid in the Philippines or the Dominican Republic and ask them to justify their rich subsidies and import restrictions.

    A friend of mine used to live in Hawaii. He moved out because not only were his property taxes high to account for sugar growers being exempt, the smoke from the burning cane was giving his kids asthma. The sugar companies need to be just taken out and shot. It’s an industry completely dependent on government largesse.

  • Yet another example of why I hate Big Education. Anyone who oppose scholarship for poor kids needs to be drawn and quartered.
  • When I grow up, I want to be a duck-billed platypus.
  • Ah, government. They force you to add something to gasoline. And when it pollutes, you pick up the tab.
  • Selection Effect

    Saturday, May 10th, 2008

    Parts of the blogosphere are touting the merits of a very sophisticated system for projecting primaries that came close to Indiana and North Carolina’s actual results.

    Humbug.

    We see this all the time on Wall Street. If you have enough idiots making models of the stock market, it’s likely that one will have a run of success just by chance. When everyone stampedes to that model … well, their luck runs out and you get a hedge fund collapse.

    When this guy has predicted seven or eight primaries in a row, then you can call me.

    Rats

    Thursday, May 8th, 2008

    A must-read from Welch over at Reason about the state of city governments. It’s pathetic to see cities doling out millions in big projects while basic things like road repair and sanitation fall apart. This was my experience in Baltimore.

    There is going to come a tipping point where our big cities will just collapse. Hopefully, we can pick up the pieces and put effective government in charge.

    The problem is really nationwide. Governments — state, local and federal — are spending billions on dumb social spending and big projects while letting infrastructure and basic services fade. What the hell are we doing to this country?

    No Cycle For You

    Wednesday, May 7th, 2008

    One of my pet peeves — overprotective parents.

    Parents’ fears about road safety are turning children into a lost generation of cyclists, says a government-backed agency that promotes cycling.

    Four out of five children are banned from cycling to school by their parents, a poll of 1,079 parents for Cycling England suggests.

    This compares with the 35% of parents who were allowed to bike to school when they were children themselves.

    Launching Bike to School Week the group said road accidents are declining.

    The survey found 81% of parents ban children from cycling independently.

    This was creating a new breed of “cul-de-sac kids” restricted to cycling only in their own road and neighbouring streets, Cycling England warned.

    Fat, lazy kids. But at least they’re safe. Or not, since cars are more dangerous.

    Weeds

    Tuesday, May 6th, 2008

    Between Sue taking care of Abby, a wet summer and my lack of interest, our lawn wasn’t too different from this last year. There is no force on Earth more powerful than Texas weeds. I had weeds that were taller than me.

    Also with more certain employment.

    So Much For All That

    Tuesday, May 6th, 2008

    Housing crunch? Collapsing real estate market? My home appraisal for tax purposes just went up an even 10%. Of course, that was the first rise since I bought it three years ago.

    Observation

    Tuesday, May 6th, 2008

    Even when your career is hanging by a thread and the NSF is hacking at it with all its might, the Brandenberg Concertos can make you feel better. A world that can produce such exquisite music can’t be all bad.

    Boy, did that sound music snobby or what?

    Update: (Pretension Alert) The 3rd Concerto may be the most perfectly balanced piece of music ever written. My tastes roam far and wide in the classical ouevre and there is some modern music I like — at least when Sue plays it. I’ve come to accept, for example, that it is possible to like Dido and still be heterosexual. And Purple Rain is one of my favorite albums. But my heart truly lies in classical, especially Stravinsky, Wagner, Beethoven and Bach.

    Friday Night Linkorama

    Friday, May 2nd, 2008
  • God, Hillary Clinton is an idiot on suing OPEC:

    Here’s a list of reasons that won’t work. More to the point, OPEC isn’t restricting production right now; pretty much everyone is working their capacity flat out. Hillary Clinton wants to sue OPEC for not producing oil from wells they haven’t drilled yet. Next: a lawsuit against Ford for not building us the cool flying cars we were promised in The Jetsons. I WANT MY FLYING CAR!!!!

  • Is it a dead cat bounce or are we avoiding a recession? We should know in just a few years.
  • Score one for the good guys. NYC’s stupid lawsuits against gun companies is tossed.
  • The myth of organic food. It’s amazing how widespread ludditism is.
  • More environmentalist bullshit. Mass transit? Bad for the environment. They’re to foist one of these things on Austin right now, which is going to go over like a gay pride parade in Salt Lake City.
  • A very scary post on the search of ET life. That we aren’t finding it may indicate intelligent species are likely to destroy themselves. I’m thinking of the Large Hadron Collider. The “degree in astrophysics” part of my mind knows it’s safe. The “scared of nothing” part is worried.
  • Elliot Spitzer’s whore is all class. She’s suing Girls Gone Wild because she lied about her age to appear in a video at age 17.
  • Thursday Linkorama

    Thursday, May 1st, 2008
  • Just a little insight into the country the Democrats are screwing over to pander to unions.
  • Pot arrests are way up in NYC. But I’m sure giving this people a pointless damaging drug conviction is accomplishing something.
  • This has got to be one of the dumbest things I’ve read. The Yanks spent five hours digging up a Red Sox jersey a worker buried in their new stadium. I’m with Jim Baker.

    Before I go on the following rant, I just want to make sure I have my facts straight. You’re telling me that a couple of weeks ago, a large corporation authorized the demolition of recently completed construction to remove a piece of cloth from a non-load-bearing area of their new facility? Let me check to make sure this actually happened. OK. Now, let me check the calendar. Son of a gun, it says right here that it’s 2008.

    You realize what this means, right? It means we are no better at gauging cause and effect than the brother-in-law of the guy who discovered fire. We have, in spite of technological developments that might argue otherwise, no more right to the high ground of logic than the fellow whose job it was to select the proper virgin to be dumped into the volcano to appease the rumbly god therein. We might have gotten over the notion that the world is flat, but that’s probably the best thing you can say about us.

    Five hours with jackhammers, folks. Five hours! That’s not counting the time it took to remediate the damage, either. Please don’t tell me it’s “all in good fun,” either. Good fun is spending $50 to hire an actor to dress like a wizard and put a pretend curse on the other team. This, on the other hand, is the work of people determined to undo what they believe to be a palpable threat to the well being of their enterprise. I have to know: did the Age of Reason bypass the Bronx?

  • The biggest porker in Washington? Why, Hillary Clinton, is that you?
  • The gross incompetence of the Bush Administration continues to boggle the mind.
  • Can there really be any doubt that Media Matters is nothing but a part of the Clinton machine?
  • Karl Rove admits stress positions are torture. At least for Americans.
  • A very original proposal backfires. I think, however, that if he shags the babe in the picture, he’ll think it was worth it.
  • We Heart Government

    Thursday, May 1st, 2008

    Here is a site dedicated to praising government. Don’t read and face your computer at the same time unless you want your keyboard covered in puke.

    As usual, they are confusing “small government ideology” with “anarchy”. The conservative agenda is, apparently, to abolish even the things we can all agree government should do like build roads, enforce laws, protect private property and punish wrongdoers

    What gets me, however, is how craven the site is. To read it, one would think we should go to bed each night thanking God that our wonderful and glorious government is there to save us from ourselves. Without government, the site argues, all of us evil stupid greedy senseless people would be dead.

    It’s a target rich environment, but I’ll take on the Day in the Life tripe, which walks you through your day and tells you how much you should get on your knees and thank God for our divine rulers.

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