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Sunday, August 09, 2009

Lane Violation
Balllance at the Washington Post

Chuck Lane manages to out do "Opinions on Shape of Earth Differ: Both Sides Have a Point"

Lane and I went to the same progressive alternative elementary and middle school Green Acres School. He has become rather famous. This makes me envious.

update: Oh nooo not only did I harshly criticize a fellow Green Acres alumnus, but I got a link from someone from dread hated rival Sidwell Friends (I mean we considered them rivals, they didn't even notice us).

Also, although I tried to tone my post down, it still seems to me to be shriller than Somerby's which is alarming.

He discusses Section 1233 of the House reform bill which provides for funding for end of life counseling. The Section has become notorious because the notorious Betsey McCaughey claimed that medicare recipients will be required to undergo such counseling every 5 years whether they want it or not -- that it will be mandatory for medicare recipients.

This is simply a lie. It is very hard to find two sides to the question. The section says that medicare recipients may obtain such counseling as part of medicare at most once every five years.

end update.

It would have seemed to me impossible to write a "Opinions on shape of earth differ -- both sides have a point" column on this debate, but Lane writes "Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist."

Does he apply the same standard to all things doctors might want to bring up for which they are paid ? Does he consider it a violation of patients rights for a doctor to suggest a treatment based on a physical and not wait for the patient to ask for it ?

Lane's view seems to be that doctors can get something for nothing if they are paid for the consultation. That would be the incentive. This shows that Lane has no clue about quality medical care or existing distortions in payments. All doctors I know agree that the problem with medicare is that it pays too much for "doing something" and too little for "talking to patients." It is just not true that if you offer someone positive money to do something you are giving them an incentive to do it (consider jury duty). MD's time is very valuable. Their economic incentive is to make money as fast as they can. In particular Lane does not discuss the duration of the counseling or the fee (I assume neither is in the bill). Evidently he would consider the bill to improperly influence MDs even if it offered to pay them $10 per hour for the counseling.

Paying someone for their time is not giving them an incentive unless you pay them over their reservation wage. I think it is very safe to say that medicare pays physicians less than their reservation wage to talk to patients (and Waaaaaaay less to listen to patients who are typically interrupted within seconds of beginning to describe their symptoms). Physicians have to choose between maximizing their income by not talking to patients and performing procedures or doing the right thing by talking to their patients. Unless there is some other change somewhere that Lane didn't bother to mention, this applies to end of life counseling (except for the compensating differential that it is very unpleasant which means it implies twice over to end of life counseling).

Or maybe Lane thinks it is improper for doctors to be paid for their time at all.

Strangely he asserts that where there is smoke there is fire *after* noting that the far right is telling total lies

Still, I was not reassured to read in an Aug. 1 Post article that "Democratic strategists" are "hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors."

If Section 1233 is innocuous, why would "strategists" want to tip-toe around the subject?

Lane claims that people don't worry about attracting attention to an issue if they are right. He's 1 year younger than me, so I don't know if he remembers LBJ, but surely he's heard "but we can make that son of a bitch deny it?" Has he managed not to notice Karl Rove's strategy ?

So we appear to have
1) Ignorance of an almost universal criticism of current rules for MD compensation.
2) No sign of any grasp of economics or the value of time (except he doesn't seem to have wasted much of his time on research)
3) Ignorance of the way political debate actually works.
4) Ignorance of psychology.

And all in one column.
I know he's not stupid. He's just bound and determined to write a balllanced column about whether a blatant lie is a lie.

Balllance just means going beyond Ballance.

"Lane Violation" is a quote of someone (not me I swear) at Green Acres who liked to shout "lane violation" whenever Chuck touched a basketball.

Mark Kleiman has a much better critique of the column and notes that one of Lane's few claims of fact is false.

Lane continues:

Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice - even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs?

That's an interesting question. Rather, it would be an interesting question if its factual predicate were accurate. In fact, section 1233 is in Title II of the bill, labeled "Medicare Beneficiary Improvements," No part of Title II has anything to do with cost containment;


Roger Albin said...

Its obvious that Lane knows nothing about medical practice.

wh said...

I know this whole conversation is insane, but where is the Doctor (as a human being, not an abstraction) in all this? What on earth makes anyone think that Doctors will just start pushing people toward suicide to save the government a few bucks? Hippocratic Oath anyone?

Anonymous said...

This is what is insane but this is from a health care adviser to the President, a President who is still not capable of promising that Medicare benefits will be preserved:

November, 1996

Where Civic Republicanism and Deliberative Democracy Meet
By Ezekiel J. Emanuel

This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity — those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberation — are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.

Anonymous said...

Weeks ago, I began hearing nice people in church worrying about Medicare benefits. Weeks have passed and where is the President to reassure people that Medicare benefits will not be cut?

Interestingly, a prominent supposedly liberal economist at Berkeley wants Ezekiel Emanuel to write on health care for the Atlantic, as though Emanuel has not done enough damage in writing already (no surprise though).