I find describing my political leanings difficult sometimes. An easy answer would probably be “liberal,” since I favor a pretty robust social safety net, and am definitely to the left on most social issues. That said, I am aware of liberalism’s more corrosive effects, and have a healthy degree of respect for the traditions and institutions that have stabilized society across the centuries. There are little pools of conservatism burbling away inside me.
And of course I have my libertarian leanings, too. I am wary of undue government power, and would rather it not intervene in a problem if some other entity can do so, or if the problem is not sufficiently pressing as to warrant intervention at all. In balancing liberty against equality and order, I am generally in favor of liberty as the prevailing value (while nonetheless recognizing that a certain degree of equality and order are necessary for a flourishing society). Maybe I’ve just been hanging around the League too long, but if I were to place myself on some kind of political grid, I’d be somewhere in the area where liberalism and libertarianism admix.
So when I read this story the other day, I found myself wondering if there is any solution beyond government regulation to keep the problems described from recurring.
HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing. Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.
Questions about the necessity of medical procedures — especially in the realm of cardiology — are not uncommon. None of the internal documents reviewed calculate just how many such procedures there were or how many patients might have died or been injured as a result. But the documents suggest that the problems at HCA went beyond a rogue doctor or two.
This issue was raised in the comments following my most recent post, and illustrated with unfortunate precision in this case. What to do about physicians whose financial interests compel them to order tests and interventions for their patients that their patients could well do without? I don’t know (and suspect it would be nigh unto impossible to really pin down) how much these ethically suspect doctor’s orders contribute to the burgeoning healthcare costs in this country, but even if it is a relatively small proportion that doesn’t make it any more right. Not only is it taking egregious liberties with the physician-patient relationship and exploiting the trust invested in medical providers, it (as the article makes clear) exposes some patients to potential or actual physical harm.
Now, I happen to feel strongly enough about this issue that I, as a physician, would accept a limit on my liberty in the form of a ban on certain kinds of ownership arrangements and incentives for medical providers. (In my case this limit is likely to remain abstract, as I have no intention in entering into the kind of arrangement that would fall under such a ban.) Where that ban would fall is a hard question to answer, and there has to be some accommodation for certain kinds of medical providers having their own facilities to perform certain procedures without undue inconvenience to their patients and themselves. But I happen to think some kind of limit on the financial rewards a provider can enjoy for ordering tests and interventions is appropriate, and removes or mitigates the incentive to order them for reasons other than the patient’s legitimate medical needs.
Here is where you paste the “liberal” label on me and shake your head in dismay.
But is there a non-governmental solution to this? Is the problem even sufficiently grave as to warrant some kind of preventive measure at all? (I plainly think so, but perhaps you disagree.) If there happen to be any stray libertarians lurking about who would like to suggest how the market might better handle this problem, I would be sincerely interested in hearing an alternate view.
For my part, I don’t see how a market solution exists. Ideally, patients are fully informed about the risks and benefits of any recommended procedure. But the knowledge differential between a physician and a patient is such that at a certain point almost all patients who are not medical providers themselves have to trust that their doctor is giving them the best advice with their welfare the foremost consideration. Being able to entrust someone with more training than you with diagnosing and treating your illnesses is why we bother with doctors in the first place. I don’t see how there is a mechanism within the free market alone that would correct the potential for exploitation by the unscrupulous few.
But that’s why I hang around here, to learn new things. To me the need for some kind of regulation is self-evident. Those of you who balk at such things, what alternative would you propose? Or is an alternative even necessary?