Wednesday, September 23, 2009

On Hypocrisy

I made a comment elsewhere quite a while ago that I wanted to capture here so I could find it more easily. It is something that has been bothering me for a while: charges of hypocrisy against conservative politicians who have affairs.


There is a more subtle point to be made here. Hypocrisy is frequently expressed as the divergence of one’s words with one’s actions. I’d alter that traditional definition a bit. I would say that hypocrisy is the divergence of one’s words from one’s true beliefs.

Let me give two examples. Joe is a public campaigner against overeating. Joe is 400 lbs. Joe may not be a hypocrite. He may merely be weak, a much less damning offense. He knows what a trap food has become for him and he wants to help others avoid his fate.

John is a public campaigner against overeating. John’s primary business is selling deep fried Twinkies at parties. John is more likely to be a hypocrite. We can more easily believe that he really doesn’t have a problem with people who have bad eating habits but that he merely says those things publicly because he thinks they will make him more popular.

I must admit that I haven’t read much about Ensign’s affair and the aftermath. Nor do I know anything about him as a person. So instead, let me speak to a hypothetical politician in his same situation. We’ll call him Fred.

Fred actually believes the things that he spoke publicly about morality and marriage. He recognized the weakness in himself that tempted him to violate his marriage vows. He recognized the damage breaking those vows would do to his family and to society at large. Thus, he took public positions that sought to encourage others to uphold those vows and virtues. Eventually, however, Fred succumbed to temptation and did what he knew he shouldn’t do. He still believes that what he did was wrong and is willing to publicly admit the same.

So far, Fred is not a hypocrite. He may be unfit for public office, but that is a separate question of trustworthiness and judgment.

Now suppose that Fred had frequently called for other politicians who strayed to step aside and relinquish their posts. But when his own failing comes, he decides not to step aside. Now I would say that Fred is a hypocrite. (I’m looking at you, Mr. Sanford.) He believes that what is right for him is different that what he’s been saying all along.

Tuesday, September 22, 2009

Coarse Politics

Tony Blankley offered quite a zinger on the most recent episode of "Left, Right & Center." Obviously, he went a bit over the top, but the point was dead on. The subject was the "coarsening of our politics."
Initially, the Democrats called the demonstrators who opposed health care “demonstrators”, then they call them a “mob”. Then the Senate Democratic leader, Harry Reid, called them “evil”. Then the House Democratic leader, Steny Hoyer, called them “un-American”. Then the Speaker of the House Nancy Pelosi called them “Nazis”. Then the president, on Labor Day, called them “liars”. Then the former Democratic President of United States, Jimmy Carter, called them “racists”. And then the Speaker of the House called them “encouraging assassins” a la Harvey Milk’s murder in San Francisco.

And then the president laments the coarsening of political dialogue. And he does it in an accusatory rather than a concessionary tone. That is an extraordinary list of statements made by the senior elected leadership of the Democratic party against the people who have been making nothing but policy arguments. So yes, there’s been a coarsening, but who’s doing the coarsening?
There were a few other comments, and then Tony had 15 more seconds for his "rant" at the end of the show and said this.

It is interesting that in order to find some rude or outrageous statements on the opposition side they have to look for signs in a crowd of 200,000 people. And for me to find rude and outrageous statements, I go to the senior elected Democratic leaders of the nation. I think that’s an interesting comparison.
Interesting, indeed.

Monday, September 21, 2009

Second Guessing the Doctor

It is challenging as a parent to get medical advice from doctors that you don't believe you need to follow. Not that you believe it would be harmful to follow the advice, just wasteful. How can you avoid feeling like a terrible parent if you choose to ignore the physician's advice? What if the improbable occurs? It will be all my fault!

That psychology costs us a lot of money in health care. I've felt it many times in dealing with my own children.

My third child has spina bifida. This health condition carries a lot of risks. On the spectrum of spina bifida kids, my child is very blessed and is in excellent condition. When therapists tell us we should engage or this or that treatment or should have visits on a weekly basis, my wife and I look at each other and shake our heads. We suspect that some of the treatments are unnecessary, but we don't dare say no since we aren't experts. What if we're wrong?!

My fourth child was affected by jaundice after he was born. That is a high level of bilirubin in the blood that causes the skin to turn yellow and can result in brain damage. Yikes! Fortunately, the treatment is well known and simple. The child is placed under special blue lights that break down the substance in the blood and keeps him safe. In nearly all cases, the condition is temporary.

However, the hospital only had these lights in the ICU. That meant that the cost of his hospital stay was through the roof. ICU isn't cheap. And they gave him the attention that a baby in the ICU should receive! But he didn't need it. We would have been just fine in taking the lights home (as they eventually allowed us to do) and brought him in for daily blood tests. But the doctors had to be excessively cautious and so they ran a lot of tests that, in hindsight, didn't provide any value.

How could I tell them no, even though my wife and I agreed that the situation was absurd? We didn't dare! What if something DID go wrong? Would they sue us for being bad parents and take away our children? We had good insurance and so we just rode it out, bit the bullet, and paid our share. In the end, though, a lot of money was spent providing medical care that didn't enhance or prolong life.

How can we empower patients to say no? Unless we address this psychological challenge, we can't.

Monday, September 07, 2009

That Cost Me What?

I'm in the IT field, so I can readily appreciate that the value I provide is not only in pressing buttons on a keyboard, a task which any monkey can do, but in knowing which buttons to press and when. Likewise, I expect to pay a neurosurgeon a lot of money for the knowledge that he brings to the operating table in addition to the physical task that he performs.

Even with that caveat, I'm astonished at some of the prices I've been charged for health care procedures. Here is a sampling of some of the costs that blew my mind. I don't want to come across as ungrateful since I literally owe my child's life to the people who have cared for him.
  • $2,693: U of U Neonatal ICU room: My son was born with spina bifida. That meant that part of his spinal cord was poking out of his back in a little bubble when he was born. Obviously a touchy situation right after birth. After he was born, they passed him through a window from the delivery room into the neonatal ICU room. (We knew about the condition before his birth and were in the right place to be prepared to deal with it.) He stayed there for 90 minutes. They kept his back clean and safe in preparation for transport to Primary Children's Medical Center (PCMC).
  • $237: IHC Life Flight Service: This was the cost to roll my son through a hallway/tunnel that connects the U of U hospital (where he was born) into PCMC. Sure the gurney was like a space capsule, but it was obvious that it was massive lawsuit-avoidance overkill in transporting him between the two facilities. The task took about 15 minutes with two attendants. There was no helicopter involved. My part of the monthly premium (though my employer pays the lion's share) for health insurance is $277. If this tiny part of the care for my child is consumed with a pretty mundane task, how can we hope that I'll ever pay in enough to cover all the rest of this stuff?
  • $5,291: Neurosurgeon's bill. The surgery took a couple of hours. The quality of this surgery will affect the rest of my son's life. From what I can tell, it was done flawlessly. I list the price here for comparison with the neonatal room above. Sure, the surgeon made more in two hours than I earned in the month, but some things are worth paying for. I think this was one of them.
  • $161: Pediatrician visit in hospital. The doctor moves from room to room, checking on each child and answering questions from the parents. Each time he visited us for 5-8 minutes, they billed the same $161. I realize that I'm paying something for his availability and skill, but for a visit that was so brief, the price seems exorbitant. For an 8 minute visit, that works out to $20/minute. Most people feel good about making that much per hour.
  • $3,966: Neurosurgeon's bill. This was a shunt placement a few weeks after birth. It was literally brain surgery that inserted a tube into the middle of my boy's head and then down his body, underneath the skin, into his abdomen. I don't remember how this one compared in time to the previous surgery on his spine. This one will probably be performed a few times in his life as these tubes frequently fail. Remember that this is just the surgeon's bill. The hospital, drugs, anesthesia, and so on are all billed separately. (My wife reminds me that the plastic shunt valve itself also cost a small fortune... and has since been recalled. Does that mean we should get a refund?) I don't know why the price of this surgery was different from the previous one. It was the same surgeon, though obviously a very different procedure. I suspect both were equally complex, but I wouldn't really know.
The above list also proves that I have a very poor ability to gauge the value of the service that is being provided to me. Because the prices are so hidden at the time of service, we haven't developed any intuition for them like we have with other items we spend so much money on.

Would health care be different if we all knew the price up front? Would that necessarily be a good thing in every case? Would it even matter? I should note that nobody ever asked me whether we should do anything for my child. It was only a question of when, if even that. More on that in a future post.

Thursday, September 03, 2009

Let's Start With the Price

Price is a market signal that should reflect, over time, all the cumulative cost of the components of a product or service. As we ponder the health care system, it seems like the first thing we need to do is break down the prices we are paying to understand why they are so high. Once we understand the thing that drives the price up, we can work to address those areas with market solutions.

Royce Flippin wrote an article that I've been meaning to write for a long time. Titled "The Price is Right: How Greater Transparency Can Help Fix Our Health Care System," the article makes the case that consumers must know what the price of service is before it is rendered so that they can make an informed choice.

One of the reasons people pay so much for health care is that average people are not told what their fees will be at the time of service. And even if a patient takes it upon himself to ask, getting the full answer is far from easy: He can usually find out the basic charge for an office visit--but what about a scan or a lab test? And how about the cost of those prescription medications being swiftly scribbled down? Most likely, the doctor or his or her staff will tell the inquisitive patient he has to wait for his insurance statement--or worse, the bill--to arrive in the mail.

This is so true. I never know what something will cost before I get it in health care with the partial exception of my dentist. When he tells me how much work I need, I do get a predicted bill for the service. The dentist is forced to do this because he doesn't want to perform work that people can't pay for. It is in his interest to give me advance disclosure, so he does. Why doesn't this apply to all doctors?

In a future post, I want to post some examples of prices I've been charged for medical care that astonished me.