Category Archives: Health care

“The Tragedy of Electronic Medical Records”

Yves here. We’ve written about the pitfalls of electronic health records in the past. One of the surprising reactions is the “dazzled by technology” response of some readers. While there are problems with relying on paper-based records, and electronic records could in fact remedy many of them, a large swathe of the public seems unwilling to hear that what is good in theory may not turn out well in practice.

The sorry fact is that electronic health records, which in theory should reduce errors and allow for more consistent delivery of medical services, were instead designed only with patient billing and control over doctors in mind. As a result, they are if anything worsening medical outcomes. One indicator: as we reported, the latest ECRI Institute puts health care information technology as the top risk in its 2014 Patient Safety Concerns for Large Health Care Organizations report. Note that this ranking is based on the collection and analysis of over 300,000 events since 2009.

This is another example of crapification. Electronic medical records have been implemented, with apparent success, in other economics. For instance, when I lived in Australia from 2002 to 2004, it was normal for doctors to make use of them during patient visits, making entries into the system, and I never got the impression they found it onerous. Here, in New York City, I still see doctors making considerable use of paper records. As the article indicates below, the reason is the US systems are costly, lower productivity, and make doctors less likely to review patient information.

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WalMart Makes Empty Gesture to End Minimum Wage Pay While Cutting Pay Levels

WalMart just announced that it will at some unspecified point down the road end minimum wage-level pay for its workers. As we’ll demonstrate, there is way less here than meets the eye. In fact, all in pay levels, including benefits, are falling for WalMart workers, not rising.

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Can Our Commercialized Health Care System Contain Ebola?

Yves here. I’m not one to fan Ebola fears. In fact, I’m a bit loath to give it the prominence in Links that I am, given the small number of cases in the US and in the world ex the afflicted parts of Africa. While the mortality rate is high, it’s not all that infectious. You are still more at risk from dying by virtue of driving (if you drive) than you are of dying from Ebola or terrorism.

However, whether or not Ebola morphs into a more virulent version, concern about it is legitimate, if for no other reason than that the US healthcare system is neither willing nor able to cope well with flareups of deadly diseases.

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Maggie Mahar: 1/3 of Medicare Spending is Wasted

Yves here. Maggie Mahar’s post focuses on a pet peeve of mine, namely, the way treatments and procedures are overprescribed in the US. She includes a favorite example, that of colonoscopies.

However, I take issue with Mahar’s conclusion, that waste in Medicare means that Medicare for all should not serve as a way to get to single payer (even assuming that issue can be opened up again in the next decade).

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Merging Finance and Health Care Leadership – Robert Rubin Proteges Running DHHS, Spouse of Hedge Fund Magnate Running the FDA

Yves here. This post describes a pair of examples in the mistaken assumption that financiers, or at least people with connections to financiers, are the best people to put in charge of anything. Of course, whether people actually believe that assumption, or use that as a cover to curry favor with the 0.1% remains to be seen. But there is evidence that at least some people in positions of influence actually do believe it. For instance, during the famed auto bailouts, for instance, that the government brought in a dealmaker, Steve Rattner, whose investment banking experience was concentrated in media companies. And the crisis showed that the Masters of the Universe were better at lining their pockets rather than doing the job that ostensively justifies their elevated position and outsized pay: allocating capital efficiently, to the best outcomes for society as a whole.

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Getting Sucked into ObamaCare is a Lot Like Being on Probation

Yves here. Lambert, in his relentless Obamacare skullduggery, has unearthed yet another ugly feature of this Rube Goldberg contraption for enriching health insurers: unprecedented levels of required reporting to the Federal government. Your humble blogger had already flagged one, that Obamacare is designed with the bizarre assumption that everyone in America has a steady paycheck. You are supposed to be able to estimate your income. How can people who are part-time workers, with employers who ratchet up and down how much time they need, supposed to comply? Or even worse, how about self-employed people, who have variable and unpredictable income and expenses, as well as the occasional collection issue.

But Obamacare policyholders are ALSO required to report on a raft of “lifestyle changes” including when you become pregnant (which means you also need to report if you have a change in that “status” via miscarriage or abortion), or a change in “household size”. One assumes that means “household” from an IRS standpoint, but could it mean from a Census perspective? Do renters have to report if they take on a roommate?

And even better, as Lambert discusses in detail, HHS also makes it hard to prove that you’ve made the required updates. Charming.

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Obamacare: Complexity and Crapification Mean Rescission Abuses Are Alive and Well

Yves here. Obamacare is proving to be a graduate-level course in the study of craponomics. What distinguished good old fashioned mere shoddiness from crapification is that crapification is institutionalized and on its way to becoming systemic. And as this discussion illustrates, one often-used ploy is unnecessary product complexity, so that what Elizabeth Warren called “tricks and traps” can be characterized as consumer neglect and error, meaning they and not the sneaky, misleading vendor are at fault.

We were early to point out that Obamacare would do nothing to eliminate the widespread practice by insurers of canceling coverage when policy-holders submit large claims, meaning when they expect the insurance to act like insurance. The reason was that it continues to allow insurers to cancel policies for fraud, and the definition of fraud is astonishingly broad.

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