Panda will always provide me with plenty to blog back about . He rails about personal responsibility and health care policy, which just makes no sense to me at all. Let’s go one by one:

“Nothing wili [sic] ever change, no matter how or to whom you shift the costs because:
1.Patients are not encouraged or expected to take personal responsibility for their own health.”

I think patients are encouraged all the time to take personal responsibility for their health. Every doctor tells them this, and they know this. We all have to take personal responsibility for ourselves. I should probably eat less cereal and more vegetables. Some of my patients should probably take their antibiotics so they don’t develop worse infections.

I think the health care system also expects patients to take personal responsibility– and almost all of them do ! Panda is experiencing quite the selection bias–in fact, all hospital-based physicians experience it. We don’t see all the healthy people in the world, only the ones who are sick, or were healthy but didn’t take “personal responsibility.” But what should we do, Panda, if patients fail to meet our expectations? I would love to hear his answer: three strikes and you’re out? No more medical care? Just triage you right to hospice?

I agree that personal responsibility is important, but I feel like the “personal responsibility” crowd doesn’t acknowledge that systemic and societal issues greatly impact how much time, energy, and money a patient has to perform said personal health care maintenance.

“2. As every insurance scheme insulates the patient from the true cost of health care, there is no incentive for patients to make good economic decisions.”

This is true. But as I’ve said before , the “good economic decisions” people could make make up only a very small portion of the health care costs in the country. Rail against the molehill of incentives and economic decisions all you want, but it won’t do anything for the mountain of expenses you’re ignoring.

“3. The legal environment makes it impossible for anyone in authority to exercise common sense.”

Agree here. I think we should reform the tort system to a “loser pays” system–in Canada, for example (oh no, Canada!), if you sue someone and you lose, you pay their legal expenses.

“4. Futile care, which is in no way discouraged, sucks up a vast amount of medical care, everything from the physicians time to the cleaning lady mopping the floor of the ICU.”

Agree. People need to have more rational discussions about death, dying, and care with their loved ones. Sometimes I think Americans are so afraid of death and so obsessed with youth that we put a lot of dying people through a lot of sufffering so that the living can feel more comfortable. Grand daughter to me: “The doctors told me my grandmother may only have less than a year to live.” Me: “Well, yes, that very well could be true–she is 91.”

“5. Doctors don’t know how to say “no” or admit defeat.”

Eh. I don’t know if it’s our place to say no. But that’s a whole other post entirely.

“The true crime is that the zealots believe a single-payer system or some other scheme of “We Swear It’s Not Socialized Medicine” is going to make health care less expensive. Unfortunately, until the structural problems are addressed, health care will just keep getting more expensive. To address them is, ironically, to preclude the need for anything other than consumer driven changes which are the only kind that will work.”

Oh come on. This is another silly attack on single-payer, and Panda doesn’t even know what he’s talking about. No serious single-payer advocate has ever argued that it will make health care less expensive. We argue that it will reduce the rate of increasing health care expenditures. We argue that it will make more health care dollars go to patient care instead of advertisements, million dollar executive pay, shareholder premiums, and administrative overhead, but the single-payer plans I’ve seen all keep the US health care expenditures at the same level as they are currently–they don’t say we should or can cut costs.

I agree that our health care system is setup to continually increase expenses, but for my reasoning, read Money Driven Medicine by Maggie Mahar . She’s spot on.

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