Monday, September 3, 2012

Labor Day Links

A commentary in the NYT by economist Uwe Reinhardt looks at whether or not there is a physician dearth or glut. Not being highly conversant in the byzantine vocabulary of the dismal science, I cannot evaluate the merits of the article--nor am I totally sure that Reinhardt comes squarely down on one side of the argument (though he seems to imply we have too few physicians as a consequence of bad policies dating back to the mid-90s). The relevance here is that if you are contemplating attending medical school, you shouldn't let a story like this sway you one way or another. Yes, all sorts of things in medicine are changing, and yes, we have no way of knowing how those changes will affect things like salary and lifestyle and what subspecialties will be available; but we'll still need doctors a generation from now, so just apply.

NYT also notes a new strain of swine flu has claimed its first human victim, in addition to the fact that the CDC has stated that the strain can be spread human-to-human instead of the (less scary) pig-to-human manner. As we recently noted with the breathless coverage of the spread of West Nile Virus, fear can quickly warp a realistic sense of the danger this virus poses. Cheeseburgers, beer, and cigarettes continue to be considerably more lethal for the moment. (Though that said, we maintain a healthy respect for influenza here at the Billy Rubin Blog. When available, get your vaccinations!)

Sarah Kliff, a health policy reporter at WaPo, writes about health legislation in California defining the phrase "essential health benefits" to make explicit to insurers what services must be covered for the new customers being delivered to them compliments of the Affordable Care Act, aka Obamacare. (We could just as easily call this "Romneycare", though the Republican Presidential nominee would deny this to the point of an epileptic fit, so desperate is he to prove his bonafides to various Brownshirt constituencies. Whatever. At any rate, while the law is Federal, the States become the arbiters of local coverage to be provided by insurance companies.)

What's beyond mere wonkishness in this post is that the legislation includes acupuncture in the "must cover" list, while leaving out infertility treatment as well as hair restoration. Also off the list (so far) is chiropractic, as well as "massage therapy". This is an early signal of the kinds of battles that may well be looming as we begin to make hard choices about how we will spend money on health care in the years to come. Well-organized special interest groups may come to define what kind of care gets reimbursed, regardless of whether or not there is scientific evidence to support claims for health benefit. For instance, "acupuncture" is covered--but for what indication? Is it just acupuncture in general? Psychologists doing talk therapy are currently hamstrung by much tighter regulations than that, having to provide a specific psychiatric diagnosis for each session, even if several of those sessions could be easily described as "normal people working through normal problems".

I don't hold a strong opinion about this right now--there is a sufficient amount of incredibly expensive procedures in "mainstream medicine" that have little data to support their practice (back surgeries, anyone?). I am, however, concerned about medical reimbursements driven more by advocacy groups than by a rational analysis of studies designed to discover whether a given treatment really does have a benefit. I have no beef with people who want to go to their weekly rolfing session; I do not feel particularly inclined to subsidize it through my annual insurance premium.

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