Wednesday, December 29, 2004

A few more things to give you that warm holiday feeling

Okay, my cockles have cooled some, so let's see what we have.

- From the New York Times for December 24:
Some federal doctors and medical researchers do not enjoy the same protections to blow the whistle on wrongdoing as other government employees, an administrative law judge has ruled.

The Nov. 9 decision, by Judge Raphael Ben-Ami of the United States Merit Systems Protection Board, held that Dr. Jonathan Fishbein, a specialist for the National Institutes of Health, could not invoke the Whistleblower Protection Act to keep from being fired. ...

Judge Ben-Ami ruled that Dr. Fishbein was not covered by the law, because he was a so-called Title 42 employee and therefore enjoyed "no appeal rights" during his probationary period.
Title 42 employees are consultants hired outside the civil service system in order to pay them salaries that compete with the private sector.

Fishbein was one of several employees of NIH who raised concerns about a study in Africa involving the AIDS drug nevirapine, one which was sloppily done and violated federal patient safety rules. Nonetheless, use of the drug in Africa was approved. And Fishbein wasn't.

The decision strips whistleblower protection from the 3,900 Title 42 employees now working for NIH.

- From the Kansas City Star for December 25:
Muslims planned to turn an old sod farm near Memphis into a cemetery, but angry neighbors protested, complaining the burial ground could become a staging ground for terrorists or spread disease from unembalmed bodies.

It was not the first time a group faced opposition when trying to build a cemetery or a mosque, but the dispute stood out for the clarity of its anti-Muslim rhetoric.

"We know for a fact that Muslim mosques have been used as terrorist hideouts and centers for terrorist activities," farmer John Wilson told members of a planning commission last month. ...

Opponents told the Fayette County planning commission in November that power lines would be prime targets for terrorists in the region about 20 miles east of Memphis.

"Ladies and gentlemen, you may think this is farfetched, but that is what the Jewish people thought when the Nazis started taking a small foothold, a little at a time, in their community," Wilson said. ...

One woman yelled, "We don't need bin Laden's cousins in our neighborhood."
The article also mentions that similar opposition to plans by Muslim groups have arisen elsewhere, including Voorhees, NJ, and Atlanta. Must be some of that fabled Christian forbearance we're always hearing about.

- From the Baltimore Sun for December 25:
As legislators in Maryland and other states try to curb skyrocketing medical liability costs, President Bush and Republicans in Congress are renewing their push for a sweeping national measure that would strictly limit payouts to patients in malpractice cases.

The state and federal efforts are fueled by Bush's strong support and by a well-funded lobbying effort from insurers and physicians designed to convince Americans that a malpractice crisis is driving up the cost of health care and threatening to cut off patients' access to their doctors.
"Designed to convince" is the key phrase. I'm sure this will get (and deserve) more attention in the near future, but for the moment just consider that according to a Congressional Budget Office report from last January (available here in .pdf format), malpractice costs are just 2% of overall health care spending. So even cutting such costs dramatically - by even say, 50% - would reduce health care costs by no more than 1%.

So what's at stake? Not protecting patients, not protecting access to health care. But protecting first doctors who refuse to effectively police their own profession to get rid of the relative handful of incompetents whose blunders drive higher insurance rates and second the insurance companies who intend to maintain their profit and they don't care at whose expense. Doubt it? Check this out:
Medical liability reform "doesn't tend to rate as high as the economy or affordable health care, but it's very, very easy to connect medical malpractice and the need for legal reform in a broader sense to those issues, and people get it; people make the connection," said Lori Weigel, a partner at the polling firm [Public Opinion Strategies, a Virginia-based outfit hired by the Republican Governors Association].

"It's not very difficult at all to move this issue up on voters' agenda," Weigel said.
Note well: She's not saying the argument is accurate or even relevant. Rather, she's bragging about how easy it is to manipulate people into thinking that limiting their own access to legal redress is for their own good.

Nearly 30 years ago, in response to an earlier supposed malpractice "crisis," this one in New Jersey, I proposed having the state become an issuer of malpractice insurance, which it could do on a non-profit basis and very likely at far lower administrative costs (based on the federal experience with Medicare and Medicaid). I still think that how one views that or a similar proposal is a good indicator of if the concern is for patient protection or profit protection.

Footnote: The next time someone tries to lay something on you about "the powerful trial lawyers' lobby," another right-wing shibboleth, let them know that according to data compiled by PoliticalMoneyLine, which monitors money spent on lobbying, since 2002 the American Medical Association has spent more than four times as much lobbying Congress as the American Trial Lawyers Association has ($41 million to $10.2 million).

Another footnote: An interesting and as far as this non-expert can tell, reasonably balanced consideration is found in this article, which appeared in the January 21, 2004 issue of Health Affairs.

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