For patients with prostate cancer, it is a common surgical procedure: a doctor implants dozens of radioactive seeds to attack the disease. But when Dr. Gary D. Kao treated one patient at the veterans' hospital in Philadelphia, his aim was more than a little off.Not because hospitals are above covering up malpractice, or because doctors don't protect other doctors, but because any private hospital would have been terrified of getting sued. The VA is very hard to sue because of sovereign immunity.Most of the seeds, 40 in all, landed in the patient's healthy bladder, not the prostate.
It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear.
He simply rewrote his surgical plan to match the number of seeds in the prostate, investigators said.
The revision may have made Dr. Kao look better, but it did nothing for the patient, who had to undergo a second implant. It failed, too, resulting in an unintended dose to the rectum. Regulators knew nothing of this second mistake because no one reported it.
Two years later, in 2005, Dr. Kao rewrote another surgical plan after putting half the seeds in the wrong organ. Once again, regulators did not object.
Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years -- and then kept quiet about it, according to interviews with investigators, government officials and public records.
The team continued implants for a year even though the equipment that measured whether patients received the proper radiation dose was broken. The radiation safety committee at the Veterans Affairs hospital knew of this problem but took no action, records show.
« Fear of Failure | Main | Moving Towards Prosperity » Rogue Cancer Unit at the Veterans Administration22 Jun 2009 07:05 am
We often hear wonderful things about what the VA can do because it's not a private sector system. I suspect this is also one of the things that can only happen at the VA:
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You're conflating a hospital's poor maintenance and a doctor's hiding negligence with the VA's does well.
My son is a passenger in a pick-up truck that was in an accident two years ago. (They were forced off the road by a tractor trailer.) In the emergency room, I saw the driver of the pick-up, complain of knee pain repeatedly during the nearly 7 hours I was there with them. Yet he was discharged without even an x-ray on the knee. My son, who fractured a molar, was discharged without an x-ray of his jaw. Two weeks later, with it hurting more and more, the driver went to his primary-care doctor, had an x-ray, and soon after the first of two surgeries to repair the fracture on his knee. And my son was back at the hospital for an MRI of his jaw.
What's important here is that while the ER room spent virtually no time discussing his knee pain of jaw pain, they spent nearly all the time trying to figure out what the insurance would pay. They were so busy focusing on the payment system that they failed to focus on the patient.
The VA, thankfully, is spared that bit of silliness.
At least they didn't plant some radioactive seeds in his knee...
Yes. At least.
They didn't in my dad, either. A cancer-research hospital -- not a VA hospital -- just radiated the hell out of his abdomen when he got prostate cancer; destroying much of his organ function.
That's because Brachytherapy is a prostate cancer therapy.
Ken, given the time, I suspect my dad was part of a trail comparing treatments. But other trails had already settled this particular treatment issue for his diagnosis; or so my husband's colleagues at ECOG told me at the time.
If you want a public option, just say so and quit making stuff up.
ER docs could give a darn about the cost of examinations.
Not all patients injuries are obvious at presentation. That your son needed an MRI meant he didn't have a fracture, he had a soft tissue injury (probably to the TMJ) which would not show up on a regular xray, and would clinically present as a bruise or other self limited injury. As for the knee, same thing.
Public option means no option. 300 million people, all clamoring for the same thing...everything. When the lines start to form, don't surprised to be at the back.
As for the radiation to you dad's abdomen...that was to his pelvis. I assume you mean bowel function, but that's something that can happen with any radiation therapy to the abdomne.
That you misunderstand so much of the health care system and base your observations on anecdotal ignorance, is one reason people should be careful about what they ask for...in this case, government medicine. You might just get it.
I have been loud and vocal about wanting a public option on this blog.
And I mean my dad's abdomen; not just his pelvis.
I have a number of friends in Europe; they all like their systems, and most are fear having to seek out medical treatment here. Some are in the medical field, others are wealthy enough to buy any number of cadillac plans.
You've just been drinking the AMA kool-aid. Not good for your healthcare.
Why is it so hard for folks to believe that many, many Americans now get second-rate care because of their insurance, where they live, or incompetent or over-worked providers? I don't get it. It's kinda like boasting how GM and Chrysler make the best cars ever.
"Two weeks later, with it hurting more and more, the driver went to his primary-care doctor,"
Why would he wait 2 weeks to see his PCP? He'll sit for 7 hours untreated in the ER, but he won't make an appointment to see his doc the next day? Just doesn't have the ring of truth.
After a physical examination, cleaning wounds, removal of glass, x-ray of eyes to make sure there was no glass in them, etc., they said he was find, would be sore for several days, and sent him walking out the door.
What can I say? That's what happened.
Wait a minute, are you promoting the use of malpractice suits against private doctors when they screw up? Should we cap awards on these types of suits?
Just curious.
I think the point is about recourse. When a doctor messes up, there is recourse - it's difficult, but it exists. With the government, there is no recourse - and thus no reason for any "regulators" to regulate anything.
Can't wait for Obama care. Goody, goody! Just don't get sick.
No, you can sue the VA as well, it's just a LOT easier to sue a non-VA hospital or medical practice.
zic,
"spent nearly all the time trying to figure out what the insurance would pay."
Hum... that is highly unlikely. An ER doc has no fear of ordering anything he does however have a huge fear of a malpractice suit.
You explanation of what happened is frankly totally unbelievable.
I'm not saying it didn't happen like you say, but the reasons aren't what you claim.
So you say. I sat there for seven hours; just on the other side of a partition from the ER "office."
I know what they talked about, and it was insurance, not treatment.
Every ER I've been in is segmented where some people talk about payment while others talk about treatment. Generally they talk about insurance at the intake stations which are much more accessible to be overheard. They talk about treatment usually on the other side of a thick wall where you can't hear how the mayor's aide stuffed a squirrel where he shouldn't have and other sorts of medical reality that can ruin a patient's reputation for life. I suggest you might have been hearing just part of the conversation and assumed that the nurse doing specialized intake duty was the only medical professional on the case.
sigh.
I was sitting on the other side of the partition from where the doctor's and nurses treating my son were. They knew I was there. They knew I could hear, because I asked questions at several points.
sigh.
You guys sure are working hard to make a truthful tale into your fairy tale.
Should I go get my husband, my son, his friend and his friend's parents to vouch for my story? They were all witnesses. And I've got nothing to gain by making this up. (That the hospital paid for the friend's surgeries should be a pretty good indication of how they screwed up, too.)
Sorry Zic you're not being truthful.
719.46 is the code for knee pain. No insurance company in the world is going to deny a claim for an x-ray after a car accident with that code.
So, I'd have to say you're just making s*it up.
They never even discussed an x-ray, jmo3.
And the hospital paid for the knee surgeries.
I'm not making anything up, you just don't believe me. But then I've never seen commentary from you that indicates you have any understanding of what most people who don't have six-digit incomes experience in this country. If it's here, I must have missed the post.
"I'm not making anything up,"
I don't think you're making things up I just think you misunderstood what you heard. The idea that an ER doc is going to spend any time "trying to figure out what the insurance would pay" is patently ridiculous.
Would they have been talking about proper coding and making sure everything was documented correctly? That they would be talking about. There are any number of things they need to ensure are in order, they need to document that you were seen and treated, what the chief complain was, the correct ICD-9 code, were you referred to your PCP, is all the coding correct for the reports to the state. Is all the documentation in order in case their is a lawsuit - as there most likely would be in an auto accident.
We they "trying to figure out what the insurance would pay" I really can't see that happening.
jmo3, of course they discussed proper coding. They discussed treatments, too.
My mom and sister have worked in hospitals since I was a child; my sister is a critical-care RN and my mom's a histologist. I worked for one summer in her lab, cleaning the morgue among other things. I know what the lingo sounds like.
And the bulk of the ER staff's time that day two years ago time was spent discussing what insurance would pay for various patients; they were very distracted from caring for their patients because of those payment concerns.
But perhaps it's the difference in location; I live in a poor rural area where most have people junk insurance unless they work for a town, a school, or the hospital itself.
I think what this reflects is that doctors and the hospitals where they have privileges do a bad job of policing incompetent doctors: faced with a choice between scrupulous examinations of their own faults on the one hand, and covering up doctors' mistakes on the other, many hospitals opt for cover up for all the obvious reasons. Some hospitals have tried to turn this around, but it's a pervasive problem.
With respect to the contention that this wouldn't happen outside the VA because of fear of liability, from which VA hospitals are purportedly protected:
1) This is not my area, but it seems to me that VA hospitals get sued all the time. If you Google for this you will find all kinds of lawyers offering to take such cases -- indeed, the page MMcA links to above is a law firm web site.
2) Assuming arguendo that non-VA hospitals are relatively more exposed to med mal liability, I'm not sure it follows that they do a better job ex post uncovering negligence by medical professionals. If anything, they have more incentive to cover up.
And the bulk of the ER staff's time that day two years ago time was spent discussing what insurance would pay for various patients; they were very distracted from caring for their patients because of those payment concerns.
Why would they have payment concerns? Getting paid is the job of the Billing and Abstracting departments not the ED docs. As long as everything is coded properly (and is medically necessary) the insurance has no choice but to pay.
Is it possible the staff didn't know what is and is not medically necessary in various circumstances? Yes, but that indicates that don't really know that they are doing.
Zic: even accepting your premise that the hospitals are very different for people in poor rural areas, who don't have six-digit incomes et.al. -- at least there is an option of moving out of the rural area and getting a six-digit income. Not a universally available option, but it's there. What would be the option for improving your health care if the government is the universal payer/provider/overseer/what have you?
sigh. pull yourself up by your bootstraps, ehh?
I already knocked that off my to-do list.
WHO's health-care system rankings. US is #37. France is #1.
WHO had a conclusion then found numbers to support that conclusion.
"People don’t purchase health care to improve aggregate outcomes; they purchase it for their personal benefit. WHO factors overall life expectancy instead of disease-specific outcomes. The closest it comes to looking at actual outcomes of what we normally think of as health care services is in its measure of responsiveness, where the U.S. ranked no. 1."
zic,
In that ranking we are #1 in actual medical care (they call responsiveness) and tied for 3rd in distribution of that responsiveness.
What hurts our numbers things that are either exogenous, only partially related or otherwise unrelated. See life expectancy, health expenditure per dollar and fairness of financial contributions. So a ranking that rewards single payer systems ranks them higher.
This also doesn't account for a number of relevant factors and is structured in a way that actual health care incidents are swamped by non-health care factors.
Zic: so, your answer is "nothing"? Take what the govt will give you?
I wonder if those heat-wave deaths figured into France's #1 rating...
My answer is that the for-profit insurance markets have failed people who need health care; and in the process, driven up the costs.
I see countries with national systems doing much better at providing a basic level of health care to people. In this country, you only get that if you've got cadillac coverage or your on the medicaid/medicare roles.
I worked in a state office as a data-base administrator, and know something of the federal/state payment systems; and I and most of my neighbors would be better off with a system like that then with the shit insurance we're offered by Anthem.
I don't particularly care if you can't get your cadillac care without paying extra. I want too many of the people being screwed for profit to get good care. I want doctors to focus on care and not insurance. And I'm not going to change my mind because of worn-out points Ronald Reagan pitched for the AMA when I was a kid.
I want a public option; and I am actively lobbying for one with my senators Collins and snowe.
And I have moved to the US from a country with national healthcare system. I'll be damned if all the twittering lefties can make a dent in the conclusions I made from seeing the reality with my own eyes.
Max, maybe universal healthcare sucked in your country and that is reflected in your country statistics. Could that be the case? What country is that?
I spent one year as a frequent flyer at Georgetown University Hospital's ER room (kids getting sick, having accidents, helping a diabetic friend), and they put only the most cursory effort into getting contact info. It was a complete afterthought.
In addition, the care was top-knotch and very compassionate. There was some waiting around, naturally, but it was the best medical care I have ever seen to this day. I totally understand why some people use ER rooms as their primary care--these people are really the best. Oh yeah--and they saved my friend's life and then the hospital eventually forgave much of her medical expenses after we filled out some forms.
Zic, I believe that that hospital was every bit as bad as you say it was. However, it's your job to stand up for yourself and your family in medical situations and not let go until they get proper care.
Of course, under Obama's plan, and every health care plan in Congress right now, doctors won't be working for the government and won't have protection of sovereign immunity.
But still, I'm sure those tort-reform conservatives will argue that we shouldn't have universal health care because government doctors can't be sued. Why not? They've been hypocritical on everything else for the past 10+ years.
If you read the NYTimes story, you learn the doc was a highly credentialed physician/PhD and part of a group on contract from UPenn. You would have thought that UPenn's peer review/quality control would have some impact.
The point is that they hired him on contract at the VA hospital -- outside of his normal working group at UPenn. Among other things, I think this is a good example of why contracting things out isn't always the right solution. Sometimes you need to have the in-house expertise yourself.
@alkali: I think what this reflects is that doctors and the hospitals where they have privileges do a bad job of policing incompetent doctors: faced with a choice between scrupulous examinations of their own faults on the one hand, and covering up doctors' mistakes on the other, many hospitals opt for cover up for all the obvious reasons.
Well, the reality is more complicated. The majority of physicians who practice at a hosptial don't work for the hospital and may practice at several hospitals so the traditional employer/employee relationship doens't apply. Even hospital-based services like ER, radiology, pathology, and anesthesia services are often contracted out to a physician group or company that specializes in that field. The nurses may work for the hospital or the physician group.
My spouse is a physician (anesthesia) and has seen her share of surgeons that she would never refer someone to. However, she dares not make a negative comment about them (or her colleagues in anesthesia) for a number of reasons.
1 - She can be sued for libel. Since she isn't a surgeon, she would be attacked for talking about a specialty she is not competent to discuss, since she's not board certified in it.
2 - She can be sued for anti-trust violations and restraint of trade, as her remarks could be seen as attempting to interfere in the business of other physicians.
3 - She could have private investigators tailing her, snooping around our private life. (Happened to my dad when he chaired a discipline panel for a medical society, back when medical societies had some power over doctors. They don't anymore. The AMA, et.al. have no power over individual doctors and their practices.)
4 - She could get accused of being motiviated by racial or religious bigotry. (Happened to my dad. Fortunately, a close friend was board president of his synagogue and wrote a letter to the ADL.)
All of these have occured to physicians that spoke out about colleagues. There are some places where you can make comments without being liable. When you apply for admitting/treatment rights at a hospital (to be "on staff"), you waive the right to see or hear the comments made by your peers that are asked for references. There are sometimes some peer review activities that are also protected, but only in narrow cases.
Now since getting thrown off staff at a hospital can have major impacts on a physician's income, it's not done lightly and without major due process. Since lawyers are involved, it's gonna be expensive and time-consuming. It's not uncommon for it to take years for a state to take away the license of a bad physician due to all the appeals and court challenges.
Oh, and VA physicians are usually civil servants.
I endorse entirely ech's qualification to my comment, and would point out that the state case law reporters are filled with doctor-on-doctor and doctor-on-hospital litigation of the type ech describes.
My answer is that the for-profit insurance markets have failed people who need health care; and in the process, driven up the costs...I'm not going to change my mind because of worn-out points Ronald Reagan pitched for the AMA when I was a kid
Would you change your mind if a study by a trusted organization--say, I don't know, the WHO--showed that you're wrong, and that in fact, people who need health care in the US get it, and that the care they get is very good?
Because that's what the study you cited appears to show.
No.
I'd like to take the yoke of health insurance off business, and would prefer a single-payer system as they have in Canada or the UK.
But I'd compromise for a public option.
So regardless of what the study YOU cited shows, you know what you want and you know it is the right course of action... you're not an advocate, you're an evangelist for your faith. You haven't been reasoned into this position, so you can't be reasoned out. You should be more upfront about that point.
No, I just see too many people getting "the best medical care in the world" and it sucks. I see too many small business either unable to offer health care or unable to succeed because they do offer it. I see too many doctors who spend their time filling out forms instead of treating patients. (I wish mine would spend as much time with me as he spent convincing my insurance company to approve testing he thought I needed.) And I see too much profit being squeezed out of all those failures.
And having spent a number of years helping write/maintain the software to process medicaid/medicare systems, I simply don't have the fear of a public system that's been brainwashed into most people by the powers that pay for persuasion. I've also had a mom and sister in the field, many close friends in the field -- ranging from primary care physicians and research doctors to alternative and counter-culture healers, and a spouse who worked for one of the best clinical-trial organizations in the country.
We can do much better for millions of people we're now failing.
Just because some people may get the best medical care in this country does not mean that our health-care system is the best.
In the single payer system in the UK, that patient would not have received any treatment for his prostate cancer. That might have worked out better for him, but for most patients that is not a good thing.
The 5 year survival rate for prostate cancer is 44% in the UK but 82% in the US (Lancet Oncology, 2007). Maybe this patient didn't see the benefit, but I would much rather take the odds in the US than in the UK.
I and most of my neighbors would be better off with a system like that then with the shit insurance we're offered by Anthem.
Hum... is the thing.
"Two weeks later, with it hurting more and more, the driver went to his primary-care doctor, had an x-ray, and soon after the first of two surgeries to repair the fracture on his knee. And my son was back at the hospital for an MRI of his jaw."
You want an MRI right there while you wait. If it certainly possible that 80% of the people complaining of knee pain after an accident - who are not obviously injured - will get better on their own. If it still hurts in a few days go to your PCP and they'll send you for an x-ray or MRI.
That's what is required to get the costs of healthcare down. But, do that, and people like you will scream about their "shit insurance".
This is indeed a horrifying story, but the notion that the VA is appreciably harder to sue than a private provider is really not true. Unlike some of the times when I pop off, I actually know what I'm talking about; I was an Asst. U.S. Attorney handling civil matters (including med-mal claims against the VA) for five years. Under the Federal Tort Claims Act, the only significant differences between a suit against a VA provider (or other federal provider, like a military hospital) and a private provider are (a) you have to file an administrative claim first, and then possibly have to wait six months before you can sue, and (b) you don't get a jury.
If we're trying to think through why this sort of thing could happen at the VA and not (we hope) elsewhere, we gots to keep on thinking.
I knew you could sue under the Federal Tort Claims Act, for any tort recognized in the State in which the wrongful act took pace, and I ain't even one of them fancy lawyer-folk. I just wrote a kinda mediocre undergraduate-level paper on the subject, some years ago.
So how could this happen? Maybe part of the answer is the insurance market. The federal government does not have to submit its practices and procedures to a private insurer, which would be on the hook for a mega-millions settlement or verdict.
But many on this thread have thought more about this question than me.
My father used to work at the VA and he said that the joke there was that the only way to get fired was to kill two patients in one day. Two in two days was ok, five in a week was ok, but two in one day was where they drew the line. Don't know if there's any real truth to that, but he never said that about any other hospital (and he's worked in a ton).
It's not the 'sued' part except possibly in a metaphorical sense. After all from the standpoint of that VA hospital budget it probably doesn't matter if the US government pays for suits against them or F-22 parts. The difference with which this and your previous post might be compared and contrasted are, in a sense, the difference in feedback loops in dealing with the federal government and a local business.
Sorry not 'previous post' referred to in my comment above but the other topic: zic's son and the knee and molar or jaw injuries. Federal law should already more than cover this and I would suggest you, zic, talk to Senator Snowe about why EMTALA, the 'Emergency Meical Transfer Act,' is not being enforced in Maine; you might also talk to the state hospital board.
EMTALA arises out of a case where a pregnant uninsured lady went to an ER in labor. Due to the financial situation she was transferred and the baby or mother died as an arguable result. EMTALA specifies that if a hospital treats a condition and has an ER that any patient presenting unstable with that condition, such as in labor, must be treated to the point of stability before they are discharged. Thus it is standard practice in ER's to (my bad) 'shoot the X-ray's first and worry about payment later.' The hospital can be shut down and or fined. It's like saving on your taxes by not reporting obvious income; not prudent.
Most people who hold the VA up as an example of medical excellence 1) haven't worked there, and 2) have an agenda. I'm not saying they're wrong, but I've yet to see much credible evidence put forward that the VA is this magical system that we all should copy.
On the other hand, as someone in the military (and who thus knows lots of retirees) and whose Uncle was a doctor at the VA, I've heard a fair share of very scary anecdotal evidence that the care at the VA is routinely sub-par.
I'd suggest that care in general is routinely sub-par, with the exception of teaching hospitals. I don't think the VA has any monopoly here.
The portion of the VA system that people think we should copy is the negotiation portion. They have the right to negotiate prices.
I have worked in hospitals in the US, Canada and the UK. The health care professionals in all three are dedicated, compassionate, and knowledgeable. However, the equipment in the UK is often antiquated, and many of the facilities are in poor condition (with very poor infection control). In Canada, the facilities and equipment are more modern, but there just isn't enough of the equipment! In both places, the staff are more stressed and overworked than in the US.
In the US, the problem is not so much access to care as it is access to affordable health insurance coverage. The care in most US hospitals is excellent, not sub-par - whether in a teaching hospital or in a community hospital.
The universal health systems will make quality of care equal; the problem is that it won't be done by elevating the level of care to a high standard, but will be done by bringing down the care to the lowest common denominator.
"sub-par, with the exception of teaching hospitals"
The VA hospital that messed up the prostate cancer treatments is a teaching hospital for the University of Pennsylvania, at least according to the Philadelphia Enquirer. http://www.philly.com/philly/news/homepage/48757382.html
No.
So...you're saying that you won't change your mind in the face of contrary evidence?
What can I say to that?
Rob, it's not contrary evidence. It's that I'd opt for a better system for more people instead of access to the best for myself.
That's why we're #37. We fail to deliver for too many.
But libetarians are not known for making personal choices based on the greater good, it seems. It often seems like selfishness to me. And my social conscience seems like "spreading the wealth around" to you, I'm sure.
I have the kind of insurance you say you like -- catastrophic illness coverage. It's never paid a single penny for my family's health care. Yet it's also denied recommended treatments and tests; we've had to fight to get things done EVEN THOUGH THEY WON'T BE PAYING FOR IT. And we pay more than $7,000 a year for this.
So who's wealth is being spread around? And who's health care is being rationed?
Yet if you own a small business or are self-employed (high-paid lawyers excepted), this kind of insurance is likely to be the only option that doesn't push you toward foreclosure/bankruptcy.
But the crux of the matter is that we've got different problems to deal with that are often lumped into a single problem -- access to care, quality of care, payment for care, and research and development. Megan posted about one instance of the VA providing poor care and conflated it to mean the VA system doesn't have anything to offer in improving the overall system.
And that's just wrong. You know it, too.
That's simply not true. The WHO report ranks us #1 in care and #3 in distribution of care. We're lower in total cost, life expectancy and distribution of cost. None of those things is symptomatic of lower overall care. As I said above, you are a zealot approaching this on faith in the face of disconfirming evidence - hell, you even cite disconfirming evidence.
I've worked for small companies and have seen different approaches to health care. You can afford decent coverage (we offer 0 deductible, low deductible and high deductible HSA plans) and the price points are all under 12k a year for a family of 4. All of it is paid by our employees though. It's a better, transparent system and doesn't force us into any financial difficulties.
But like I said before, you're not arguing this from reason, you're arguing this on faith: that a single payer system would provide overall greater utility regardless of the details. You're talking about overhauling the entire medical establishment in order to extend coverage by something like 5%.
I'm all for a public option that ISN'T subsidized by other revenues - but we all know that isn't what a public option is. A public option will be subsidized, invite companies (like yours and Wal-Mart) to stop offering insurance (pocket some of it, give you some) and tell you to use the public option. This road will lead right where you want it: bureaucrats forcing doctors to spend their time filling out forms instead of treating patients and convincing your public insurance company to approve testing he thought I needed. Or simply accepting the government mandated ban on test in that case and thus keeping costs down.
You keep talking about how you want more medical services, more tests, quicker and without oversight and then assert that this will magically keep costs down?
Negotiate prices...I like that.
Of course, you don't mean what I mean. Your negotiated price means as cheap as you want, and I, the provider, have no say in the matter.
Single payer is statist health care. But, tell you what. Leave me and others like me an option to opt out, and in return for not using your government monopoly health care system, you can't use our free market system.
Even Medicare would crumble if private health care were removed from the equation...I also believe Congress will opt out of any system them make the rest of us take.
I used to work for the VA, so let me provide some insights.
One thing that should be imitated is the electronic medical record. I could pull every prescription, lab result, X-ray, and office note from any VA. This is of immeasurable use to providing good quality care, and keeping down costs. Another thing of note, is while the VA can be sued, VA doctors, on the whole cannot. The Federal Government is responsible for any malpractice by its employees. It appears that Dr. Kao may have been a contractor and not a VA employee like most VA docs. But the VA would also serve as an experiment if the lack of malpractice worries eliminates defensive medicine. In addition, while you can sue the VA, note that the law limits attorney's fees to 20-25% versus the 40-45% that personal injury lawyers can get, and also note that the lawyers are suing the Federal Government, and also do not have to worry about a sympathetic jury as the case will be tried in Federal Court in front of a judge, which as noted above have lawyers who are already on the payroll defending it, have the power of taxation to pay out claims, and so have much less incentive to settle quickly. All this reduces the incentive to sue.
Zic -
"That the hospital paid for the friend's surgeries should be a pretty good indication of how they screwed up, too."
Then what is the point of your story? The hospital's decision on testing obviously wasn't motivated by profit, since their choice led to them having to pay for your friend's operation later. So, this was a plain old fashioned screw-up. Are you honestly telling me that putting our medical care in the hands of a government monopoly will make mistakes less likely? Aren't you deterred at all by the massive volumes of evidence that government monopolies generally aren't very efficient or accurate?
"I want too many of the people being screwed for profit to get good care."
In other words, you have this fixed ideological idea that anything done "for profit" is bad, while having things done by government bureaucrats with no incentive whatsoever to accomplish anything somehow means that people try harder precisely because they don't care. In your example in the emergency room, assuming that it's as you've told it, the hospital lost money by not doing the right tests (because it had to pay for the later surgery), and thus, if the hospital is profit-motivated, it will learn to do the appropriate tests next time regardless of insurance coverage, because the hospital will be liable for failing to do the right tests. But in the world you prefer, emergency rooms won't have to worry about what happens later, because that will be a different department and they're all just on fixed pay anyway, with civil service protections, so who cares? There may even be budgetary incentives not to do tests, since later damage costs may be born by a different department, whereas the testing would be in your department's budget. Or are you assuming that we'll keep down costs by not having budgets or keeping score at all?
"But libetarians are not known for making personal choices based on the greater good, it seems. It often seems like selfishness to me. And my social conscience seems like "spreading the wealth around" to you, I'm sure."
You're saying that anyone who questions the effectiveness of government monopolies simply has no "social conscience"? Nice try in terms of stacking the deck, but you're the one arguing for a system that would hurt vast numbers of people, including those at the bottom that you say you care about. You've told nice anecdotes about how you've seen that our system just isn't working, but even if you indeed had evidence that our system now isn't sufficient, that doesn't mean that eliminating profit and competition will make things better.
You need more than just insults and claims of moral superiority. How about spelling out the logic behind your preferred system? What discipline and incentives would there be if all medical personnel were government-paid civil servants? Have you compared, for instance, wait times for various operations between the US and the countries you want us to copy? Wasn't it Australia a few years ago that solved the problem of long wait times by simply taking people off lists when they had been on too long, forcing them to reapply and go to the end of the line? How long do people wait for a hip replacement in the UK, and how many of them die while waiting when they might have had several more years of life if they'd gotten timely care?
But never mind, I forgot that you have "a number of friends in Europe" that all like their care. So I guess you're not just relying on anecdotes after all. And that WHO study says just what you want it to say, as long as you cherry-pick only the irrelevant measures and ignore the relevant ones.