Med Reform | Gary Rubinstein’s Blog

2 Aug

Imagine a day when a group of politicians and philanthropists read in the newspaper that the United States does not have the highest life expectancy in the world. Not only that, we are actually ranked 38th in the world at 78.2, a full four and a half years below the number one country Japan. Outraged, they decide to ‘do something’ about this crisis. Despite knowing little about health and medicine, they become ‘medical reformers.’

They start a campaign educating the public about the problem. They say that we should not be content with people in this country living shorter lives than people in other countries. This is, after all, life and death.

Another report comes out and points out that we have in this country over 15% of all people (and over 22% of all children) live in poverty, and the life expectancy of poorer people is less than the life expectancy of richer people so our position on the life expectancy list is a bit misleading since the countries above us on the list have much lower percentages of poor people.

The med reformers say that anyone who uses this argument as an excuse is not valuing the lives of the poor. There is no reason why we can’t get the life expectancy of the poor up to the life expectancy of the rich, thus increasing our countries position on the life expectancy list to the top.

Every person has had ‘good’ doctors and ‘bad’ doctors. The med reformers say that research shows that doctors have the greatest in-hospital impact of any other component. They decide that to get the life expectancy up for the poor, and for the rich too, we need to identify who the best doctors are and reward them and identify the worst doctors and fire them. They develop a complicated formula where we measure the amount of years-added to a person’s life as a result of having one doctor or another.

When professional doctors complain that they are not miracle workers and are unable to overcome all the out of hospital experiences that can shorten someone’s life, the med reformers tell them to stop making excuses. The med reformers are convinced that doctors can overcome every out of hospital experience because they have seen the miraculous results of charter hospitals and their young doctors who trained for just five weeks, but have managed to accomplish an amazing amount of years-added.

Doctors who know that this is too good to be true start investigating the claims of these charter hospitals. They find that these hospitals are refusing to treat patients who require too much time and effort and can make them less able to keep up their years-added statistics. Other hospitals with miraculous results resort to other gimmicks to artificially boost their years-added scores. Some cryogenically freeze their patients just before they die. Some keep their dying patients alive on life-support systems. Some even redefine ‘year’ to mean just 200 days.

Despite all this evidence, med reformers insist that the results of the miracle hospitals are genuine. The President of the United States allys himself with a group called DFMR (Democrats For Medical Reform) and they encourage him to appoint as surgeon general a man who has never studied medicine. That surgeon general imposes a new program Race To The Top (of the life expectancy list) based on evaluating doctors by the years-added metric, firing doctors who score low, and shutting down hospitals that have low years-added scores.

As a result of these programs, ironically, the life expectancy in the U.S. actually goes down. Though about less than 1% of people (5% of hospitals are charter hospitals, but only 1 in 6 of them have better years-added than public hospitals) do live longer lives, artificially or not, the other 99% of people suffer as resources are poured into the charter hospitals and doctors at the public hospitals get fed up and leave the profession.

Eventually the public begins to realize that the original premise, that we ‘should’ be at the top of the life expectancy list was not the right goal. Getting to that goal by blaming and firing doctors and shutting down ‘failing’ hospitals is doomed to fail. Instead the reformers should not have been looking for a short cut. They should have deeply examined why our countries life expectancy was low and invested resources into preventative treatments, like pre-natal care for pregnant mothers, and dedicating more resources to the ‘poverty’ even though that is a scary problem to face.

via Med Reform | Gary Rubinstein’s Blog.


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