In this issue

Jonathan Tobin: Defending the Right to a Jewish State

Heather Hale: Compliment your kids without giving them big heads

Megan Shauri: 10 ways you are ruining your own happiness

Carolyn Bigda: 8 Best Dividend Stocks for 2015

Kiplinger's Personal Finance editors: 7 Things You Didn't Know About Paying Off Student Loans

Samantha Olson: The Crucial Mistake 55% Of Parents Are Making At Their Baby's Bedtime

Densie Well, Ph.D., R.D. Open your eyes to yellow vegetables

The Kosher Gourmet by Megan Gordon With its colorful cache of purples and oranges and reds, COLLARD GREEN SLAW is a marvelous mood booster --- not to mention just downright delish
April 18, 2014

Rabbi Yonason Goldson: Clarifying one of the greatest philosophical conundrums in theology

Caroline B. Glick: The disappearance of US will

Megan Wallgren: 10 things I've learned from my teenagers

Lizette Borreli: Green Tea Boosts Brain Power, May Help Treat Dementia

John Ericson: Trying hard to be 'positive' but never succeeding? Blame Your Brain

The Kosher Gourmet by Julie Rothman Almondy, flourless torta del re (Italian king's cake), has royal roots, is simple to make, . . . but devour it because it's simply delicious

April 14, 2014

Rabbi Dr Naftali Brawer: Passover frees us from the tyranny of time

Greg Crosby: Passing Over Religion

Eric Schulzke: First degree: How America really recovered from a murder epidemic

Georgia Lee: When love is not enough: Teaching your kids about the realities of adult relationships

Cameron Huddleston: Freebies for Your Lawn and Garden

Gordon Pape: How you can tell if your financial adviser is setting you up for potential ruin

Dana Dovey: Up to 500,000 people die each year from hepatitis C-related liver disease. New Treatment Has Over 90% Success Rate

Justin Caba: Eating Watermelon Can Help Control High Blood Pressure

The Kosher Gourmet by Joshua E. London and Lou Marmon Don't dare pass over these Pesach picks for Manischewitz!

April 11, 2014

Rabbi Hillel Goldberg: Silence is much more than golden

Caroline B. Glick: Forgetting freedom at Passover

Susan Swann: How to value a child for who he is, not just what he does

Cameron Huddleston: 7 Financial Tasks You Should Tackle Right Now

Sandra Block and Lisa Gerstner: How to Profit From Your Passion

Susan Scutti: A Simple Blood Test Might Soon Diagnose Cancer

Chris Weller: Have A Slow Metabolism? Let Science Speed It Up For You

The Kosher Gourmet by Diane Rossen Worthington Whitefish Terrine: A French take on gefilte fish

April 9, 2014

Jonathan Tobin: Why Did Kerry Lie About Israeli Blame?

Samuel G. Freedman: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Jessica Ivins: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Kim Giles: Asking for help is not weakness

Kathy Kristof and Barbara Hoch Marcus: 7 Great Growth Israeli Stocks

Matthew Mientka: How Beans, Peas, And Chickpeas Cleanse Bad Cholesterol and Lowers Risk of Heart Disease

Sabrina Bachai: 5 At-Home Treatments For Headaches

The Kosher Gourmet by Daniel Neman Have yourself a matzo ball: The secrets bubby never told you and recipes she could have never imagined

April 8, 2014

Lori Nawyn: At Your Wit's End and Back: Finding Peace

Susan B. Garland and Rachel L. Sheedy: Strategies Married Couples Can Use to Boost Benefits

David Muhlbaum: Smart Tax Deductions Non-Itemizers Can Claim

Jill Weisenberger, M.S., R.D.N., C.D.E : Before You Lose Your Mental Edge

Dana Dovey: Coffee Drinkers Rejoice! Your Cup Of Joe Can Prevent Death From Liver Disease

Chris Weller: Electric 'Thinking Cap' Puts Your Brain Power Into High Gear

The Kosher Gourmet by Marlene Parrish A gift of hazelnuts keeps giving --- for a variety of nutty recipes: Entree, side, soup, dessert

April 4, 2014

Rabbi David Gutterman: The Word for Nothing Means Everything

Charles Krauthammer: Kerry's folly, Chapter 3

Amy Peterson: A life of love: How to build lasting relationships with your children

John Ericson: Older Women: Save Your Heart, Prevent Stroke Don't Drink Diet

John Ericson: Why 50 million Americans will still have spring allergies after taking meds

Cameron Huddleston: Best and Worst Buys of April 2014

Stacy Rapacon: Great Mutual Funds for Young Investors

Sarah Boesveld: Teacher keeps promise to mail thousands of former students letters written by their past selves

The Kosher Gourmet by Sharon Thompson Anyone can make a salad, you say. But can they make a great salad? (SECRETS, TESTED TECHNIQUES + 4 RECIPES, INCLUDING DRESSINGS)

April 2, 2014

Paul Greenberg: Death and joy in the spring

Dan Barry: Should South Carolina Jews be forced to maintain this chimney built by Germans serving the Nazis?

Mayra Bitsko: Save me! An alien took over my child's personality

Frank Clayton: Get happy: 20 scientifically proven happiness activities

Susan Scutti: It's Genetic! Obesity and the 'Carb Breakdown' Gene

Lecia Bushak: Why Hand Sanitizer May Actually Harm Your Health

Stacy Rapacon: Great Funds You Can Own for $500 or Less

Cameron Huddleston: 7 Ways to Save on Home Decor

The Kosher Gourmet by Steve Petusevsky Exploring ingredients as edible-stuffed containers (TWO RECIPES + TIPS & TECHINQUES)

Jewish World Review August 24, 2007 / 10 Elul 5767

Medicare Visits Utopia — No errors allowed

By Drs. Michael A. Glueck & Robert J. Cihak

The Medicine Men
Printer Friendly Version
Email this article

http://www.JewishWorldReview.com | Psychiatrists have long recognized that rewarding desired behavior is far more effective than punishing undesired ones. Judging from a recent New York Times editorial ["Not Paying for Medical Errors," August 21], some editors, journalists and government bureaucrats have not accepted this axiom.

The editorial reports that "Medicare has announced that it will soon stop paying hospitals for the extra costs of treating certain patients whose illnesses are compounded by preventable errors" and goes on to claim this will promote better care and, if expanded, could reduce medical costs.

Without giving government reviewers any responsibility for medical outcomes, this approach gives them the authority to make medical judgments once the outcomes are known. The "perfect medicine or else" approach advocated impugns the competency and desire to provide quality care shared by the vast majority of health-care providers and illustrates an absence of in-depth consideration of unintended consequences.

Improved medical care at affordable cost is a proper goal, however we believe that emphasis on patient choice and responsibility, coupled with positive reinforcement of positive outcomes is the preferred method to accomplish this goal. Patients should be able to select their own doctors and, with their guidance and advice, select a course of treatment. Decisions jointly made by patient and doctor, and payment for proper services rendered, is the "old fashioned" doctor-patient relationship.

Under the system advocated in the NYT Editorial, the risk to the physician of being denied payment for services could force health-care professionals to refuse services for life saving, but difficult and dangerous procedures.

What about the specialist or super specialist who is asked to treat a complication on a patient that is not originally his own? Since all payments have been cut by Medicare why would he or she take such a case and face instant personal, professional, medical-legal and financial risk?

Emergency operations on the heart, brain and aorta almost always have some complications — many of which can be treated to save the patient's life. In reality doctors may be forced to order more tests intended as much for risk mitigation as for proper diagnoses. Such additional tests drive up costs rather than decrease them and often delay care.

All medical cases are not alike. Some are relatively routine while others are much more complex, yet current Medicare payment schedules do not differentiate between care provided by an experienced nationally renowned physician and that provided by a newly licensed physician. Care providers must be treated in a fashion that encourages them to expand their training and skills and address riskier cases without fear of financial penalties or legal punishment.

Adjusting payment schedules based on case complexity and physician expertise while limiting putative legal settlements would provide needed positive incentives. The system advocated in the NYT editorial provides no such incentives, but instead gives the authority to deny payment to anonymous government bureaucrats many of which do not have medical expertise. Reviewers are provided with the incentive to find as many errors, real or imagined, as possible.

We certainly agree that some medical errors are indeed preventable and health-care professionals and hospitals should be held responsible for reducing such errors.

Likewise, some chronic diseases are exacerbated by risky personal behaviors (i.e., "preventable errors" to use The NY Times term) such as drug, alcohol and tobacco abuse, obesity and lack of exercise. Does the NY Times suggest these patients take the medical financial responsibility for the outcomes of their preventable behavior errors? We believe it would be preferable to provide positive incentives, such as subsidized health care memberships, to encourage individuals to adopt healthier lifestyles.

Although the Medicare proposal may seem appropriate at first glance, the result will be an extremely slippery slope. This steep slope will further destroy the patient doctor relationship, cause physicians to step away from difficult and lifesaving procedures for fear of being punished, and force more physicians to opt out of the Medicare system. The most serious unintended consequence will be that more and more seniors will find themselves without their physicians.

Editor's Note: Michael Arnold Glueck, M.D., wrote this week's commentary and thanks Consultant Thomas Damiani who contributed to the column.

Every weekday JewishWorldReview.com publishes what many in in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here.

Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.


© 2007,