What we have to look forward to as health care gets more nationalized and more bureaucratized:
A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.
But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.
Read the whole thing.
A comment: The problem is, in part, a bureaucracy can only monitor a large system if the parts are standardized. It can only do that by taking discretion away from doctors. That’s where we’ve been headed for quite some time. Health regulations helped to push the US toward HMOs, and now are pushing us toward government-paid health care. Perhaps the multi-culturalists will say such standardization and bureaucratization happens in the US because American culture tends to work that way. Whatever the reason, I find it terribly unlikely that this trend will not continue, unless we start to re-empower patients. The only effective way to do that, however, is to give them more say over how their health care money is spent. That’s not the direction we’re going.
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