We tackle issues that matter to doctors

Ep. 83 The Faulty Economics of Health Insurance: Arrow Revisited (Pt. 2)

Robert P. Murphy, PhD

It is commonly believed that healthcare is a sector plagued by “market failure.” A heavy dose of government intervention is therefore necessary to optimize the needs of society. A paper most commonly cited in support of that view is one published in 1963 by Nobel Prize winner Kenneth Arrow, one of the giants of economic theory in the 20th century, and titled “Uncertainty and the Welfare Economics of Medical Care.”

But how does economic theory arrive at the concept of market failure and how do economists conceive of health care when they apply their theoretical models to medical practice?

To help sort this out, we have as our guest Robert P. Murphy, economist, teacher, and author of many books.  Dr. Murphy obtained his PhD from NYU and is Senior Fellow at the Mises Institute.  He is co-host, with Tom Woods, of the popular podcast Contra Krugman and he is also host of The Bob Murphy Show, “a podcast promoting free markets, free minds, and grateful souls.”

The episode in in 2 parts.  In the first part, we reviewed the theoretical framework that forms the background to Arrow’s paper.  In this second part, we delve into the paper itself, discuss how economists conceive (or misconceive) of medical care, and what the implications have been for the US healthcare system as a whole.

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Ep. 82 The Economics of Healthcare: Market Failure or Faulty Models? (Part 1)

Robert P. Murphy, PhD

It is commonly believed that healthcare is a sector plagued by “market failure.” A heavy dose of government intervention is therefore necessary to optimize the needs of society. A paper most commonly cited in support of that view is one published in 1963 by Nobel Prize winner Kenneth Arrow, one of the giants of economic theory in the 20th century, and titled “Uncertainty and the Welfare Economics of Medical Care.”

But how does economic theory arrive at the concept of market failure and how do economists conceive of health care when they apply their theoretical models to medical practice?

To help sort this out, we have as our guest Robert P. Murphy, economist, teacher, and author of many books.  Dr. Murphy obtained his PhD from NYU and is Senior Fellow at the Mises Institute.  He is co-host, with Tom Woods, of the popular podcast Contra Krugman and he is also host of The Bob Murphy Show, “a podcast promoting free markets, free minds, and grateful souls.”

The episode in in 2 parts.  In this first part, we review the theoretical framework that forms the background to Arrow’s paper.  In the upcoming second part, we will delve into the paper itself, discuss how economists conceive (or misconceive) of medical care and what the implications have been for the US healthcare system as a whole.

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Ep. 81 The Opioid Epidemic: Is Pharma To Blame?

J.J. Rich

The Commonwealth of Massachusetts’ lawsuit against Purdue Pharmaceuticals exemplifies a common narrative that lays a large part of the blame for the opioid epidemic at the feet of the manufacturer of prescription opioids for manipulating physicians into prescribing the drugs more liberally.  Is there merit to that story?

To examine that question, we have as our guest Jacob James Rich, a policy analyst at Reason Foundation.  Mr. Rich holds master’s degrees in economics and mathematics from Eastern Michigan University.  Prior to joining Reason, he conducted research for the Cato Institute focused on opioids and the drug war.

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Ep. 80 How To Rollback Bad Health Care Laws

Marcelo Hochman, MD

Is the healthcare mess so hopeless that physicians should either leave it or wait for it to collapse?  Are there legislative steps that doctors can take to tangibly improve the practice of medicine?  And, if so, how should physicians act within the problematic framework of “organized medicine” to bring about such changes?

Our guest is Dr. Marcelo Hochman, who is sharing with us some hopeful successes in introducing important legislation by working in conjunction with his local and state medical societies.   The 3 issues he has focused on are 1) a repeal of certificate-of-need laws, 2) a ruling against “non-compete clauses” in physician contracts, and 3) a tax deduction for charitable work provided by physicians.  All 3 issues appeal to the notion that expanding the settings in which physicians can be free to practice will benefit both doctors and society.

Dr. Hochman is an independent solo pediatric facial plastic surgeon who practices in Charleston, South Carolina.  He has specialized in the treatment of congenital vascular anomalies.  He is a recipient of the Order of the Palmetto, South Carolina’s highest civilian award, and of other national and local professional and community honors. He currently serves as the President of the Charleston County Medical Society, as Chair of the Coalition to Repeal  CON (Certificate of Need),  and as Director of The Hemangioma Treatment Foundation.

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Ep. 79 Can 12th-Century Medicine Save 21st-Century Health Care?

Victoria Sweet, MD

Is the body a machine?  Are doctors mere technicians who simply “fix” biological defects in their patients?  In a very real sense, that’s how modern societies conceive of medical practice, so much so that healthcare is now frequently experienced as an industrial process: doctors and nurses churning patients through an assembly line.  And that process is taking a huge economic, physical, and mental toll on everyone.

The mechanical model on which modern medicine is based has obviously brought technological wonders to the practice of medicine—and it should be celebrated for these extraordinary achievements.  But have we become so wedded to the machine metaphor that we ignore more fundamental aspects of human reality?  Can another way of conceiving of health and life be brought to bear on the practice of medicine positively, without discarding the achievements of the scientific age?

Our guest is Dr. Victoria Sweet, author of the best-sellers God’s Hotel and Slow Medicine, two of the most important books on medicine in recent times.  Those books were inspired by Dr. Sweet’s rediscovery of the medical texts of Hildegard of Bingen, a 12th-century mystic and nun whose practical approach to medicine may well contain the very principles that can help cure 21st-century health care from its seemingly irremediable predicament.

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Ep. 78 In the Footsteps of Donabedian: The US News and World Report Hospital Ranking System

Ben Harder

Quality ratings of hospitals and physicians: help or hindrance?  Surely, the general public demands and is entitled to an assessment of hospital quality based on sound methodology.  And ratings coming from the private sector are far more likely to be unbiased and to adjust to an ever changing healthcare landscape than those coming from the government and public policy sector.  But is there a downside to scrutinizing the healthcare enterprise?

We have a fascinating conversation with one of the most knowledgeable persons on the topic.  Ben Harder is Chief of Health Analysis and US News and World Report and oversees the team of analysts and statisticians who produce the most recognized ranking of hospitals in the country.  Ben holds a Bachelor of Science in Biological Anthropology from Harvard University and began his career in health and science journalism before taking the job of quality czar at US News and World Report and

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Ep. 77 A Debate on Vaccine Mandates

Dorit Reiss, PhD

Two distinguished guests join us to debate the issue of vaccine mandates.

Dorit Reiss is Professor of Law at UC Hastings College of the Law in San Francisco, California.  She holds an undergraduate degree in Law and Political Science from the Faculty of Law at Hebrew University in Jerusalem and a  PhD in Jurisprudence and Social Policy from the University of California, Berkeley.  She is a legal authority on the question of vaccines and vaccine mandates.  She has published numerous articles on this topic in a variety of law review journals and her expertise is recognized around the world.

Jonathan Howard, MD

Jonathan Howard is Assistant Professor in the Departments of Neurology and Psychiatry at New York University Langone.  He is Director of the Neurology Service at Bellevue Hospital and Director of Clerkship Director for the Clinical Neurological Sciences at NYU.

Dorit and Jonathan have co-authored a book chapter entitled “The Anti-Vaccine Movement: A Litany of Fallacy and Errors,” in Pseudoscience: A Conspiracy Against Science.

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Ep. 75 Bridging Health and Community with Pritpal Tamber

Pritpal S. Tamber, MBChB

If ‘health’ is an elusive concept, how much harder it must be to articulate what a healthy community should be.  But that should not stop us from grappling with foundational ideas and from sketching a forward-looking vision for a better society.  Our guest on this episode is Pritpal Tamber, a physician who has devoted his career to understanding better what it means to live in a healthy community.

Dr Tamber is the former Physician Editor of TEDMED, TED’s dedicated health event, a former editor at the British Medical Journal, and the former Medical Director of Map of Medicine, a company that tried to improve the flow of patients through health care on the basis of clinical evidence. Through his work with TEDMED, and informed by his insights into clinical evidence and system change, Dr Tamber is convinced that the glamorous, tech-led world of health innovation is unlikely to have much impact on the patients with the worst health—those lower down the socioeconomic gradient.

Since 2013, he has spent time with numerous community projects, principally in the US and the UK but also in The Netherlands, New Zealand and Mexico, to explore and understand the realities of the work. Through his work he has described 12 recurring principles that offer a practice-based structure for how the health sector can work with communities. Collectively, these principles describe an inclusive and participatory process, effectively illustrating that people are sick because they have little influence over their lives. Social epidemiologists have called this ‘having a sense of control’, and it is something that requires agency—the ability to make purposeful choices.

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Ep. 74 Can We Have a Reasonable Discussion About Vaccines?

Niran Al-Aqba, MD

Does the vaccine debate have to be polarized according to “Pro-Vaxx” or “Anti-Vaxx” camps?  Is it possible to have a reasonable discussion about harms and benefits of vaccines?  Are public health concerns about unvaccinated children sufficient to trump individual liberty?

Exploring the question with us is Dr. Niran Al-Aqba, a board-certified pediatrician in private practice in Washington State, an area hit by the recent outbreak of measles.  Dr. Al-Aqba is a prolific writer who speaks widely and openly on a variety of issues, including policy, ethics, and medical practice.  She is a regular contributor to the Kitsap Sun, to The Deductible blog, and to a variety of other outlets, including her own blog, MommyDoc.  She is a mother of four children who’s been voted best doctor in Kitsap County on multiple occasions.  She also serves on the clinical staff and admission committee at the University of Washington School of Medicine.

 

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