Loyalty: Medical This Time

I really do value loyalty, despite the things I say about it both last week and this. It’s just that I think we need loyalty to values or ideals, not people or groups.

I hate taxes as much as the next guy, but I see their purpose if they serve a goal I embrace. I got elected to the Idaho legislature right after the Affordable Care Act passed and the Republican animus against this health care policy was palpable in the state house. It might have been my second year serving when a resolution came through castigating the Affordable Care Act’s tax on medical devices. The resolution was telling our representatives in Washington DC to work to repeal the tax; the list of reasons for the repeal was long. The tax has been postponed, not repealed, thanks to another government shut down deal.

Why should medical devices pay an extra tax? They can save lives, heck most of us are walking around with one in us. I am. I had a hip resurfaced about eight years ago. I researched the different choices and made my decision, then found a surgeon that used that kind and had the procedure done.

But then consider the situation I have seen in a nearby hospital. This hospital has three different orthopedic surgeons and they all do hip replacement surgery. (Not the resurfacing like I had, the total replacement kind, whole new ball and socket.) Here’s the catch: each surgeon uses a different model of hip replacement device. Each believes strongly that the model they use is the best. So, the hospital where they work has to stock multiple sizes of each model, keep on hand the different tools required for the procedures, and keep the OR personnel trained in the use and surgery of all three different devices and tools. Do you think this might contribute to the high cost of healthcare?

This is something else you need to understand: there is no clear evidence that one type of device is better than the next. And device manufacturers are always coming up with “new and improved” versions, requiring new tools, different training and OR procedures.

I can understand the loyalty of the surgeons who have used a certain device. They trust their familiarity with the tools and their skills with the procedures. But when there is no clear evidence, the surgeon’s loyalty to their preference costs all of us. Why shouldn’t a tax on these devices help the market perform better?

There is no doubt “health care is complicated”. I agree with President Trump on this one. I appreciate you readers sticking with me through this maze. But if we Americans are going to solve our health care fiasco, we are going to have to be willing to have loyalties to our greater good. We should be considering the best policy based on evidence, not partisan “wins or losses”. So, the medical device excise tax made some sense to me.

But my perspective might be different than yours.

Why should lots of medical device companies making a profit worry me, or you for that matter? My IRA probably has some in there. But what I’m most concerned about, my deepest loyalty, is having affordable healthcare, accessible to all. If my IRA takes a hit, but my health insurance premium goes down, I’m OK. But it shouldn’t be our own self-interest driving this decision. It should be all of ours; the greater good.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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