“The Primal Prescription” by Murphy and McGuff

The Primal Prescription by Murphy and McGuff is a book about how the US healthcare system works and provides some health advice. The parts of the book I like are those about how the US healthcare system works. I am wary of health advice since most of it is faddish and difficult to evaluate.

Chapters 1-7 are about the history and economics of the US medical system. This history provides an illustration of how government controls cause problems and politicians respond to those problems with more controls that lead to more problems. For example, in chapter 1 the authors describe how price controls on medicine led to a reduction in the number of inpatient beds in hospitals and fewer doctors. The government responded to this by funding graduate medical training. This led to indigent patients being dumped in teaching hospitals. The Reagan Administration then passed a law called Emergency Medical Treatment and Active Labor Act (EMTALA):

EMTALA imposes three distinct duties on hospitals. First, ERs must provide a medical screening exam (MSE) on anyone who presents requesting care and determine whether an emergency medical condition (EMC) exists. This must be done regardless of the patient’s ability or intention of paying for care. Second, if an EMC exists, the hospital staff must either stabilize that condition or arrange transfer to another hospital that can. Third, if a hospital possesses specialized capabilities or facilities, they are required to accept transfer of patients in need of their specialized services (again, regardless of capability or intent of paying for these services).

Immediately after passage, critics warned that the law would be crippling for physicians and hospitals because of its vague definitions of an emergency condition, medical screening exams, and what constitutes “stabilization,” which the Act defined as “no medical deterioration should occur from or during the transfer.” As the law took effect and cases started to accumulate, it became evident that the courts interpreted these terms so strictly that nearly any patient could be considered unstable. This is because almost any complaint from an ER patient could conceivably be attached to a dangerous diagnosis that the originating hospital, per the statute, had to rule out before transferring the patient. For example, a complaint of a sore throat could be a retropharyngeal abscess or epiglottitis, and the complaint of a crick in the neck could be a vertebral artery dissection.

So the problem starts with price controls and ends up with doctors potentially ending up in court for anything bad that happens to a patient. Every step in this process spreads the problems caused by price controls to more hospitals instead of fixing the problem.

Chapters 8-13 provides advice about how to stay healthy and deal with doctors and hospitals and stuff like that. These chapters include some food fad diet stuff that I don’t think is much good. Chapter 14 is about free market reforms of the medical system and it looks okay.

About conjecturesandrefutations
My name is Alan Forrester. I am interested in science and philosophy: especially David Deutsch, Ayn Rand, Karl Popper and William Godwin.

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