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Healthcare and the Job Market

Looking for a bright spot in Friday’s dismal job report? Think how
bad it would have been had the health care sector not added 52,100 jobs
last month.

That’s right. While the rest of the economy was shedding nearly
600,000 jobs and the nation’s once-proud automobile industry went
begging for a bailout so it could continue to pay for, among other
things, its employees and retirees health care bills, hiring remained
robust at the nation’s hospitals, physician offices, diagnostic labs,
nursing homes, and home health care agencies.

This raises an interesting conundrum for health care reformers who
are primarily concerned about the unsustainable rise in health care
costs. Who in the midst of a deep recession will be willing to whack
away at medical waste when it is one of the only sectors generating
lots of new jobs for thousands of fearful Americans?

Waste warriors like Peter Orszag, President-elect Obama’s pick to
run the White House budget office, must realize that the anemic job
growth of the Bush years would have been far worse had it not been for
the health care sector. The economy added less than eight million new
jobs between the trough of the recession in 2002 and the present
cycle’s peak in October 2007. (By comparison, the economy added over 20
million new jobs during the Clinton years.) But of this decade’s total,
health care and health care-related social services accounted for 3.2
million new jobs or nearly 4 of every 10 new slots.

Indeed, health care job opportunities grew by nearly 26 percent in
this decade and now make up fully 13.9 percent of all U.S. jobs, up
from 11.5 percent in 2000. And this doesn’t include jobs in the
pharmaceutical, medical device and durable medical equipment
industries, which are considered manufacturing jobs and not included in
the “health care services” job estimates by the Bureau of Labor
Statistics.

The downturn is affecting some suppliers to the health care
industry. Drug firms, for instance, have been shedding salesmen and
researchers as sales growth slows and new drug approvals lag.

But the health care services sector – doctors offices, hospitals,
home health care, nursing homes, specialty clinics – have been largely
immune to the downturn that officially began a year ago. In November,
the month after the stock market crash, every one of those sub-sectors
of the health care economy added jobs. Amazing.

Indeed, while the nation as a whole has lost nearly 1.5 jobs in the
past year, health care managed to add nearly a half million slots. That
means the rest of the economy actually lost about two million jobs.

The bottom line is that there are no signs yet that this downturn is
affecting health care, which has been on a tear for decades. Since the
trough of the last recession, home health care has added 343,000 jobs,
making it the fastest growing field (up 54 percent). Outpatient
facilities and diagnostic labs added a combined 202,000 jobs in this
decade, a 37 percent hike. Firms that provide social assistance added a
whopping 644,000 jobs, a 34 percent increase.

Doctors and dental offices in this decade added more than 622,000
jobs, but that was slightly less (24 percent) than the sector as a
whole (26 percent). Hospitals and nursing homes were relatively slow
growers by comparison, adding “only” 700,000 jobs (17.5 percent) and
373,000 jobs (14.2 percent), respectively.

These jobs numbers will take on increasing significance as the
health care reform debate emerges next year. Health care reformers tend
to break down into two camps, and they speak very different languages.

On the one side are those that focus almost exclusively on access.
Their primary concern is the nearly 50 million Americans without health
insurance, and the insurance industry’s penchant for padding profits by
denying care to those with insurance and discriminating against those
with pre-existing conditions by refusing to sell them insurance.

To the extent this group focuses on cost issues, their ire is
usually aimed at the drug industry for charging high prices. Their goal
is to give government (Medicare and Medicaid) the right to negotiate a
better deal just like private insurers, although, as this new report
from the labor-backed Change to Win coalition points out, the pharmacy
benefits management industry in general and CVS Caremark, the nation’s
largest PBM, haven’t protected consumer interests very well.

The other camp in the health care reform debate is made up of system
reformers, who focus their attention on the vast disparities in health
care costs and quality across the U.S. They fret about the unneeded
services proffered by fee-for-service practitioners; the lack of
preventive health; the overemphasis on specialist care over primary
care; the lack of coordination in treating people with multiple chronic
diseases; and the entire system’s mid-20th century methods of
exchanging information.

To system reformers, insuring the uninsured, while important from an
medical, ethical, and social standpoint, will do little to improve
overall health care outcomes in the U.S. Lack of insurance leads to an
estimated 22,000 unnecessary deaths each year. Medical errors kill
nearly 100,000 – and most of those people were undoubtedly well
insured.

The lack of communication between the two camps was reflected in an op-ed in the New York Times
Thursday. Jonathan Gruber, a health care economist at the Massachusetts
Institute of Technology and one of the chief architect’s of that
state’s universal health care reform plan, argued for spending over
$100 billion of the coming economic stimulus plan on shrinking the
ranks of the uninsured. He would channel the money first through
expanding Medicaid and the children’s state health plans and then use
the rest to pass some version of the universal coverage plans that will
be introduced in Congress next year.

Besides freeing up state and local money for infrastructure projects
and creating new information technology jobs by increasing investment
in health IT, expanded coverage will, according to Gruber:

". . . drive demand for high-paying, rewarding jobs in
health services. . . These jobs could provide a landing spot for
workers who have lost jobs in other sectors of the economy.

Notably, Gruber does not address the question of mis-utilization of existing resources. Indeed, he asserts that:

Experts have yet to figure out how to restrain cost increases without sacrificing the quality of care that Americans demand.

In other words, employers, government agencies and taxpayers who
foot the tab for health will have to wait on controlling skyrocketing
health care costs, which even he admits is the “greatest fiscal threat
facing this nation.”

Given the grim prospects for the economy next year, it’s an argument
that the Obama administration will probably heed. Just as the financial
crisis turned health care reform into a backburner issue during the
primaries and general election, the full-fledged downturn that has
followed in its wake, even while increasing the chances of some form of
universal coverage passing next year, has decreased the likelihood that
it will be accompanied by more systemic reforms that might curb the
health care system’s voracious growth — and the jobs that accompany it.

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25 replies »

  1. Joan,
    Although I agree with you for the most part about your concern for the health of this nation, there is something you might want to also consider. There was a recent study about 2 years old I think, I’m not sure where or what the name of the study is right now, but it stated that the increased tax on tobacco is resulting in a reduction of smokers. Sounds good at first, however, because there are more people living longer now that they have stopped smoking, they have incured increased healthcare dollars for other conditions within a longer time span. Medicare would be unable to come up with the funds to provide care for this additional population. So you see, if we reduce mortality, we increase healthcare spending.

  2. Rbar: This isn’t overlooked at all and in fact, is becoming just another issue to point our fingers at why our health care system is failing us. Although our personal choices are making us develop chronic, expensive illnesses, for some Americans, being unhealthy is not a personal choice but instead, is an only option.
    Stay away from sugars, eat a balanced diet? Not easy if your neighborhood store doesn’t carry (inexpensive) fresh fruits and vegetables.
    Stay away from simple sugars? Try avoiding all of the McDonald’s popping around your neighborhood instead.
    Can’t afford a gym membership? Get off your arse and take a walk. Wait, the neighborhoods are too unsafe.
    Don’t have time? Make time! Wait, I have two jobs and children to look after.
    This post was not meant to disparage your comments but to simply illustrate that “personal choice” is a superficial analysis of the rising costs in health care. This only highlights how poorly we in public health have poorly marketed the social determinants of health outside of our academic circles.

  3. Even though the market falls, most of the financial and other sector has been affected. But it is clearly seems that medical fields are still showing their potential and contributed to the nation’s economy.In my view in any condition, medical should not be affected as medicine is important as the aspect of life. If such case arises, Government should take extra care for it.

  4. One of the things I see CONSISTENTLY overlooked on all of the analyses of the healthcare delivery system woes of this country (and granted there are many), is the role of the contribution each individual’s life style choices make in the creation of VERY EXPENSIVE diseases that the healthcare system must then pay for.
    To keep it simple, let’s just look at the implications for just one disease. Type II diabetes is largely preventable — yet this disease and the complications that come along with it are amoungst the most expensive in healthcare today. Stay away from simple sugars, eat a diet that balances complex carbohyrates, healthy fats and lean protein with adequate physical exercise – and for the most part, Type II diabetes doesn’t develop. Every one of those things I mentioned are 100% within the control of each individual and aren’t expensive. Can’t afford a gym membership? Then walk, job, run up and down the stairs in your home, jump rope — you get the picture. Instead of purchasing a bag of Doritos at the grocery store, purchase a 3 lb bag of apples (the price is the same within pennies).
    Right now, Americans literally want their cake and to eat it too. They don’t want to work at maintaining their health, but instead want their “Blue Cross credit card” (ie, their health insurance) to pay for pills, surgery, other medical care to manage the disease they develop.
    As Americans, we’re largely a lazy people who, in general, don’t take individual, personal responsibility for maintaining our health. Until Americans get some significant “skin in this game”, it’s reasonable to expect that healthcare costs are going to continue to rise because our population is sicker – and getting sicker (and therefore developing the expensive complications of their disease) at an earlier and earlier age.
    I’m not talking the high deductible health plans or the so called “consumer directed healthcare” (ha! Boy did we get snookered by the insurance lobby with THAT one!) I’m talking about taxing the snot out of those things that add to the morbidity of the people this country. Anything with high fructose corn syrup? Add a $5 per serving tax on the product. Any product with using a grain ingredient that has had the fiber stripped away (hello white bread!), add a $1/serving tax on the product. While cigarettes, cigars, chewing tobacco, etc have a pretty significant tax already, add a significant chunk more and see what happens to the demand curve for those highly carcinogenic products. Products with a % of saturated fat over a certain threshold, add $x dollars per serving tax to those, as well. You get the picture.
    Then use those tax collections to fund health insurance for the uninsured.
    This isn’t about making these things something that only the rich can afford. It’s about making unhealthy choices so dang expensive that anyone with an ounce of sense (regardless of the size of their pocketbook) is going to select the less expensive (and therefore healthier) alternative.
    And those businesses that currently thrive on making unhealthy products available for us? Well, necessity is the mother of inventive, yes? If they see that the demand for product A is going to plummet due to this horrific “sin tax”, don’t you think they’ll shift their R&D and ultimately shift production to making healthier products that don’t incur the “sin tax” so that overall demand for their products remains the same (or rises!)?
    I think the oil crisis this past summer demonstrated the power of dramatic shifts in cost making rapid, dramatic (and what looks to be longer lasting) shifts in human behavior/consumption.
    If we want a healthier America….if we want to curb the rise in healthcare costs…if we want the goods we produce here in the US have a better chances being competitively priced in the world market (due to both lower benefit costs as well as higher productivity due to a healthier employee pool)….., then we’ve got to bite the bullet and recognize that there are 3 parties in the healthcare equation (insurers, providers and patients).
    And as such, for any solution to our healthcare dilemma is going to be anything more than a “finger in the dike”, we must realize that the problem is MUCH MUCH bigger than access to healthcare and coverage for the expenses incurred.
    Simply making health insurance available to more people and trying to cut down costs solely by “squeezing” the providers and insurers is simply treating the symptom of the healthcare ills of this country. If you want to eliminate the disease, you have to create an environment to hold the individual citizen accountable for minimizing their individual chances of developing preventable disease.

  5. Oh no, sonomaca, I am writing from a country where patients first thought, when something hurts, is: get a scan … the fancier, the better. And this culture gets to the providers by cultural osmosis, and I bet you that the US is the number one in percentage of negative scanning.

  6. Maggie: Medical imaging is in an absolute depression, thanks in part to DRA, to the credit crisis, and to the fact that everything non-government is subject to prior auth. Companies such as GE, Philips, and Siemens have let go thousands employees in imaging. Smaller vendors, such as Emageon, Merge, and Amicas, have been absolutely devastated. Believe me, there isn’t any waste in imaging. On the contrary: I would argue that imaging has been so restricted that necessary procedures in cardiology and pathology (an evolving imaging field) are underutilized, and that more frequent use of imaging procedures in these areas could actually SAVE money.
    Your arguments may have been true in 2005. No longer.

  7. Healthcare is no more recession-proof than the Titanic was Unsinkable or the Yankees Unbeatable. Yes, healthcare is faring better than other industries despite the economic crisis.
    In June, the Washington Post noted, “The health-care economy now employs about 16.5 million Americans. In the past three decades, the total national spending on health care has more than doubled to 16 percent of the gross domestic product. The Congressional Budget Office forecasts that by 2082, rising health care costs will push that spending to nearly 50 percent. —- By 2016, the Bureau of Labor Statistics predicts health-care employment to double the projected growth of all other industries combined.” Terry Schau, an economist at the bureau was quoted, “It’s one of those industries that doesn’t seem to be affected by economic downturn. People get sick, and they’re going to need health care. The state of the economy may affect their ability to pay but not the demand.”
    The Chicago Tribune (and FierceHealthcare.com) said, “The health-care industry, often deemed recession-proof, may not be so immune to the economic downturn, according to a parade of recent reports from Moody’s Investors Service. The New York-based financial ratings firm has issued reports in the past two weeks on various sectors, from hospitals and medical devices to insurance companies, revising the health-care industry’s 12- to 18-month outlook to “negative” from “stable” ––.”
    However, the American Hospital Association’s recent report cited in Modern Healthcare indicated that Q4’s negative profit margins has more than half of survey respondents pondering staff reductions, while more than a quarter of the hospitals are deciding whether to reduce services. The financial pinch comes amid falling revenue, declining admissions and negative investment earnings, even as experts predict that high unemployment will lead to more patients seeking uncompensated care at emergency rooms.
    All this at a time when the Centers for Medicare and Medicaid have issued their “final rule” mandate, indicating they will no longer paying for a growing list of “preventable errors”. Now more than ever, with volumes growing, uninsured on the rise, new care providers at the bedside, financial and regulatory changes abounding, hospitals and healthcare providers are seeing never before seen pressures and are in greater need for highly skilled, trained, and deployable personnel working an environment that has been methodically cleansed of process waste and inefficiency.
    Merrill’s WSJ Blog/commentary, voicing concern about “ Who in the midst of a deep recession will be willing to whack away at medical waste when it is one of the only sectors generating lots of new jobs for thousands of fearful Americans? –Waste warriors like Peter Orszag, President-elect Obama’s pick to run the White House budget office, must realize that the anemic job growth of the Bush years would have been far worse had it not been for the health care sector” implies that waste-cutting must mean quality and/or jobs and or care elimination, but that isn’t what “Lean” (based upon the Toyota Production System) healthcare solutions are about. This brilliant, systemic approach to healthcare reform is a win/win scenario, advocating transformation — not amputations. RWD Technologies, the firm I work for has successfully implemented deep and lasting change within healthcare organizations with dramatic success. Orszag and Obama’s speeches and policy are full of references to Lean/TPS terms. TPS-based approaches to healthcare reform are unique, as they reduce waste by taking a human-based approach to processes and people. St. Luke’s Episcopal Hospital in Houston is a shining example of how healthcare organizations can minimize errors and waste while optimizing overall performance and patient outcomes. It’s the ideal solution, Lean Healthcare for Lean Times. Lean meets all the criteria and pain points which have been raised while ensuring lasting, continuous improvement. The approach engages and inspires workers at all levels, in a blame-free environment – embracing the “bottom up” approach Obama advocates. Those healthcare providers who are implementing Lean are driving excellence in all aspects of care. They have looked to a most notable example of growth and improvement in the evolution of Toyota in a global market. In applying their methods, they are reaping the same financial strength without sacrifice to quality, safety or the bottom line.
    If not before, now is certainly time to sit up and take notice.

  8. What’s surprising is that the health care indexes have gotten slammed worse than many other sectors. I think the whole health care sector is undervalued.

  9. Now the presidential election is over, and soon to be President Obama will eventually offer some form of universal health care coverage. However, we need to fix the health care system as well.
    As a patient and a former employee (I used to work at a famous hospital on
    Long Island) of the health care system – I have first-hand knowledge on how
    the care system works in America.
    Close to 100,000 people die each year in hospitals due to medical errors.
    The hospital I worked at had too much administrative waste. There was
    endless paperwork in processing patient information.
    Many of the positions, especially in the non-medical areas, were filled
    through nepotism. Many of the supervisors and mid-level managers at this
    hospital were concerned about how they looked to top administrators, rather
    then perform their jobs effectively. (CYA was the major activity).
    A question I would like to ask the general public, particularly doctors –
    How come doctors never challenge other doctors?
    Right after I graduated college I was “confused,” doing drugs, and getting into trouble; so my parents sent me to psychiatrist. The psychiatrist said I was “mentally ill” and he sent me to neurologist for my tests. (Our family doctor stated at first I did not need any tests, and then he changed his mind.) The neurologist examined my brain and said I was fine. I just needed to “grow up.”

  10. I agree with most of the points so far, but we can’t ignore the issue of employment in the sector. If/when we cut out the waste that we’re all talking about, where are all of those people going to go for jobs? I hope someone has a plan for addressing that because it’s not a pretty scenario. Our economy has been propped up by both an excessive use of credit and healthcare employment in recent times. Kinda frightening!

  11. Of the 250k jobs that were shed in November by the private sector, about 79k were from small businesses. Still, small businesses actually ADDED jobs overall in Nov. even though it was a minuscule 0.26% according to SurePayroll’s survey of over 20,000 small employers through out the US.
    Problem is that these are the types of employers that aren’t going to offer health insurance coverage. Additionally, according to the same survey by SurePayroll, employees at small employers have seen a -2.6% decrease in their salaries year-to-year. Given the continued deflation we are going to see through at least Q1 next year, it is going to be very hard for workers at small employers command any kind of meaningful salary increases.
    So the only part of the private sector that is holding up so-far is the small employers but wages are going to be severely curtailed here and these employers are much less likely to offer health insurance.
    Just more salt in the uninsured woes.

  12. Agree w/ Peter yet again. Merrill has authored a bizarre and poorly informed post.
    It is hardly a sign of health that healthcare has created 40% of the new jobs in the US this decade. Who paid for all those jobs? Employers who are laying off workers by the hundreds of thousands, state governments which are cutting benefits to poor people to pay their Medicaid bills, and workers whose paychecks are no longer growing because they are diverted into health insurance premiums. If the hospital is the largest employer in a community, that’s a sign of economic decline, not economic health.
    Merrill and Maggie haven’t seen the extensive reporting about the recession hitting the healthcare industry. If doctors and hospitals are still hiring, they will shortly be laying the new hires off: physician visits and elective hospital admissions are off, at an accelerating rate. Filled prescriptions are also falling. Hospital bad debts are rising. Hospitals have gotten HAMMERED in the last three months: tens of billions in investment losses, borrowing costs doubled or tripled, operating income vanishing, etc. If this sector is still HIRING, it is terrible management at work, not some sign of robust good health. And yes, Maggie, hospital construction projects are being cancelled right and left (not in r a year, but last month, the month before etc.).
    The idea that we should wait to contain healthcare costs, that we should postpone asking this bloated sector to become more efficient, is just as inappropriate as asking taxpayers to underwrite those $108 thousand a year fork lift operators at GM, or pay for the UAW’s job bank. The huge amount of unnecessary health cost are about as useful to our economy as thirty pounds of rocks in a backpack of a laboring long distance runner.

  13. I think one of the keys here is that we need to reform the payment system to pay for what we want — good value which we (at the Mayo Clinic Health Policy Center) define as better outcomes, better service and better safety divided by the cost of care over time. As consumers, we can demand that our insurers and employers reward better preventive services, encourage primary care, reward care coordination, and demand evidence-based medicine. In short, we need to put our money into right care, at the right time, in the right place, for the right reasons, provided by the right provider. This will cut waste.
    One excellent example of demanding better value and then paying for it is demonstrated by Starbucks, Aetna and Virginia Mason. By working together, baristas from Starbucks got better care for back pain, Virginia Mason decreased the number of expensive MRIs that were performed and Aetna increased their payment for the appropriate treatment — everyone benefited and waste was reduced. An article about this is published in Virginia Mason’s newsletter at this link beginnin on page 2: https://www.virginiamason.org/home/workfiles/clinicians/Winter_Contact_2008.pdf .
    This is just one example; it takes everyone working together and addressing multiple interrelated issues — in the end, better value.

  14. Are the jobs in prevention growing? Or are we just adding costs to the “wait till it’s broke” model? Companies are leading the charge with prevention, but it wouyld be great to have the first wellness president.

  15. I want to join Peter and Maggie and remind people not to look only at job creation, but also what we produce with the manpower and money devoted to these jobs:
    -with defense spending, we get fighter planes, tanks, military infrastructure and – wars
    -with incr. spending for public transport (as it is currently in the papers), we get not only safer bridges (good), but more highway lanes and asphalted surfaces, in times of manmade climate change and sweet water shortages. It certainly would be nice and reasonable to have decent public transportation in and inbetween most densely populated areas (say, any US city with 100 K people and larger)
    -with incr. healthcare spending in the current MO, you will not only get more nurses, technicians and doctors, but also more scans, stents, drugs, coders, case reviewers, pharm reps, without the population actually getting much healthier or having more good quality years of life.

  16. It’s really not true that the health care industry is not affected by the recession. Fewer people are getting elective procedures. Also those with high deductible health plans are unable to pay their portion of their deductible. This is leading to some health care providers cutting jobs. Check the story out at
    http://minnesota.publicradio.org/display/web/2008/10/28/medical_procedures_delayed/
    http://www.startribune.com/lifestyle/health/35618079.html?elr=KArksUUUU

  17. Talk about perverse incentives. Expansion of our bloated, misallocated and inflationary healthcare system may provide some short term economic relief, but at what long-term cost?

  18. Merrill–
    Excellent post– particularly the point that many more Ameircans are killed by medical errors than by lack of
    health insurace.
    Also, these facts: health care has added 343,000 jobs, making it the fastest growing field (up 54 percent). Outpatient facilities and diagnostic labs added a combined 202,000 jobs in this decade, a 37 percent hike.
    Many of those 202,000 jobs (particularly in diagnostic imaging labs) are costing us a fortune in unnecessary, overpriced imaging. This is good news for GE’s shareholders. Bad news for the patients who are harmed by unnecessary diagnostic imaging, false positives, unnecessary procedures and biopsies that follow . . .
    Meanwhile you point out that “Hospitals and nursing homes were relatively slow growers by comparison, adding “only” 700,000 jobs (17.5 percent) and 373,000 jobs (14.2 percent), respectively.”
    This is why hospitals and nursing homes are such scary places. The average U.S. hospial has only 85% of the nurses that it is supposed to have to be fully staffed.
    Thanks to corporate takeovers, consolidation and down-sizing, the nation’s nursing homes are way understaffed. Too few RNs. Tragic stories.
    Home health care is growing–but not wages. Home health care workers are underpaid, and undertrained. This does provide jobs for immigrants, and many are doing the best job they can. But this is hardly a bright spot in the economy.
    Finally, the hospital building boom that began a few years ago cannot be sustained. Hospitals are not keeping up with their construction bills. I predict we’ll see construction projects grind to a halt, midway, over the next year or so.
    Unlike the infrastructure repairs that Obama proposes these hospital expansions were not needed. They tend to be in the parts of the country where we least need more beds—or more very expensive hospitals offering “5-star hotel amenities.”
    Overall, we have more beds than we need in most of the country.
    Insofar as we put money into health care it has to be done very, very carefully. This is not an industry that we want to see grow–that will be disastrous for the economy as well as for our health. Assets are maldistributed–and a bloated industry is killing people.
    Finally, as others have indicated, when jobs are added in the health care sector, they are lost in other industries that cannot afford to hire employees and give them health care benefits to cover all of the unnecessary diagnostic imaging.

  19. Peter is absolutely right. This is ludicrous to think that somehow we magically create jobs in health care without some negative impact. Our employers are bearing a tremendous burden – particularly in a global market – supporting all of these jobs in health care. If Mass. taught us anything its that just covering people is not enough and that if you pour money into the existing system it will soak it up like a sponge.

  20. If we’re going to talk about protecting healthcare waste to protect and build healthcare jobs, we’d better also talk about the other side of the balance sheet. Who’s going pay for all this waste and how does that paying for, rob other sectors of growth and jobs and stagnate incomes. Would people argue that we need to start another war to sustain and grow our defense industry and the jobs it creates?

  21. Great article. If you put the growth in the health care sector with the financial and housing sectors, these were really only the sources of job creation since the last recession.
    Everybody talks about “green industries” and other ideas but I don’t see where the next spark is going to come from in terms of jobs growth and not like the recovery will be driven by the manufacturing economy (which has been further hollowed out the past 10 years) or exports in general which are getting hurt by a temporarily inflated U.S. dollar.

  22. One question that would be useful to address is not HOW many jobs but WHAT type of jobs and WERE they are located. How we can strategically invest in health care in ways that will pay off down the line (for example focusing on staffing medical homes that focus on those with chronic conditions) and view this is an investment in our “infrastructure” just like roads or schools.
    Some health care advocates, public policy experts as well as large employers and labor groups who are self insured understand that you need to focus on quality simultaneously with access and cost. We need to do this to mitigate some of the problems that are happening in Mass (Even though Boston has one of the highest number of providers to patients newly insured patients are unable to get in to see Physicians and are resorting to ER’s for care but very few providers are adjusting how often they see existing patients) and where the largest systems already have HIT but are the highest cost providers in the region.
    As you mentioned there is the one camp that focuses on the wide variation in care. IE According to the Dartmouth Atlas Studies – If the spending per patient everywhere mirrored that in Mayo’s home region of Rochester, Minn., Medicare could have saved $50.1 billion, or 17.3 percent of all spending on these patients alone.
    Elliott Fisher, MD and others have said, “a crash program to learn how leading organizations such as Mayo
    use fewer resources and spend less per capita than their peers while receiving high marks on quality measures. “Medicare policy, including reimbursement, should support “organized” systems of effective care management, with a strong primary care component,””
    Who is going to stop patients from seeing specialists who practice in New York and Boston twice as often as other cities? Who is going to limit access to MRI’s or specialty hospitals or drugs that newly empowered consumer learns about on a social networking site? Are the Health 2.0 companies lining up at the bar there to save anyone money?
    The crisis could in fact give us a huge opportunity to invest in training and targeted jobs (nursing for example has an average age of 47 but we are cutting slots in States with budget shortfalls) and HIT often takes nurses out of patient care versus unemployed auto workers. Without changes to workflows and cost sharing we will just be adding an expense to providers (the savings accrue to insurance carriers – outside of closed systems like Kaiser or the VA) although everyone should benefit from increase quality and safety.
    Hopefully payment reform (ie paying for outcomes, implementing the medical home model, rewarding primary care coordination, etc) will occur simultaneously with investments in HIT. It is a long step from data, to information to knowledge and behavior change.
    Cost, quality and access are not mutually exclusive but business and political interests are as siloed as medical care is. It will take genuine community wide leadership combined with investing in the right jobs (and technology) in order to obtain patient centered, higher quality, more cost effective care but this is an exciting time to be in health care.

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