The answer is only if they read the book—so unlikely! I of course haven’t read this book but Matt Guidin at F&S tells me it’s good. Here’s the review from ex RWJ Prez Steve Schroeder.
POLICY/PHYSICIANS: Reducing waste in US health care systems, by Walter Bradley
Walter Bradley is the Chairman of the Department of Neurology at the school of Medicine at the University of Miami. Previously on TCHB he wrote a piece on how we should solve the uninsurance problem. Today he takes aim at waste reduction.
R.W.Bush published a paper entitled “Reducing Waste in US Health Care Systems” in the current issue of JAMA (subscription boringly required). In this, he describes the application of the Lean Production methods of Toyota to eliminate waste. In this context, “lean” is “any activity that does not serve the valid requirements of the customer.” This approach is innovative and he was able to demonstrate that improving efficiency saved money, improved patient care and made the system more “user-friendly.” Waste is undoubtedly one of the elements involved in over-utilization that leads to the high cost of US health care. Others elements that have been suggested to be responsible for the US expending the highest proportion of GDP on health care of all nations in the world include bureaucracy and administration, malpractice insurance and defensive medicine, and the high cost of goods and salaries of health care workers.
POLICY/QUALITY: Why does Health Care in the USA cost so much? Over-utilization is an important factor by Walter Bradley
Walter Bradley has not only written the shorter piece today, but has sent me a longer piece citing over-utilization as a cause of high health care costs in the US. I’m inclined to agree with him even if Anderson doesn’t. It’s a longer more academic piece and I’ve buried most of it behind the fold.
Introduction
The United States (US) invests a higher proportion of gross domestic product (GDP) on health care than all other developed countries, despite which the US population suffers poorer access, a higher individual financial burden, inefficient care and a higher medical error rate than people in most other developed countries.
POLICY: A National Disgrace By John Irvine
When the story first came out, it didn’t look like much.
Just a few problems that needed correction: a little mold here, a few repairs
there, the inevitable complaints from disgruntled patients. But two and a half
weeks after the Washington Post ran a little story by reporters Dana Priest and
Anne Hull titled “Soldiers Face Neglect, Frustration At Army’s Top Medical
Facility“ the Walter Reed scandal has become without question the top story in the country.
Today, Priest and Hull return with another lengthy piece examining
conditions in the military healthcare system in other parts of the country titled
“Walter Reed Not an isolated case.” The two reporters say that after their initial story ran they were contacted by "literally hundreds of soldiers" from around the
country with similar stories to share. The pair writes:
Nearly 4,000
outpatients are currently in the military’s Medical Holding or Medical Holdover
companies, which oversee the wounded. Soldiers and veterans report bureaucratic
disarray similar to Walter Reed’s: indifferent, untrained staff; lost
paperwork; medical appointments that drop from the computers; and long waits
for consultations.
That appears to answer a question that many people had been wondering about. As New York Democrat Charles Schumer put it over the weekend “if it’s
this bad at the outpatient facilities at Walter Reed, how is it in the rest of the country?” On Sunday,
Schumer called for a bipartisan commission – possibly to be headed by former
secretary of state Colin Powell – to examine conditions facing returning
service men and women.
Predictably, conservative critics around the blogosphere are
pointing at the debacle as evidence that any government run healthcare system
would be a disaster. Kevin MD writes: “What’s happening at Walter Reed is small
sample of how government-run health care would turn out. Does the public understand
the implications of a nationally-run health care system?”
"Will the Bush-bashers join with free-market critics to effect real change and
help the troops who need and deserve better care? We’ll see," writes Michelle Malkin.
POLICY: In Defense of the VA System
Like fellow contributor Eric Novack, THCB alum Maggie Mahar has been following the Walter Reed story closely. Maggie doesn’t buy the criticism that the problems at the facility are due to the fact that Walter Reed is a government run hospital. She’s also unhappy about the fact that critics are using the occasion to target the VA system in general. Maggie is the author of the critically acclaimed “Money Driven Medicine: The Real Reason Health Care Costs so Much.”
Too many news reports about the scandal at Walter Reed use the story to malign the VA hospital system–and to suggest that when government gets involved in health care, the result is disaster.
First, Walter Reed is not part of the Veterans Administration Health Care System. It is a U.S. Army Medical Center.Secondly, while not every VA hospital is perfect, overall, the VA is one of the very best health care systems in the U.S.–thanks to a major overhaul by undersecretary of health Kenneth Kizer in the 1990s. Its electronic medical system has done an extraordinary job of co-ordinating care and all but eliminating medication errors.
As Business Week reported last year (July 17th, 2006) , “if you want to be sure of top-notch care, join the military. The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatments to the percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers.”
A string of studies published in published in medical jouranls back up these claims. For the full story of the VA’s transformation. see Philip Longman’s “The Best Care Anywhere” in Washington Monthly, January 2007.
That said, the Bush administration has steadily cut funding for the VA hospital system, and as a result, access and waiting times have suffered. By 2005 the number of patients the Veterans Administration was treating had doubled over 10 years to roughly 7 million. Meanwhile, the VA had cut costs by half. Such efficiency is admirable– but at that point, the budget was too tight.
And that was 2005. As the war in Iraq dragged on, the number of wounded multiplied.
Yet just as this administration failed to provide fighting soliders with the armor they needed, it has failed to give the VA the resources it needed to keep up with the carnage.
POLICY: The Not So Common Good
Catching up from when I was gone….this article on health reform went up at Spot-on a couple of weeks back. It’s called The Not So Common Good.
We’ve been hearing a lot about the problems of the uninsured. We’ve
been hearing more how the cost of healthcare is making it harder and
harder for individuals to afford insurance, and for employers to
provide benefits to employees. Those are the drivers for why health
care reform has suddenly emerged as a political force – even if the
governor who once led discussion of the topic, Mitt Romney, is
backpedaling away from his "liberal Governor of Massachusetts" pro-gay,
pro-big government stance so that he can appear sufficiently
conservative to win a Republican primary or two.
But the train is out of the station on the reform message. Even though the chances of real reform are slim,
everyone and their dog has a plan. Most of these plans are
self-serving. And even the ones that aren’t are generally built on
continuing the employment-based health care system that got us into
this mess in the first place; Senator Ron Wyden, economist Vic Fuchs
and the single payer crowd being the honorable exceptions. Continue
POLICY/HEALTH PLANS: The individual market is screwed
Whenever you hear some “free-marketeer” complaining that people with incomes over $50K don’t buy health insurance and so uninsurance is voluntary, think about this woman, featured in the NY Times, who would love to buy health insurance but has cancer and so cannot—unless she comes up with $27,000 a year out of her $60K income.
The individual market is corrupt and evil, and inherently unfair. And the organizations that make their living there (hello HealthMarkets, Assurant, Golden Rule et al) are the kinds that you find on the bottom of your shoe. (I’m awaiting Jon Cohn’s book coming out next month to tell you more…).
It is of course not strictly speaking the insurers’ fault. They live in a world where they’re selected against by both sick people and the competition—so it is a collective race to the bottom. Just to remind you for the one millionth time, individual choices of health benefit plans can only be effective and fair within a universal single pool system that needs its rules and boundaries set very carefully, and has risk adjustment built in the back end. And don’t let the libertarians tell you that if you take away all the rules and regs natural pooling will sort it out, unless they’re prepared to move to N.Carolina, get cancer and see how they get on.
POLICY: Breakfast of Champions By Brian Klepper
THCB welcomes back frequent contributor Brian Klepper. Brian is the president of the Center for Practical Health Reform in Baton Rouge Louisiana. Brian has something to say about economist Daniel McFadden’s recent OP-ED piece in the Wall Street Journal. If you like this post, you may enjoy his most recent post: "Can Consumerism Save Healthcare?"
Several people dropped me notes last Friday, asking for comments on a WSJ piece
by Daniel McFadden, a Nobel Laureate in Economics at the University of
California Berkeley. Dr. McFadden provided an eloquent view of the
crisis and its necessary solutions, and also argued that Medicare D
was, according to his research, working well.
This
is an interesting problem. After all, Dr. McFadden IS a Nobelist and,
well, I’m not. And he’s a formally trained and obviously highly
respected economist while, again, I’m not.
On
the other hand, he’s not really a health care professional. So it may
not be unreasonable to point out that some of his assumptions are naïve
and – how do I say this – exactly wrong.
POLICY: Underfunded? By Eric Novack
Governors from around the country are in Washington D.C.this week for the annual meeting of the National Governors Association. One of
the main bones of contention at this years’ meetings has been the expansion of
federal funding for state SCHIP programs. The governors want more, and lots of it. THCB’s own Eric Novack has been following this story like a hawk. And, as usual, he’s got a question.
The State Children’s Health Insurance Program was designed
by Congress to help states have money to provide Medicaid services to, well,
kids. The intent of Congress was clear,
given the “C” in the program’s name. Now
governors are screaming that SCHIP funding proposals by the federal government
are woefully inadequate.
Except for one thing—many states use SCHIP dollars to pay
for Medicaid for adults! Using 2005 data: In Minnesota, 87% of total SCHIP
enrollees in 2005 were adults, and 66% in Wisconsin. In Arizona, 56% of those enrolled
in SCHIP were adults.
Perhaps the states ought to use the funds for what they were
intended before complaining that they are being underfunded. If a child spent his ‘snack bar’ allowance on going to the movies, and then complained he was short, we would be likely to
require guarantees that the money would be spent properly in the future before
handing over the cash.
POLICY: Perry Unhappy
When a company comes to me and says we have a cure for cancer, for me
not to
say, ‘Please come into my office and let’s hear your story for
the people of the state of Texas, for young ladies who are dying of
cancer,’ would be the height of irresponsibility. Whether
or not they contributed to my campaign, I would suggest to you, are
some of those weeds that we are trying to cut our way through.
Texas Governor Rick Perry (R) expresses anger over widespread criticism of the executive order he issued earlier this month requiring that all girls entering the sixth grade in the state receive Merck’s new HPV vaccine. (Houston Chronicle). See Maggie Mahar: "Merck’s miracle vaccine: What is this story really about?"
