Good Magazine has this interesting graphical representation of the problems facing health care in the U.S. Considering how complex health care is, I think it’s a great attempt to put lots of information visually on one page to provoke conversation. The visual aspect is key because few people have the patience or desire to read long diatribes.
The Health Care Blog regular Michael Millenson wrote a great piece recently in Miller-McCune Magazine on the necessity of practicing more evidenced-based medicine, and why it’s not happening.
Here is a powerful snippet but it’s definitely worth checking out in its entirety.
Experts believe that a stunning 20 to 40 percent of the $2.4 trillion America spends on health care in 2008 will be wasted on misuse (including harmful and fatal errors), overuse (care that’s unnecessary) or underuse ( effective care that’s not provided). If you take a midrange figure — let’s say 30 percent — you end up with $720 billion in savings. That’s enough in health care savings to pay the cumulative costs of the Iraq war (about $560 billion by mid-September 2008) and still have enough cash left over to pay for universal health care and the entire federal education budget. If you simply sent out a rebate check, it would come to some $2,100 for every man, woman and child in the country.And that’s just one year of savings.The failure to follow best practice carries a price tag in human lives, too, and it is equally enormous. Providing appropriate, effective and safe care where we know how to do it — no “medical mysteries” included — could annually prevent the deaths of hundreds of thousands of Americans in and out of the hospital and millions of injuries.
When campaigning politicians talk about reforming America’s health care system, they’re understandably quiet in identifying who will take the pain that will ultimately be allocated between the three basic groups involved –- patients, providers and payers.
If politicians ever get serious about reform, their big challenge will lie in finding a balance that at least two of these groups find tolerable. They’re not serious yet.
A new analysis this week by the Tax Policy Center confirms that, giving neither presidential campaign credit for doing anything to cap costs and sensibly concluding that the bottom line here is that insuring more people requires spending more money (Obama’s plan, it concludes spends more money more efficiently to insure many more people).
So the current spate of ads on the topic may seem a bit puzzling. Here’s how to decode them.
"Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation," said John McCain to a reporter in an interview in Contingencies magazine. The article is titled: "Better Care at Lower Cost for Every American."
This isn’t a Photo-shopped, made-up comment. See page 30 of the publication, the last paragraph in the left hand-column which continues into the right side.
Contingencies is the magazine of the American Academy of Actuaries. These are those sober professionals who, according to their mission statement, "put a price tag on risk." They do that through evaluating the likelihood of future events, and, in their words, "designing creative ways to reduce the likelihood of undesirable events."
"Jane has missed the most obvious implication of the implosion: the
bailout will use up the fiscal margin for any subsidized solution to
health reform. There will simply be no extra dollars in the federal
budget for the uninsured for many years. Obama’s health reform plan,
which relied on new taxes, is dead as a doornail unless he is willing
to push the budget deficit into Argentinian territory, or finance it
from savings inside existing health spending or health related tax
subsidies. Even the existing base of health spending will probably have
to be re-examined. Stay tuned for a more detailed analysis."
Last week was an interesting one in Health 2.0, most notably for the disagreement on the direction of Health 2.0 that turned personal between Matthew Holt and Dmitriy Kruglyak.
Also, Fard Johnmar summed up nicely the potential steps going forward where the empowering/ democratizing models of health 2.0 meet real profit-sustaining enterprise.
–Medical Decisions: This includes decisions about what medications physicians should prescribe and how to manage end of life care cost effectively.
–Information Sharing: Providing valuable health data and education to consumers, providers, payers and others.
–Medical Technology: Tools that help prolong lives, reduce administrative costs and meet emerging health needs.
–Funding: Ensuring scarce health resources are allocated effectively and finding ways to stop breaking the health care budget.
New surgery technique uses the somebody’s existing openings to allow for scarless surgery, the Washington Post reports. The new experimental procedure takes "minimally invasive to a new level."
Microsoft plans to buy back another $40 billion of its own stock — the single largest buyback in U.S. history, the Associated Press reports. Analysts say the move is an attempt to use spare cash to boost its share price.
What were they thinking? The Wall Street Journal Health Blog reports that employees at the University of New Mexico Hospital were fired after posting pictures of patients on MySpace.
Expanding health coverage isn’t enough if there are no doctors to see you. The Boston Globe reports that patients are waiting longer than ever to see a primary care doctor. What’s that you say about the awful Canadian wait times?
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Health Affairs ran a couple of partisan analyses last week. Joseph Antos, of AEI, Gail Wilensky, former Bush 41 HCFA administrator, and Hans Kuttner labeled the Obama plan as excessive tax and spend socialized gulag regulation.
In the other analysis, four liberal academic wonks — Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz — derided the McCain plan as the counter-productive ravings of a right wing nutjob. OK so they didn’t exactly say that, but you get the message. No surprises here.
The McCain plan is so far out of the mainstream that, when Bush proposed something very similar in 2006, he could not even get it introduced into a Republican-controlled Congress. Obama’s plan is a wishwashy centrist Democrat plan that doesn’t even pretend to get to real universal coverage and ignores the fact that the vast majority of Democrats prefer a straight single-payer plan (and so does he when scratched hard!).
So who does Health Affairs chooses to create a middling compromise between these two?
A few months ago, the MA Division of Health Care Finance and Policy (DHCFP) released a study that showed that mandated health insurance benefits cost insurance purchasers about $1.3 billion – or 12% of their premiums – each year. Thanks to DHCFP for publishing the study. This issue is always the source of heated debate, and it’s nice to have a piece included on it that tries to inform the discussion.
Business people read the study and said, “Ah ha! Mandates cost a lot of money!” That would be correct. Health care advocates read the study and said, “Ah ha! Mandates don’t cost that much money!” That’s correct too – sort of. As usual, where you stand depends on where you sit, how much twelve percent is worth to you for what you’re getting, and who pays the bill.
It’s also hard to tell if this kind of reporting influences the policy debate in MA or not. People here are screaming about the rising cost of health care, and the legislature responded by focusing on and enacting a cost containment bill. But at the same time, the legislature considered many new mandates during its last legislative session, including significantly expanding the mental health benefit mandate for kids and adults. Many in the legislature would argue – correctly – that the final bills that passed didn’t expand the benefit as broadly as many advocates would have liked, thereby significantly limiting the increase in costs associated with the new coverage requirements. Again, I think this is mostly a philosophical argument about how much is enough – and one that on the margin is hard to calculate.
By Matthew Holt
A version of this review appeared at Spot-on last week, but as you know over there I get heavily edited by Chris Nolan who’s a real journalist and all that. The beauty of the zero cost of publishing online is that you can show lots of versions. This is what it looked before it got to her. Enjoy.
Despite being buried in Health 2.0 work, somehow I’ve been managing to read a few books lately. But none of them have been quite as staggering as Free Lunch, the latest from former NY Times investigative reporter David Cay Johnston.
Johnston’s best known for his exhaustive investigation into how corporations and very very rich individuals subvert the tax code so that they pay less, while the rest of us pay more. But in this book (probably because he’s no longer a NY Times Reporter and is off the leash of restraint that the Grey Lady seems to put on its reporters) he gets almost biblical in calling out the cheats, crooks and murderers.
And when I say murderers, Johnston is talking about John Snow, Bush’s former treasury secretary — yup the one who did such a great job regulating the sub-prime mortgage market that the potential for a credit and housing collapse in the latter part of this decade was avoided…oh, wait….
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