Imagining thet only bad things will happen if the system is changed one particular way, is just that -imagining, and very incomplete imagining, at that.

In the meantime, many of the factors contributing to higher costs have been identified, and they have an equal chance of being dealt with, reagrdless of the nature of the reforms. It’s a side issue, although one with a primary importance.

the first step on the road to reigning in the ballooning costs is shining a big bright light on the practices of the back end of the business side of healthcare

Well, in addition to fraud, there’s the profits in the system (successive markups). By going to non-profit the advocates of government (I won’t use the stupid term “single-payer”; WHO’S THE PAYER?) believe the savings from the elimination of profits as well as unnecessary complexity will enable everyone to be given health care.

That remains to be seen, much less proven, and even if this were initially achieved, long-term health care costs are only going to rise, and rise very substantially.

What has happened in some instances to keep costs down is to restrict or reduce payments to physicians and other health care providers, to the point where they have lost money relative to inflation over several years, or are actually losing money, i.e., operating at a loss, which they cannot sustain.

In some cases, what happens is that private insurance providers are charged much, much more than Medicare, in part to recoup money lost from Medicare underpayment.

This in turn has led Medicare to shift costs onto the private sector, and in at least one case recently, has extended the period of private insurance coverage for something before Medicare pays for it. The insurers and large employers hate it, the providers and presumably those in the federal government love it; the difference in what is charged is on the order of 2-3 times for insurers what Medicare pays ($120,000-180,000 annually vs. about $60,000). You can read about this example here.

The methods that will decrease waste, fraud and error in socialized medicine are the same methods that will work to do so in privatized medicine. Greed goes where money flows; it’s not choosy about the political ambience.

In medicine, like in any other area of public concern, there is a distinct difference in how the mission is defined. If public service is the mission, the goals and implementation will be decidedly different than if profit is the mission.

Choosing profits as the mission has both a positive and a negaive impact. Competing for profit may spur competition and consequent improvement in the final priduct. On the other hand, it can make all sorts of collusion attractive for the sake of increasing profit.

The business model across the board has changed in that serving the community (consumers) used to be part of the definition of doing business but is so no longer.
In areas like news coverage and medicine, serving the community as the mission simply can not be discarded without incurring drastic consequences.

The claim that free markets haven’t worked because they haven’t been given the chance to be really free is inapplicable when public service is at stake. Making choices in the provision and consumption of health care is not anything ike making decisions in offering and buying a washing machine.

From a pragmatic viewpoint, then, I like the socialized angle on health care because it will never abandon meeting public sevice obligations as the mission. Recognizing the need to deal with costs, however, I also recognize the need to utilize whatever is necessary and prudent from the business world to accomplish the goals.

I wouldn’t expect any system to be perfect, as perfection is possible only in paradise. I would expect any system to be followed carefully and to be adjusted accordintgly when problems rise to the surface.

Pew (from Stateline) has a new report about California and health care here.

… The sheer size of California and its volume of uninsured – who outnumber the entire population of Massachusetts – plus the state’s and governor’s political clout could help rev up the momentum for health-reform discussion at the national level, said Drew Altman, head of the Henry J. Kaiser Family Foundation, a nonprofit group that conducts national health-policy research. Health care already is emerging as a major issue in the 2008 presidential election. …

The US is the only health care system without socialized medicine in the West. But corruption and antiquated technology are bigger problem.

Actually, we do have socialized medicine already, for the elderly (and some for the poor as well). That is a fact even if health care providers remain at least nominally private (as they would under the Conyers-Kucinich “Medicare for All” scheme).

Right, corruption is outside (beyond) the scope merely of Medicare (and Medicaid). Technology, I wouldn’t view as a panacea. What I would concentrate on would be the relatively low overhead of Medicare and a potentially great reduction in complexity, not to mention ending problems with delay or refusal of insurance companies to pay claims if Medicare were extended to everybody. The Medicare bureaucracy is large and cumbersome, but the insurance companies are cutting their own throats by deliberately making it complex and difficult to get claims paid, each company having a different system to some extent (a single system, even using “old” tech, is better than multiple all-new systems), all playing games with claims.

To the extent we’d be switching from private insurance (a false name; normally it is pre-paid health care, not true insurance) to Medicare, we would exchange one set of problems for another (including more Medicare fraud), but given the problems with the insurance-HMO-based private system, a conversion to Medicare might appeal to many (at least one’s health care would be paid for fairly promptly, one would hope). Ten years ago the thought of extending Medicare to everyone would have still been radical, truly extremist, and even silly; nowadays that is a mainstream and even a common thought. “It’s not just Conyers and Kucinich,” even if their plan has some radical elements that disqualify it from serious consideration. (Forcing all medicine to go public non-profit without compensating for 20-30 years’ lost profits [growing annually] is obviously an unconstitutional seizure, a confiscation, i.e., government theft, for example.)

The November 1999 report recommends that automated drug-ordering systems can effectively reduce the number of medication errors and deaths.

The above report is eight years old, why the wait to change an antiquated system?

The Wingnuts want a national ID supplies bu MC or Fedex, I want my doctor using something better than a Commodore 64, if they are even using that. I have personal knowledge in regards to the following.
http://www.roboticsonline.com/public/articles/archivedetails.cfm?id=1663
http://henryfordmacomb.com/body.cfm?id=48365
http://www.zoominfo.com/people/Harrington_Steven_93694170.aspx
If the Internets exploded in 10 years, whats wrong with medicine? Politics is the least of medical problems.

Just looking for a moment at something notorious in Medicare, EPO (the red-blood-cell-boosting drug used by dialysis and cancer patients and also abused by athletes), what we have includes: a) a long-established monopoly provider of the original drug; b) “rebates” to users of the drug for purchasing it. This encompasses activities outside the strictly-defined public sector, i.e., Medicare or Medicaid.

Another abuse is self-referral, referral of patients to facilities owned by the physicians themselves. In past years there were problems with home health care companies, and nowadays you probably know about the problems with imaging centers as well as clinical laboratories.

(Then there is the practice of markup on tests that are done by different people altogether.)

Health Net and other insurers are in the news for illegitimate rescissions of insurance policies to those who become sick.

The scope obviously goes beyond the public sector. But Medicare fraud is a fact, and of course Medicare is not “saving us from socialism” but instead is socialism.

Computerized prescription system reduces errors caused by bad handwriting

Rush-Presbyterian-St. Luke’s Medical Center a Leader by Implementing Physician Order Entry System

According to the Institute of Medicine (IOM) report “To Err is Human: Building a Better Health System,” medication errors account for 7,000 deaths annually in the United States. The November 1999 report recommends that automated drug-ordering systems can effectively reduce the number of medication errors and deaths.

One hospital in Chicago, Rush-Presbyterian-St. Luke’s Medical Center, has been methodically implementing such a system since 1993. Most of Rush’s medical center will be using it by the end of the year.

“It’s great that the IOM recommends automation for drug ordering,” said Dr. John H. Brill, medical director of information services at Rush. “But if a hospital were to begin installing an automated system after the IOM report was released, it would still take years to complete.”

Automation and IMS could save lives and maybe help against malpractise, but may in medicine are dragging their feet. The cutting edge in heart surgery now uses robots. Yet, paper office records are handled by teen agers making just over minimum wage…

The announcement is part of the government’s push to have “most” doctors on EMRs (or EHRs) by 2014. The extra money is meant to help pay the cost of computing.

Hospital bureaucrats at an Health and Human Services event all predicted the move will spur adoption of technology by small doctors’ offices.

The government says the main problem is that insurers and employers are capturing the benefits of electronic records while doctors and patients pay the bills.

The government estimates only 10% of medical offices and 5% of solo practitioners have installed electronic records. This doesn’t count those who installed systems which didn’t work, or which failed to keep up with new equipment.

The enormity of the task ahead can also be seen in news that the Department of Defense and Veterans Administration are just now starting to integrate their own electronic health records. A private report on how to do it is expected next year.

7-11 and WalMart are using barcodes and moving to RFID tags to fully automate inventory at their stores. Notice how grocery stores use barcodes/lasers, do you think the old paper system was cost effective compared to laptops, hand-help PA and wireless networks. If A&P can track a dozen eggs throughout the system, why doesn’t the medical field follow suit. Does Brown and FedEx carry around catalog’s /reams of paper to tract shipment?

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Also, like Rudi points out, elective cosmetic surgery should not be acceptied as part of regular health care.

Re law suits, I agree that they have to be reigned in with award limits and other guidelines. However, I would definitely not go so far as to call all lawsuits frivolous. There are too many mistakes, and those responsible should be held accountable. There is too much of a buddy system in health care, where professional loyalty among peers trumps personal responsibility. There must be a rational middle ground, where a broken finger nail is treated differenrly than the amputation of the wrong limb.

Wasted, as well as stolen, money is the name of the game in every department and every program.
While this kind of article usually elicits the ‘big governemtn’ mantra, greed and irresponsibility will surface under any system with impunity.

The reaction to exposes like this is usually only about 5 minutes of dismay and tut-tutteing.