New Ideas About Healthcare Reform
Well, they’re not exactly new ideas. They’re new to me. More importantly, they’re ideas that didn’t seem to make the cut for either Democratic or Republican talking points. Which doesn’t mean they’re good ideas, but at least they’re thought provoking. (Hat tip: david1clark)
In June, New Yorker correspondent and practicing physician Atul Gawande profiled the town of McAllen, Texas, which has the honor of having the highest Medicare cost per patient in the nation. Healthcare costs are so high in McAllen because doctors there prescribe so many more tests and procedures (although there is no evidence this translates into additional health for their patients).
That’s interesting, because neither party seems to be saying that the problem in America is that we get too much healthcare. The President says he will save hundreds of billions by eliminating waste and fraud, not by limiting treatement.
Why are doctors so interventionist in McAllen? In one word, the answer is capitalism. Doctors in McAllen have quite an entrepreneurial streak and seem to be interested in making as much money as possible. In other words, Gawande thinks President Obama may have been onto something when he suggested that doctors remove kids’ tonsils just to make money.
Going further, Gawande argues that paying doctors by the procedure is why costs are out of control throughout the country, not just in McAllen. At the world-famous Mayo Clinic, which pays its doctors a salary, costs remain low even though the care is the best in the world.
Would it be so easy to duplicate that achievement on a national level? I don’t know. Is it possible that doctors everywhere are too interested in money? I’m skeptical. None of my friends who’ve gone to medical are in it for the money. But misaligned incentives can lead good people to make bad decisions. Color me curious.
Cross-posted at Conventional Folly
12 Responses to “New Ideas About Healthcare Reform”
We know it can be done, the rest of the modern world has already done it. It's just a matter of eliminating the false propaganda emanating from paid media propagandists spreading lies to the gullible.
I suggest publicly caning Rush Limbaugh as a start.
It's OUR (myself included) basic overall ignorance as to what it REALLY costs and what REALLY happens in countries that have “Single Payer” “Universal” health plans that have lead us to emotional rather than reasoned positions on Health Care Reform in the United States.
So I went to both the British and Canadian Health Services Home Pages to see what they were doing, I was pleasantly surprised.
Here's links to their home pages:
British NHS Website: http://www.nhs.uk/Pages/HomePage.aspx
HealthCanada Website: http://www.hc-sc.gc.ca/index-eng.php
To compare the information provided up front and no charge assistance given to this 'yank' I decided to compare them to three major US Health Providers.
Here's links to their home pages:
Kaiser Permanente: https://www.kaiserpermanente.org
CIGNA: http://www.cigna.com/
Blue Cross / Blue Shield: http://www.bcbs.com/
The information I was able (or not able) to obtain from these links have reinforced SOME of my old opinions… though I've come to a FEW new ones in the process, too.
—————————————
Additionally we all have preconceived ideas as to whether or not “Single Payer” “Universal” health plans would require more or less of the Federal Budget (more or less of OUR money) so I checked into what percentage of the overall budget is being spent on Health Care in Canada versus what is being spent in the United States.
Canada
2008 National Defense = 10.2%
2008 National Health Care = 9.4%
http://www.fin.gc.ca/afr-rfa/2008/afr2008_1-eng…
United States
2008 National Defense = 21%
2008 Medicare / Medicaid = 23%
http://upload.wikimedia.org/wikipedia/en/7/7a/U…
Wait times for surgery in Canada at all-time high: study
http://www.cbc.ca/health/story/2007/10/15/waitt…
<snip>
The 2007 survey found the total median waiting time for patients between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, increased to 18.3 weeks from 17.8 weeks observed in 2006. This was primarily due to an increase in the first waiting period, between seeing the general practitioner and attending a consultation with a specialist.
The Gawande article has been around a while. The question is how to doctors to quit doing so many procedures. I think there are three keys:
1. reduce the disparity between cognitive and procedural services, ie pay doctors as much to think and counsel as you do to do procedures.
2. tort reform to reduce the procedures done to “cover your butt”.
3. change patient expectations to be more accepting of less procedures, less labs, X-rays, MRIs, etc. This will be much tougher than the first two – look how the end-of-life counseling went over.
There are many other possibilities but those would be a start.
David, to respond to your comment about how many doctors are in it for the money I think most doctors want to make money but most also behave themselves. There are more than a few doctors though that will do every test and procedure they can think of if they can make a buck. I've worked in the medical field a long time and I could sure tell some stories. Often patients are very happy with these doctors since they think they're being “thorough”.
Well Leonidas, The New England Journal of Medicine sees it a little differently: Waiting Times for Knee-Replacement Surgery in the United States and Ontario
But who are they… and what do they think they know, eh?
Lets see your study says:
” The median waiting time for an initial consultation was two weeks in the United States and four weeks in Ontario “
and
” The median waiting time for knee replacement from the time surgery was planned was three weeks in the United States and eight weeks in Ontario”
5 weeks in the US vs 12 weeks in Ontario
Now is Ontario representative of Canada? well what did my linked article say?
http://www.cbc.ca/health/story/2007/10/15/waitt…
<snip>
“Ontario recorded the shortest waiting time overall (the wait between visiting a general practitioner and receiving treatment) at 15.0 weeks, followed by British Columbia (19.0 weeks) and Quebec (19.4 weeks). Saskatchewan (27.2 weeks), New Brunswick (25.2 weeks) and Nova Scotia (24.8 weeks) recorded the longest waits in Canada.”
So, looks like you took the best of Canada and it still took 2.4 times as long as the US states it was compared to. Gee would you want to wait an extra two months for a knee replacement?
I'm not sure how responsive our nation's doctors will be to a “only do what you know is totally necessary” policy. How can you possibly legislate something like this? The whole argument is founded upon a generalization; I'm actually curious as to how you might enact this type of policy.
This article actually scratches the surface of a question that I've always had about the administration's proposed system for healthcare reform. What kind of treatment is included? In addition to that, what type of premiums will we be facing? All this talk of “good, affordable treatment” tells me nothing. Maybe someone on here knows those answers?
I still like your idea, and like the approach you take. It's just a shame that it has little realistic potential for development into anything more than an idea (and I mean that sincerely).
“Why are doctors so interventionist in McAllen? In one word, the answer is capitalism.”
No, Medicare-funded waste is not an example of capitalism in action, it's an example of single-payer inaction.
There's nothing wrong with doctors, even doctors with personal financial goals. But you're absolutely right that incentives need to be properly aligned, that someone has to be watching that what's being delivered is worth the money. It's a great New Yorker piece, and it catches Medicare asleep at the checkbook, blithely spending billions of other people's money without even bothering to mention to the McAllen hospitals that they seemed to be charging an awful lot.
It wouldn't be hard to expand the co-op model nationally, and it's a shame the health care power brokers currently in charge (private insurers and the government) haven't done so already. The first obvious step: throw the bums out, and give power to someone who will actually care about value for money.
Well OF COURSE the elimination of waste is one reason why they're against it! I've been saying this entire time that the big groups opposing were more interested in their bottom line than in actual care. (And if doctors really are providing unneeded treatments or surgeries, then yes, it can do more harm than good.)
Take for example the guy who founded Conservatives for Patients' Rights (CPR). (They're behind most of the astroturfing, and while that's not saying that ALL the shouting in town halls has been this group, this group did in fact organize a fair amount. They also plan more of the same in response to a Democratic push back to their strategy, according to an internal memo.) Richard Scott has quite an interesting history in the health care industry that is very focused on bottom line. And he was ousted from a health care company in 1997 as they pled guilty to fraud which included overbilling state and federal health care programs. So yeah, considering his history, of course he's going to be firmly against anything that will affect his bottom line– and without any interest in actual CARE.
Interestingly enough, I'd mentioned somewhere before that the last time I saw so much fact checking on a group, it was Swift Boat Veterans for Truth. Turns out that the two groups are actually related, as both are clients of the CRC public relations group.
Leonidas, the article you showed is from 2007, and the Canadian government has vastly improved since then. In other news, I'm still wondering if waiting for a surgery is so bad when under the private system many people wouldn't even qualify to have the surgery at all. Meanwhile, I have to schedule a visit with my dentist 4 months ahead of time, my pediatrician 2 months ahead, my primary care 4 months ahead, and my OB/GYN 5 months ahead. Those are just routine checkups, mind you. I shudder to think what I'd have to wait for surgery, should I need it.
The other day, I received an interesting and very instructive e-mail from my brother Jeff who lives in France. He asked me to share it with the readers of my blog. I think I shall also share it with you
“As an American who has been living in Europe for most of the last 20 years, one who has visited doctors numerous times in four different countries, whose two children were brought into this world in European hospitals (France and England), who has himself spent a week in a public British hospital, and who underwent an operation in a private British clinic, I think I can say a thing or two about health care in Europe.
“Our out of pocket expenses for the births? Zero, even though in France my wife spent 5 days in the hospital after the birth, which is standard, by the way.
“During the three years we lived in England, we never once paid for medicine for our children. Children get drugs for free in the UK. Visits to the GP are free for everybody.
“My expenses for the week in the NHS hospital? Zero.
“The cost of the operation in the private clinic? Zero, it was covered by my work insurance, as was the post-op physical therapy I needed.
“In Western Europe you would never be forced to sell your home in order to pay for your medical bills, as happens all too often in America when catastrophic illness strikes and the insurance company decides that your condition was ‘pre-existing’.
“The quality of the care? Mostly good. French hospitals are excellent, even the food is decent. The food at the NHS hospital was beyond awful, but then again most English food is pretty bad (though they do have great Indian food). At night, they were understaffed, but I am guessing that, apart from that place where Dr. House works, most American hospitals are understaffed at night, too.
“In short, in the US, you pay more, get less, and die younger than we do in Europe. What part of that don’t you understand?
“My fellow Americans, you have nothing to fear except those who would use fear to keep you enslaved to the myth of the might of the American health care system.”
Jeff Degan
What can I tell you? The guy is a Communist. Not only does he live in France, he actually likes it there. An eternal shame to our family's good name. Let us boil down his seven paragraphs to their juicy essentials, shall we?
HEALTH CARE IN THIS COUNTRY STINKS.
Here is (Excuse me, I meant to say, “Here was“) a golden opportunity for real reform and the idiotic Americans are screaming about socialism. Is it any wonder that we have become the laughingstock of the Western world?
http://www.tomdegan.blogspot.com
Tom Degan
Goshen, NY
Almoderate
” Leonidas, the article you showed is from 2007, and the Canadian government has vastly improved since then.”
fair enough, can you point to more recent figures than provided on the official government site to back this claim?
“neither party seems to be saying that the problem in America is that we get too much healthcare”
False. This was the _specific_ reason that some in Congress (and in the Obama administration), who otherwise say we don't get enough health care, want to tax the costliest (and most care-providing) employment health care insurance (care) plans. “Too much health care” or “overuse of services” (the favored phrase the Dems have been using), etc., whatever you want to call it, while saying otherwise the problem is not enough, or inability to get, health care.
(as also will be the case in “futile” circumstances involving the elderly, a common rational concern so many have — related to this is other things the elderly are worried about facing, such as this:)
http://online.wsj.com/article/SB200014240529702…
Nobody intelligent believes what the Dems are telling people, not about this any more than about the magic “savings” that will happen with Medicare and reduction and elimination of the fluffy “waste, fraud, and abuse” (while looting $500B from Medicare to “pay for” the new effort)