With so much of the fight over health care reform now coming down to issues of health care cost containment, it's a pretty good time to take a look at the available evidence about where our system seems to "over-price" care as opposed to other countries.
TDS Co-Editor William Galston did a fascinating piece for The New Republic last week detailing the results of a McKinsey & Company study comparing health care spending patterns in the U.S. to those of other OECD (i.e., advanced) countries. Unsurprisingly, the U.S. has higher costs (about $2,000 per capita higher each year) and poorer health outcomes, and not because we are unhealthier to begin with.
One of the differential costs factors is pretty well known: Rx drug prices in the U.S. are on average 50 percent higher than in other OECD countries, and it's attributable to marketing expenditures, not just R&D.
But two other factors are less well known:
* Much of the spending gap is attributable to the soaring use of out-patient services, which generate much higher profit margins than do hospital-based services. The ability of physicians to control the number of procedures patients receive drives up costs, and physicians’ ownership of testing facilities and ambulatory surgical clinics give them an incentive to drive up utilization.... * Generous physician compensation also contributes to higher costs. On average, U.S. general physicians earn 4.1 times per capita GDP, compared with the OECD average of 2.8 times. For specialists, the gap was even greater: 6.5 times per capita GDP, compared with 3.9 times elsewhere. McKinsey finds that higher than average physician incomes added $64 billion to total U.S. health care expenditures in 2006.This has two big policy implications: the first is that there is indeed a tension between cost containment and the well-known desire of Americans to let physicians call most of the shots in terms of tests and treatments. The second is that the President is right in claiming that there are often less expensive ways of delivering quality health care, and that insisting on them is not, as conservatives so often argue, a form of "rationing."
Still another important McKinsey finding is that cost-shifting from public to private insurance programs is in fact a significant problem in the growth of private health care costs. This is important in terms of proposed changes in Medicare and Medicaid reimbursement policies, and in the design of any "public option."
Here's Galston's bottom line:
[W]e must look for ways of cutting the link between physicians’ earnings and the multiplication of high-cost procedures. Eliminating the loopholes in laws preventing physicians from owning test facilities would be a good start, as would reducing the compensation for high-tech tests to more reasonable levels. In the long run, fee-for-service is an unsustainable model of physician compensation, and health insurance reform should create incentives to move away from it.We also need ways of exposing consumers more fully to the cost of the services they want without discouraging them from using the services they need. One strategy is to focus insurance coverage more on truly insurable events--the big-ticket medical events that can disrupt lives and bankrupt families--and less on routine medical expenditures and elective procedures. It should be possible to protect average families from spending an unaffordable share of their income on health care without entirely eliminating their awareness of trade-offs and costs.
Unfortunately, identifying unnecessary costs and then overcoming the institutional resistance to steps to reign them in, tough as that is, may not be enough in the current political climate. There's also the problem of getting official recognition of costs savings--particularly by the Congressional Budget Office, which refuses to "score" some of the most fundamental structural changes as big cost-savers because, well, they haven't been tried before.
And that's why despite the understandable obsession with cost containment and the associated issue of covering the uninsured, we must continue paying attention to the third item on the health care reform agenda aside from cost and acces--health care quality. What we are buying for our dollars is as important as the price, and may well determine whether universal health coverage can achieve a more effective health care system both for individuals and for the country. And if we don't pay attention to quality, then health care reform could be caught up in a destructive triage between cost and access factors that pit the insured against the uninsured with no common higher ground.
Wednesday, July 29, 2009
Health Care in America
Friday, April 24, 2009
Health Care Reform
From the Kaiser Health Tracking Poll:
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Overall, six in ten (59 percent) say they have taken at least one of seven steps to delay or skip care this past year. Most common was relying on home remedies or over the counter drugs rather than consulting a physician, which 42 percent report, followed by skipping dental care. Three in ten reported not filling a prescription.
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Overall, one in four Americans (26 percent) say someone in their household has had trouble paying medical bills over the course of the past year. But in lower income households or households without insurance coverage, these problems are even more frequent, affecting upwards of four in ten Americans (43 percent and 46 percent, respectively).
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A majority of Americans (59 percent) continue to say that economic challenges make it more important than ever to take on health care reform now, while 37 percent say we can’t afford to tackle reform at this point.
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A majority of Democrats (77 percent) and independents (56 percent) saying we need health care reform now, and a majority of Republicans saying now is not the right time (57 percent).
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A majority of Americans (56 percent) believe that the country would be better off if Congress and the president do pass health care reform. Overall, 43 percent believe their own family would be better off, while 36 percent say it wouldn’t affect them and 14 percent say they would be worse off.
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Topping the list in terms of popularity are a Medicare buy-in for those aged 55 to 64. Overall, just over half of Americans (53 percent) “strongly” support such a proposal and an additional 26 percent say they support it somewhat, totaling 79 percent backing. There is similar support for expanding state government programs for low income people, and just slightly less for individual and employer mandates.
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57 percent of Americans say that having private insurance companies compete both with each other and with a public plan would be a better way of encouraging the private sector to “provide the best product for the lowest price.” Roughly a third (35 percent) say that private sector competition alone would provide a superior product.
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Currently, however, 67 percent of Americans are favorably disposed to a public health insurance option. It’s worth noting, however, that only half of this support – 34 percent overall – comes from those who say they are strongly committed to the concept. Support for the idea remained equally high (an identical 67 percent) when a separate sample was asked a version of the question that included the words “government-administered” in describing the plan.
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Currently seven in ten support increasing taxes on families making more than $250,000 per year, nearly the identical proportion who supported this proposal last December. There is no such widespread support for raising income taxes more generally, however. Overall, only 28 percent would support increasing income taxes for all taxpayers. Fully half “strongly oppose” such a plan.
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Overall, six in ten say they would be in favor of raising taxes on “items that are thought to be unhealthy, such as soda, alcohol,junk food and cigarettes” when these items are presented as a group. Roughly four in ten say they “strongly support” this, with the rest of the backing coming from more lukewarm supporters. Though one argument against these sort of taxes tends to be that they hit lower income Americans harder, those with lower incomes are somewhat more likely to be strongly in favor of the tax. Overall, 68 percent of those in households making under $30,000 per year say they favor the tax, including 47 percent who strongly favor it, compared to 55 percent among those making more than $75,000 per year (35 percent strongly favoring).
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Though some have expressed interest in changing the tax treatment of employer-provided health insurance for those with the most generous benefits, this proposal is not currently popular with a majority of Americans. Overall, roughly four in ten (41 percent) back the idea, while 52 percent are opposed to this change in a current benefit. Those who currently have employer-sponsored health insurance are even more likely to oppose the proposal (33 percent favor, 62 percent oppose). Among this group, 38 percent say they believe they would qualify as having generous benefits and so be subject to the tax.
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Just over three in four Americans say the Medicare program is “very important” for the country as a whole, and just over half say it is very important for their own family. Seniors – who make up the bulk of current participants – are even more likely to say the program is important to them: nine in ten of those aged 65 and up say the program is important to them and their family, with nearly all of these (78 percent overall) calling it “very important.” Medicare is also viewed as particularly vital by those with fewer resources – fully 68 percent of those in households making less than $30,000 per year say Medicare is very important to them. It’s worth noting that the program is also viewed as very important by half (49 percent) of those making more middle class incomes ($30,000-75,000 per year)
For more go to Health Care for All
Wednesday, April 15, 2009
let the health care lies begin...
Astroturf campaign uses fake letters from senior citizens to push for Medicare Advantage.
The Eagle-Tribune reports that a lobbying group hired by America’s Health Insurance Plans, a trade group for insurance companies, is waging a pro-Medicare Advantage astroturf campaign. The Dewey Sqaure Group, a consulting group founded by Democratic operatives, sent letters to the editor purportedly written by seniors urging support of the costly private Medicare plans, which the Obama administration plans to eliminate. However, some of these seniors had never written any such letters; a few didn’t even know what Medicare Advantage was:
A letter supposedly from Ana Abascal of Lawrence said she “wanted to express how important my Medicare Advantage health plan is to me and other fixed-income seniors in my community.”
But when contacted by The Eagle-Tribune, Abascal was shocked and concerned to learn someone was using her name on a letter to the editor. She did not know what the Medicare Advantage plan was.
The Eagle-Tribune writes that the “tip off” to the fake campaign came when a man who turned out to be a Dewey intern called the paper to check if a letter from Gloria Gosselin had been published, falsely claiming to be Gosselin’s grandson. (HT: Romenesko)
Bookman on Health Care
Jay Bookman makes a great point... it falls in line with my quandry when debating true classical liberals--in the fact that political reality and their philosophical preferences run head long into one another...
Does the right to life include the right not to die?
Do people have a right to health care? That’s the crucial question — the question that resolves many lesser questions — in the ongoing debate over health care reform.
Personally, I’d say yes, of course people have a right to health care. Others argue no, they don’t.
When it comes down to it, though, I doubt most of the opponents really mean it. They may mean it in a political sense, in an ideological or theoretical sense. But they don’t mean it where it counts, in real life.
In real life, here’s how the question would be put: Are you willing to deny life-saving surgery to Mr. X, a father with two children, on grounds that he or she could not afford it? Would you allow Mr. X to die?
If your answer is yes, then you sincerely don’t believe people have a right to health care.
However, if your answer is no, you would not be willing to deny life-saving care to Mr. X, then at some level you do believe that access to health care is a right and the whole debate changes.
Having crossed the threshhold of whether to treat that person, the question becomes how. How will you pay for it? How will you provide it?
At the moment, we’re trying as a society to straddle the fence. We won’t insure the millions of uninsured, because we haven’t accepted that health care is a right. But we also won’t turn the uninsured away from the emergency room, because we actually sort of do believe that health care is a right.
As a consequence of that indecision, we provide health care to the uninsured in the most expensive, irrational and inefficient means possible. It’s a bad system for everybody involved.
Because we are going to end up paying to save that persons life, shouldn't we have some kind of system to fall back on to control costs? Only those who don't care about government spending would not care about controling those costs... (which would make the other insurance companies more competative as well...)
single payer system
A Victory for Media Activism
Single-payer healthcare has proven to work well in other countries. It has been proposed in a bill with considerable congressional support, it polls well with the public, and it's supported by a majority of physicians.
So why is it so rarely mentioned in corporate media?
In the wake of a Frontline documentary that failed to examine single-payer national healthcare system as a possible alternative to the U.S. healthcare system, even PBS's own ombud is asking the question.
Citing FAIR’s recent study, "Media Blackout on Single-Payer Health Insurance," which documented that single-payer advocates were all but shut out of the media discussion about healthcare reform, ombud Michael Getler stated:
I find myself in agreement with those who wrote initially and who felt it was a missed opportunity by Frontline to shed some light on where this specific idea--clearly telegraphed in the previous program about how other countries do it, enjoying some level of popular and professional support and formalized in a bill before Congress--stood in today's political environment.
The ombud's report marked a victory for media activists who wrote in to complain about the program in the wake of a critical article by Corporate Crime Reporter's Russell Mokhiber (founder of the website Single Payer Action) and a FAIR Action Alert.
FAIR had criticized the film for misrepresenting the findings of Frontline's earlier documentary, Sick Around the World, which had emphasized that other countries ban insurance companies from making a profit on basic care, and had discussed single-payer alternatives, including Taiwan's healthcare system.
The only alternative to the current U.S. healthcare system that was examined in any depth in Sick Around America was Massachusetts' system of mandating that people buy insurance from for-profit health insurance companies. The documentary implied that all developed countries that provide universal healthcare have similar systems.
I don't support single payer for many of the same reasons I didn't support imeaching Bush or Cheney... but as in that case if it came down to it I know which side I'd end up on. I just don't see it as productive politically speaking.... But I do believe single payer should be in the debate. Escpecially with how popular it is within this country.
Heritage on Health Care
Understanding the Uninsured Numbers
Moffit told the Des Moines Register: “The number of people who are persistently or chronically uninsured is relatively small.”
Moffit said many people lose insurance temporarily while they change jobs, but quickly regain it. That pattern has increased over time, as people began switching employers more frequently, he said.
The solution to this issue is to make the health insurance market more stable by changing tax laws to encourage Americans to buy their own insurance. Moffit explains in MedCity News:
Let’s tie health insurance to the person rather than the job … Rather than push for a nationalized health system or even a public health insurance plan that could crowd out the private insurance market, Americans should have the opportunity to own and control their health insurance.
Qua? Via the Famlies USA March Report
One in Three Uninsured: 2007-2008
- 86.7 million people under the age of 65 went without health insurance for some or all of the two-year period from 2007 to 2008.
- One out of three people (33.1 percent) under the age of 65 were uninsured for some or all of 2007-2008.
Number of Months Uninsured
- Of the 86.7 million uninsured individuals, three in five (60.2 percent) were uninsured for nine months or more. Nearly three-quarters (74.5 percent) were uninsured for six months or more.
- Among all people under the age of 65 who were uninsured in 2007-2008, one quarter (25.3 percent) were uninsured for the full 24 months during 2007-2008; 19.5 percent were uninsured for 13 to 23 months; 15.4 percent were uninsured for nine to 12 months; 14.3 percent were uninsured for six to eight months; and 20.1 percent were uninsured for three to five months. Only 5.4 percent were uninsured for two months or less.
Nine months or more is persistent enough...
Plus, here's a question. Doesn't one want to
a) cover as many people as one can
yet at the same time
b) do it for as cheap as possible
Why would I want to spend more money buying insurance on the open market for individuals, when I can group together with others to get a cheaper deal, with better coverage, and more bells and whistles?
How does one own and control ones own health insurance? If I buy from a private insurance company... someone is making cost cutting decisions that impact me. I don't get a direct line to the CEO.
What does it mean to control ones own health insurance, seriously... I'm wondering what that would look like, and can anyone show me a real life example of that?
I get it, Heritage supports spending lots of our nations wealth in the health care sector... but why do the rest of us care about proping up the health care industry?
Friday, April 10, 2009
Olympia Snowe and Susan Collins key to health care reform
If a health care bill passes this year, it will be because Olympia Snowe and Susan Collins like it a lot.
First-dollar coverage for lumberjacking industries? Super-cobra for workers laid off from their seasonal jobs tapping maple trees?
The Washington Monthly: If Democrats are going to need some Republican votes to pass a major health care reform initiative, it looks like they should start with Sen. Olympia Snowe (R) of Maine. Snowe hosted a "listening session" on health care reform this week and made it clear that she wants to support significant changes to the status quo. (thanks to reader A.F. for the tip)
Speaking to the members of the group before taking their testimony, Snowe, a senior member of the Senate Finance Committee, said the committee is determined to draft legislation by June and to have it ready for debate on the Senate floor by July. The last attempt to overhaul the nation's health care system was proposed in 1993 and dissolved in "polarization and partisanship," she noted. "I believe the climate in Washington is different now," Snowe said. Recognition is widespread that the nation's health care system is unsustainable, ineffective and inequitable, she said, and the current economic crisis is only making things worse. "This is precisely the right time" for national reform, Snowe said.
Snowe added that she expects to see a vote in the Senate before the end of this year.
"We have a totally dysfunctional system now," she said. While like most Republicans she would prefer to see the private sector collaborate on an effective change, a government-run health care system may be the only way to get the job done, she said. [emphasis added]
Now, that's obviously a paraphrase, not a direct quote. But if Snowe really said this -- the Bangor Daily News, which ran this report, has not run a correction -- it seems like a pretty encouraging development.
FAIR on PBS distorts health care
PBS Distorts Global Healthcare Options
A recent Frontline documentary (3/31/09) presented mandatory for-profit healthcare as the only alternative to the current U.S. healthcare system, suggesting that this was the system all other developed nations use--even though the documentary was a sequel to an earlier Frontline report (4/15/08) that examined a wide range of international options, including Taiwan's single-payer model.
If you'd like to ask Frontline why it distorted the healthcare policy options, you can take part in FAIR's Action Alert here. And you can leave copies of letters you send to Frontline in the comments of this post.
Obama is a "socialist" (in as big and scary of a voice as I can muster...)
Really Existing Socialism
Since 1989 American conservatives have been saying that European countries like France, Germany, Sweden, Britain, and Spain are "socialist." They are pretty nice places: lots of parks, lots of museums, good public transportation, no worries about being unable to pay for health care, good food, wine that approaches that of California, et cetera.
As a result, when you ask the young about "socialism" they think of wetern Europe--quite a change from the days when really existing socialism was East Germany or the Soviet Union.
Thursday, April 9, 2009
Ocean of debt
We need to worry about the deficits in 2015, 2020, 2025, and beyond--not about the deficits in 2009, 2010, and 2011...
The key to dealing with the deficits in 2015, 2020, 2025, and beyond is--you guessed it--health care. That is the entire ballgame...
[These] long-run deficits...are not much, much worse than they were in 2003--they are somewhat better. Obama has cut the long-run deficit. Bush boosted it. It remains a big problem--but it's not a problem of Clinton's or Obama's or Pelosi's or Reed's creation, it's a problem created by Bush and his cheerleaders
CEPR's done the leg work regarding this with their IOUSA Budget Deficit Calculator which:
allows you to see what the projected U.S. budget deficit would be, as a percentage of GDP, if the United States had the same per person health care costs as various other countries which enjoy longer life expectancies than the United States.
Its time we join the rest of the industrialized world and have some form of Universal Health Care reform--those who oppose competition in the marketplace, which would hurt the profits of insurance companies and help lower the costs for consumers--are the ones creating this long term crisis.
As if ranking 37th in the world for health care isn't bad enough for people... our kids are paying to subsidize private profits...
To see more on our progress in regards to the budget itself you can check out Congressional Budgets Pass Early Tests on Deficits and Economy, but Questions Remain from CBPP
On the whole, the budget plans that the House and Senate approved yesterday pass the twin tests of: (1) beginning to address long-term deficits, or at least not making these deficits worse; and (2) not undermining the fiscal stimulus Congress recently passed. [i] The Senate’s adoption, however, of amendments that are intended both to facilitate a further large tax cut for the estates of the nation’s wealthiest individuals and to make it less likely that Congress will allow the Bush tax cuts to expire for people at the top of the income scale suggests that significant dangers lie ahead. The adoption of these measures raises questions about Senators’ professed concerns about deficits and debt and about whether Congress has the fortitude to begin making hard choices.
Monday, April 6, 2009
competition is good for the marketplace
The Case For A Public Health Care Plan
Though President Obama and 73 percent of voters strongly support a new public health insurance plan that can compete with private insurers equally and transparently within an insurance exchange, some lawmakers have indicated that a public plan may not be part of the final reform legislation.
Friday, March 27, 2009
How many of the uninsured are U.S. citizens?
The "47 million uninsured" figure is from the 2006 U.S. Census Bureau report. In 2007, the Census Bureau reported that the number actually declined somewhat, to 45.7 million people under 65 (the age of Medicare eligibility).
Ever since health coverage became a major issue in the 2008 presidential campaign, we've received periodic questions from readers who wonder whether a large percentage of the uninsured are non-citizens or illegal immigrants. They're not. According to the nonpartisan Kaiser Family Foundation, 79 percent of the uninsured are native or naturalized U.S. citizens. The remaining 21 percent accounts for both legal and illegal immigrants.
Tuesday, March 17, 2009
Healthcare and Competitiveness
"Ultimately, what matters to firms is the compensation they pay workers. The composition of compensation between cash wages and fringe benefits like healthcare does not matter for the firms' costs of production. In short run when cash wages are sticky, the cost of healthcare may affect competitiveness: Lower costs of fringe benefits would reduce compensation and thus reduce firms' cost of production. But in the long run, compensation is set by supply and demand in labor markets. If more compensation is paid in the form of fringe benefits like healthcare, less is paid in the form of cash. And if less is paid in fringes, more is paid in wages.*
Let me put the point in the context of General Motors: If, for example, the U.S. taxpayer were to assume all the workers' healthcare costs through a policy of national health insurance, GM would immediately become more competitive. Because cash wages would not be immediately renegotiated, compensation paid by the firm would fall, so costs would fall. But in the longer run, the workers via their union would most likely not be satisfied seeing GM pay lower compensation, so cash wages would start rising. (Those higher wages would help workers pay the higher taxes that would be needed to finance the national health insurance). GM would lose the competitive advantage it temporarily enjoyed."
Monday, January 12, 2009
Health Care Crisis
Back in 2003, the Institute of Medicine of the National Academies concluded that the societal benefits of covering the uninsured "are likely greater than" the added costs to society. It also determined that the potential economic value from covering all Americans was between $65 billion and $130 billion a year. A more recent report, from the New America Foundation in 2008, reached a similar verdict: "The economic cost of failing to fix our broken health care system is greater than the upfront expense of comprehensive health reform. In 2006, our economy lost as much as $200 billion because of the poor health and shorter lifespan of the uninsured."
Tauzin cited a 2007 study by the Milken Institute, and funded by his organization, that found common chronic diseases had an impact on the U.S. economy, both in real dollars and lost productivity. The Milken study found that seven chronic diseases had a $1.3 trillion impact on the economy annually, with the majority of that figure, $1.1 trillion, in the form of lost productivity. The study didn't call for universal health care as a fix, and some of the diseases could be mitigated with public health measures even without addressing insurance. But the Milken report did say that improving people's health, by increasing prevention efforts and early intervention, and reducing obesity rates – all things that could come about with a solid health plan – would lower costs and boost workers' output.
The ad ends by saying that "quality, affordable health care" is "not just something we should do for America's families. It's something we must do for America's economy." Hours after the group launched the ad, Barack Obama mentioned health care in what was billed as a major speech on the economy, pushing for electronic medical records and echoing the words of Nielsen in saying that an investment in health care (along with energy and education) "will jump-start economic growth."
Thursday, January 8, 2009
Federal Budget
Rather than spending time trying to hammer out complex budget procedures of dubious merit and effectiveness, policymakers should focus on actual steps they can start taking to reduce projected deficits by slowing the growth of health care spending throughout the U.S. health care system while also reforming Medicare, closing the Social Security shortfall, and raising more revenue. While policymakers may not yet be ready to address such matters fully, they can begin by seeking “grand bargains” involving changes in both the big spending programs and taxes, including the changes suggested below. To be sure, some of these changes will be difficult to enact on their own. But, in the spirit of “shared sacrifice” as exemplified by the deficit‐reduction packages of 1990 and 1993, these measures may be achievable as part of overall deficit‐reduction packages. (Note: Not all signatories to this statement favor all of the following measures, but all favor at least a majority of them.)
• Adopting recommendations of Congress’ Medicare Payment Advisory Commission, which could generate substantial savings;
• Increasing the Medicare premiums that affluent beneficiaries pay;
• Instituting vigorous research programs to determine the comparative effectiveness of different health care treatments and procedures as well as what is causing the huge differences in health care costs across the country, and using the results as the basis for new policies to restrain health care costs without compromising health care quality;
• Curbing or eliminating outdated or unproductive tax expenditures;
• Switching to the Bureau of Labor Statistics’ alternative, more accurate Consumer Price Index in computing the annual cost‐of‐living adjustments in Social Security and other entitlement programs (while taking steps to shield low‐income and other vulnerable beneficiaries) and the annual inflation adjustments in the tax code;
• Reforming farm price supports; and
• Adhering to Pay‐As‐You‐Go rules for both increases in mandatory programs and tax cuts.
While, taken together, these proposals would have a substantial effect on future deficits, policymakers will need ultimately to enact more extensive measures to achieve long‐term fiscal sustainability.
Monday, December 22, 2008
health care crisis...
Today, CBO is releasing two volumes that focus on health care issues: Key Issues in Analyzing Major Health Insurance Proposals and Budget Options, Volume 1: Health Care. These two volumes build upon CBO’s previous analytical work on health insurance and health care financing issues and are intended to assist the Congress as it contemplates possible changes– both large and small– to federal health programs and the nation’s health insurance and health care systems. In keeping with CBO’s mandate to provide objective, impartial analysis, neither volume makes any recommendations
Wednesday, December 17, 2008
the auto industry crisis...
A shutdown would eliminate up to 3.3 million U.S. jobs within the next year in all 50 states and the District of Columbia. The loss of total state employment would be anywhere from 4.0% to 8.9% in Michigan, Indiana, Kentucky, Alabama, Tennessee, and Ohio (see Map). Traditional auto manufacturing states would certainly be hard hit, but Southern states—including the Carolinas, Mississippi, and Oklahoma—would be, too.What if we had just increased our mileage standards a long time ago? Might that have made our cars more appealing? Or what if we fixed the health care crisis--which is pulling not just the auto industry down (here too!), but other corporations, and our long term budget outlook itself.
But unions get the hit. Nice to have a fall guy.
Nothing like a little propaganda push
When supporters of President-elect Barack Obama hold house parties to discuss ways of fixing the health care system over the next two weeks, they may find some unexpected guests.
The health insurance industry is encouraging its employees and satisfied customers to attend. A trade group representing some of the nation’s largest health care businesses, including drug companies, is organizing several meetings. The American Medical Association and other medical societies are encouraging doctors to get involved.
Nothing like a little good old fashioned profit motive to bring more civic participation:
Insurers are also fighting Mr. Obama’s proposal to cut the Medicare payments they receive for providing comprehensive care to more than 10 million of the 44 million Medicare beneficiaries. Many independent studies have found that Medicare overpays the private plans.
Things I didn't know about Medicare
Go read The Evidence Gap in todays paper where a few other things pop up.
I'm botherd by things like using treatments that have been untested:
CyberKnife, made by Accuray of Sunnyvale, Calif., was allowed onto the market by the Food and Drug Administration in 1999 as a treatment for brain and spine tumors. Two years later the F.D.A. authorized it for use throughout the body. Accuray, as well as hospitals and clinics that operate the CyberKnife machines, which cost $3 million to $5 million, have been promoting their use on various cancers, including lung and pancreatic cancer — and, increasingly, prostate cancer.
According to Accuray, patients can get by on fewer treatments because the machines deliver highly focused beams of radiation at heavier doses than conventional systems. But some leading radiation oncologists worry that the cumulative radiation that CyberKnife delivers over a course of prostate treatments — ultimately lower than what patients would receive in standard therapy — is not adequate to treat the disease.
“They are basically pushing the envelope,” said Dr. William R. Lee, a radiation oncologist at Duke University. “If they’re right, it’s going to be an important advance. If they’re wrong, there’s a potential for a big downside.”
With about 80 patients studied under the regimen in published peer-reviewed research over five years, the results for CyberKnife are promising. Yet, because prostate cancer is frequently slow-growing, Dr. Lee argues that five-year data with so few patients may not be very meaningful. Others raise concerns that high daily doses may increase radiation side effects that can show up years after treatment.
The board of the radiation oncology society, the American Society for Therapeutic Radiology and Oncology, or Astro, has called CyberKnife promising, but raised questions this year about the evidence supporting its use in prostate cancer, saying “there is not sufficient or mature data to demonstrate equivalency to existing standard treatment modalities.”
Also I have a huge problem with selling a medical treatment to consumers directly:
Citing the variety of proven treatments for prostate cancer, one member of the Astro board, Dr. Louis Potters of North Shore-Long Island Jewish Health System, said that advertising CyberKnife directly to consumers could confuse patients, who have to choose the best treatment from an already bewildering array of options.They aren't exactly experts. And will often want more, wrong, or unproven treatments.
“Patients are becoming commodities and prostate cancer is the ultimate example,” Dr. Potters said.
Saturday, December 6, 2008
here's how the dodge works... and other tricks of the health care trade...
Waiting times: Here's how the dodge works: If you look at waiting times, you'll see that relatively few Americans wait more than four months for surgery, which helps folks claim that America doesn't ration care, and makes our system look pretty good on the waiting times metric. Here's what they don't tell you: When you look at who foregoes care, the international comparisons reverse themselves. About 23% of Americans report that they didn't receive care, or get a test due to cost. In Canada, that number is 5.5%.
Worse, the American number is understated, as in order to know you need a surgery or further care, you need to go for an initial appointment, and as it happens, many Americans -- including 36 percent below average income -- aren't even seeking that. And it's this group -- which is largely low-income, and I'd guess, largely urban -- who would, in another country, be experiencing terrific wait times. Here, they never get care at all. We call that "no wait" rather than infinite wait. The studies misleadingly write them out of the waiting statistics, making it look like America has low wait times when the relevant population is simply never getting care at all. But would you rather be the urban poor in London, who wait a year for a hip replacement, or the urban poor in America, who never get one?
So it's not good and it's not pleasant. Maybe it's cheap?
Canada: $3678
France: $3449
Germany: $3371
UK: $2760
USA: $6714
The difference between UK and America could buy every America 5.3 ounces of pure gold per year.
Value: Who has better outcomes is like Camry vs. Accord. Some things are better on one car, some things are worse. But if you paid 15,000 for your Camry, and I paid $22,000 for my Accord, then in fact the Camry is MUCH better.
So it's not cheap, and it's not pleasant, and it's not good. We may not agree on what reform looks like, but we should be able to agree that this is not acceptable. There is no defense for a system delivering such poor value.
Sidenote: The evidence seems to be that systems that spend $2,500 and systems that spend $7,000 give fairly similar results. More health care dollars does not bring you more health care results, and this is true across nations, but also across states (Minnesota v. Florida). Health care does not seem like a good place to overspend. We should probably err on the side of spending less, not more. Instead, we err on the side of spending much more.