Save a Trillion on Health Care—It’s not only feasible, it’s easy

Victor Fuchs tells us how to save a trillion on health care……by doing what other countries have done.

Americans spend more than 17 percent of GDP on health care; other high income industrial democracies spend only about 11 percent. The 6 percent difference in our $17 trillion economy amounts to $1 trillion..

The excess in the United States is primarily attributable to a more expensive mix of procedures and services, higher prices paid to drug companies and physicians, and inefficiencies in the financing of health care. There are undoubtedly cultural differences between the United States and other countries, but it is also true that Swedes differ from Italians, Germans from French, and the English from all of the above.

Read the article.

Medicynical Note:  Essentially we need to change from a revenue generating system to a health care system.  It’s that easy. 

In the U.S. at every level the emphasis is on increasing revenue rather than improving health care, even with the advent of health reform.  We overuse, over prescribe and over charge without any brake on expenditures.  To gain control and assure access and quality we have to figure out the riddle—most other countries have figured it out.  I’m not optimistic we that we can do it because of our religious-like dogged devotion to failed approaches. 

Health Care in France: Expensive takes on a new meaning

An American in Paris becomes pregnant and encounters a “socialized” health care system.  Does she survive?  Are there “death panels?”  Oh the horror.   Read here

Medicynical note:  Expensive is relative and the U.S. is relatively the most expensive.  No other country is close.  

We also have a large uninsured population now decreasing no thanks to our repub friends.  We also lead the industrialized world in that dubious category.  

The best healthcare system in the world?  Not us.

American Health Care: It’s the Money, Stupid

American health care is the best  i.e. the most expensive in the world:  See this to get an idea of the problem:

According to his bill, the hospital charged $81,000 for a four-vial dose of the medication.

Shocked at the price tag, Ferguson told the Charlotte Observer he and his wife found the same vials online for retail prices as low as $750.

Medicynical Note:  Health care value is an oxymoron in the U.S.  To these “providers” it’s the money that counts.

Quality, cost efficiency, access, good outcomes are not their primary issues. 

Health Care: It’s about the money, again

Hospital systems just can’t resist the temptation to maximize revenue and profits.    Another example of this was cited in the NY Times “Hospital Chain said to Scheme to Inflate Bills”

In the the article:

Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.

The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that Health Management Associates, a for-profit hospital chain based in Naples, Fla., kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital.

Read the article for the details.

Medicynical Note:  This is not much different than the common practice of having multiple levels of fees for services provided.  For insurers there are discounts sometimes exceeding 50% while individuals without insurance are charged the full rate.  

Going to the hospital is increasingly like going to a used car dealer (no offense intended).  Prices aren’t what they seem; you need to bargain hard for the best deal and yes and scamming the customer) and system)  seems to be a problem. 

Oh yes, did I mention health care value, quality and access……….not really a prime concern.

Hospital mergers: Not Good for the System or the Patient

Published in The Systhesis Project published by Robert Wood Johnson Foundation:

Hospital consolidation generally results in higher prices. This is true across geographic markets and different data sources. When hospitals merge in already concentrated markets, the price increase can be dramatic, often exceeding 20 percent.

Hospital competition improves quality of care. This is true under both administered price systems, such as Medicare and the English National Health Service, and market determined pricing such as the private health insurance market. The evidence is more mixed from studies of market determined systems, however.

Physician-hospital consolidation has not led to either improved quality or reduced costs. Studies find that consolidation was primarily for the purpose of enhanced bargaining power with payers, and hence did not lead to true integration. Consolidation without integration does not lead to enhanced performance.

Medicynical Note:  So consolidation costs more and doesn’t improve  care.  It also decreases choice, for example as when a religious based “Health”system dominates an area.  Not good. 

Vitamins—Triumph of hype over reason, but, then again, who needs facts

The medical industrial complex excels at creating disease states and then marketing “cures.”  The use of vitamins has been a recommendation for years for problems as disparate as  the common cold and cancer.  But always with the promise that it will do no harm….except to your pocketbook.

The some is good means that more must be better mentality (even with no evidence of either) has reigned for the last 60 or so years, particularly when one talks vitamins.  Megavits, vitamin C for what ails you, vitamins for the well nourished…..all are marketing triumphs.  It’s dubious that demand for them will change, even the  news that they do no good and indeed in some people may cause harm .

Multiple sources (here, here) quote the Annals of Internal Medicine study and editorialA review of vitamin use was published in the NY Times last June.

Medicynical Note:  I don’t think for one second that facts will alter America’s desire to do something, anything, even if it does nothing.

Hospital Costs: The ER Visit

We’ve talked about America’s high costs.  One reason is our overuse of ER’s for outpatient care.

The medical mafia makes a big deal about the “sacred” patient doctor relationship.  My experience the past several years is that first, there is nothing sacred going on here and second that the relationship is a somewhat romantic figment of our imagination–it no longer exists.

You realize, of course, that the solo practitioner has gone the way of dinosaurs.  For virtually everyone your family doctor (of one sort or another) is part of a group practice.  When you become ill more often than not you family doc, the guy/gal you have the sacred relationship with, is normally fully booked and you see another practitioner/nurse/physicians’ assistant.  Your doc may or may not even be aware that you have had a problem.  If you are hospitalized your care is turned over to yet another provider, the hospitalist.  Another doctor you have never met.

It’s even worse than implied above.  If you should have an emergency of one sort or another, real or not so real, you are advised to go to  the ER.  That shifts the responsibility for your care elsewhere and quite remarkably escalates our costs to unimaginable levels.  The “sacred” relationship is nowhere to be found.

Elizabeth Rosenthal of the NY Times discusses ER costs here.

A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.

Medicynical Note: Read the article for the gory details.  But it is a fact that hospitals like other players in the health care game have little to no interest in fostering efficiency and cost savings–except to benefit their bottom line.  In regard to patient’s charges, their goal is to maximize them.  They inflate their charges to unimaginable levels then cut deals with high volume insurers.  Should you be uninsured they will  stick you with the full non-discounted amount.  To the little guy it’s as confusing as dealing with a used care dealer (no insult intended) and is nothing more than a legalized scam.  Horrifying as it is, that’s what’s become of my profession and American medicine. 

Health reform while not perfect is a start on rationalizing costs, providing universal coverage, and opening up the mystery of health care costs.