Cost Control for Dummies – WSJ

Summary from National Center for Policy Analysis (as I don’t get the WSJ)
COST CONTROL FOR DUMMIES
[Source: Merrill Matthews, “Cost Control for Dummies,” Wall Street Journal, August 15, 2007.]
http://online.wsj.com/article/SB118714325206398102.html

Whenever the government controls prices, it arbitrarily determines who it will
pay, how much, and for what, explains Matthews.

Someone explain to me why this is seen as “arbitrary”? Are they tossing coins? As long as we can maintain an open debate about healthcare spending priorities, decisions will not be “arbitrary.” Though, I think , the definition of arbitrary for many, is that it didn’t go their way.

Cheers,

Most Canadians scoff at portrayal of their country as a health-care paradis

“When the government pays for healthcare, saving money is more important than saving lives. So bureaucrats have an incentive to delay – or deny – the introduction of new, costly drugs.”

The people who write this stuff are a.) not involved in healthcare (at least, not seeing actual patients in any meaningful way) and b.)must have the best G-D insurance in the world. The idea that the US would come out on top in an “anecdote-off” is laughable to all of us actually in healthcare. Our US bureaucrats in our wonderful private insurance industry would make most Soviet era bureaucrats blush.

But the key is this: when the government pays for healthcare, if they don’t cover what we demand, then that is a problem with the citizenry, not the bureaucrats, for not taking command of the situation. When we get to a single payer system, it will be up to us to be vigilant and oversee what is being done by our government. I know that is an odd concept to the Bushies, but that is how government needs to work. And, yet, I can guarantee that the Sally Pipes’ of this world will howl the loudest when money is being spent on Rituxan for someone other than her family member because it would then be “wasteful government spending”!

Cheers,

read more digg story

10 Questions: About Health Care – Couric & Co.

10 Questions: About Health Care – Couric & Co.

>>Expanding government control over the financing and delivery of medical services will guarantee even bigger bureaucracy,<< Not necessarily bigger, just different. Ask any healthcare provider or patient which bureaucracy they’d rather deal with, Medicare or a private insurer, and you’ll have your answer as to why this a bad argument for conservatives to make. We, the people, have control over our governement bureaucrats, we have none over the privateeers.

>> higher taxes,<< I know this is supposed to scare us (like invoking Castro), but the trade off is no health care premiums and higher salaries (as no more healthcare expenditures out of our total compensation). So, certainly, if this is done in a progressive manner, the top 5% may lose a little, but everyone else will be far better off.

>> and increasingly detailed regulations governing the delivery of care.<< I refer you back to my first comment.

>> Conservative candidates generally emphasize the need to re-energize the market<<
I’d say that the performance of the healthcare sector, particularly insurers and Pharma, suggest no lack of “energy.”

>> and make individuals and families the key decision-makers in the system.<< Amen to that, but the author must really live in an alternate universe if he thinks that will EVER happen with private insurers!

Postbulletin.com: If you want great care, don’t put government in charge – Wed, Aug 8, 2007

Postbulletin.com: If you want great care, don’t put government in charge – Wed, Aug 8, 2007

An op-ed from Grace-Marie Turner, president of the Galen Institute, which is funded in part by the pharmaceutical industry and medical industry, http://www.galen.org/.


Let’s take this apart line-by-line:

ALEXANDRIA, Va. — No one denies that America’s health sector faces problems. Costs continue to rise, and 45 million people lack insurance. Even worse, many politicians think they’ve discovered the cure in a single-payer system.
But that remedy would be worse than the disease. The government-dominated health systems of Europe and Canada are struggling with serious cost pressures, inefficient bureaucracies and unmet demands for more advanced medical care.


And of course, we have none of that here. I beleive her first sentence is about cost-pressures and unmet demands for care here in the US. She forgets by the time she got to the end of her thought, I guess. Perhaps she was trying to parse “advanced” medical care. If you want basic medical care and can’t afford it, that’s not our problem. And if she would like to get into a contest regarding inefficient bureaucracies and hold up private health insurance as the better system, she is truly clueless. The ignorance boggles the mind.

For the privilege of their supposedly “free” care, other countries pay much higher taxes. In 2005, taxes consumed 41 percent of GDP in Canada, 42 percent in Britain, and 51 percent in France, compared to 32 percent in the United States.


Yes, the $10-15K or so it costs to insure a family is sooo much better than higher taxes. Why do these people always ignore the cost of health insurance to employers, employees, the self-employed, the un-insured, the under-insured, etc.? Do they realize that cost to individuals becomes subsumed into taxes or some other finance mechanism? I pay less for insurance (or my employer can pay me more salary), and I pay some higher tax rate. I can live with this. And, depending upon your income, 10-20% higher taxes is a great bargain compared to $10K or more for insurance.

Single-payer systems invariably involve rationing. What good is free care if the government denies access to it?


Yes, clearly much better to have private insurers or economic circumstances ration it.
What good is the most advanced high tech medical care in the world if you can’t get it?

About 1 million people in the U.K. are on waiting lists for hospital care, including surgeries. And 200,000 more are waiting just to get on the waiting list.
Cancer patients in Britain have resorted to waging public relations campaigns because their government won’t pay for new medications for breast and kidney cancer.


Our waiting lists are nicely trimmed by leaving 1/6 of the population out of eligibility to even get into the queue. And if there were alarming statistics indicating a significant differnce in mortality in our favor in more than a few tiny niches, this might actually matter!! And if you can’t afford any medication at all beyond the $4 Wal-mart list, tough break, loser!

In Canada, the situation is no better. Long waiting lines lead to restricted access to care. There were 45 inpatient surgical procedures per 1,000 Canadians in 2003, compared to 88 in the United States. Canadians received only one-third as many MRI exams and half as many CT scans.


Again, if we could point to better outcomes, and if we didn’t ration so heavily by economics, this might be important. It is a minor concern, and if we were somehow limited in our choice of single-payer to either the Canadian system or nothing, it would only be slightly greater than a minor concern.

Meanwhile, patients in Sweden have been sent to veterinarians for diagnostic tests so the government could reduce waiting lists.


Same.


Proponents of a single-payer system argue that the United States would be different — that we could get all the money we need to finance universal health insurance by eliminating profit in the private health sector.
But that’s like trying to cure a disease with arsenic. Socializing our health-care system would mean that one-sixth of our economy would operate under different economic rules, with the government setting prices, allocating resources and deciding what medical care would be available to whom and when.


Seems to work everywhere else, apart from some issues that we should address as we move forward. But, as with all these pieces, invoking the socialism bogeyman is de rigeur. Because we all know how awful Medicare turned out. Those poor elderly bastards!

There is a better way.
We should embrace competition, not stifle it. We should reward innovators, risk-takers and entrepreneurs for providing faster, better, more affordable health care. And we should recognize that progress depends upon innovation and profit. The U.S. market already is pointing the way by responding to consumer demands for more convenient, more affordable health services.


Yes, this has worked out so well, hasn’t it?

Health plans increasingly are offering programs to help patients better manage chronic diseases like diabetes and heart problems that account for roughly 75 percent to 80 percent of our medical payments. The result: dramatic gains in lowering costs and improving healthy outcomes.
Small clinics are springing up in retail stores around the country, providing customers with easy access to nurses who treat common ailments like ear infections and poison ivy. These clinics cost less than a visit to the doctor or emergency room.


And yet, we still lag behind those poor suckers in almost every other country in the western world. They just don’t appreciate the sublime beauty of our system.

Competition is leading to more affordable prescription drugs.

And the new Medicare drug benefit shows how competition can lower costs and provide better benefits.
When the Part D program started in 2003, Congress estimated the drug benefit would cost beneficiaries an average of $37 a month. But because private drug plans compete to deliver the Medicare benefit, prices have been far lower than predicted. The average monthly cost of the standard benefit is just $22.


Hahahahahahahahahahahahahaha!

Coming in below cost is unprecedented for a government program –


and for non-government programs as well [DUH!]

– and it shows the government can lower prices by encouraging competition. It’s virtually the opposite of a single-payer system, in which governments shut out the private sector.
Rather than regressing to the failing systems of Europe –


Uh, they’re only “failing” directly depending upon the degree of underfunding. And, oh, yeah, they’re not failing: they’re doing bette than we are!!!

– with waiting lines and rationing — we must develop our own unique solution. Ultimately, that means embracing the truly American qualities of innovation and competition.

How embarrassing for her. But I’m sure she’s paid well for it.

Lebanon Daily News – When it’s free, health care really costs

Lebanon Daily News – When it’s free, health care really costs

Dismembering a typical philistine, pig-ignorant op-ed (apologies to John Cleese)

When it’s free, health care really costs
Editor:
Lebanon Daily News

The presidential candidates, the media and some local misguided souls have been turning up the rhetoric supporting universal or single-payer health care while cautiously avoiding the truth that such systems are simply socialized medicine.
Part I: Invoke socialism bogey-man. Betrays common ignorance of all right-wingers in not understanding the difference between ‘socialized medicine’ and single-payer systems. Also fails to understand that in the context of health-care, we all wish to have basic healthcare for ourselves, our families, and, I hope, if one claims some basic humanistic/Christian/Islamic/Jewish/Hindi/Buddhist/whatever qualities, for the ‘least among us.’ That means poor and lower income and those with previously diagnosed health conditions (for the empathy impaired).

Socialized medicine does not work anywhere.

Part II: Ignore all evidence to contrary of your opinion. Ignore OECD, Commonwealth fund, essentially all scientific literature on the topic.

It never has, and by it’s very structure, it never will. When I use the word “work,” I mean it in the context of providing what we have in the U.S. — the finest health care in the world.

Part II, again. Ignore all overwhelming evidence to the contrary. I’ll try to link back to evidence soon.

Hundreds of thousands of people come to our country for their health care every year because what they need is not available where they live.

I don’t think some Saudi and UAE princes count as hundreds of thousand. And they come for what is right about American medicine: the high tech, cutting edge care that cannot be BOUGHT elsewhere. That is, they can’t jump the line elsewhere, like they can here.

Certainly we have problems in our current system, but the problems are fixable if all the parties in the system will step up to their part of the problem. Some uninformed people cite the insurance companies as the single problem in our health-care system. While insurers certainly are a part of the problem, they are no more of a problem than are the providers themselves. The cost of repairing botched surgeries, medical errors, hospital-based infections, allowing medical providers who have lost their license in another state to be licensed in Pennsylvania, overutilization, underutilization and a general unwillingness to purge their ranks of known, bad providers, contributes as much or more to the cost of health care as does the “greedy” insurance industry, and every honest medical provider knows it. It’s time to stop the blame game and get on with solutions.

I’m an honest medical provider, and the writer is wrong. The litany he lists all need fixed, but will be much easier to fix in a properly funded single payer system. And, sorry, the for-profit system, the same unrestrained, repugnant greed-based system that led to Enron, Tyco, and a two billion dollar surplus for Highmark alone, is by far the biggest problem.

To cite the one-sided propaganda film “SiCKO”as beneficial because it stirs debate on health care is like endorsing communism because it will make our citizens more patriotic. It’s sicko logic.

SICKO showed some of the serious flaws in our system and showed some of the serious benefits to others. That really is the bottom line. I’ve been following the media coverage closeely, interviews with various experts, MM himself in interviews, etc. There are lots of complaints about what he “left out.” Well, it’s only a two hour movie and I think it is not his job nor his role to be the healthcare czar and review every nuance of healthcare here and abroad. He had a lot of points to make and he made them very well, very humorously and sometimes heart-breakingly poignantly. If you see it, you’ll know that he didn’t tell the downsides of universal access in other countries, but, frankly, as we healthcare providers know better than the average viewer, neither did he scratch the surface of the problems so widespread in our “system.” But he always says in interviews that of course other systems have problems. Our goal should be to take the best parts of each of those systems and craft an American system better than all the others. But, he makes no bones that this needs to be a single payer system at its core. He seems to have no bone to pick with physicians – he believes the focus of reform should be getting rid of private health insurance as we know it.

I urge everyone to see it. It engenders debate, not just about healthcare, but about who we are as a people. Are we, as Americans, about “me” or “we”? That really is the central question he asks.

For the truth about how socialized medicine does not work, go to http://www.fraserinstitute.ca/ and click on “health.” Several interesting reports are available online, but the report entitled “Paying More, Getting Less” is particularly revealing. The Fraser Institute is an independent Canadian research organization and is the only source of accurate statistics on wait times and the status of their failing system of health care.

The Fraser Institute is as reliable as the Cato Institute, the American Enterprise Institute and every other right-wing “think-tank” From Nick Scala, of Physicians for a National Health Plan ( pnhp.org)

“…data supplied by the Fraser Institute, an ultraconservative PR firm that masquerades as a legitimate research institution. Dr. Robert McMurtry, the Canadian orthopedic surgeon who is a former dean of a Canadian medical school and served on the national waiting times commission tells me that not even the right wing Canadians take them seriously. Their “scientific” method of determining wait times consists of bulk-mailing a list of pro-privatization physicians and asking them how long they think their patients will have to wait to see them. If they return the mailing they are entered in a drawing to win a $2,000 cash prize. It’s pathetic. Unsurprisingly, Fraser comes up with outrageous waiting time estimates (17.8 weeks last year, as I recall), and is quite adept at publicizing them in the American media. Wait times are scientifically measured every year by Statistics Canada (the counterpart to the U.S. Census Bureau). I’m sure most Americans would be surprised at the results of scientific measurement: In 2005, median wait times were 4 weeks for elective surgery, 4 weeks for specialist care, and 3 weeks for diagnostic tests.

http://www.statcan.ca/Daily/English/060131/d060131b.htm

Also, the Canadian Health Services Research Foundation has done a short, scholarly critique of Fraser’s methods and compared them with real studies. (In fact, I think they’re far too kind to Fraser).” (Thanks, Nick!)

If you think health care is expensive now, wait until you see what it costs when it’s free.

Final bit, trot out a really stupid, non-sensical cliche. We spend nearly twice as much per capita as every other western country, and we’re supposed to worry about “what it costs when it’s free?”

Stan Alekna, Cornwall

Sorry, Stan, but that is a really lame rehashing of right-wing garbage that does not stand up to even mild critical analysis.

Christopher M. Hughes, MD

CNN.com – Paging Dr. Gupta Blog

CNN.com – Paging Dr. Gupta Blog:
Someone responding to Dr. Gupta’s point from Larry King Live last night:
“Hello Dr. Gupta.

I watched your discussion with Micheal last night, which I thought was quite interesting as I have the good fortune to live in Canada where we do have universal health care. This is certanly an issue that needs to be discussed. I did want to comment on one of the points you brought up last night as i felt it did not seem exactly true with my experiences. I am an advanced life support paramedic in Alberta and often treat and transport patients needing urgent angiograms. Althought weight times are an issue with urgent unstable angina type patients, it seemed you were painting a picture of emergent AMI patients were waiting six days to recieve life saving angiograms.
My experiece is nothing like that. I am proud to say that our region EMS services around Calgary have developed a system in which in feild 12-lead ECG’s are read by responding paramedics and if determined that the patient is having a miocardial infarct, the 12 lead is faxed to the trauma centre and the patient is transported directly to the catheter lab, by-passing the emergency department decreasing the door to cath time.
Many incidents have seen patinets arriving for angiogram /plasty in less than an hour of onset of symptoms.
It is important to note that this service is available to everyone. As a front line health care worker paramedics experience first hand many of the delays in our healhcare system in Alberta, however, emergency situations are always dealt with in a timely manner, with no bias or discrimination based on wallet size.

humbly yours,

K. Palmer
EMT-Paramedic
Banff, Alberta Canada “

WSJ 2006 “The Doctor’s Office” on Single Payer

Government-Funded Care
Is the Best Health Solution

Multiple Insurers, Multiple Plans
Create Expensive, Draining Hassle
April 18, 2006
:

“Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45% of the patients I see.
The rest are privately insured under 301 different insurance products (my staff and I counted). The companies set the fees and the contracts are largely non-negotiable by individual doctors.
The amount of time, staff costs and IT overhead associated with keeping track of all those plans eats up most of the money we make above Medicare rates. As it is now, I see patients and wait between 30 and 90 days to get paid. My practice requires two full-time staff members for billing. My two secretaries spend about half their time collecting insurance information. Plus, there’s $9,000 in computer expenses yearly to handle the insurance information and billing follow up. I suspect I could go from four people in the paper chase to one with a single-payer system.”

It’s so obvious that it hurts.

Aussie, Aussie, Aussie

Aussie, Aussie, Aussie: by Ian Morrison (author, consultant and futurist based in Menlo Park, Calif.)

“Somebody must be doing it right, we start to think. Well, actually, every system around the world is an ugly compromise among cost, quality, access and security of benefits, and almost all systems are in crisis according to the local news media. We in the United States have a bad bargain, maybe the worst: high costs, uneven quality, poor access and no security of benefits except for those over age 65.”

Nice overview of a system we rarely hear about in discussions of universal healthcare, Australia.
Now, let me conclude this post with a prayer: Australia, Australia, Australia, We Love You. Amen. Crack the tubes!