While the U.S. Spends Heavily on Health Care, a Study Faults the Quality – NYTimes.com

While the U.S. Spends Heavily on Health Care, a Study Faults the Quality – NYTimes.com:

“In some cases, the nation’s progress was overshadowed by improvements in other industrialized countries, which typically have more centralized health systems, which makes it easier to put changes in place.

The United States, for example, has reduced the number of preventable deaths for people under the age of 75 to 110 deaths for every 100,000 people, compared with 115 deaths five years earlier, but other countries have made greater strides. As a result, the United States now ranks last in preventable mortality, just below Ireland and Portugal, according to the Commonwealth Fund’s analysis of World Health Organization data. The leader by that measure is France, followed by Japan and Australia.

Other countries worked hard to improve, according to the Commonwealth Fund researchers. Britain, for example, focused on steps like improving the performance of individual hospitals that had been the least successful in treating heart disease. The success is related to “really making a government priority to get top-quality care,” Ms. Davis said.”

The Commonwealtth Fund’s Report is here:
Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008July 17, 2008 Volume 97
The Commonwealth Fund Commission on a High Performance Health System

Doctor shortage worsens as student debt rises

Doctor shortage worsens as student debt rises:

“the debt burden on graduates is daunting, especially given that they must spend at least three more years on post-graduate residency training that pays about $44,000 to $45,000 for the first year, according to the Association of American Medical Colleges.

While in their residencies, many future doctors choose to defer their school loan payments, so their arrears grow even larger as they accrue interest, Black said.
That option will be gone, however, beginning in July 2009, when the U.S. Department of Education ends medical school payment deferment — a move that could further put aspiring doctors in a financial bind, said Chromy, who helped author the resolution.

‘We’re required to do this residency, but we can’t defer,’ she said. ‘If we’re trying to increase the supply of physicians, the answer is not to make it harder to make physicians.’

The resolution estimates that the average monthly payment on debt of about $160,000 starts at $1,400 a month on a 25-year repayment plan — or about 50 percent of the post-tax income of a resident’s salary.

In his two years of medical school at Wayne State, Joseph Khouri has racked up about $140,000 in debt, a figure that includes out-of-state tuition and loans to pay for living expenses.

‘I mean, this is ridiculous,’ said Khouri, who is from Cleveland. ‘Medicine isn’t about money and it never was about it for me. But graduating $280,000 in debt is intimidating.’

It could be worse for future medical students at Wayne State Medical School. One report by the medical college association projects debt for graduates could rise to about $750,000 by 2033.”

This is the new social contract we have accidentally made. We tell our students to suck it up and pay extraordinary tuition to become doctors. Then we tell them they should be going into primary care, where they would be doing the most good caring for patients, but will never catch up to their peers in income, accumulation of home equity, retirement funds or wealth in general.

The saying that “it’s just as easy to fall in love with a rich man as a poor man” comes to mind. While in training, it is just as easy to fall in love with a handsomely reimbursed specialty as it is a poorly reimbursed one.

Kennedy leads renewed effort on universal healthcare – The Boston Globe

Kennedy leads renewed effort on universal healthcare – The Boston Globe:

“Kennedy is not alone in trying to get a head start on the healthcare debate. Senator Max Baucus, a Democrat from Montana and chairman of the Senate Finance Committee, held a healthcare summit in mid-June, and a bipartisan proposal to make private insurance accessible to all Americans has been put forward by Senator Ron Wyden, a Democrat from Oregon, and Robert Bennett, a Republican from Utah.”

The “Big Mo” building just in time for a new, Democratic President in 2009…

Miles Mogulescu: Why Not Single Payer? Part 6: New “Health Care For America Now” Coalition May Reflect Divisions in the Movement for Universal Healthcare – Politics on The Huffington Post

Miles Mogulescu: Why Not Single Payer? Part 6: New “Health Care For America Now” Coalition May Reflect Divisions in the Movement for Universal Healthcare – Politics on The Huffington Post

We all saw sicko, but many of us also saw Frontline’s Sick Around the World program : http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Certainly Single payer can work and might be the best system possible, but I don’t think the Bismarkian systems of Germany, Switzerland and others can be dismissed out of hand. If you go to the frontline website and watch the show, be sure to read the supplementary materials, especially he interview with Uwe Reinhardt. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/reinhardt.html

I had not given Bismarkian systems much thought until I heard a representative from the Stark Raving Loonie Party (Sorry, that’s Python – I meant the Fraser Institute of Canada) actually confess that he could see working with reform along the Bismarkian lines:http://cmhmd.blogspot.com/2008/03/single-payer-debate-at-duquesne-u-31008.html

Further, Sen. Ron Wyden and others have introduced a plan along these lines, so HR 676 isn’t the only ball in play at the moment.
Wyden Press release: http://wyden.senate.gov/newsroom/record.cfm?id=297073&
Other commentary: http://www.blueoregon.com/2006/12/progressives_re.html

So I guess I’d say not to discount the Wyden plan out of hand as not being “pure” single payer. because we have examples of this system working as well as single payer can.

Cheers,

Today in Investor’s Business Daily stock analysis and business news

Today in Investor’s Business Daily stock analysis and business news:

“Americans should know that one of the founding fathers of Canada’s government-run health care system has turned against his own creation. If Claude Castonguay is abandoning ship, why should Americans bother climbing on board?”

The author points out the failings of the Canadian and UK systems, but not their successes, nor our failures here in the US.

I think both Canada and the UK have the opportunity to right their ships (Britain is already doing so), but suggesting that the solution is something like our mess has been rejected outright by Canadians and Brits. They know they have problems, but they also know the solution does not lie in the US system.

Finally, the piece would have benefitted from pointing out, again, for those who still don’t understand it, that there are many universal healthcare systems in the world that do a far better job than our “free market” at providing care at lower cost with better outcomes.

Cheers,

Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007 – RWJF

Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007 – RWJF:
(From the Robert Wood Johnson Foundation. Follow the link for the full report.)

“The number and proportion of Americans reporting going without or delaying needed medical care increased sharply between 2003 and 2007, according to findings from the Center for Studying Health System Change’s (HSC) nationally representative 2007 Health Tracking Household Survey. One in five Americans—59 million people—reported not getting or delaying needed medical care in 2007, up from one in seven—36 million people—in 2003. While access deteriorated for both insured and uninsured people, insured people experienced a larger relative increase in access problems compared with uninsured people. Moreover, access declined more for people in fair or poor health than for healthier people. In addition, unmet medical needs increased for low-income children, reversing earlier trends and widening the access gap with higher-income children. People reporting access problems increasingly cited cost as an obstacle to needed care, along with rising rates of health plan and health system barriers.”

Health Blog : Some Nurses Land Higher Salaries Than Primary Care Doctors

Health Blog : Some Nurses Land Higher Salaries Than Primary Care Doctors:

“The Merritt Hawkins figures for the nurses are higher than some other sources. The Medical Group Management Association, which tracks health-care salaries, puts nurse anesthetists’ median compensation at $140,000 per year — still pretty good, from where we sit. Miller said the discrepancy may be due to the fact that fewer employers go through recruiters to hire the nurses, and those who do are willing to pay top dollar.”

Editorial – The Massachusetts Model for Health Care – Editorial – NYTimes.com

Editorial – The Massachusetts Model for Health Care – Editorial – NYTimes.com:

“The chief criticism, however, is that costs have risen faster than the original projections, forcing the state to raise its spending estimates for the current fiscal year from $472 million to $625 million and from $725 million to $869 million for next year. The shortfall occurred mostly because the state underestimated the number of uninsured residents and how fast low-income people would sign up for subsidized coverage. It is a warning to other states to keep projections realistic.

The key challenge will be to keep costs under control and find new sources of revenue while maintaining widespread support for the program. How well Massachusetts handles that challenge will determine whether its pioneering health plan falls into a financial pit or points the way toward universal coverage.”

Here are the Letters in response.

Essay – Fed Up With the Frustrations, More Doctors Change Course – NYTimes.com

Essay – Fed Up With the Frustrations, More Doctors Change Course – NYTimes.com:
“Not long ago, fed up with what he perceived as a loss of professional autonomy, Dr. Bhupinder Singh, 42, a general internist in New York, sold his practice and went to work part time at a hospital in Queens.

“I’d write a prescription,” he told me, “and then insurance companies would put restrictions on almost every medication. I’d get a call: ‘Drug not covered. Write a different prescription or get preauthorization.’ If I ordered an M.R.I., I’d have to explain to a clerk why I wanted to do the test. I felt handcuffed. It was a big, big headache.”

When he decided to work in a hospital, he figured that there would be more freedom to practice his specialty.

“But managed care is like a magnet attached to you,” he said.

He continues to be frustrated by payment denials. “Thirty percent of my hospital admissions are being denied. There’s a 45-day limit on the appeal. You don’t bill in time, you lose everything. You’re discussing this with a managed-care rep on the phone and you think: ‘You’re sitting there, I’m sitting here. How do you know anything about this patient?’ ””

But if they were Government Bureaucrats, now that would be intolerable…

BTW, I included this post with the category of Rationing Healthcare because it does become rationing by attrition. Physicians often are so frustrated by the battles they fight hourly with Private Insurers, they cave in and provide less than optimal care.

NJ: Universal health care momentum

Universal health care momentum

Article from Physican News Digest regarding the New Jersey plan for increasing access to health insurance. Uses a combination of programs as seems to be the current trend. Tries to make a patch work quilt to cover most citizens.

Interestingly, there is a quote from the Medical Society of New Jersey, who “developed a policy statement on principles of coverage of the uninsured. The policy states that New Jersey must take an active role in providing coverage for the uninsured.”

I will try to find out more specifics on the program and link to it here.