It’s still, and always will be, about the costs; required reading

More care, worse outcomes.  Misaligned incentives.  Complete ignorance of the macro view.  Buckets of waste.  Gaps in medical education.  Lack of coordination and accountability.  Solving health care locally.

In other words, Atul Gawande’s most recent dispatch in “The New Yorker” is, in my opinion, required reading.  A snippet:

When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes.

The promise is on paper, fingers crossed?

Execution! “The last 98%.”

Groups representing hospitals, health-insurance companies, doctors, drug makers, medical-device makers and labor … will promise to help reduce the growth of national health-care spending by 1.5 percentage points in each of the next 10 years. (Wall Street Journal)

Cynicism aside, it’s a good first step.  Certainly a far cry from Harry and Louise (though even their views have changed).  But remember, a reduction in health care cost growth still means health care cost growth.  The left is optimistic, the right is trying to get organized.

No Medicare for you!

Anyone under 30 should fully expect to never see a Medicare dollar to help pay for health care when they reach the appropriate age.  As continued evidence of those slimming chances “60 Minutes” reported last night on an effort to increase both quantity and quality of life through Resveratrol—the substance found commonly in red wine:

http://www.cbs.com/thunder/swf30can10cbsnews/rcpHolderCbs-3-4×3.swf
Watch CBS Videos Online

The implications of an extended life are large for Medicare—even if the promises include a reduced prevalence of disease.  So any health care reform must be adaptable…isn’t that a big part of the problem now?  A reimbursement system founded on the health care delivery realities of 50+ years ago?  Science has advanced, the way we pay for that science needs to as well.

It’s what we’ve got

Path dependent policy is a reality and Atul Gawande writes in The New Yorker that health care reform must start with what we have:

Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have.

Season’s Greetings: Happy Health Care!

My roommates and I have been planning on having a holiday party in the coming weeks to celebrate the season.  It was to be a best-of-your-closet-Christmas sweater get-together.  Until this morning.

When one roommate hung this article on the bathroom mirror (we’re all health administration students, health care consumes the majority of our attention) we knew we had a new theme.  As it happens, our social circles seem to intertwine with other health care students (medicine, dentistry, administration, public health, health information; for it what it’s worth this limited worldview is one of the reasons our system is in its current state and one more reason to get out of health care) so the guest list will be appropriately represented (synchronistic happenstance considering the new theme).

Reported Health and Human Services secretary nominee Tom Daschle has suggested that Americans hold holiday-season parties to brainstorm solutions for the American health care system (covered here by the WSJ Health Blog).  Mr. Daschle said Friday:

Our long-term fiscal prospects will have a hard time improving as long as sky-rocketing health care costs are holding us all down.  These health care community discussions are a great way for the American people to have a direct say in our health care reform efforts.

We plan on participating and have made our intentions known to the Obama administration team through their transition website as Mr. Daschle is planning to attend one group’s event.  You should consider doing the same.

This all got me thinking about past holiday parties with friends and family and how often health care is a topic of discussion.  We’re not usually discussing how to solve our health care problems, of course.  Amidst the catching-up/political banter/good-nature ribbing with fellow attendees, the health care conversations usually entail listening to complaints and success stories of health care travails during the previous year.  Which is all well and good since an astute health care transformer should be able to pull change ideas from a laundry list of complaints.

Whether or not you host an official health reform ideas holiday party, bring your favorite note taking device to your holiday season festivities and jot down what you hear.  Our participatory democracy wants to hear about it.

Of course Christmas sweaters (the uglier the better) are still welcome, they just won’t be the featured entertainment for the evening.

In: Required Reading

Both from the Wall Street Journal‘s Health Blog:

Tom Daschle will become the next Secretary of Health and Human Services when the Obama administration takes over on January 20.  He’s got big ideas for health care reform.

CEOs: Obesity is the biggest problem facing health care.  Not only is obesity extremely unhealthy, it is also going to cost the health care system big dollars in the near future (treatment, equipment, retrofitting buildings, etc.).

$111,576,422,950

New ideas are always good.  The health care reform debate often rehashes ideas from bygone plans (maybe with a new twist on an idea for a change in semantics, not a bad thing since the ideas have been more fully vetted).  However, unique ideas are always more fun to consider.  Consider this one from Dr. Benjamin Brewer’s Wall Street Journal column last week:

Looking at the way the government is doling out money these days, I have a proposal to help improve people’s health and our system of care. What if the government gave each person $365 of their tax money back to be spent on primary health care?

That amount could be paid directly to each person’s primary care doctor for a year’s worth of services. Imagine if everyone in America could contract privately for medical care for themselves with a primary care doctor without government or insurance company red tape.

The patient would choose the doctor. The basket of services would be predefined, and the price would be locked in for a year, paid as a monthly subscription like cellphone service or movie rentals.

Money spent that way would cover a lot of preventive health, office visits, management of chronic diseases, email contact with the doctor, and after-hours advice. Make it tax deductible for individuals as well as businesses.

Some rough math:

  • 633,000 physicians in the United States x 40.4% working in primary care (according to the Bureau of Labor Statistics, 2005 data) = 255,732 primary care physicians (family medicine and general practice, internal medicine, OB/GYN, pediatrics)
  • 305,688,830 people currently live in the U.S. x $365 primary care tax rebate earmarked for primary care services = $111,576,422,950
  • $111,576,422,950 / 255,732 primary care physicians = $436,302 per physician to pay for the basket of services provided
  • Nurse practitioners and physician assistants (or anyone else) are not included, there are part time physicians to consider as well
  • Anyway, it isn’t enough to sustain a practice but it certainly seems that such a policy may have some impact

Interesting.  Also wonder if such an idea would pave the way for universal primary care?  That certainly opens a whole different can of worms.  Thoughts?