Wednesday, February 28, 2007
Correcting an Omission
In the posting of a few minutes ago, I should have mentioned that the comments of Bob Odean related to an article in the Canadian press about the problems Ontario was having in keeping doctors, who seem to be migrating to the U.S. and other Canadian province.
In the posting of a few minutes ago, I should have mentioned that the comments of Bob Odean related to an article in the Canadian press about the problems Ontario was having in keeping doctors, who seem to be migrating to the U.S. and other Canadian province.
More on Medicare for All
This subject seems to spark interest. Several responses were short and related to each other, and so I’m putting them all in one posting.
The first is from cousin Tom Van Hon in Des Moines.
“I realize I don't understand all of the complications of financing health care but I seem to agree with your friend Gielich. From a layman's perspective, why not start with a Medicare paid major medical for everyone like Humana or Secure Care and let the people pay for the nickel and dime stuff. Then work into more coverage if the US can afford it. But let’s start someplace if we're going to do it.”
The second is another response from friend and one-time colleague Pete Geilich.
“I am somewhat humbled by the realization that my modest thoughts got an insightful reaction. My thanks to Bob Odean. Perhaps from his Canadian exposure he can give insight into that country's health system. Yes, I now believe that universal health insurance is inevitable - and the right thing to do. Yes, there is a connection between clout and quality - just look at the JCAHO. In my opinion, the system would be paid by payroll taxes and perhaps, in time, by a dedicated value added tax. No system is perfect, but wouldn't most professionals agree that the United Kingdom, New Zealand, France etc have quality health care systems at much less cost? If a change is not made soon, our economy will suffer even more. We have 'lost' textiles, shoes, even coat hangers. The automobile industry is in serious trouble. Costs must be controlled.”
The third is another comment from the referenced Bob Odean, long-time friend now living in Ottawa, Ontario (I assume OMA refers to the Ontario Medical Association).
“All is not well in paradise. Apparently, Canada's socialized medical system has problems retaining doctors because of "low" pay and unsatisfactory working conditions related to how the health services are managed.
The OMA president expressed feeling that "stealing" doctors from other countries where the need is even greater is "improper." I wish we felt that way in the United States. One solution: increase the number of medical graduates -- seems reasonable -- why can't we do that?
I went to a Canadian doctor recently -- lower back pain -- I have a return visit coming. I will ask how he seems to be able to practice independently. My half-hour cost $125 Cnd.”
This subject seems to spark interest. Several responses were short and related to each other, and so I’m putting them all in one posting.
The first is from cousin Tom Van Hon in Des Moines.
“I realize I don't understand all of the complications of financing health care but I seem to agree with your friend Gielich. From a layman's perspective, why not start with a Medicare paid major medical for everyone like Humana or Secure Care and let the people pay for the nickel and dime stuff. Then work into more coverage if the US can afford it. But let’s start someplace if we're going to do it.”
The second is another response from friend and one-time colleague Pete Geilich.
“I am somewhat humbled by the realization that my modest thoughts got an insightful reaction. My thanks to Bob Odean. Perhaps from his Canadian exposure he can give insight into that country's health system. Yes, I now believe that universal health insurance is inevitable - and the right thing to do. Yes, there is a connection between clout and quality - just look at the JCAHO. In my opinion, the system would be paid by payroll taxes and perhaps, in time, by a dedicated value added tax. No system is perfect, but wouldn't most professionals agree that the United Kingdom, New Zealand, France etc have quality health care systems at much less cost? If a change is not made soon, our economy will suffer even more. We have 'lost' textiles, shoes, even coat hangers. The automobile industry is in serious trouble. Costs must be controlled.”
The third is another comment from the referenced Bob Odean, long-time friend now living in Ottawa, Ontario (I assume OMA refers to the Ontario Medical Association).
“All is not well in paradise. Apparently, Canada's socialized medical system has problems retaining doctors because of "low" pay and unsatisfactory working conditions related to how the health services are managed.
The OMA president expressed feeling that "stealing" doctors from other countries where the need is even greater is "improper." I wish we felt that way in the United States. One solution: increase the number of medical graduates -- seems reasonable -- why can't we do that?
I went to a Canadian doctor recently -- lower back pain -- I have a return visit coming. I will ask how he seems to be able to practice independently. My half-hour cost $125 Cnd.”
Monday, February 26, 2007
The Need for a Better Answer
Those who are interested in Medicare for All or other form of government sponsored universal health insurance should pay attention to the federal budget recently submitted by President George W. Bush.
The administration is understandably concerned about the spiraling cost of its health care programs. There are two possible ways to deal with that. One would be to take steps designed to reduce the cost of providing care. The other is just to pay providers less and leave them to do the best they can.
One way to approach reducing cost is to cause providers to become more efficient by changing the way they provide care. In any change, there are winners and losers. The losers complain. Politicians thrive on appealing to the disaffected and quickly promise to stop or reverse the change that is causing discontent. Perhaps the best current example is the eagerness with which politicos advocate “getting medical decisions back in the hands of doctors and patients.”
Another approach is to support programs that seem to promise improved efficiency without difficult changes. One example is the promotion of the electronic health record. Another is Medicare Advantage, a program that attempts to entice patients into supposedly more efficient managed care plans (i.e., HMOs).
These proposals allow politicians to be seen as “doing something.” Actually, they make reaching a solution more difficult. Medical decisions are at the core of health care and restricting them to doctors and patients ties the hands of whoever undertakes to make the system better and more efficient. The electronic medical record and Medicare Advantage are promoted by means of government subsidies, thereby infusing new money into the system without requiring the fundamental changes in how care is provided that would make them effective. The result is to raise cost even further.
While these approaches provide short term political benefit, they do not relieve the financial burden and when things get too tight, the problem is quietly passed along to providers by simply paying them less, which is what the recently submitted federal budget calls for.
So the natural result of universal government-sponsored health insurance is a health care system that is overcommitted and underfunded while being resistant to the changes needed to reduce cost.
We need a better answer than that.
Those who are interested in Medicare for All or other form of government sponsored universal health insurance should pay attention to the federal budget recently submitted by President George W. Bush.
The administration is understandably concerned about the spiraling cost of its health care programs. There are two possible ways to deal with that. One would be to take steps designed to reduce the cost of providing care. The other is just to pay providers less and leave them to do the best they can.
One way to approach reducing cost is to cause providers to become more efficient by changing the way they provide care. In any change, there are winners and losers. The losers complain. Politicians thrive on appealing to the disaffected and quickly promise to stop or reverse the change that is causing discontent. Perhaps the best current example is the eagerness with which politicos advocate “getting medical decisions back in the hands of doctors and patients.”
Another approach is to support programs that seem to promise improved efficiency without difficult changes. One example is the promotion of the electronic health record. Another is Medicare Advantage, a program that attempts to entice patients into supposedly more efficient managed care plans (i.e., HMOs).
These proposals allow politicians to be seen as “doing something.” Actually, they make reaching a solution more difficult. Medical decisions are at the core of health care and restricting them to doctors and patients ties the hands of whoever undertakes to make the system better and more efficient. The electronic medical record and Medicare Advantage are promoted by means of government subsidies, thereby infusing new money into the system without requiring the fundamental changes in how care is provided that would make them effective. The result is to raise cost even further.
While these approaches provide short term political benefit, they do not relieve the financial burden and when things get too tight, the problem is quietly passed along to providers by simply paying them less, which is what the recently submitted federal budget calls for.
So the natural result of universal government-sponsored health insurance is a health care system that is overcommitted and underfunded while being resistant to the changes needed to reduce cost.
We need a better answer than that.
Friday, February 23, 2007
One Out of Five?
“Health care is expected to account for $1 of every $5 spent in the United States in another decade.”
That was the leading sentence in a front page Associated Press article is the February 22, 2007 issue of the Yuma (Arizona) Sun. The article was about a report released the day before by the federal Centers for Medicare and Medicaid which predicted that “Over the coming decade, spending on health care will continue to outpace the overall economy.” Currently, Americans are spending about $1 out of $6 on health care.
Concern was expressed by Health and Human Services Secretary Mike Leavitt who said that “There is simply no place on the economic leader board for a nation that spends a fifth of its domestic product on health care.”
What to do? Opinions vary. Secretary Leavitt said that “The only force strong enough to change the course of health care is a marketplace where consumers have the information and the incentive to choose quality and keep costs low.” Economists at the Centers for Medicare and Medicaid predict that government will take over financing from employers.
There is another alternative. The marketplace referred to by Secretary Leavitt could rely on organized purchasers like large employers and health insurance agencies rather than on individual consumers – something like the managed care movement that successfully contained costs during the 1990’s. I predict that is what will happen.
“Health care is expected to account for $1 of every $5 spent in the United States in another decade.”
That was the leading sentence in a front page Associated Press article is the February 22, 2007 issue of the Yuma (Arizona) Sun. The article was about a report released the day before by the federal Centers for Medicare and Medicaid which predicted that “Over the coming decade, spending on health care will continue to outpace the overall economy.” Currently, Americans are spending about $1 out of $6 on health care.
Concern was expressed by Health and Human Services Secretary Mike Leavitt who said that “There is simply no place on the economic leader board for a nation that spends a fifth of its domestic product on health care.”
What to do? Opinions vary. Secretary Leavitt said that “The only force strong enough to change the course of health care is a marketplace where consumers have the information and the incentive to choose quality and keep costs low.” Economists at the Centers for Medicare and Medicaid predict that government will take over financing from employers.
There is another alternative. The marketplace referred to by Secretary Leavitt could rely on organized purchasers like large employers and health insurance agencies rather than on individual consumers – something like the managed care movement that successfully contained costs during the 1990’s. I predict that is what will happen.
Wednesday, February 21, 2007
Questions
Following an exchange in which I argued my case that we would not see Medicare for all, Peter Kilborn, retired Boston attorney and friend from early Boston days, responded as below. It struck me as very likely typical of what many are thinking. I will respond to his questions, but perhaps others would like to, as well.
……………………
If not Medicare for all, what is your answer? I suppose there are really two questions: (1) what would be the right solution and (2) is there a politically possible solution.
The various problems you describe are, I think, relevant to any sensible solution and are what lead me to think we will not in your and my lifetimes see anything more than small bites at the problem.
To filigree what you said: we cannot afford to pay for everything that everyone wants, both in the realm of what is covered and how the system operates.
On what is covered. At one point Oregon had (maybe still has, for all I know) a list of cures, procedures etc., ranked in order of priority. Somewhere near the top of the list would be something like "antibiotics for a sick child" . Somewhere near the bottom would be "viagra for ninety-year olds." Somehere in the list a line would be drawn, below which the system would not pay. This requires a policy decision which - as you suggest - our system just won't make. We will not countenance rationing of medical care, but without rationing, the cost, as a fraction of our GDP, becomes unsupportable.
I remember from our days on the hospital scene various and sundry saying "We cannot have a two tier health care system." But, as long as there are some more affluent than others, we have to. If we ration, as we must, the affluent must be able to insure against things not covered by the system.
How the system operates. By that I mean the Harry and Louise problem. It may well be that a system which covers everyone will require that not everyone will be guaranteed access to the physician of his/her choice. That, again, is apparently politically a non-starter. And it bleeds into the two/tier problem. In England, the rich - by paying - in effect jump the line and also get the MD of their choice.
All of the above is very elementary but it leads me to throw up my hands. We will never get the purists to agree to partial solutions, but partial solutions are the only ones which will work in our democracy.
So, if you were advising the leaders of the Democratic party in Washington, what would you advise them to do?
Following an exchange in which I argued my case that we would not see Medicare for all, Peter Kilborn, retired Boston attorney and friend from early Boston days, responded as below. It struck me as very likely typical of what many are thinking. I will respond to his questions, but perhaps others would like to, as well.
……………………
If not Medicare for all, what is your answer? I suppose there are really two questions: (1) what would be the right solution and (2) is there a politically possible solution.
The various problems you describe are, I think, relevant to any sensible solution and are what lead me to think we will not in your and my lifetimes see anything more than small bites at the problem.
To filigree what you said: we cannot afford to pay for everything that everyone wants, both in the realm of what is covered and how the system operates.
On what is covered. At one point Oregon had (maybe still has, for all I know) a list of cures, procedures etc., ranked in order of priority. Somewhere near the top of the list would be something like "antibiotics for a sick child" . Somewhere near the bottom would be "viagra for ninety-year olds." Somehere in the list a line would be drawn, below which the system would not pay. This requires a policy decision which - as you suggest - our system just won't make. We will not countenance rationing of medical care, but without rationing, the cost, as a fraction of our GDP, becomes unsupportable.
I remember from our days on the hospital scene various and sundry saying "We cannot have a two tier health care system." But, as long as there are some more affluent than others, we have to. If we ration, as we must, the affluent must be able to insure against things not covered by the system.
How the system operates. By that I mean the Harry and Louise problem. It may well be that a system which covers everyone will require that not everyone will be guaranteed access to the physician of his/her choice. That, again, is apparently politically a non-starter. And it bleeds into the two/tier problem. In England, the rich - by paying - in effect jump the line and also get the MD of their choice.
All of the above is very elementary but it leads me to throw up my hands. We will never get the purists to agree to partial solutions, but partial solutions are the only ones which will work in our democracy.
So, if you were advising the leaders of the Democratic party in Washington, what would you advise them to do?
Questions
Following an exchange in which I argued my case that we would not see Medicare for all, Peter Kilborn, retired Boston attorney and friend from early Boston days, responded as below. It struck me as very likely typical of what many are thinking. I will respond to his questions, but perhaps others would like to, as well.
……………………
If not Medicare for all, what is your answer? I suppose there are really two questions: (1) what would be the right solution and (2) is there a politically possible solution.
The various problems you describe are, I think, relevant to any sensible solution and are what lead me to think we will not in your and my lifetimes see anything more than small bites at the problem.
To filigree what you said: we cannot afford to pay for everything that everyone wants, both in the realm of what is covered and how the system operates.
On what is covered. At one point Oregon had (maybe still has, for all I know) a list of cures, procedures etc., ranked in order of priority. Somewhere near the top of the list would be something like "antibiotics for a sick child" . Somewhere near the bottom would be "viagra for ninety-year olds." Somehere in the list a line would be drawn, below which the system would not pay. This requires a policy decision which - as you suggest - our system just won't make. We will not countenance rationing of medical care, but without rationing, the cost, as a fraction of our GDP, becomes unsupportable.
I remember from our days on the hospital scene various and sundry saying "We cannot have a two tier health care system." But, as long as there are some more affluent than others, we have to. If we ration, as we must, the affluent must be able to insure against things not covered by the system.
How the system operates. By that I mean the Harry and Louise problem. It may well be that a system which covers everyone will require that not everyone will be guaranteed access to the physician of his/her choice. That, again, is apparently politically a non-starter. And it bleeds into the two/tier problem. In England, the rich - by paying - in effect jump the line and also get the MD of their choice.
All of the above is very elementary but it leads me to throw up my hands. We will never get the purists to agree to partial solutions, but partial solutions are the only ones which will work in our democracy.
So, if you were advising the leaders of the Democratic party in Washington, what would you advise them to do?
Following an exchange in which I argued my case that we would not see Medicare for all, Peter Kilborn, retired Boston attorney and friend from early Boston days, responded as below. It struck me as very likely typical of what many are thinking. I will respond to his questions, but perhaps others would like to, as well.
……………………
If not Medicare for all, what is your answer? I suppose there are really two questions: (1) what would be the right solution and (2) is there a politically possible solution.
The various problems you describe are, I think, relevant to any sensible solution and are what lead me to think we will not in your and my lifetimes see anything more than small bites at the problem.
To filigree what you said: we cannot afford to pay for everything that everyone wants, both in the realm of what is covered and how the system operates.
On what is covered. At one point Oregon had (maybe still has, for all I know) a list of cures, procedures etc., ranked in order of priority. Somewhere near the top of the list would be something like "antibiotics for a sick child" . Somewhere near the bottom would be "viagra for ninety-year olds." Somehere in the list a line would be drawn, below which the system would not pay. This requires a policy decision which - as you suggest - our system just won't make. We will not countenance rationing of medical care, but without rationing, the cost, as a fraction of our GDP, becomes unsupportable.
I remember from our days on the hospital scene various and sundry saying "We cannot have a two tier health care system." But, as long as there are some more affluent than others, we have to. If we ration, as we must, the affluent must be able to insure against things not covered by the system.
How the system operates. By that I mean the Harry and Louise problem. It may well be that a system which covers everyone will require that not everyone will be guaranteed access to the physician of his/her choice. That, again, is apparently politically a non-starter. And it bleeds into the two/tier problem. In England, the rich - by paying - in effect jump the line and also get the MD of their choice.
All of the above is very elementary but it leads me to throw up my hands. We will never get the purists to agree to partial solutions, but partial solutions are the only ones which will work in our democracy.
So, if you were advising the leaders of the Democratic party in Washington, what would you advise them to do?
Thursday, February 15, 2007
A Response on Medicare for All
The below comes in from long-time friend Bob Odean, now living in Ottawa, Ontario where his wife is employed at the United States Embassy. Bob’s career included the Christian ministry, Washington D.C. lobbying, and college administration.
…………………………….
Relative to Pete Geilich’s conclusion on how health care ought to be paid for: I am not significantly knowledgeable as to the merits of the Medicare Program to believe it deserves to be expanded into a universal program. I assume Geilich is speaking only to insiders who know better than I do, and is thus engaged in what we used to call “preaching to the choir.”
How would such a universal health care, payment system work? How much support is there for this proposal within the medical professions? Is this proposal under consideration as a serious political solution? What controls are involved, and by whom are they to be decided? Is this another “big brother” system? How are costs being controlled in this scheme of things?
For laymen, the argument favoring this proposal requires more than the claim that it is “well-managed and cost efficient.” I don’t see the connection between “clout” and “quality.” Ultimately, it is the layman who will be called on to make the political decisions involved. Geilich needs to make his case clearer.
Obviously, there are detractors and counter arguments; I would be interested in learning the problems and limitations in universalizing the Medicare Program’s payment system -- if that is the problem Geilich is addressing.
The first issue that caught my attention in Pete Geilich’s opinion piece was his concern about the high cost of “end of life care.” Using the example of his mother-in-law and her problem in maintaining “control of her basic bodily functions,” he gave credit to a “palliative MD” for her dying “comfortably.”
Since “palliative” is not a word in my normal vocabulary, I had to consult Webster for its meaning. “Palliate” is “to conceal, cloak,” “1) to lessen the pain or severity of without actually curing…” -- this is apparently the sense in which the word is being used.
Hopefully, reading between the lines, Geilich is not suggesting a means to cut costs by which we end the lives of those for whom there is no cure – and are ”miserable.” Rather, I would like to believe, he is arguing against “heroic” procedures to prolong life needlessly at exorbitant costs that offer no cure and ultimately make no sense.
I am assuming the “palliative MD” in the case of his mother-in-law, apparently provided the comfort of such drugs as to alleviate her suffering and allow unhindered the dying process.
The below comes in from long-time friend Bob Odean, now living in Ottawa, Ontario where his wife is employed at the United States Embassy. Bob’s career included the Christian ministry, Washington D.C. lobbying, and college administration.
…………………………….
Relative to Pete Geilich’s conclusion on how health care ought to be paid for: I am not significantly knowledgeable as to the merits of the Medicare Program to believe it deserves to be expanded into a universal program. I assume Geilich is speaking only to insiders who know better than I do, and is thus engaged in what we used to call “preaching to the choir.”
How would such a universal health care, payment system work? How much support is there for this proposal within the medical professions? Is this proposal under consideration as a serious political solution? What controls are involved, and by whom are they to be decided? Is this another “big brother” system? How are costs being controlled in this scheme of things?
For laymen, the argument favoring this proposal requires more than the claim that it is “well-managed and cost efficient.” I don’t see the connection between “clout” and “quality.” Ultimately, it is the layman who will be called on to make the political decisions involved. Geilich needs to make his case clearer.
Obviously, there are detractors and counter arguments; I would be interested in learning the problems and limitations in universalizing the Medicare Program’s payment system -- if that is the problem Geilich is addressing.
The first issue that caught my attention in Pete Geilich’s opinion piece was his concern about the high cost of “end of life care.” Using the example of his mother-in-law and her problem in maintaining “control of her basic bodily functions,” he gave credit to a “palliative MD” for her dying “comfortably.”
Since “palliative” is not a word in my normal vocabulary, I had to consult Webster for its meaning. “Palliate” is “to conceal, cloak,” “1) to lessen the pain or severity of without actually curing…” -- this is apparently the sense in which the word is being used.
Hopefully, reading between the lines, Geilich is not suggesting a means to cut costs by which we end the lives of those for whom there is no cure – and are ”miserable.” Rather, I would like to believe, he is arguing against “heroic” procedures to prolong life needlessly at exorbitant costs that offer no cure and ultimately make no sense.
I am assuming the “palliative MD” in the case of his mother-in-law, apparently provided the comfort of such drugs as to alleviate her suffering and allow unhindered the dying process.
Saturday, February 10, 2007
I’m Published
This morning’s Boston Globe (February 10, 2007) published the following Letter to the Editor from me.
………………………
Isn’t it ironic that the Globe, published in a city that considers itself second to none when it comes to things medical, should choose to title its Feb. 9 editorial “….and too few medical experts?”
The editorial deals with the tragic and heavily reported death of 4-year-old Rebecca Riley, allegedly from an overdose of psychotropic drugs. It states “A social worker with a queasy feeling that a case is being mismanaged by a doctor doesn’t have much clout.” One would like to think that reporting such a feeling to the hospital would set off a flurry of investigation and, if indicated, remedial action. That ought to be the least to expect and besides, what hospital wants to be known for harboring doctors who mismanage their cases?
The editorial talks about providing the Department of Social Services with a panel of “medical experts with the heft to challenge other physicians.” Wouldn’t it be less expensive and more effective simply to insist that our internationally renowned local hospitals do their jobs?
……………….
The context should be clear for the most part from the text. The first part of the editorial was titled “Too much medication…..” According to newspaper reports, the psychiatrist who prescribed the drug, an employee of Tufts-New England Medical Center, has agreed to suspend her practice while the matter is being investigated and is on paid leave. The parents who administered the overdose were arrested. None of the stories have held Tufts-NEMC accountable to any extent for what happened.
This morning’s Boston Globe (February 10, 2007) published the following Letter to the Editor from me.
………………………
Isn’t it ironic that the Globe, published in a city that considers itself second to none when it comes to things medical, should choose to title its Feb. 9 editorial “….and too few medical experts?”
The editorial deals with the tragic and heavily reported death of 4-year-old Rebecca Riley, allegedly from an overdose of psychotropic drugs. It states “A social worker with a queasy feeling that a case is being mismanaged by a doctor doesn’t have much clout.” One would like to think that reporting such a feeling to the hospital would set off a flurry of investigation and, if indicated, remedial action. That ought to be the least to expect and besides, what hospital wants to be known for harboring doctors who mismanage their cases?
The editorial talks about providing the Department of Social Services with a panel of “medical experts with the heft to challenge other physicians.” Wouldn’t it be less expensive and more effective simply to insist that our internationally renowned local hospitals do their jobs?
……………….
The context should be clear for the most part from the text. The first part of the editorial was titled “Too much medication…..” According to newspaper reports, the psychiatrist who prescribed the drug, an employee of Tufts-New England Medical Center, has agreed to suspend her practice while the matter is being investigated and is on paid leave. The parents who administered the overdose were arrested. None of the stories have held Tufts-NEMC accountable to any extent for what happened.
Friday, February 09, 2007
Unintended Consequences
Periodically, the big corporations make noises like they intend to do something about the high cost of health care (and, consequently, of the health care benefits they pay for) The latest flurry of interest was reported in the cover article of the January 2007 issue of H&HN (Hospitals and Health Networks), the journal of the American Hospital Association.
One area in which the companies want to be active is in the promotion of greater use of information technology (i.e., computers) in health care. They seem to think that hospitals should learn to use computers to improve efficiency like other forms of enterprise have done.
They are most likely correct about that, but if experience is any guide, all of their pushing is likely to have consequences different from those intended. If they make a big enough fuss, hospitals will expand their use of computers sure enough, but they will do so more to quiet their critics than to improve efficiency. They will continue to do things more or less in the same way they always have, adding expensive hardware and software to the mix, with the result that cost will increase even faster.
There may be ways to get the health care system to be more efficient, but urging them to spend money on computers is probably not one of them.
Periodically, the big corporations make noises like they intend to do something about the high cost of health care (and, consequently, of the health care benefits they pay for) The latest flurry of interest was reported in the cover article of the January 2007 issue of H&HN (Hospitals and Health Networks), the journal of the American Hospital Association.
One area in which the companies want to be active is in the promotion of greater use of information technology (i.e., computers) in health care. They seem to think that hospitals should learn to use computers to improve efficiency like other forms of enterprise have done.
They are most likely correct about that, but if experience is any guide, all of their pushing is likely to have consequences different from those intended. If they make a big enough fuss, hospitals will expand their use of computers sure enough, but they will do so more to quiet their critics than to improve efficiency. They will continue to do things more or less in the same way they always have, adding expensive hardware and software to the mix, with the result that cost will increase even faster.
There may be ways to get the health care system to be more efficient, but urging them to spend money on computers is probably not one of them.
Wednesday, February 07, 2007
Medicare for All
Pete Geilich, friend, one-time colleague and occasional contributor to this blog has reached a conclusion about how health care ought to be paid for. Here it is:
……………………………
The more I think about it, it seems to me that the existing Medicare program needs to just be expanded to everyone. It is well-managed and cost efficient. There could still be supplemental insurance for folks that want it and can afford it to provide for deductibles and special services and Medicaid to cover those who can not pay the deductibles. What clout a national program would have on costs and, I believe, quality. I continue to be concerned about the high cost of end of life care - my mother-in-law died last year comfortably, because we had a palliative MD attend to her when it was obvious she would not have any sort of quality of life and was miserable being out of control with her basic bodily functions. Rarely did I see that as a hospital CEO.
Pete Geilich, friend, one-time colleague and occasional contributor to this blog has reached a conclusion about how health care ought to be paid for. Here it is:
……………………………
The more I think about it, it seems to me that the existing Medicare program needs to just be expanded to everyone. It is well-managed and cost efficient. There could still be supplemental insurance for folks that want it and can afford it to provide for deductibles and special services and Medicaid to cover those who can not pay the deductibles. What clout a national program would have on costs and, I believe, quality. I continue to be concerned about the high cost of end of life care - my mother-in-law died last year comfortably, because we had a palliative MD attend to her when it was obvious she would not have any sort of quality of life and was miserable being out of control with her basic bodily functions. Rarely did I see that as a hospital CEO.
Tuesday, February 06, 2007
The Math of Growth
Back in the old days when health care as a percentage of the total economy was still in single digits, we thought that surely it could never get higher than 10 %. We didn’t know what would keep it at or below that number, but assumed that the level of public tolerance would be reached and that something would be done.
Well, it didn’t happen. Health care just kept on growing. It is now above 15% and shows no signs of stopping.
I’ve wondered how that could be. And then the other day I did a little simple math that cast some light on the subject – at least for me.
Let us suppose that last year’s economy was 100, with health care being 15 and the rest of the economy 85.
Then let us suppose that the total economy grew by 4% and the health care economy by 10% (not too far off from what has been happening).
The result would be a total economy of 104 (100 x 104%) with the health care portion being 16.5 (15 x 110%) and the rest of the economy 87.5 (104 minus 16.5).
Thus, although the health care sector of the economy grew disproportionately, the rest of the economy still expanded (from 85 to 87.5).
In other words, alarm may be expressed about the inordinate rise in the cost of health care, but the overall economy doesn’t really feel it because the remaining portion is still bigger every year than it was the year before.
At present rates of growth, that could go on for a long time (until health care constituted more than one-third of the economy) before the higher rate of growth in health care stopped the rest of the economy from expanding (you can do the math yourself).
Of course, other factors may intervene – like pressure on government budgets and international competitiveness. But unless they do, health care may well continue its expansion for some time yet.
Back in the old days when health care as a percentage of the total economy was still in single digits, we thought that surely it could never get higher than 10 %. We didn’t know what would keep it at or below that number, but assumed that the level of public tolerance would be reached and that something would be done.
Well, it didn’t happen. Health care just kept on growing. It is now above 15% and shows no signs of stopping.
I’ve wondered how that could be. And then the other day I did a little simple math that cast some light on the subject – at least for me.
Let us suppose that last year’s economy was 100, with health care being 15 and the rest of the economy 85.
Then let us suppose that the total economy grew by 4% and the health care economy by 10% (not too far off from what has been happening).
The result would be a total economy of 104 (100 x 104%) with the health care portion being 16.5 (15 x 110%) and the rest of the economy 87.5 (104 minus 16.5).
Thus, although the health care sector of the economy grew disproportionately, the rest of the economy still expanded (from 85 to 87.5).
In other words, alarm may be expressed about the inordinate rise in the cost of health care, but the overall economy doesn’t really feel it because the remaining portion is still bigger every year than it was the year before.
At present rates of growth, that could go on for a long time (until health care constituted more than one-third of the economy) before the higher rate of growth in health care stopped the rest of the economy from expanding (you can do the math yourself).
Of course, other factors may intervene – like pressure on government budgets and international competitiveness. But unless they do, health care may well continue its expansion for some time yet.
