How to reduce healthcare costs and improve quality

http://histalk2.com/2009/11/30/readers-write-12109/

by pseale • 17 years ago

12 47 17 years ago

histalk2.com

RyanMcGreal2• 17 years ago

1 idea to reduce healthcare costs and improve quality:

* Institute a national, single-payer health insurance program.

tptacek9• 17 years ago

I think he's saying the same thing, but his proposed program is a high-deductable+HSA plan.

pwnstigator9• 17 years ago

One second-order benefit of universal healthcare is that countries with such plans view health problems as a social cost, so there's more regulation of food production, industrial practices, et cetera. Consequently, Western Europe is a safer and environmentally cleaner place, in many ways, to live.

yummyfajitas9• 17 years ago

This will help how? There are few economies of scale to be gained by going national [1], and single-payer gives consumers no incentive to consume less.

[1] You save a bit of money by having the IRS collect payments, but the billing department is not a major component of healthcare costs.

abstractbill2• 17 years ago

It seems to be working rather well in a large number of other first-world countries (I'm speaking from experience - I'm British, and my wife is half-French and grew up in France. Now we live in the US where we enjoy just about everything except for the healthcare system).

"single-payer gives consumers no incentive to consume less"

Having been fortunate enough to live in a country with a single-payer system, I never saw the kind of over-consumption you're hinting at.

Retric4• 17 years ago

I have seen numbers anywhere between 15 to 30% as the overhead / billing cost of healthcare in the USA. It depends on what you call overhead, but pre approval for a procedure is not free. Neither is 3 or 4 letters back and forth between the healthcare provider and the insurance company.

PS: Many small doctors’ offices have 1/3 of their staff devoted to dealing with insurance and billing issues.

tptacek9• 17 years ago

Uh, isn't this --- respectfully --- ass backwards? The benefit of going national is that you greatly expand the risk pool. All I know about insurance I got from listening to Robert Schiller's financial markets class on iTunes, but, I'm pretty sure that's how insurance is supposed to work.

mattmaroon4• 17 years ago

I like almost all of those, but it fails to address issue #1 which is the employer-funded health care system (which itself is an artifact of salary restrictions that were part of WWII rationing). Right now most people get what appears to them to be unlimited health care at a fixed price and thus have no incentive to strive for cost-effectiveness.

Imagine your employer said "We made a deal with Safeway. We'll take $30/mo out of your paycheck, and you can go to Safeway and all of your groceries are free." You'd be eating Filet Mignon washed down with a bottle of '82 Margaux every night.

That's effectively the way our health care system works. It won't become truly efficient until the people consuming the service are paying for it too.

Retric4• 17 years ago

Single payer systems don't just write blank checks. The real issue with US healthcare is it's become a game where the players spend money to lower their percentage of the healthcare burden without lowering the total costs. The net effect of which is the average person pays a lot more for zero average gain. With a small number of people get a free ride and everyone doing a lot of extra paperwork.

pwnstigator9• 17 years ago

Somehow, I think there's a difference between eating filet mignon and being treated for cancer. I could eat a good steak every day, but I wouldn't want chemotherapy unless I was pretty sure I had cancer in the first place.

Most people are just trying to get the treatment necessary to keep them at a high level of function. Why should anyone be denied that? Almost no one goes into a hospital and demands thousands of dollars worth of unnecessary tests for diseases they couldn't possibly have-- and those who do are often mentally ill hypochondriacs, given inappropriate treatment because (surprise!) health insurers are generally shitty about MH issues.

mattmaroon4• 17 years ago

You completely and totally missed the point.

yummyfajitas9• 17 years ago

There is actually not much of a difference. Filet Mignon makes you marginally happier, and cancer care (mostly) makes you live only marginally longer.

http://www.washingtonpost.com/wp-dyn/content/article/2009/11...

Incidentally, last time we did a study to measure it, we found that at least 30% of health care consumed by patients is unnecessary.

http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experimen...

The conclusion of the study is that health care you are unwilling to pay for out of pocket doesn't help more than it harms (on average).

A specific example of care people don't need but will get: mammograms. They are pointless (benefits don't outweigh harms) for people under 50. I mentioned this to a few women I know, but all said they intend to continue getting them.

[wow, down to -1 in 20 minutes from citing an expert opinion and an experiment. I should go back to reddit.]

teej• 17 years ago

People absolutely go to the hospital to seek treatment thy don't need. We see it in the US already - people flooding emergency rooms with the sniffles looking for antibiotics. That's entirely the reason triage exists, to seperate out the people looking for clinic care and the people with real emergencies.

You are correct about cancer and major surgeries - almost no one is going to elect to have these if they can avoid it. The only exception is obeseity cases where people would rather have a gastric bypass then have to suffer through diet and exercise.

tptacek9• 17 years ago

The nationwide direct costs of arthritis are within 90% of the direct costs of cancer. Matt wasn't saying "withhold chemo".

pragmatic• 17 years ago

A deductible (present in most systems I've used) minimizes this buffet style spending.

tptacek9• 17 years ago

I don't think this is the #1 issue with health care, Matt.

I think the #1 issue with health care is that virtually all market health care in the US is provided through insurance companies who collude with providers to set prices.

It's hard to convince me that our big problem is that people are paying for unnecessary care when we have no idea what care costs. Per-service cost numbers are arrived at via allocation schemes based on bulk purchase agreements between hospital chains and giant insurers.

Unnecessary care certainly is an issue, but how do you rank it when you don't know what an MRI, a hospital bed, an ambulance ride, or an appendectomy should actually cost?

3pt141592• 17 years ago

These 4 would lower costs the most:

----

Tort reform. Cap every state as has been done in California and Texas.

Eliminate doctors’ malpractice costs for patients who demand free care. If the government insists that ED docs see every patient (through EMTALA), they are de facto government employees for those patients and should receive government indemnification.

Give needles to addicts, along with access to treatment.

Strongly consider legalizing and decriminalizing drugs.

----

I would also add:

Make it legal to see anyone for healthcare. If I want to have my veterinarian cousin administer 5 stitches, then I should be allowed to.

Make it legal to OPTIONALLY sign away your right to sue.

tptacek9• 17 years ago

If you make it legal to optionally sign away your right to sue, then everyone will lose their right to sue, except for the few adverse venues of last resort (public-funded hospital emergency rooms, perhaps) that won't be able to decline services.

The same thing happens with the "let people shop interstate for insurance" idea. If you look just a couple moves ahead into that game, you see that that proposal is just cover for "adopt the lowest common denominator of insurance regulation nationwide", because every rational insurance company will simply move to Alaska or Wyoming or wherever regulations are least onerous.

The exact same thing happens in banking, which is why Charlotte is a US banking hub.

3pt141592• 17 years ago

The probability of the event happening * the loss = the premium of the surgery. That is it. If you would rather pay 1000 dollars for a surgery than 3000 then that is your business. I certainly wouldn't sign away my right to sue when I'm under back surgery.

evgen• 17 years ago

> Tort reform. Cap every state as has been done in California and Texas.

Most studies show this claim to be specious at best. Tort reform has almost no impact on quality of care or cost of that care. The only real impact of tort reform in the realm of medical malpractice is to transfer money from the pockets of wealthy litigators to the pockets of wealthy insurance executives.

pwnstigator9• 17 years ago

Some good ideas, but mostly revolting. He's basically trying to preserve a system where the wealthy get better treatment than the rest. (See items #3, 9, 14, and 15.)

Realize that screening doesn’t save money for society.

Um, link? Although current screening practices may be overly aggressive-- I have no idea-- this is different from saying that screening is an unconditional money-loser, which is what the OP strongly implies.

Notice this, as well: Dan Field is a physician with The Permanente Medical Group.

So, at least he discloses the pocket he's in.

tsuraan• 17 years ago

Yeah, the bit about name-brand drugs being only for those who an afford them out of pocket is especially bad. Drug patents are 20 years, so the peasants would be getting 20-year-old cancer treatments, while the select few would be getting actual modern medicine. Besides the ethics, though, what would the cost of modern medicines be for those few thousand who can actually afford them? Today, plenty of middle-class people get modern drugs because their insurance pays for it, so the cost of research, clinical trials, manufacturing, etc is distributed among a large population. What would the price of a pill be if only the richest of the rich could afford treatment?

johnl• 17 years ago

Socialize the judicial portion with flat rates for doctor/hospital boo-boos and a government panel to oversee and "punish". 3 strikes and you loose your license, back to school. No lawyers, reduced insurance, speeder payment processes. = Reduced rates for us.

How to reduce healthcare costs and improve quality

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