Health-care ‘system’ broken, requires fixing

May 27, 2011 Leave a comment

It’s time for the U.S. health-care ‘system’ to “become better and cheaper for everyone — to get cheaper by getting better,” declares columnist-futurist Joe Flower. I agree 100%.

We’re not talking “bending the cost curve,” cutting a few points off the inflation chart. We’re not talking a little cheaper, a little less per capita, a few percentage points off the cut of GDP that health care sucks up. We’re talking way cheaper. Half the cost. You know, like in normal countries.

We’re not talking a little better—skipping a few unnecessary tests, cutting the percentage of surgical infections a few points. No. Don’t even think about it. We’re talking way better. Save the children, help the people who should know better, nobody dies before their time, no unnecessary suffering. Seriously.

For people who are working somewhere inside the current system, that level of change seems unimaginable. When I was still working, that’s how it seemed to me.

For reference, Flower talks about highway safety. If you drove a car or truck in 2010, he points out, you were 10 times more likely to live through each mile you drove than was your father or grandfather 60 years ago. Not because drivers are better — but because a host of tweaks adds up to dramatic improvements in the auto safety system.

Contrary to conventional political wisdom, “The federal health care reform law is a catalyst, an enabler and an accelerator of the change we are going through,” Flower says.

It is not the change itself nor the cause of it, because the change is driven by much larger economic and demographic factors, especially by the crushing cost of health care. If the reform law were to go away, the change would not go away.

Bill Sez: Most people — even most dedicated change-leaders — think in terms of little tweaks or minor adjustments; they want to make the system better without turning it upside-down or inside-out. When Flower declares, “[E]verybody in the business has come to believe that the usual way of doing business is crumbling under them,” I’m not so sure.


Recession slows health-care cost increase

May 25, 2011 Leave a comment

So there’s good news and bad news about U.S. health-care spending in a new report from the California Health Care Foundation.

First, the good news: health-care spending increased only 4% in 2009, continuing a slower-growth trend that dates back to 2003. The bad news: the slower growth is partly due to the Great Recession, and health care spending still increased to almost 18% of GDP, the highest of all developed nations.

The U.S. continues to spend much more per capita on health care than other countries while achieving mediocre health outcomes. In 2009, per-capita spending exceeded $8,000!

Some economists and Pain Caucus advocates say excess spending is driven by health insurance coverage, that Americans don’t have enough “skin in the game” to be more price-conscious and cost-conscious in their use of health care services. Not so, according to the report: household spending accounts for 28% of all health-care expenditures, more than any other category.

Insurance does pay a large share of the cost of hospital stays and doctor visits, it’s true. But out-of-pocket spending goes heavily towards paying for Rx drugs and medical products, nursing-home care, and dental care, the data shows.

Special interests feast at health-care trough

May 21, 2011 Leave a comment

If all U.S. health-care providers and organizations followed the lead of those who deliver high-quality care at 20% less cost than the average, health-care spending would retreat from 17% of GDP and we would have a $640 billion windfall to apply to other needs.

What stands in the way? Too many individuals and organizations are enriched by the current system and don’t want to change it, according to two prominent physicians who ask “Why Does Cost-Effective Care Diffuse So Slowly?” at the New England Journal of Medicine’s Health Policy and Reform website.

“The answers to this $640 billion question lie in the perceptions and behaviors of the major participants in health care,” say Drs. Victor Fuchs and Arnold Milstein.

For example, health insurance plans don’t want to standardize coverage or administrative processes to save $200 billion a year because that could end up putting downward pressure on profits…and executive pay. Hospital administrators oppose efforts to reduce admissions and occupancy because lower revenues would make it harder to cover fixed costs. Physicians object to any reforms that reduce individual autonomy (to disregard evidence and practice as they please) or alter fee-for-service payment systems that reward specialists for doing more treatments. Legislators are too busy collecting campaign contributions from healthcare interests that benefit from the current arrangements to try to reform the system.

Of course, Fuchs and Milstein agree, the folks with the most to lose are the drug-makers and device and equipment manufacturers

Marketing to consumers and physicians will be much less successful if purchasing and prescribing decisions are made by organizations such as managed-care plans or accountable care organizations that … have the incentive and the ability to evaluate competing products and can negotiate with suppliers for the best value. To preserve the present system, manufacturers of health care products spend heavily on federal lobbying.

Sounds hopeless, doesn’t it? Nevertheless, Fuchs and Milstein call on their professional colleagues to lead the charge:

…physicians are the most influential element in health care. The public’s trust in them makes physicians the only plausible catalyst of policies to accelerate diffusion of cost-effective care. Are U.S. physicians sufficiently visionary, public-minded, and well led to respond to this national fiscal and ethical imperative? It’s a $640 billion question.

Hospitals front for “medical-industrial complex”

May 21, 2011 Leave a comment

Yet more evidence surfaces about how and why the U.S. spends much more per capita on health care than other developed nations yet gets such mediocre results. Like its counterparts in the military-industrial complex, the medical-industrial complex puts profits first and relies on trusted “front men” to make the sale.

First, a new study reveals that, while many hospitals tout robotic surgery on their websites, “Materials provided by hospitals regarding the surgical robot overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer.” More specifically, among the 41% of randomly selected hospital websites that describe robotic surgery,

37% percent presented robotic surgery on their homepage, 73% used manufacturer-provided stock images or text, and 33% linked to a manufacturer website. Statements of clinical superiority were made on 86% of websites, with 32% describing improved cancer control, and 2% described a reference group. No hospital website mentioned risks.

As Fierce Healthcare editor Janice Simmons points out,

[A]ccording to lead researcher Marty Makary, MD, of Johns Hopkins, no randomized, controlled studies have been completed showing patient benefit in robotic surgery. “New doesn’t always mean better,” he says, adding that robotic surgeries take more time, keep patients under anesthesia longer and are more costly.

In an interview with Science Daily, Makary went on to say, “We’re allowing industry to speak on behalf of hospitals and make unsubstantiated claims….Hospitals need to be more conscientious of their role as trusted medical advisers and ensure that information provided on their websites represents the best available evidence.  Otherwise, it’s a violation of the public trust.”

H/t: Gary Schwitzer’s Health News Review Blog.

Millionaire pundit’s boo-hoo-hoo deserves ridicule

May 19, 2011 Leave a comment

The Millionaire Pundit Class gets a fair amount of attention at The Daily Howler, where Bob Somerby reminds us regularly that highly paid “journalists” don’t face the same kinds of problems that trouble ordinary folks…like us. That helps to explain why so much class-conscious piffle gets published and broadcast, he suggests.

One boo-hoo-hoo topic that fully deserves scorn is the “down and out on $250,000 a year” meme, recently deployed again in the Fiscal Times and sympathetically portrayed by NY Times reporter-columnist Andew Ross Sorkin.

The original FT piece examined a hypothetical two-earner family with $250 K in income who “end up in the red” anyway. Of course, these “poor” people are setting aside $41,000 a year in savings, spend more than $16,000 owning two cars, and put another $19,000 a year towards child-care and after-school care. (Remember, as Felix Salmon points out, the average U.S. family of four earns about $66,000 a year pre-tax…not much more than the $250 K family puts into savings and cars.)

The point of the piece? These “poor” people earning $250 K can’t possibly afford to pay higher taxes.

Why would NYT pundit Sorkin look favorably on this idea? Well, for one thing, he recently purchased a posh apartment on NYC’s Upper West Side for more than $2.3 million! The very idea of higher tax rates must put his shorts in a twist.

Felix Salmon’s take is spot-on:

The thing which really annoys me about all these pieces is that they seem to be based on the idea that a sensible fiscal policy would only raise taxes on people who are so rich that they never need to worry about money. Which of course is ridiculous.

Klein cashes in on education “reform”

May 19, 2011 Leave a comment

With the possible exception of Michelle Rhee, no leader of the education “reform” claque says worse things about teachers than Joel Klein, the former NY City schools chancellor.

Klein is at it again in The Atlantic, with the modestly titled “Who Ruined Our Schools: An Insider Tells All.”  Any guesses who’s at fault? Here’s Valerie Strauss’s summary:

[A]dults in education (except for him and others who agree with him) only care about themselves and not about helping kids learn and … the lousy teaching corps and its unions are responsible for the sorry state of public education.

So who did Klein go to work for when he left the NYC schools? Renowned public-education advocate Rupert Murdoch, that’s who!

He now is executive vice president at … News Corp.; two weeks after his move was announced, the company said it was buying a technology company with big financial ties to the New York City school system.

Klein champions the Billionaire Boys Club agenda, especially the insistence on linking teacher evaluation to student scores on standardized tests. (Just because his claims about test-score improvement on his watch in NYC proved untrue, and just because research shows the linkage lacks validity and reliability, he doesn’t care. Like Bush 43, Klein apparently believes the same things on Wednesday as he did on Monday, no matter what happens on Tuesday.)

Bill Sez: I fully agree with Valerie Strauss –

Accusing several million teachers of being lazy and caring only for their pensions won’t improve public schools. Using questionable methods to evaluate teachers won’t either. And turning the public education system, a civic institution that is not a business and should not be run as one, into “a competitive marketplace,” as Klein suggests, will cause enormous damage that leaves far more kids behind than there are now.

New NY Education Commish Fits Billionaire Boys Club Model

May 18, 2011 Leave a comment

There’s a powerful personal story in the appointment of Dr. John King, Jr., to be New York’s new state education commissioner, the first African-American and first Puerto Rican to hold the post. King’s parents both died before he turned 13, and he credits public-school teachers with encouraging him on a path to undergraduate study at Harvard, a law degree from Yale and a doctorate from Columbia.

Chancellor of the NYS Board of Regents Meryl Tisch was fulsome in her praise for King:

“John has dedicated his career to closing the achievement gap and raising the level of achievement for all,” she said in a statement. “He has a deep, passionate, personal commitment to public education and will be an outstanding commissioner for all New Yorkers.”

What might be on King’s agenda as commissioner? Look at his background and take a guess: he co-founded a charter school in Boston and was managing director with Uncommon Schools, described as a non-profit charter management organization. Think he might be favorable to more charter schools in public education?

Is anyone surprised that an advocate of education “reform” ideas got this job? Could it be related to incredible levels of spending by the Billionaire Boys Club to advance an agenda that includes charter schools, mayoral control, and teacher evaluation and pay tied to student test scores?

Read more…