Special interests feast at health-care trough

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.

Millionaire pundit’s boo-hoo-hoo deserves ridicule

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.

To screen or not to screen….

Lots of older Americans are undergoing colon cancer tests they don’t need, putting themselves at risk and costing Medicare money it shouldn’t be spending. But when your doctor refers you for screening, don’t you go?

And what happens when screening recommendations change but medical practice doesn’t?

Billionaire-driven education “reform” fails again

It’s not surprising former media executive Cathie Black lasted only three months as NYC schools commissioner. The surprise is that NYC mayor Bloomberg and his cronies in the education “reform” crowd thought it was a good idea to appoint her in the first place.

How unqualified was Black? Dana Goldstein reports,

A publishing executive with no personal or professional experience with any public school system–let alone with the incredibly complex New York City public school system–Black sent her own two children to private boarding school in Connecticut, and had attended parochial schools herself. …[O]ne of Black’s first comments upon visiting New York City school buildings was that they seemed “clean.”

The “reforms” being pushed by Bloomberg, Gates, Broad et al focus on opening charter schools, closing neighborhood schools, and enforcing teacher “accountability” for students’ standardized test scores. But these ideas are not broadly accepted by actual public school parents, Goldstein notes.

Smart guys agree: Brooks is a con man

The Republican budget plan fomented by Congr. Paul Ryan et al is being called the ‘blogger full employment act of 2011.’ And it pleases me no end to see smart people agreeing about the absolute hackyness of David Brooks’ fulsome praise for Ryan’s proposal.

Dean Baker weighed in quickly:

Representative Ryan has provided a valuable service to the country by tossing out a piece of warmed-over dreck that calls for a massive upward redistribution from the nation’s workers to the rich. ….[M]any pundits will applaud the plan as brave, innovative and creative. In making these pronouncements these pundits will immediately reveal themselves as worthless hacks who either lack the ability or desire to do their own thinking.

James Kwak also gagged at Brooks’s ‘moment of blather’:

The Ryan plan will affect health care consumption, because poor seniors won’t be able to afford the health care they get now. So it will reduce overall spending on health care — but exactly by depriving people of care they would have had under Medicare. I think that’s called “rationing.”

….Ryan decided to go after Medicare. And, according to David Brooks, “His proposal will set the standard of seriousness for anybody who wants to play in this discussion.” No. Seriousness means doing something about health care costs themselves — not transferring the fiscal problem to households.

Both Kwak and Baker point out that the real problem is health care costs, not Medicare or Medicaid. More on that soon.

NPR, Guy Raz strike (out) again

Knight Science Journalism Tracker catches another softball interview by NPR’s Guy Raz. It turns out he’s just as credulous about scientific research as he is about disgraced former DC schools chief Michelle Rhee.

Last Saturday, Raz interviewed a Dutch researcher about the causes of ADHD and a possible new treatment option. He appeared to swallow the researcher’s claims that ADHD is usually caused by diet and that diet changes can usually cure it hook, line and sinker.

Nobody else was interviewed, and Raz made no effort to put the story in context–namely, to note that others are far more skeptical about the relationship between diet and ADHD. At the very least, NPR should have interviewed one or two others with different points of view.

Instead of being reeled in, Raz might have actually read the study; it says, “A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food.” In other words, a screening mechanism, not a cure.

Bill Sez: KSJ’s Paul Raeburn is on the mark: “NPR, you know better than this. Or you should. Was the science desk closed over the weekend? If so, you should have held this until Monday so the science folks could take a look.”

Not a reason to strip NPR of federal funds, but a reminder how sloppy their journalism can be sometimes.