Tuesday, June 16, 2009

Time for a Change!

The political theme of the moment is health care reform. I thought I'd link to Atul Gawande's article in the The New Yorker, " The Cost Conundrum."

Gawande visits McAllen, Texas, a town where health care costs have escalated to twice the national average (per Medicare) for unclear reasons. He asks questions and hunts for answers, and he compares the medical system there to other systems, including that of the Mayo Clinic where care seems to flow in a more patient-centered, less economically-driven way.

Gawande concludes:

Instead, McAllen and other cities like it have to be weaned away from their untenably fragmented, quantity-driven systems of health care, step by step. And that will mean rewarding doctors and hospitals if they band together to form Grand Junction-like accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers—whether public or private—would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don’t form these organizations.


Retriever said...

Where I live, the costs are all about liability. Our litigiousness and greed are partly to blame. Also, people's refusal to accept that the bodies we love are mortal, that physical sickness and death are inevitable.

The interesting thing to me about the article is that it focusses only on physical ailments. Where is the data on mental health care costs, current, and projected? Not to mention that even as care for people's physical ailments has got better and better (albeit expensive) care for their psychiatric ills has got worse, hospital beds have been cut, medication unaffordable (and of dubious benefit anyway). Parity is a joke. Good mental health care is more expensive than care for people's physical ailments, and perhaps that is why even shrinks are fairly quiet on the issue.

Anonymous said...

I am perplexed by the proposals to band doctors together as a way to save money. How does this help? My GYN, endocrinologist and psychiatrist all have independent practices and are tops in their fields. It would not improve their care to force them into being banded together with other doctors. My GP organized his own multi-doctor practice in which he profits from the work the other doctors do. I still see my doctor but in an emergency when I am really sick I get shunted to one of the hired-hand doctors who often don't speak English very well and I feel unsure of the quality of care. That does not please me. I don't see how a group like that saves money. It allows doctors who'd not be able to form an independent practice to work, but besides that how does a group help cut costs or serve the patient? I admit that health care is a mess right now but currently I see insurance companies and drug companies as "bad guys" and doctors as "good guys".

Ellen said...

I still have never heard a clear, rational reason that health care rates increase so much faster than inflation. Can any of the smart healthcare workers here explain it to me? Our insurance shopper told us health insurance companies are so overburdened with paperwork that they require a shockingly high gross profit to break even (something like 50%). Only thing that occurs to me is malpractice/liability insurance...and seems like there should be a better way of curing that than pulling a mulligan on the entire system, e.g. easier, cheaper alternatives to litigation, caps on payouts, higher theshold for suits accepted by courts, researching socially/legally permissible ways to eradicate lawyers and politician-lawyers, etc....

Even so, are the lawyers the whole story? They can't be. Something's gotta give, and I'm actually looking forward to that moment.

(I'm all for parity though. For legit cases and evidence-based treatment, not having it is a joke.)

tracy said...

i <3 Dr. Gawande. His website is great and also contains much information and interviews.

alfavita y2k said...

Actually, high costs of public medicare is something unplausible in a nomrally developed country.

Anybody who was born sane in mind and body will not require any kind of medical care until he is a senior citizen.

Becouse of this simple natural fact, in a normally developed country the society can afford cheap medicare for everybody who would request it, it seems obvious.

Then why and who are all those people who are in need of medical care until they reach th esenior citizen age status?

You see, the high cost of medicare means only one thing, that somehow there are a lot of people being born in this country with inborn disfunctions, or being damaged by their parents since childhood.

In case of these inborn or careless parenthood health problems, it is obvious that they cannot not be normal people, but connected to criminality, such as prostitution or crooks, becouse it is the only kind of people who are able to give bith to degenerated children.

Probably it would be a great idea to investigate further how many exactly criminals and prostitutes were able to create a family and procteare defective children, insane in mind and body.

Anonymous said...

Sounds like Kaiser. Not sure everyone would be happy with that approach but it is cheap and they do a good job with things like diabetes and high blood pressure. You are forced to sacrafice some of your privacy rights though, their formulary is more limited and the psych care is spotty at best.