Wednesday, October 24, 2007

Joint Canada/United States Survey of Health: Findings and public-use microdata file: Analytical report

Joint Canada/United States Survey of Health: Findings and public-use microdata file: Analytical report:

"Overall, most Canadians (88%) and Americans (85%) reported being in good, very good or excellent health. However, the range of health status was more polarized in the United States. More Americans reported being at either end of the health status spectrum – in excellent health (26%) and in fair and poor health (15%) – compared with Canadians (24% and 12% respectively)."

I saw a post arguing that this data proved the US system is better, and I just wanted to post the summary report for reference. Follow the link for the rest of it. It's worth remembering how much more we spend here than there as you review the numbers, and it's worth restating that we want to build an American system that is the best in the world in its totality, not just in niches of high tech and procedural related care.

Sphere: Related Content

James C. Capretta on Medicare on National Review Online

James C. Capretta on Medicare on National Review Online:

It is a useful exercise for me to go through these now and again to make sure my arguments are on the up-and-up.

Clinton has now embraced and updated the idea — enrollment would be voluntary, not mandatory as it was in the 1990’s version — but the effect would be the same: more bureaucratic control of health-care arrangements, with lower quality, less innovation, more inefficiency, and still rapidly rising costs. Indeed, the irony of Medicare is that the program’s complex and burdensome payment regulations, aimed at controlling costs, actually drive up costs for the program — and everyone else who pays for health care too.

It is truly amazing that people outside of healthcare have this idea that Medicare is the insurance plan that has the stultifying bureaucracy and that the government (you know, with the NIH, NCI, IOM, CDC, and millions of grant dollars every year) are responsible for reducing quality and innovation.

Government-run Medicare is 1960’s-style fee-for-service insurance. No attempt is made to manage the use of services with a network of affiliated providers or other mechanisms. The only way to controls costs in this kind of insurance is to require enrollees to pay for some of the costs when they get health care, thus discouraging unnecessary use, or to cut the payment rates per service. Predictably, politicians have preferred to cut payments rates rather than impose cost-sharing on beneficiaries. Today, most Medicare fee-for-service enrollees pay little or nothing at the point of service.

The result? An explosion in demand. The Medicare Payment Advisory Commission (MedPAC) reports that the average Medicare beneficiary used 30 percent more physician services in 2005 than they did just five years earlier. Spending for physician-administered tests went up 46 percent during this period, while use of CT scans and MRIs went up 61 percent.

I don't think this is an either-or proposition, but I'll play: Either you want rationing or not. If you want rationing, call it rationing, don't call it "managing services" or "discouraging unnecessary use". If your preferred method of rationing is bureaucracy and co-pays and economic rationing based on which plan you can afford, well, we already have that. It's called private insurance.

To combat the costs of rising service use, Medicare administrators have tried just about every trick in the price control playbook. Indeed, the care and feeding of the payment systems for hospitals, physicians, physical therapists, nursing homes, labs, home health agencies and many others is now an all-consuming, all-year enterprise for the Medicare bureaucracy. Not surprisingly, doctors, hospitals, and other service providers have engaged their own small army of advocates to watch the bureaucracy’s every move and respond as necessary to protect their financial interests.

More often than not, it’s the health-care service providers who come out ahead in this struggle. Politicians and program officials do not want to be accused of disrupting how or where seniors get care. So, naturally, service providers use exactly that threat — closed facilities and reduced access — to extract payment rate concessions. And so, despite the issuance of mountains of payment rules by the bureaucracy, Medicare’s costs continue to rise as rapidly as ever, with no end in sight.

OK, so Mr. Capretta, I presume, want to wants to ration by his method, economically, in which you get only what you can afford, rather than based upon need. I prefer a societal discussion on how we allocate resources and services.

Medicare’s price controls not only don’t work to control costs, they also undermine the incentive for true, cost-reducing innovation. New types of organizations (like integrated hospital-physician efforts), pricing approaches (like a single bundled payment for a full episode of care), and ways of taking care of a patient (like over the internet and phone) are simply not accommodated by the program’s inflexible payment rules. Doctors and hospitals are thus understandably reluctant to invest in new, consumer-friendly and cost-effective approaches to providing care which will only pay off in the unlikely event Medicare officials will accommodate the change within a reasonable time frame. The result is that today’s costly system for delivering services is virtually frozen in place — for all users of U.S. health care, not just Medicare beneficiaries.

Well, if you want to take an example, the VA helathcare system, the socialized US model in which the government owns and runs the whole thing, is making great strides in electronic health records and medical infomatics. It is much easier for them because they have a single insurance/payment system to interact with, all providers get the same system within whcih to work, and there are not dozens of different insurers trying to deny services in hundreds of different way each and every minute of the day.

If Clinton succeeded in creating a new Medicare-like insurance option for working-age households, there is no reason to believe the results would differ from the four-decade experience of current Medicare. Many workers would enroll in the new government-run insurance because the price control system and other rules would shield them from high cost-sharing. With prices artificially low, demand for services would be high, and the government would respond with flawed and clumsy attempts to keep a lid on costs with tighter payment rates and more regulation. All the while, service providers would become resigned to working the payment regulator for higher fees instead of searching for better and less expensive ways of providing care.

Same deal, he wants economic rationing, I want a societal agreement.

What’s needed is a Medicare reform which deregulates consumption and fosters competition and cost-cutting innovation while ensuring reliable insurance for enrollees.

Reformers should look to the design of the new drug benefit for how to get started. For drug coverage, the government relies on price competition, not price controls, to keep overall costs in check. The Medicare program pays 65 percent of the weighted-average of the bids submitted by the competing insurance plans. The beneficiary then pays all of the difference between the Medicare payment and the actual premium charged by the insurance plan they have chosen.

The competition for drug benefit enrollees is not distorted by the presence of government-run insurance with regulated pricing. Drug plan sponsors are all private insurers competing on exactly the same terms: their ability, using only private-sector tools and innovation, to put together an attractive combination of covered drugs, price per prescription, and beneficiary cost-sharing — at the lowest possible premium.

The results have been promising — and unheard of in health care. Beneficiary premiums fell from 2006 to 2007, and Medicare officials announced in August that the average monthly premium for 2008 will be just $2 higher than it was in 2006 — and 40-percent below original projections.

I do not claim to be a real economist, I am willing to listen, but did this have anything to do with the mountain of cash infused into the system for the Part D benefit?

Non-italics from:
James C. Capretta is a fellow at the Ethics and Public Policy Center. He is also a health-policy and research consultant.


Sphere: Related Content

Doctor X takes on flawed (Irish) system

Doctor X takes on flawed system:

"He told ‘Morning Ireland’ that the two biggest problems in Ireland were lack of accountability in the Health Service Executive, and the two-tiered system of private and public health. “Consultants hold all the power in the Irish system, and that is one of the main problems,” he said. The Bitter Pill devotes a chapter to his criticisms of the two-tier system. “In order that a private health service can justify its existence, it is necessary that it offers a better service than the public health service. It follows, then, that the public service is below-par and therefore unable to deliver best practice,” he writes. Among the many flaws he describes is the fact that consultants are often not in a hospital when one of their patients is ready for discharge, because they are at their private clinics. This can mean that a patient who is ready to leave must stay in hospital, sometimes over a weekend, with all the attendant costs on the system and the ‘blocking of the bed’ for the next sick person."

His book is The Bitter Pill: An Insider’s Shocking Expose of the Irish Health System.

There is another book, Emergency Irish Hospitals In Chaos - Author Marie O Connor , and I'm trying to find out more about it. Here's something.

In any case, just trying to gather information about what we want in a healthcare system and what we want to avoid.

Sphere: Related Content

Friday, October 19, 2007

The McGill Daily - Hyde Park: When universal healthcare isn’t

The McGill Daily:

"But as any medical professional will tell you, this vaunted Canadian universalism is gradually being attenuated. As I recently discovered, universal in Ontario does not always translate to universal in Quebec. Specialized doctors are increasingly compelling their out-of-province patients – a group that includes many university students – to pay out-of-pocket for medical services.

"Specialists are adopting this practice because it relieves them of the cost of processing out-of-province claims and protects them from the occasional loss should a patient turn out to lack provincial health coverage. While out-of-province patients are still entitled to reimbursement from their home provinces, they must seek recovery on their own, a process that can take many weeks. If an out-of-province patient fails to pay, however, the specialist may refuse treatment, a course of action that carries no disciplinary consequences. "

Another caveat. Makes state by state action less appealing. Medicare-for-all looks better as Medicare causes no trouble when traveling to say, Florida for part of the year.

Sphere: Related Content

Thursday, October 18, 2007

Curing Canada's chronic ills - features

Curing Canada's chronic ills - features:

"Advocates of the public system, such as McBane, insist that universal health care is one of the strongest manifestations of Canadian values and identity. 'We don't think we can survive with rugged individualism alone. We believe that we need community, especially to take care of sickness. The sick shouldn't be alone to take care of themselves,' he says. 'That's how we've organized a lot of social policy. Around collective approaches to problems, not survival of the fittest-which is very American.'

"Day, however, insists that even adament supporters of private care do not aspire to everntually 'adopt an American-style health system.'

"Despite prevailing anti-American sentiments, Professor Soderstrom maintains that the best way to analyze the likely effects of a private provision on the performance of health care in Canada is to look at the American experience for guidance.

" 'There is a large amount of literature out there that looks at the likely effects of private provision on the performance of the health care services. If you look at the preponderance of evidence, it suggests that the full profit provision does not improve quality of care, does not improve productivity and it's not at all clear that it improves access,' he says. 'There is even literature that looks at private clinics and says if you look at the quality of care, the private clinics have it much worse than public clinics. Unfortunately, [Canada] is not yet marked by this debate.'"

Clearly there are caveats in this piece for America as we adopt a single payer system.

Sphere: Related Content

Wednesday, October 17, 2007

2008 Presidential Candidates Healthcare Proposals Side by Side Comparison

Analysis -

"This side-by-side comparison of the candidates positions on health care was prepared by the Kaiser Family Foundation with the assistance of Health Policy Alternatives, Inc. and is based on information appearing on the candidates websites as supplemented by information from candidate speeches, the campaign debates and news reports. The sources of information are identified for each candidates summary (with links to the Internet). The comparison highlights information on the candidates' positions related to access to health care coverage, cost containment, improving the quality of care and financing. Information will be updated regularly as the campaign unfolds."

This is an interesting exercise. I suggest you click on Kucinich and anyone else and view them side by side.

Sphere: Related Content

Tuesday, October 16, 2007

Survey Confirms Growing Demand for Primary Care Physicians -- AAFP News Now -- American Academy of Family Physicians

Survey Confirms Growing Demand for Primary Care Physicians -- AAFP News Now -- American Academy of Family Physicians:

"The average salary or income-guarantee offers made to family physicians increased from $145,000 in 2005-06 to $161,000 in 2006-07, a gain of 11 percent; however, average offers made to FPs who also practice obstetrics remained relatively flat, increasing from $158,000 in 2005-06 to only $159,000 in 2006-07. "

It's good to see some move towards better compemsation for PCP's. If reimbursement weren't so heavily skewed towards procedures, we'd get more appropriate distrubution among specialties.

Sphere: Related Content

House Republicans plan their own health plan - The Crypt's Blog -

House Republicans plan their own health plan - The Crypt's Blog -

"Under fierce attack by Democrats over the children’s health insurance plan, House Minority Leader John A. Boehner said Sunday Republicans will unveil their own health care plan over the next few months. “Republicans are working on a plan that will provide access to all Americans to high quality health insurance, make sure that we increase the quality of insurance that we have in American, and we want to foster a sprit of innovation,” said Boehner on “Fox News Sunday.” “This is a plan we’ll see over the next coming months where we put the patients in charge of their health care.”"

Wow. Another step to the tipping point?

Sphere: Related Content

Thursday, October 11, 2007

The Doc's In, but It'll Be a While (Business Week)

The Doc's In, but It'll Be a While:

"The Doc's In, but It'll Be a While Despite spending lots more per capita on health care, the U.S. is often as bad or worse than other industrialized nations in wait times "

h/t to Marc Brown

It is from June '07, but it was new to me...

Sphere: Related Content

Wednesday, October 10, 2007

Sadly, No! » Malkin vs. Malkin

Sadly, No! » Malkin vs. Malkin

Too funny! (Or is it too sad?)

Sphere: Related Content

Capitol Feud: A 12-Year-Old Is the Fodder - New York Times

Capitol Feud: A 12-Year-Old Is the Fodder - New York Times:

"An aide to Senator Mitch McConnell of Kentucky, the Republican leader, expressed relief that his office had not issued a press release criticizing the Frosts.

But Michelle Malkin, one of the bloggers who have strongly criticized the Frosts, insisted Republicans should hold their ground and not pull punches.

“The bottom line here is that this family has considerable assets,” Ms. Malkin wrote in an e-mail message."

I realize this is somewhat off-topic for a single-payer blog, but here goes anyway.

Since when does Michele Malkin think that having considerable assets means one should not try to take the government for all one can, be that corporate welfare, no-bid contracts, capital gains tax cuts, killing the estate tax for the mega-wealthy, etc.?

I expect I won't be the first one to say, without embarrasment, that it really frosts me how they are treating the Frosts. My God, if we went after every person St. Ronald of Reagan threw at us to "put a human face" on a situation, we'd still be at it 20 years later! Not to mention the Snowflake babies and their families ("any abortionists in the family, ma'am? anybody with Parkinsons?")!

But I would like to know when someone is going to have the Edward R. Murrow moment or the Joseph Welch moment.

"Have you left no sense of decency?" When George W. Bush said after 9/11 that you were either with us or against us, I had presumed he meant with America and the liberal democracies in the world or not. No, as it turned out, he meant that you were either with the far right wing of the American Republican Party, the neocons, the fundamentalists, the constitutional "originalists," the unitary executive-ists, the authoritarians, the xenophobes, the selfish, the unilateralists, the imperialists, and the military industrial complex. If you were not one of that "us," you were unpatriotic, anti-american, ungodly. You deserved to be labeled with Newt Gingrich's dirty words from his infamous GOPAC memo.

Cheers (or, Good night and good luck)

Sphere: Related Content

Sunday, October 7, 2007

Medicare Audits Show Problems in Private Plans - New York Times

Medicare Audits Show Problems in Private Plans - New York Times:

"The audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications. "

"I'm shocked, shocked," says Captain Renault...

Update: I've trackbacked (or is it trackedback?) to firedoglake post on this, so that if you need lots more examples of why we need single payer, you can click on the various topics I have set up on the right to get data when you are in a fracas...

Sphere: Related Content

Wednesday, October 3, 2007

Harold Meyerson - Return of the Goldwater GOP -

Harold Meyerson - Return of the Goldwater GOP -

"Today's Republicans seem determined to re-create that magical Goldwater self-marginalization. Opposing the provision of health care to children because it conflicts with one's faith in an economic future (capitalism insures everyone) that capitalism itself does not really share (or it would insure everyone) is the same kind of theological nuttiness that led to the Goldwater debacle. In the name of attacking socialism, what Republicans are really doing is affronting the empiricism and the pragmatism, not to mention the decency, of the American people. At, one need hardly add, their own risk. "

A nice piece that covers nicely the ideology leading to opposition to SCHIP, let alone Medicare-for-All.

Sphere: Related Content