Friday, May 08, 2009
Health care wonkery
Not surprisingly, there are a large number of physicians and other healthcare industry people among the readers of this blog. With them in mind, I hereby supply the link to the first of three forthcoming Senate Finance Committee reports on the reform of the health care. I printed off a copy for my own amusement -- that's the kind of guy I am -- and will report back if I see anything blogworthy.
6 Comments:
By 
, at
Sat May 09, 12:40:00 PM:
Link:
I know little about healthcare -- but that won't stop me from making a few observations.
Our federal government only has big crude levers -- this is true for any large government -- it's an apolitical phenomenon. But we seem to be going in the direction of trying to micromanage things -- I can't wait to see the debacle we'll see in healthcare, as if what we have isn't bad enough already.
Most of the money in healthcare spending goes to eight or nine chronic diseases. If we want government to own healthcare -- and had vision -- we'd seriously pursue disease management. Diabetes alone is worth doing. Interestingly Arab people have some of the highest rates of diabetes -- is it crazy to create joint research programs and have them kick in?
I confess to having been involved in one failed business venture in healthcare -- the lesson I learned is that individual caregivers can be good, but that the system as a whole doesn't give a rat's ass about patient outcomes ... only about billing.
Many healthcare spending decisions are implicitly about valuing human life. If you don't address this expressly, you are addressing it implicitedly. We need a serious national conversation about what's appropriate care for the elderly. I don't mean this in a mean spirited way ... but I don't think we should be routinely giving hip replacements to 80-year olds. Am I wrong? I'd rather we spent more to help the young -- who have their whole lives ahead of them.
Once we get to a certain age -- say 70 - 75 -- all we should expect from the government is all the morphine we want and our choice of nurse.
By 
Georg Felis, at
Sat May 09, 01:34:00 PM:
I would suspect that once you hit 80, in good health, and with the possiblity of 20 years of crippling pain in front of you, you will suddenly be in favor of hip replacments for people your age. (disclaimer: I have a half-dozen bionic relatives in that age range.) Hip replacements are getting to be routine, and a *lot* cheaper, and better. I suspect by the time I'm 80, it may be less expensive and painful than removing wisdom teeth. (which I'm not looking forward to either)
By JPMcT, at
Sat May 09, 11:28:00 PM:
"Once we get to a certain age -- say 70 - 75 -- all we should expect from the government is all the morphine we want and our choice of nurse"
Yeah...just like the first income tax was only 1% on the top fringe of income. Gee, look how that has metastasized! Give the government this power and before you know it your "certain age" will be 50!!
I personally have operated on lots of people in their 80's with cancer, aneurysms, cerebrovascular disease, etc. etc. By and large the key factor in a sucessful outcome is judgement. There are a lot of people in their 40's and 50's I wouldn't touch with a ten foot pole. The octogenarians tend to be healthy, appreciative and do very well. It ain't my role to play God.
Therin is the rub. If you socialize medicine, nobody in their right mind is going to put his/her life on hold for 10 years of post graduate training, a hostile legal climate,enormous educational debt...and no control over your business.
The rewards of a career in medicine when I started out were intellectual, financial and social.
It was the perfect place to flex your brain, actively DO SOMETHING to help people, have the respect of your community and make a fair living in the process.
What will be left?
By , at
Sun May 10, 11:03:00 AM:
To JPMcT from Link:
I have a 17 year old. I'm telling him that he should be a surgeon or a New York fireman. I still want to believe that being a surgeon should be a good long-term career path -- the demand will be there, because of demographics ... and people will still care about "quality" when they pick a surgeon. Is this true?
I wrote about "morphine and a nurse" to be provocative, but only half in jest. Because a medical procedure is available, should every 80-year old be entitled to get it at government expense? I'm not saying this to be cruel -- but as a reality check. We're all going to die ... I don't want my kids bled dry financially to pay for the boomer generation trying to delay the inevitable by a year or two. Each of us needs to realize that if we make it to 70 ... or 80 in decent health, count your blessings.
Healthcare expense may be our biggest challenge -- what we have is unsustainable both economically and politically. It's an underlying reason for the collapse of GM and Chrysler. California would be going bankrupt this year were it not for Obama's stimulus bailout -- in part because of unfunded Medicare mandates and illegal immigrants using emergency rooms for primary care. Kids like my son will eventually become a very large and very angry voting block. I don't expect to see a dime out of Medicare by the time I become eligible -- but I'll be expected to pay for the healthcare of fifty-year old retired state workers -- that will make me an angry voter too. It may take ten years or more, but I wouldn't be surprised by a major political realignment around these and related issues.
By JPMcT, at
Sun May 10, 01:49:00 PM:
Anon, we are on the same page.
We don't really "lose" money on appropriate care for the elderly, since Medicare is set up with a "revenue neutral" formula. If I fix an aortic aneurysm on an older petient, I get about 22-25 cents on the dollar...or, looked at another way...I get the same reimbursement that I got about 15 years ago, indexing for inflation.
We lose money on health car efor a lot of reasons...most of the reasons will not change with nationalized health care:
1. Society and families are incapable of dealing with patients who are "at the end of the road". We want "everything" done...primarily (I think) to leave a clear conscience when our elderly family menber, neglected for years, finally bites the dust. MASSIVE expense is incurred for "end of life" care.
Education will help. Reinstilling understanding and reverence for the elderly into our value system will help. Nationalized health care wont help.
2. Malpractice. Every doctor in the "real world" spends lots and lots of money being certain that their patient charts are "review friendly", including ordering a lot of stuff that simple is NOT needed from a practical standpoint. Hell, I do it. When I look at the things my colleagues get sued for, and look at the wife and three kids that I have, I am completely unapologetic about it. I pay almost 50 grand a year in insurance, even though I have never been sued and consider myself at the top of my game. Looking around the country, I am LUCKY to be paying this pittance. Tort reform will help. Caps will help. Making the losers pay litigation costs will help. Being like Texas will help. National Health care wont help.
3. Western society has slowly come to consider age an inconvenience that can be erased with high tech medical care, plastic surgery, wonder drugs and doctors like on TV. In reality, we have token preventive care, hospital systems that have become megacartels appealing to the consumer side of medecine, lawsuits deemed appropriate if ANYTHING goes wrong and an almost complete lack of personal responsibility. Again, education will help. Here, nationalized health care MAY help...only if it FORCES people and hospital systems to change their focus. pardon me if I am pessimistic.
As far as your 17 year old goes, he/she will have more than enough time to test the waters before making a decision. The US will need upwards of 10,000 MORE surgeons over the next generation. Unfortunatley, the US will not be getting that many. Even though I have encouraged my own kids to do something wlse (being concerned about their happiness), I still can't imagine doing anything else with my life and have had an absolute blast doing this over the past 30 years. Your kid will do whatever they want to do anyway, regardless of how well you aim the arrow.
By , at
Mon May 11, 08:45:00 AM:
To JPMcT from Link. Thanks for the response. Obama is supposed to announce a healthcare cost-cutting proposal today. Let's see what it brings.
