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Old 12-20-2009, 08:18 AM   #21
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10. Lack of portability caused by the employer healthcare model leads to inefficiencies in the labor market as people take suboptimal jobs solely for the health care.
Yeah, this is one I've certainly harped on here in the past, so I'm surprised I didn't mention it again. It's sad to think about how much entrepreneurial spirit -- and economic value-added -- has been lost because some people with both great ideas and the ability to execute a solid business plan never did so because they were chained to Megacorp's health insurance, not to mention that their dreams are stifled by feeling chained to those benefits. I sort of mentioned it by calling out the silly linkage between health insurance and employer, but this is another consequence of it which I didn't list.
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Old 12-20-2009, 08:36 AM   #22
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To add just one thing to Gumby and Ziggy's lists:

15. Outmoded and inefficient medical procedures. For example, from a 2008 CBO report:
Variations in health care are often most dramatic when there is uncertainty about
what kind of treatment to administer. For example, it is clear that aspirin should
almost always be provided to a patient upon admission to the hospital for a heart
attack, and there is very little variation in that practice. However, there is significantgeographic variation in the use of imaging and diagnostic tests, and it is often unclear when those services generate useful information or how frequently they should be provided.
Similarly, admission to the hospital for a hip fracture is always indicated, and admissionrates for people with that injury show little variation; but much less of a consensus exists about back surgery, and the related admission rates vary much more widely.
Overuse of supply-sensitive services and differences in social norms among local
physicians seem to drive regional approaches in the use of innovations and treatments.
Some regions appear more prone to adopt low-cost, highly effective patterns of care, whereas others are more prone to adopt high-cost patterns of care and to deliver treatments that provide little benefit or are even harmful.

* * *
However, even among elite medical centers, there is
significant variation in cost. Among the UCLA (University of California, Los Angeles)
Medical Center, Massachusetts General Hospital, and the Mayo Clinic (St. Mary’s
Hospital), for example, composite quality scores are very similar (81.5, 85.9, and
90.4, respectively). Although the Mayo Clinic scores above the other two, its cost per beneficiary for Medicare clients in the last six months of life ($26,330) is nearly half that at the UCLA Medical Center ($50,522) and significantly lower than the cost at Massachusetts General Hospital ($40,181). Uwe Reinhardt, renowned professor of
economics at Princeton University, asks, “How can it be that ‘the best medical care in the world’ costs twice as much as the best medical care in the world?”2
So how much could all this amount to? Researchers have estimated that nearly 30 percent of Medicare’s costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level in low-cost areas.

http://www.cbo.gov/ftpdocs/93xx/doc9...althSummit.pdf


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Old 12-20-2009, 08:36 AM   #23
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Interesting, but where is this going? Just asking...
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Old 12-20-2009, 08:37 AM   #24
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Interesting, but where is this going? Just asking...
Nowhere. We have no lobbying power.
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Old 12-20-2009, 08:41 AM   #25
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Interesting, but where is this going? Just asking...
I just think it's interesting to see what we think the problems are, and contrast that to what the politicians are doing. I think it's interesting and positive to note that we have been creating a list that is fairly "multi-ideological" in that these are problems that one side or the other is advocating for or against, yet it looks like a lot of us (as opposed to the folks in Washington) can see that neither side has all the answers to what needs to be done.

And yet both sides act as if they know all the things that need to be done, even when both sides are tainted with partisan agendas and the desire to protect their pet constituents. We collectively have no such taint, and it's showing in the rather non-partisan list of problems we've documented -- some from column A, some from column B and a little bit that's not in either column, if you will.
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Old 12-20-2009, 09:24 AM   #26
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We are with a Medicare Advantage health plan which includes a perscription drug plan. The drugs still cost us a lot as we both hit the donut hole this year. That's $2750 each (our cost plus their cost). I'm trying something different right now. I'm on Plavix which cost me $116 for a 90 day supply through my health plan mail order service (their cost is $326). That's $442 toward the donut hole. So, I decided to try a Canadian pharmacy that advertizes here locally and has four offices in the county. My doctor's office is familiar with this pharmacy and recommended I talk to them. The US can't yet sell the generic version but I can get it through Canada for $53 plus $10 shipping for a 90 day supply. Their manufacturer is a company in India that is FDA aproved. It's one of this Canadian company's biggest seller because of the generic version being available outside the US. I'm paying about half price and it won't count toward the donut hole. I've got it on order and will see how this system works out.
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Old 12-21-2009, 07:47 PM   #27
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One issue that I have never seen addressed and it surprises me.

we maintain too many separate hospitals system with each requiring, buildings, support facilities, vehicles, equipment, supplies, doctors, nurses, staff, admin.
1. Veterans Hospitals
2. Military Hospitals for active duty and dependents
3. Private Hospitals
4. Children Hospitals
5. Public Hospitals
6. University Hospitals.

etc.

You would think that some efficiency would be gained by having some standardization and pooled resources.
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Old 12-31-2009, 04:52 PM   #28
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Here's the #1 most ineffecient part of the healthcare system - third party payers. If we got rid of those altogether, healthcare costs would drop like a rock....but nobody wants to do that because they love their $15 co-pays.
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Old 01-12-2010, 01:38 PM   #29
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Haven't had time to fully comprehend this article, but I'm posting it fyi...

Issues in Science and Technology, Winter 2010, Better U.S. Health Care at Lower Cost
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Old 01-14-2010, 10:08 AM   #30
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Here's another article I found addressing the issues of cost and effectiveness...

Yahoo! Personal Finance: Calculators,Money Advice,Guides,& More

Quote:
To get your mind around the concept of "cost effective," think about the following exercise. Suppose I offered you a choice today -- while you are presumably healthy -- between $400,000 and an extra two weeks of life at some point. Most people would take the $400,000. We don't have unlimited resources. The best way to get excellent health outcomes at an affordable long term cost is to channel our resources to the kinds of medical care that have the most pronounced impact on health.
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Old 01-15-2010, 06:07 PM   #31
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"Cadillac" plans that are tied to collective bargaining agreements may run into tax/fee healthcare legislation problems in the near future.

Oh, never mind that has now been resolved, I believe.
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