[Rich_in_Tampa]

Evidence-based medicine (EBM) is something I know a bit about, and probably is the golden nugget that providers can seek in order to provide value-oriented care. It has been estimated that in addition to improving outcomes, it would drop costs about 30%. This jives with my last "report card" while I had HMO patients: my "outcomes" were favorable and my charges were close to 30% below the mean (small, statistically insignificant meaningless sample, but interesting).

The other part is due to financial and political issues and probably the providers are not the right pressure point. In my mind, it relates to the fact that health care does not respond to capitalism and market pressures in a way that other service sectors do.

I am no economist, but simplistically, important health services cannot simply be withheld if unpaid for (like a car could), there are moral and ethical standards and risks that come into play that are unique, and the absence of rationing (a societal issue) means that issues such as age, frailty, comorbidity and others cannot be factored in when determining who gets services like dialysis, bone marrow transplants, and even complex surgery. Consumers cannot effectively compare the value and quality among providers.

Any successful system in my opinion will have to address universal access, probably governmental subsidy for big ticket items, and at some level a degree of rationing sanctioned by society, with providers held harmless assuming they follow the rules.

Yesterday I took on the care of a 93 year old woman with advanced pancreatic cancer and no living relatives who cared enough to come visit her. She is now in the ICU on a ventilator, bless her soul, and will likely remain there for weeks or longer. The cost of her care is astronomical, everyone agrees that her benefit is negligible, and no one is empowered or protected in doing anything about it. One of many.