Health care?

[explanade]

I have always thought that there are many facets to the issue of high health care costs in the US. Here's another example. In both my family doctor and my dentist offices, I saw about the same number of clerical workers as the number of health care professionals, i.e. nurses or PA and the doctor himself. Obviously, they need many paper pushers to deal with Medicare and the private insurance companies. And then, on the other end, who knows how many are employed by the government and the insurance companies to haggle back and forth with the health care providers. Meanwhile, do the patients know if the charges are correct, or do they even care how much certain procedures cost?

There was a famous Harvard Medical School study a few years ago which estimated that at least 25% of our total health care spending goes to processing insurance claims. We're talking half a trillion per year or more.

Doctors have to hire full-time staff to process insurance payments, as different insurers use different codes for the same conditions. Even then, many doctors have to spend a big chunk of their time handling the insurance claims as well.

Oddly though, during the whole health care debate, it was pointed out that the total revenues of all health insurance carriers was a small fraction of total health care spending, under 10% IIRC. But then the processing of the insurance takes a lot of time and money.

 

[marko]

Just wondering how many of these "great" national health systems (Canada, UK, etc etc) have been indirectly 'subsidized' by the US system.

By that I mean the US pharma cos (who spend billions on drug research...and expect a payback), US med-tech cos, (who again spend billions and expect a payback), US trained research/doctors, etc etc. Leading edge tech/pharma -most developed here-- costs a lot of money and the costs of healthcare reflect that...paid for by you and me.

BUT! At the same time, the nationalized systems are also beneficiaries as they get the tools, drugs, information and techniques that were developed here in the US (again, at our expense) become available to them as well.

So, can a fair comparison be made when a lot of the infrastructure/innovation/(heavy lifting) in other countries is actually being paid for by someone else? I wonder if the UK had to re-invent all their current resources from scratch how good their system would be.

Might be a bad example, but it's sort like the bat-boy showing off his World Series ring.

Jus' sayin'

 

[Midpack]

There was a famous Harvard Medical School study a few years ago which estimated that at least 25% of our total health care spending goes to processing insurance claims. We're talking half a trillion per year or more.

Doctors have to hire full-time staff to process insurance payments, as different insurers use different codes for the same conditions. Even then, many doctors have to spend a big chunk of their time handling the insurance claims as well.

Oddly though, during the whole health care debate, it was pointed out that the total revenues of all health insurance carriers was a small fraction of total health care spending, under 10% IIRC. But then the processing of the insurance takes a lot of time and money.

Everything I've read says administrative costs are one of the reasons (of many) we pay so much more for health care in the US. Coordinating among so many providers, insurance companies, employers, etc. isn't efficient. And many other countries have or are moving to online medical records which helps considerably. Here's just one US vs Canada illustration re: health care admin costs, shocking IMO...and necessary

US health care costs are higher because of administrative waste - Something Not Unlike Research

 

[explanade]

A lot of the major pharmaceuticals are in fact based in Europe. But they dip into US funded research and certainly make a big chunk, if not most of their profits in the US market.

 

[nun]

Just wondering how many of these "great" national health systems (Canada, UK, etc etc) have been indirectly 'subsidized' by the US system.

By that I mean the US pharma cos (who spend billions on drug research...and expect a payback), US med-tech cos, (who again spend billions and expect a payback), US trained research/doctors, etc etc. Leading edge tech/pharma -most developed here-- costs a lot of money and the costs of healthcare reflect that...paid for by you and me.

Pharma is not a good example to choose to make your point as the French, Swiss, German and UK pharma industry is enormous. So the US profits from all that European innovation too.

IMHO such arguments are made as a last resort to try to rationalize a US system that is expensive and inefficient.

But even if it were true that the US spends so much more that the rest of the world on innovation and then the rest of the world benefits, why doesn't the US recoup it's research investment in royalties and sales of medical hardware and drugs and deliver medical care at a cost that is competitive with the rest of the world?

 

[marko]

As the previous poster noted: "...A lot of the major pharmaceuticals are in fact based in Europe. But they dip into US funded research and certainly make a big chunk, if not most of their profits in the US market...", I say 'follow the money'...somebody has to pay for it and it may as well be us!!

I wasn't trying to make an argument for the current system but just trying to point out that a lot of the smugness coming from the national systems isn't fully warranted.

At the same time, we need only to look at the current events in Greece to see how crippling the cradle to grave benefit approach can become.

 

[Alan]

At the same time, we need only to look at the current events in Greece to see how crippling the cradle to grave benefit approach can become.

Greece is tiny. Financially less than 2% of the GDP of the Eurozone. It is only news because it was allowed to join the Euro even though it didn't meet the standards required. If it was still on the Drachma it would have imploded with such a small financial pop it may not have even made the main news networks.

It is not Healthcare (<3% GDP compared to >16% in the USA) that has caused the Greek economy to be in such bad shape but a combination of things. (this thread is about universal healthcare, right?)

Health care in Greece is provided by the state through a universal health care system funded mostly through national health insurance, although private health care is also an option. According to the 2011 budget, the Greek healthcare system was allocated 6.1 billion euro, or 2.8% of GDP.

 

[nun]

I wasn't trying to make an argument for the current system but just trying to point out that a lot of the smugness coming from the national systems isn't fully warranted.

At the same time, we need only to look at the current events in Greece to see how crippling the cradle to grave benefit approach can become.

I fully agree about excessive spending and your point about Greece is well taken as far as general spending is concerned not as far as it's healthcare system as it's a far smaller %age of GDP than the US spends and everyone is covered. My point is that America spends twice as much as most other countries on healthcare and gets half the value, it is worse than Greece. If America were to adopt one of the systems from abroad it would save money and probably cover more people too.

 

[marko]

Ok, ok, ok.

Not to go further off topic, but I do remember when Bush was spending < 3% GDP in Iraq...a lot of people claimed that was going to bankrupt us.

But, point taken. Thanks!

Still wish I was back living in Greece again though: free healthcare, good food and nice weather....good living until the tear gas start flying.

 

[MichaelB]

Ok, ok, ok.

Not to go further off topic, but I do remember when Bush was spending < 3% GDP in Iraq...a lot of people claimed that was going to bankrupt us.
.

Totally off topic.

 

[marko]

Totally off topic.

Of course.

Sorry.

 

[Midpack]

Viewed an interview with this gentleman this morning (Dan Rather's program on HDNet). For those of you who contend we can't reduce health care costs while increasing quality of health care. The details are readily available...

Candid Advice From a Health Care Visionary
Dr. Donald Berwick, who was the administrator of the agency that runs Medicare and Medicaid (alas only 17 months), has been speaking out.

Berwick began his career as a pediatrician at Harvard Community Health Plan; in 1983 he became the plan's first Vice President of Quality-of-Care Measurement. In that position, Berwick investigated quality control measures in other industries such as aeronautics and manufacturing and considered their application in health care settings. From 1987-1991, Berwick was co-founder and Co-Principal Investigator for the National Demonstration Project on Quality Improvement in Health Care, designed to explore opportunities for quality improvement in health care. Based on this work, Berwick left Harvard Community Health Plan in 1989 and co-founded the IHI (Institute for Healthcare Improvement).
​

He also found signs everywhere that hospital systems, specialty medical societies, patient safety programs, health insurers, employers, labor unions and various states are already taking steps to improve the quality and lower the cost of health care. He said there is still plenty of room for savings in a complex system where, he estimates, 20 percent to 30 percent of all health spending — or more than $1 trillion a year — may be “waste” that does nothing to help patients.

 

[nun]

Viewed an interview with this gentleman this morning (Dan Rather's program on HDNet). For those of you who contend we can't reduce health care costs while increasing quality of health care. The details are readily available...

I've heard him on NPR a couple of times. He's a Harvard academic with a long list of degrees from Harvard College, the Kennedy School and the Medical School. He has advocated introducing some of the methods used in the NHS and other foreign systems. This all makes him sound impressive and pragmatic to me, but many will not be as enamored of his background or approach.

 

[Midpack]

I've heard him on NPR a couple of times. He's a Harvard academic with a long list of degrees from Harvard College, the Kennedy School and the Medical School. He has advocated introducing some of the methods used in the NHS and other foreign systems. This all makes him sound impressive and pragmatic to me, but many will not be as enamored of his background or approach.

Just one of the many ways he's been misquoted/out of context...which has indeed led (unfairly) to your last sentence.

We have got to get past making judgements based on sound bites, though it's prevalent these days.

 

[nun]

Just one of the many ways he's been misquoted/out of context...which has indeed led (unfairly) to your last sentence.

We have got to get past making judgements based on sound bites, though it's prevalent these days.

I'm not sure I know where I was incorrect. In the interviews I heard he talked about cost savings and how foreign schemes might be applied to the US.

I think this is a good idea, as will many others, but many won't agree

 

[Meadbh]

Viewed an interview with this gentleman this morning (Dan Rather's program on HDNet). For those of you who contend we can't reduce health care costs while increasing quality of health care. The details are readily available...

I have met Dr. Berwick and seen him present many times, because I have been involved in healthcare quality improvement for years. There is an enormous amount of waste in healthcare in every country in which I have worked, and there are many opportunities to improve it. There are many examples of specific examples of outstanding improvement across the globe and the NHS in Britain has some of the best. (See NICE, the National Centre of Clinical Excellence). If you are interested in learning more, take a look at the website of the organization Dr. Berwick founded, the Institute of Healthcare Improvement (IHI Home Page). There are many barriers to spreading improvement across broad health systems, including complexity, change management, lack of leadership, politics and special interests.

 

[Mulligan]

I wonder how much the increased ease and availability in joint replacements will effect health care costs down the road. I read this week that one out of 20 people over the age of 50 now has had some joint replaced already. The article said that older people used to just adjust their lifestyle to fit their pain cmfort level. Now people want it fixed and return as quickly to their previous lifestyle. The article questioned that this might in turn require more replacements down the road since they are occuring at younger ages and in turn these replaced joints will in turn need repaired or replaced.

 

[Alan]

I wonder how much the increased ease and availability in joint replacements will effect health care costs down the road. I read this week that one out of 20 people over the age of 50 now has had some joint replaced already. The article said that older people used to just adjust their lifestyle to fit their pain cmfort level. Now people want it fixed and return as quickly to their previous lifestyle. The article questioned that this might in turn require more replacements down the road since they are occuring at younger ages and in turn these replaced joints will in turn need repaired or replaced.

I expect it is quite a complex calculation when looking at the cost. MIL had both knee joints replaced and it certainly kept her mobile and moving. I'd like to think that the extra exercise she got being mobile contributed not only to a healthier life, but lower costs in LTC as she she could well have ended up in a nursing home otherwise. Since it was done under the NHS I have no idea about the relative costs of the surgery and nursing home care.

 

[Mulligan]

I expect it is quite a complex calculation when looking at the cost. MIL had both knee joints replaced and it certainly kept her mobile and moving. I'd like to think that the extra exercise she got being mobile contributed not only to a healthier life, but lower costs in LTC as she she could well have ended up in a nursing home otherwise. Since it was done under the NHS I have no idea about the relative costs of the surgery and nursing home care.

That is a very good point. I was just thinking in the narrow sense of health care cost and its effect on premiums for just the surgery. There are other varibles to consider in measuring the total cost in relation to health care.

 

[Nords]

Over 140 posts and the thread's not closed yet. I'm [-]darn surprised[/-] impressed.

I wonder how much the increased ease and availability in joint replacements will effect health care costs down the road. I read this week that one out of 20 people over the age of 50 now has had some joint replaced already. The article said that older people used to just adjust their lifestyle to fit their pain cmfort level. Now people want it fixed and return as quickly to their previous lifestyle. The article questioned that this might in turn require more replacements down the road since they are occuring at younger ages and in turn these replaced joints will in turn need repaired or replaced.

That is a very good point. I was just thinking in the narrow sense of health care cost and its effect on premiums for just the surgery. There are other varibles to consider in measuring the total cost in relation to health care.

I saw a business analysis of a surgeon's innovative new hip joint. (It's still in the lab. Let's not get our hopes up.) He went through all the problems with current hip-replacement surgery, a survey of all the models, and a forecast of the market.

From a business perspective of the current state-of-the-art surgery, you need a factory assembly line of hip surgeons. It doesn't have to be quite like Foxconn but it helps to have something like a rotating eight-table layout similar to LASIK clinics. Then you need to keep churning out those hip replacements as fast as you can file the Medicare & health insurance claims.

But everyone perked up when the surgeon pointed out that his device will be tested in dogs before it goes to humans. It turns out that veterinarians do more hip surgery per capita than surgeons, and they get a lot more money for it... One potential investor actually said "Forget the Boomers, let's fix golden retrievers!"

Based on what I learned from that discussion, the future of controlling surgical expenses lies in minimally-invasive techniques that augment existing systems (like cartilage) rather than replacing infrastructure (like bones). In other words, the cost-cutting only comes from less cutting.

 

[Alan]

In other words, the cost-cutting only comes from less cutting.

another version of "a stich in time saves 9"

I love it, and it makes so much sense. It has been over 7 years since I had carpentry work done on both shoulders. In each case DW dropped me at the surgery at 6am and picked me up before 9am. Within a couple weeks I was pain free with full mobility. Quite incredible, as simple tasks such as shaving had either become really difficult and painful, or impossible to achieve.

 

[nun]

Technological advances that reduce hospital stay times can greatly reduce costs, but good public health, preventative care and early and easy access to health care are vital in controlling overall costs.

I firmly believe that the 50 million uninsured in the US don't go to the doctor often enough, if at all, and chronic conditions that could be easily treated develop into acute illness requiring expensive treatment.

 

[Buckeye]

Technological advances that reduce hospital stay times can greatly reduce costs, but good public health, preventative care and early and easy access to health care are vital in controlling overall costs.

I firmly believe that the 50 million uninsured in the US don't go to the doctor often enough, if at all, and chronic conditions that could be easily treated develop into acute illness requiring expensive treatment.

+1

Even just the simplest thing as identifying and controlling high blood pressure. Huge future costs involved if not controlled with a very inexpensive medication.

 

[Midpack]

Over 140 posts and the thread's not closed yet. I'm [-]darn surprised[/-] impressed.

I'm impressed with the members too, though we've had lengthy non-political discussions re: health care here before. It is a crucial retirement topic of course, glad we can exchange views (for the most part) without resorting to the political scare tactic sound bites and out of date "facts" that prevents progress. There is no way we can just accept the health care status quo, I wish we'd get on with it, and maybe we are.

 

[modhatter]

I admire the way the UK has tackled health care. They are VERY proactive in preventative treatment, to the point of advertising on transit systems, TV, people out in the street directing people inside a little temporary vaccination clinic to get their flu shots.

Doctors receive a base salary of say around $80,000 to $100,000 and then get bonuses for achieving success with their patients. If they are successful in getting people to stop smoking, they get so many points, lose weight, more points, bring cholesterol down, more points, diabetes under control more points, etc. etc. This translates into yearly bonuses for the doctors, and can easily double their annual salary. It's payment for success. Sounds to me like they really got a system that rewards results, and strives to keep people healthy.