Doctors Drive Costs

A new study last week pointed to the common practices of doctors as one driver of high healthcare costs.

Doctors often order medical tests and procedures in the unjustified belief that the test or treatment will be helpful. But actual data comparing outcomes shows that some of the doctor's orders make no difference in results.

Of course, under a rational system, data on outcomes would guide clinical practice. Under the present system, insurance rules, advertising, pharmaceutical sales presentations, the occasional journal article, seminars and conferences all appear to influence test and treatment decisions.

Read the Dartmouth press release here. The story was also covered by covered the New Hampshire Union Leader.

Data driven or evidence based medicine is changing medical practice, however. For a look at the incorporation of data driven medicine into public policy, read this whitepaper. For an overview of the application of evidence based medicine on laboratory testing, consult this article from Clinical Chemistry.

Medicare for All

An editorial appeared in the Kansas City Star Sunday supporting a program of "Medicare for All." The concept attracts, because of its simplicity, obvious advantages, and the way it builds on well understood programs already in place. But would it solve the problems we face?

In my humble opinion, it would not.

My young adult son, with no health insurance, would not gain anything from a system of Medicare for all. Neither would any young uninsured person. To understand why, we must understand a little about Medicare.

Medicare has three parts; part A covers hospital expenses, part B covers medical expenses and the newly formed part D covers prescription drugs. Part A is fully funded by the payroll tax; parts B and D both require monthly premiums.

A young adult with a minimum wage job cannot meet basic needs for himself such as adequate food, shelter, and transportation to work. Premiums for part B will be $88.50 monthly effective January, 2006. A worker earning minimum wage grosses $10,712.00 annually, or $892.67 per month.

Of course, that money is subject to various taxes; the net after tax may be as little as $750.00 per month. A number of studies have been done on the “living wage” issue, attempting to quantify the minimum cost of living for a single individual. This study gives a figure of $21,694.40 for a single individual living in one of the higher cost areas of the US. Even allowing for the fact my son lives in one of the cheapest areas of the country, he still cannot pay for basic needs. Under his present circumstances, he will never enroll in parts B or D of Medicare.

Under current law, hospitals provide life-saving services to uninsured individuals regardless of ability to pay. With Medicare for all, hospitals would fare much better than under the current system, which has them dunning deadbeats in an hopeless attempt to cut their losses.

But from the consumer's point of view, nothing would have changed. Routine preventative care, of the sort that would keep them out of the hospital, would still not be covered. Prescription drugs, insulin or asthma medications, of the kind that prevents acute illness, would be out of reach.

Medicare for all sounds good, and would be a step in the right direction. Alas, it would also be a few steps short of solving the whole problem.

USA: World Leader in Medical Errors

One of the myths used to justify prices for medical care in the US is that we have the "best system in the world."

A new study gives the lie to that idea, because actual data shows we have a slight edge over other developed countries in the number of medical errors made in our system.

The Commonwealth Foundation study looked at error rates in six developed nations over the last 2 years. At 34%, the US was ahead of Canada, with 30%, and so on down to 22% in Britain.

Of course, most of the countries studied except the US had some form of universal healthcare in place. Coincidence?

More details are available from Reuters.

Hospitals Sued for Overcharging Uninsured

Hundreds of hospitals in 27 states are being sued for charging uninsured patients more than other patients. The Providence hospital chain in Oregon settled one such lawsuit Tuesday.

One patient, Gerry Hugo, paid $13,000 for a routine hernia operation. If the settlement is finally approved, he will receive a refund of $7,300.

According to this AP Story, the settlement will result in charges for tens of thousands of low income patients for the last four years being recalculated, as well as for the next two years.

Of course, if we had true transparency in healthcare markets, the price of a routine hernia would be common knowledge, like a brake job or oil change is.

Under a system of universal healthcare, a single payer would know how much each and every hernia operation cost in every hospital in the United States. A single payer would use its enormous market power to push costs down for everybody. And Gerry Hugo would not have to sue for fair treatment.

Avian Flu Preparedness

A.B.C. News asks, "Is the Government Ready for an Epidemic?"

In light of recent events highlighting government inability to respond to domestic emergencies, this question deserves much higher priority than it's getting.

The Bush Administration just announced $7.1 billion worth of half-measures, apparently hoping the epidemic will hit on someone else's watch.

Don't count on it.

Most of the measures announced so far will take years to implement, assuming they are followed up on by the next administration. For example, tens of millions of doses of the anti-viral medicine, "Tamiflu" cannot be delivered in less than 18 months no matter how much cash the president throws at the French manufacturer. The capacity to produce the drug is constrained because the factories do not yet exist to meet the worldwide demand. Even if new factories were to go online tomorrow, the complicated, time-consuming process of making the drug would prevent speedy delivery.

The magazine Scientific American carried a special report, Preparing for a Pandemic , in the November, 2005 issue. They said, "Scientists cannot predict which influenza strain will cause a pandemic or when the next one will break out. They can warn only that another is bound to come and that the conditions now seem ripe, with a fierce strain of avian flu killing people in Asia and infecting birds in a rapid westward lunge toward Europe."

Of course, in the United States, the lead responsibility for public health resides at the state level; just as the lead for disaster preparedness rested on the shoulders of state and local officials like Louisiana governor Blanco .

In nations with systems of Universal Healthcare, national officials are in a better position to oversee preparations. For example, the United States is nowhere near the top of the list of customers in line to get the drug Tamiflu; other countries beat us to the punch. In addition, according to Scientific American, Australia, Britain, France and other European governments are negotiating contracts with vaccine producers to ensure supplies of vaccine will be equitably distributed when it becomes available. The United States is not.

Of course, if the predicted pandemic arrives in the next few years, no country will be fully prepared.

But we have to ask, would a system that allows universal access to routine medical care such as flu shots fare better than a system that denies millions of people access to that same care? Does the uninsured population of 45 million in our nation represent a vast Petri dish for the cultivation of deadly diseases?

The experts view a new influenza pandemic as inevitable; the question is not, "Will it happen?" but, "When."

What frightens this writer is the uncanny prescience of Scientific American.

In 2001, they published an article about a potential disaster. They described, in great detail, exactly how complacency and penny-pinching had rendered us vulnerable to a catastrophe with vast property destruction and significant loss of life. A catastrophe that we predicted, that we knew was only a matter of "when," not "if."

The title of that report was, "Drowning New Orleans."