Map of life expectancy at birth from Global Education Project.

Wednesday, March 06, 2013

Another Open Door Crashed Through

But, sometimes you need a prestigious panel to lead the way. The report of the National Commission on Physician Payment Reform is here. The highfalutin' name is maybe a little pretentious -- it was convened by the Society of General Internal Medicine, not the gummint. And yes, internists -- primary care docs -- have a lot of skin in this game. But they say all the stuff that needs to be said.

I've been raving about these issues here for years, so I'll take this opportunity to hit a couple of high points that might fit on a bumper sticker, maybe a really big one.

First of all, did you know that the U.S. already spends about as much public money -- taxpayers' money -- per capita on health care as the other rich countries that have universal coverage and better results? It's true -- we spend more than Canada, Switzerland, France, the UK, Australia and many others. Then we spend an approximately equal amount of private money on top of that. As a result our total spending on health care per person is more than twice the average of the other wealthy countries, and by far the highest on earth. And yet we don't provide any health insurance at all to 48 million people. And our population's health status is worse than that of Paraguay.

In other words, if we were as smart as the cheese eating surrender monkeys, we could take the public money we are spending today on health care, and provide excellent health care to everyone, without making anybody pay a single dollar out of pocket. 

Why is that? Basically: we pay more for the same goods and services; we pay for a lot of stuff we'd be better off without; we don't pay enough for stuff we need more of. The fee-for-service payment model creates an incentive to do more, but not to get the best results. We pay much more to certain specialists who do expensive, high technology procedures than we do to primary care doctors who can figure out what we really need, do the cheap stuff early that really matters, and save us from unnecessary or even harmful and very expensive interventions. To whit: a radiologist earns, on average, $315,000 a year, while a primary care physician earns $158,000. No wonder there is a crushing shortage of primary care physicians, and no wonder we get far too many imaging procedures.

All this talk about the unsustainability of Medicare and Medicaid, and how we just have to cut benefits and raise the eligibility age, is either ignorant blather or deliberate lies. We can easily afford high quality care for everyone. But we aren't even having the right discussion.


Anonymous said...

If medical, health care, is a for profit biz, the patient will always pay more or extravagant, as compared to ‘basic costs’, whatever they are figured to be in terms of ‘reasonable’ doc salaries, price of med equipment, hospital beds, etc. He or she will pay ‘more’ in a ‘free’ market as his or her concern is care, cure, comfort, help for self or a loved one. Not, of course, that anyone knows what the ‘correct’ costs are.

Education is going down a similar route. But that is another story.

All those working in the med industry (medicos, insurance, pharma, med. machines, hospital staff, etc.) have a tremendous stake in the status quo - and many families all over the US have a mom, dad, uncle, working in this industry and supporting other family members. And the bureaucracy requires specially trained scribes, who earn good money...

The huge and illegit spending is simply shunting some impressive % of GDP to ppl in this sector in an opaque way. Insurance is a vital topic here.

Kicking in open doors sorry.


Daniel said...

Cervantes, Let's assume for a moment that we could reduce our spending on health care to 12% of GDP. A rough calculation is that we would spend about $750 billion less on health care.

What are the implications of this to the health care system? Would it not be a most significant economic event/disruption?

How would you see us getting from here to there. Call me a pessimist, but I think we're addicted/dependent to this turkey.

Cervantes said...

Indeed Daniel, one person's waste is another person's income. That's the problem we have in a nutshell. How we get from here to there is a puzzle, but as a general principle, we need to divide and conquer. Gore ox A in order to keep the thing affordable to pour the gravy for Ox B; then gore B for the sake of C; and so on. That's the only way I can see. Protecting the beneficiaries as we do this is the hardest part, however, since the Republicans just want to go after them and them only.

Anonymous said...

More open doors - *amplification* only, sorry.

If profit making is a primary motive, then it is natural to invest in what ppl will pay and go broke for, such as health care (education in the form of student loans as well.) It is also natural to extract, or attempt to, the small surplus the poor hold until they are broken and have nothing left. (Then maybe prison labor can furnish some income.)

It is also obvious that more bodies - humans as a commodity - are endlessly needed to ensure ‘growth’, of say the radiology ‘industry’ or big Pharma. The only way forward is to remove the profit motive, but that smacks of communism or socialism and doesn’t fly in the US. So that is a deeply political issue that can’t be solved by reports like the one linked to, though it looked fine to me. Nor by Obama care, etc.

The health care mess is also linked to misperception of pay-out vs. pay-back and asymmetrical information (as you emphasize on yr blog) - though I dislike referring to junk free-market economics and prefer to speak of power relations. ‘Health’ ‘Costs’ are completely opaque in themselves (this is deliberate of course) and even if they were known or ‘discoverable’ (more free market terms) very few could judge their value in terms of pay-back - be it in well-being, mobility, in comfort, happiness, in years left to live, in Gvmt. stipends accrued, insurance pay-outs, possible future earning power, perception by others (being bi-polar = horrific; beating breast cancer = social kudos) or whatever - and ALL of these count!

This last point touches on education and ethics in a society, and how the common good is conceived.


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