Thursday, June 14, 2007
U.S. Health System -Review of Reece Book and Article by Grace-Marie Turner, Galen Institute
Prelude: Yesterday I spoke to Grace Marie Turner, who heads and speaks for the Galen Institute, a market-based health care think tank, in Alexandra, Virginia. She told me her greatest fear was that the government would completely take over health care through a series of incremental steps – e.g. universal coverage of children and government negotiation of Medicare drug prices. She said we are nearly there: the governments already pays for 46% of health care and, in one way or another, sets the fee schedules for most providers.
She was kind enough to: A: run the following brief review of my book in here widely read newsletter; B) to share this article containing her thoughts on U.S. health care vis a vis that of other nations;
INNOVATION-DRIVEN HEALTH CARE 34 KEY CONCEPTS FOR TRANSFORMATION \
Author: Richard L. Reece, MD
Source: Jones and Bartlett Publishers, 04/07
In his new book, Dr. Richard L. Reece, a pathologist, writer, editor, consultant, and speaker, provides an in-depth look at innovative trends health care from both the physician's and consumer's perspective. Reece breaks down health care innovations within six key areas, including hospital-physician joint venture innovations, employer an health plan innovations, constraining costs and expanding markets, and consumer innovations. Dr. Reece's book “is an intelligent, knowledgeable analysis of the impact of innovations on the future of U.S health care. ,” writes Harvard Professor and Manhattan Institute senior fellow Regina Herzlinger. “If you want to continue doing what you are doing, this book will enable you to assess how you fit into this new world and to adapt yourself if needed.”
B)You Get What You Pay For, By Grace Marie Turner
We have precisely the health sector in this country that we are paying for. As we are barraged from all sides with articles, books, and now movies about how absolutely awful our system is, it is important to realize that if we want change, we must start by improving the payment and incentive structures that direct how it functions.
•A conference of senior and seasoned health policy analysts that I attended in Princeton this week focused on the shortages today -- and the much greater shortages projected for the future -- in the health care workforce, especially primary care doctors and nurses.
But why is this surprising? Primary care doctors are paid an average of about $90 for half an hour of their time (which must cover their own salary as well as all of their office overhead) while radiologists, for example, are paid about $600 for the same amount of time. Medical school graduates are making very smart economic decisions in flocking to specialties because that is what we are paying them to do.
•Florida is becoming renowned for having a huge concentration of specialists catering to wealthy seniors. Between Medicare and their supplementary Medigap or retiree coverage, seniors' health care consumption is virtually free. (One Princeton speaker observed: If you think you are old and rich, go to West Palm Beach and you will find that you are neither…)
Jack Wennberg of Dartmouth and others have shown that seniors in Miami consume more than twice as many Medicare dollars as seniors in Minneapolis, for example, but the Miami outcomes are no better and in some cases, they are worse. Seniors in Florida are consuming a great deal of health care because that's what the system subsidizes them to do, and physicians respond by offering an abundance of services.
•And speaking of outcomes, one participant at the Princeton conference said our current system could just as easily be called “pay for mistakes.” Doctors and hospitals get paid even if they make errors. And you could argue that they get paid more if they make mistakes because they can be paid again to fix the problem.
This week, we received refreshing news that the Geisinger Health System in Pennsylvania is offering surgery with a guarantee: The hospitals will charge a flat fee that includes a 90-day warranty. And the doctors themselves came up with a list of what they considered best practices to help avoid errors in the first place. We offer a short summary of an article about the initiative in the round-up below.
•And the big news of the week was the saturation coverage of Michael Moore's newest movie, “Sicko,” due in a theater near you on June 29. That is, if the U.S. government doesn't ban it because Moore may have gone to Cuba illegally in his search of the best-on-the-planet health care for a group of sick American patients.
Give me a break! Cuban surgeons botched several surgeries on Fidel Castro, for heaven's sake, and a surgeon from Spain had to try to repair the damage. One has to wonder, if Moore were to need medical care for heart trouble, for example, do we really think he would go to Cuba for his care?
•Already a rebuttal to Sicko is circulating. It's worth a few minutes of your time to watch this short clip about the difficulty of obtaining surgery in Canada and the consequences of the long waiting lines for one woman who needed surgery for a bladder malfunction.
The only surgeon who could do the procedure in her region was limited to 12 a year, and he already had more than 30 people on his waiting list. The outcome for this Canadian woman was not good. And the film also depicts the distortions of decisions about who gets surgery in a health care system where payment decisions are made by politicians.
Canada spends a lot less on medical care than we do in the United States, and they, too, get what they pay for.
•And in the United Kingdom, Prime Minister Tony Blair had made improving the health care system one of his top priorities. The parliament boosted spending on the National Health Service from 6.5% to 9.4% of GDP, primarily focused on increasing access to care by hiring more health care workers and giving new incentives to general practitioners to produce better results.
They did boost the pay of GPs, but are questioning whether they got anything for the added spending. A report from the House of Commons shows that one group did particularly well -- the number of senior managers went up by more than 62% compared to an overall increase in the health care workforce of 24%.
But while Americans are being brainwashed into believing that our health care system is the worst in the developed world, opinion polls consistently show that the great majority of Americans are satisfied with their health care system.
We have an obligation to embrace what is good and to do a much better job than we have of fixing what is wrong, particularly by adjusting the incentives to get better care and lower costs and to cover more of the uninsured. We can show the world what a functional, responsive, innovative, and affordable 21st century health care system should look like. We just have to shift the incentives so that is what we are paying for.