Sunday, September 2, 2007 care system - The More Things Change, The More They Remain the Same

In 1988 Eli Ginzberg, leading medical economist of his time, wrote The Medical Triangle: Physician, Politicians, and the Public (Harvard University Press). As I read it now, I realize how much has changed but how most things remain the same.

Here is what Ginzberg said “about beliefs that run counter to reality.”

Cost Containment
: “All the talk and action notwithstanding, data provide unequivocal evidence cost containment has been largely sound and fury signifying nothing.” When Ginzberg wrote, health costs were $497 billion, of 11.2% of GNP: today these figures are $2.2 trillion or 16.0% of GNP. What we’re seeing today is more sound and fury.

Waste and Ineffective Care: “Investigators and critics have failed to design a practical program for identifying practical and eliminating suspect and harmful interventions. Today we’re at it again, with P4P and assorted metrics, which have yet to prove “practical.”

Physician Supply:
“By the year 2010, there will likely a
shortage after 2010, when the baby boomers will reach
retirement age.” Ditto. Shortages are now predicted to be
50,000 by 2010 and 200,000 by 2020. More nurse
practitioners, physician assistants, and retail clinics will
not solve this problem.

Health Maintenance Organizations: “Not enough
attention has been given to the fact that new HMOs were
for-profit organizations that did not conform to the classic
staffmodel.” Well, attention has now been given, and
physicians and the public don’t like what they see.

The Pro-Competition Solution:
“Alain Enthoven, author of
the “pro-competition” approach proposed that the
purchasers of insurance be encouraged to shop around on
the basis of price.” Enthoven was talking about competing
HMOs. Now we’re talking about competing consumers
and doctors. It’s early, but competition is has yet to
to dent costs

Private Insurance: “Corporations opted for self-insurance
rather than to continue to be part of a larger pool likely to
contain high-risk individuals.” This is one reason
why private insurance can no longer afford to cover most
of the population.

Long-Term Care: “Medicare is grievously deficient in
meeting the health needs due to marginal contributions to
nursing home, home, and congregate living care. Ditto.

Rationing Expensive Care: “Proponents of this view have
advanced no evidence that such a harsh approach would be
acceptable to the American public.” Or to American
physicians and American lawyers.

Prevention: “Many believers advocate monetary
incentives for those who pursue a healthy life style: it is
important to remembers some obvious facts: those who jog
develop orthopedic problems; many who are overweight
suffer from glandular, not overeating disturbances; many
chronic medical conditions are inherited ; and even the
most health-conscious, exercise-oriented , cautious
individual is not immune to cancer and other devastating
diseases. My sentiments exactly.

The Canadian Health Care System: “Several reservations
must be noted. The population of Canada is about the size
of California. Emergency departments have ad to be shut
down because of lack of beds; many filled with patients awaiting transfers to longer-term facilities that do not exist. Hospitals have been unable to purchase new equipment True, universal overage has been ensured, but the long-term outlook is not sanguine.” And long waiting times led to Canadian Supreme Court decision allowing private clinics, which are opening at the rate of one per week.


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