Monday, January 16, 2012

The “Specious” 30% Argument for Health Reform

Spe-cious - Seeming to be good, sound, correct, logical, etc without really being so, plausible but not genuine.

Dictionary definition of specious

I dare say that I have worked off my fundamental formula on you that the chief aim of man is to frame general propositions and that no general proposition is worth a damn.

Oliver Wendell Holmes, Jr. (1841-1935), Letter to Pollock, written on November 22, 1920

January 16, 2012 - I do not know exactly where the argument started that the U.S. health system “wastes” 30% on “unnecessary” care. Yet I read about this waste everywhere I turn.

The proposition that health care is 30% unnecesary waste and emblematic of rampant inefficiecy may have begun with John Wennberg and his colleagues at the Dartmouth Institute of Health Policy and Clinical Practice. Using Dartmouth’s Medicare Atlas maps, Wennberg et al showed a 30% regional difference in Medicare costs. They logically assumed the U.S. spent 30% too much treating chronic disease for the elderly, and presumably for everybody else as well. The New England Healthcare Institute, McKinsey, and Thomson-Reuters took up the 30% torch. The flame was passed to the Obama administration, whose experts, such as Ezekial Emanuel, MD, and Donald Berwick, MD, have perpetuated the 30% proposition.

It is, of course, true that humankind – individually, in groups, businesses, governments, hospitals, physicians, and patients - vary by at least 30% in their efficiency, performance, output, and outcomes. If one believes that people and organizations should be homogeneous, this 30% difference is indeed unnecessary, off-putting, even alarming.

It is alarming that 30% of Americans are overweight, incomes across the U.S. vary by +/-30% (some way 99%), only 30% of our doctors are primary care practitioners, 30% of Medicare money is spent on the last illness, 30% of us either drink or smoke too much, doctors consume 30% of money spent on health care, hospitals take another 30%, 30% of the population is responsible for at least 90% of health costs, only 30% of employers have wellness or prevention programs, government programs pay for 30% of the population but spend 50% of health care monies.

It’s not only alarming. It’s a shame. Theoretically, we could erase these 30% differences by.

• Offering coordinated, continuous, evidence-based care for the chronically -ill across the health care spectrum.

• Bundling and budgeting care for hospitals and physicians and paying only for outcomes.

• Paying doctors more for maintaining health and less for ordering tests, doing procedures, treating illnesses, and warding off disabilities, life style dysfunctions, and even prolonging life.

• Compiling massive data bases to show unequivocally what works and doesn’t work and paying only for what works.

• Doing away with fee-for-service for doctors to destroy the Greed Monster.

• Eliminating poverty, which causes people to be sick until it’s too late to treat them “parsimoniously.”

• Minimizing “individual differences” by paying for statistical averages of “populations.”

A Crying Shame

Yes, it’s all a crying shame. If we could only do away with human expectations, doctors doing what they are trained to do, if only we would do what is good, sound, correct, and logical, and if we could only eliminate that feckless thing known as human nature, all would be well.

Tweet: Patients misbehaving, wanting the best, doctors doing what they do, costs the U.S. 30% more than it should.

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