Fogel on Universal Healthcare
82 year old Nobel Prize winning University of Chicago economist Robert Fogel spoke recently at the annual Lindau meeting for Nobel Laureates. Fogel won the Nobel prize along with Douglass North in 1993 for the application of statistical methods to economic history, often with controversial results. At the Lindau meeting he said that the rising spending on healthcare in developing nations reflects the rising income of consumers along with a strong appetite for heathcare. He argued that “As people get richer they want to spend a larger share of their income on health.”
This comment drew an almost unanimous expression of sarcastic derision from readers of the Wall Street Journal, most of whom, evidently failed to understand that independently of the current American healthcare system, rising wealth, whether individual or national, correlates with greater healthcare spending. Fogel also said that governments should not interfere to decrease demand for healthcare in an effort to lower costs but should move to some form of universal healthcare for essential services with extra user costs for additional services such as shorter wating times, private hospital rooms, and expensive elective surgeries. Now, am I daft or can these comments be constructively applied to the USA?
Top Ten Most Expensive Medical Conditions
The top 10 most expensive medical conditions in US as determined by the Agency for Healthcare Research and Quality
| Condition | Cost ($ billion) |
| Heart conditions | 76 |
| Trauma disorders | 72 |
| Cancer | 70 |
| Mental disorders including depression | 56 |
| Asthma and chronic obstructive pulmonary disease | 54 |
| Hypertension | 42 |
| Diabetes | 34 |
| Osteoarthritis and other joint diseases | 34 |
| Back problems | 32 |
| Normal childbirth | 32 |
Who’s Making Money From Medical Debt?
An article by Brian Grow and Robert Berner in Business Week profiles the revolution in the world of medical debt.
The new reality for a growing proportion of the 50 million or so uninsured Americans is that treating that diabetes, acute gallbladder, or even a child’s late-night earache, means more consumer debt. Current interest rates begin at about 13.5% and increase to 27% for overdue accounts.
According to Grow and Berner, “Collecting from “self-pay” patients … has long been the bane of medical administrators. When they don’t get paid immediately, hospitals typically recover around 10¢ on the dollar owed, even when they hire collection specialists. So hospitals and clinics are bringing in more sophisticated help. They are transferring patient accounts wholesale to finance experts, banks, credit-card companies, and even private equity firms. Many of these third parties use credit scores and risk-analysis software to price the debt and impose interest rates as high as 27% on past-due bills.”
Who are these companies? Many small companies have sprung up in regional markets such as Complete Care of Little Rock Arkansas, but bigger, more familiar companies are entering the field. Some of these include, General Electric (Care Credit), Citi Group, and Capital One. Wachovia is also considering entry into the lucrative market which for GE will amount to $5 billion this year.
“Hospitals can’t just be an interest-free finance vehicle,” says Todd Cole, director of patient accounting at TriHealth, a $2 billion pair of nonprofit hospitals in Cincinnati. “The world of $5 sent to the hospital and they will never send me to collections, never sue me — that world has gone away,” he adds. TriHealth sells patient accounts at a steep discount to firms that specialize in collecting delinquent consumer debt. “Hospitals need their cash,” Cole says. “It is the lifeblood that supports the doctors, the nurses.”
Illness is inevitable and treatment is costly, isn’t that a reasonable argument for the world’s most powerful nation to revisit the creation of a nationalized health care plan?
The complete article (Fresh Pain for the Uninsured) may be read here
Go here to visit “Physicians for a National Health Care Program
Faint Praise for Medicare, Drug Benefit
The Kaiser Family foundation released studies on Thursday showing that most Physicians and Pharmacists believe that the Medicare, prescription, drug benefit is helping people save money but feel that it is overly complex.
Among the findings in the survey of 834 Physicians and 802 Pharmacists:
For the complete article visit the Kaiser network.
Can anyone say “Nationalized Healthcare?”
Acceptable Medical Losses?
In a Canadian retro-review of 1240 heart attack cases only 3% (41 patients) survived after efforts to restart a heart through CPR, electric shock and transport to hospital, discouraging results to be sure.
Lead researcher Dr. Laurie J. Morrison of the University of Toronto then isolated three criteria to help rural paramedics determine when to cease resuccitation efforts in the field and avoid additional measures that can severely strain healthcare delivery systems and that pose unique hazards of their own. ”Taking such lost causes to the hospital ties up ambulances and emergency departments, and the race to get there is hazardous for rescue workers and other motorists,” the researchers said.
The team’s recommendations specified that paramedics terminate CPR if a pulse couldn’t be restored, if the defibrillator determined that an electric shock shouldn’t be given and if the cardiac arrest wasn’t witnessed by a rescue worker. The criteria were applied in the course of ongoing emergency responses. Researchers say that the test closely predicted throughout the study who was likely to die. Overall, 776 patients met all three criteria, and all except four died, a survival rate of 0.5 percent (1 in 200).
“If the test were applied,” said the article, “it would reduce by about two-thirds the number of patients taken to the hospital, the researchers said. When two more criteria were added — paramedic arrival time of more than eight minutes and an attack not witnessed by a bystander — the test worked even better.”
For Feedback:
1) What level of payoff is insignificant for emergency care? 1 in 200? 1 in 400?…
2) Are you comfortable allowing a rural paramedic with 2 years or less of training to decide whether you live or die?
Health Care Rationing and the NHS London’s Troubling Precedent
NHS London is the Strategic Health Authority for London, England. A paper leaked in April of this year openly acknowledged NHS London’s new mandate for cost containment through health care rationing, this, despite it’s stated mission to “deliver world-class care.”
Among the cost cutting measures:
1) Panels were established across London to monitor the rates at which General Practitioners refer patients to hospital. Local health trusts were instructed to cut GP referral rates to the levels of the lowest 10% nationally at an estimated annual saving of 25m pounds.
2) Consultant to consultant referrals are also to be limited, effectively denying second opinons. In an earlier draft paper Hammersmith and Fulham reportedly found that a fifth of consultant-to-consultant referrals were “clinically not necessary.” Trimming back referrals accross London is expected to save another 7 million, though the administrative burden is estimated at 1.6 million.
3) Emergency care practitioners in emergency departments will “redirect” 40-70 per cent of patients back to GPs or walk-in centres. If they treat those who could have been treated non-emergently, they will not be paid.
The British Medical Association condemned the plan. Hamish Meldrum, the chairman of the association’s GP committee, said that they left patients in limbo, with no one clear where the responsibility lay if the condition worsened or the patient died.
From the article:
“The plan, which is still in draft, was produced by the London Transition Team, led by John Bacon, a senior NHS manager. It is typical of the action being taken nationally to save money by reducing referrals, or, putting it more plainly, treating fewer patients.
There are serious questions about whether such systems will work. say two experts in general practice in this week’s British Medical Journal.
Myfanwy Davies and Glyn Elwyn, of the Centre for Health Services Research at Cardiff, say there is little evidence that referral management centres work to improve the quality of referrals or save money.
They say that the centres have “appeared overnight in an evidence-free zone”.”
For Feedback:
America’s costs for publicly funded healthcare are similarly spiraling out of control. How closely should we look at London’s model? Should healthcare be rationed? If so, how?