Lest we forget healthcare…a few notes and links
Health care reform blog reminds us both complexity of costs:
Thus, areas with high medical spending do not have offsetting lower pharmaceutical spending; in fact, if the coding practices in different regions are not too dissimilar, the substantial variation in pharmaceutical spending does not seem to be strongly associated with variations in medical spending at all. Spending on pharmaceuticals itself is variable and thus warrants scrutiny similar to that given to medical spending, in order to glean lessons about optimal prescribing, insurance characteristics, and resource allocation. Our findings reinforce the importance of understanding the drivers of geographic variation, since increases in medical spending or pharmaceutical spending do not appear to be associated with offsetting savings in the other realm. Using this more complete measure of spending reveals that area-level variation in total spending is not driven primarily by patient characteristics. These data may offer us an opportunity to gain insight into the underlying causes of the intensity of use of health care resources and the potential for public policy actions to improve the value of the health care delivered in the United States.
(Bolding is mine)
Advocates for health care reform (including yours truly) have frequently argued that it is possible to reduce the amount of care without reducing the quality–or, to put it more simply, that less care doesn’t have to equal worse care.
Several other links point to information to quality and costs:
The Cost Conundrum
What a Texas town can teach us about health care.
by Atul Gawande
Massachussett is still wrestling with cost:
The Mass Hospital Association did not offer access to their membership white papers when I asked, just public positions. These are the latest on the website. If represzentative. the two suggested are disappointedly indicative of the inability of insurance companies and the big hospitals to come to terms with cost despite promises of cooperation in MA.
Mass Hospital Association points to wage increases as problem:
Lots of data, but the end result appears to epmphasize the idea that higher costs of the private sector subsidizes the public sector, but cost reduction strategies appear limited. Global payment system billed as a cost savior of major proportions.
Mass Hospital Association primary recommendation to cost reduction appears to be through insurance plans:
“Employer/employee cost reduction through reduction of services and at least increased co-pay…..insurance plans are ‘rich’, premiums high because insurance mix is too rich.”
In the deficit atmosphere in MA, the public sector ‘too rich’ insurance plans will come under attack through a change in law on making health plans part of wage negotitions mandatory…towns will be able to change terms unilaterally is my bet.
Martha Coakley, Attorney General for MA, has a report showing utilizationhas not increased nearly as fast as prices over the last 3-4 years.
When Bernie Sanders ran for the Senate in 2006, his Republican opponent was IDX CEO Rich Tarrant. It pretty quickly became apparent that Tarrant didn’t know much about anything except health care, and he got clobbered at the poles. But we did get to hear debates between two guys that understand health care pretty well. Problem was that there wasn’t all that much they differed on. Basically Sanders wanted a single payer system administered by the states. Tarrant wanted to expand Medicare to cover everyone which amounts to single payer administered by the federal government. Unfortunately we ended up with neither.
One thing that Tarrant did advocate though that struck me as a really good idea. Ban advertising of pharmaceuticals. I’ve been observing TV ads for “ethical drugs” ever since. Y’know what. There isn’t a single one of them that is not deliberately misleading or worse. As far as I can see, the only bigger liars are at least two of the triad Comcast, DirectTV, and Dish Network.