The ultimate fix to the American healthcare system

One of the priorities of the new Obama administration is to reform the healthcare system in the United States. Statistics show that while the US spends the most per patient, the quality of that care is less than in those countries that spend less than we do. An article in the New Yorker magazine discusses what can be done to fix our broken system and the answer might surprise many people on both sides of the issue.

Atul Gawande, a doctor, writes in his article “The Cost Conundrum” about McAllen, Texas. Based on data from several sources it is one of the most expensive health-care markets in the country.

In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

“The Cost Conundrum”

Gawande took a look at why McAllen was so expensive and if that spending resulted in better patient outcomes.

And yet there’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average.

Nor does the care given in McAllen stand out for its quality. Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.

Gawande then visited the Mayo Clinic in Minnesota, which has the lowest cost but has the best quality:

The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. I asked Cortese how the Mayo Clinic made this possible.

“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focused first on what was best for patients, and then on how to make this financially possible.

So basically the answer to fix our system isn’t single payer or private insurance making decisions on care. The answer is to remove the profit motive from medicine all together. The whole system would pool the money coming in to pay for treatment and those who do the treatments would be paid a salary. What treatment would be used would be decided within a group, sharing data of what works and what doesn’t and so on with the mantra “The needs of the patient come first”. There would be an emphasis on preventive care.

As the article reports many doctors and medical providers see patients as a revenue stream to be squeezed as much as their insurance allows. On the other hand the insurance companies try to squeeze as much profit out of premiums paid by nickel and diming the decisions the doctors make. Neither approach addresses the problem of high cost and low quality results. The patient loses in the end.

Of course Gawande leaves one question unanswered. Who will be in charge of this new healthcare system?

Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.

I found a lot of interesting points in the article to consider. Does Gawande’s “fix” look good? I think it does but like the last quote I think we need to decide who will be in charge.

I think the Federal government is a good choice just because it is able to marshal the resources to write and setup regulations that would be needed even though those regulations would be written by people who actually treat patients. They have been managing Medicare for years so they could do health insurance for the rest of us. The money would pool together would be safe from all but the worse economic storms.

Sicko makes the point

I heard today about the throwdown on CNN between Dr. Sanjay Gupta, CNN’s resident medical expert, and filmmaker Michael Moore over the “facts” in Moore’s documentary “Sicko”. The film is an indictment of the US health care system.

Filmmaker Michael Moore launched into an 11-minute rant on American TV on Monday, during which he blasted the media for misrepresenting his new healthcare documentary Sicko. The controversial director was appearing on CNN show The Situation Room when he blasted both the network and host Wolf Blitzer for having a “poor track record” as journalists. Moore had been invited onto the program to counter a report made by CNN’s chief medical correspondent, Dr. Sanjay Gupta, which pointed out alleged false information and statistics in Sicko, which takes aim at the U.S. health care system. Moore blasted, “That report was so biased, I can’t imagine which pharmaceutical company ad is coming up right after our break. All the statistics show that we have far worse healthcare than these other industrialized countries. We’re the only ones that don’t have it free and universal.” Moore also accused the network of covering up the truth about the American healthcare system and the country’s military involvement in Iraq. He said, “You’re the ones who are fudging the facts. You’ve fudged the facts to the American people now for I don’t know how long about this issue, about the war. And I’m just curious, when are you gonna just stand there and apologize to the American people for not bringing the truth to them that isn’t sponsored by some major corporation?”

Moore Blasts Blitzer & CNN Live

In another report Gupta conceded Moore’s point in the film:

In the end, however, Gupta acknowledged that overall the movie “strikes at the irrefutable fact — [the U.S. health system] is broken.” Gupta, who continues to practice medicine, was asked by Moore whether he himself didn’t find the current health-insurance system cumbersome. The surgeon replied, “It’s a shameful system, especially when I’m dealing with some of my patients.”

Michael Moore Spars With Sanjay Gupta on CNN

Now if CNN and other media would concede they have been parroting Bush’s talking points for years now….

I admit I haven’t seen the film yet. I really don’t have to because I have had my own run-ins with the health care system so I know it is broken.

Here is one example:

I caught a bug on a Saturday and it got worse to where I had a 102 degree fever. It scared me because the year before I got a bad infection that started the same way and I ended up in the hospital for 4 days getting massive I.V.s of antibiotics.

Being a Sunday I decided to save my HMO some cash and I went to an Urgent Care center instead of the Emergency room. Not only would it save money but it would save time. When I went to the ER when I had my bad infection I waited for 12 hours before I was seen by a doctor.

I went to the Urgent Care place and waited maybe 30 minutes. The doctor confirmed that all I had was a bad cold. *Whew*.

A month later I get a letter from my HMO denying coverage because I didn’t call them first. That cost me $156.

That same year I was getting some physical therapy as result of the previous infection and I didn’t learn until after my 2 weeks of therapy that the HMO wasn’t paying for it because the doctor didn’t go through the referral process – that’s where they clear a therapy with the HMO. That cost me $7000. Don’t even get me started as to why 10 one hour meetings with someone who only wrapped my legs in bandages cost $7000. That’s $700 an hour. I did file an appeal but the HMO only said “rules are rules.”

Then there is the fact that many plans won’t pay for weight loss programs or smoking deterrents. They will pay for the resulting medical conditions from being fat or a smoker but they refuse to cover treating the causes.

Here is a comentary on the film from James Clay Fuller of the Twin Cities Daily Planet:

[Philip M. Boffey of the New York Times] says it is “hard to know how true” are the stories Moore puts on film -– stories such as that of a young woman who was retroactively denied health care insurance because of a minor yeast infection that was cured years before she applied for and got the insurance that was taken away when she needed it.

Well, I’ll tell him. There is not the slightest reason to doubt any of the individual stories Moore has used in the film.

First, the director is too smart to use a phony story, and risk getting caught, when there are, as he says, countless such stories. When he put out a request on his Web site for personal stories of being screwed by health insurers, Moore was inundated. Within days, he had more than 20,000 such stories.

Second, I can recount four or five such tales from the years I was the primary caregiver for my aged mother, and another dozen from among my acquaintances. This moment, I am deeply concerned about a friend who is in despair because of the years-long battle he has had to wage with his health insurer in order to get care he must have to live, and the debt that has piled up as a result.

Anyone who hasn’t experienced such a situation, or doesn’t at least know someone who has had to fight for his or her life in such a way, must live in another country.

Sicko: Commenting on commentaries

I support moving to a single-payer health care system. It preserves choice and allows for people to get the treatment they need. As some one commented on the above story put it “Single payer reform is NOT socialized medicine. It’s socialized INSURANCE. Cuts out the middle man but the delivery system remains private and people can go to any doctor or hospital they want.”

For more info see:

Single Payer Universal Health Insurance “Sicko”