alarming cost

Health care cost in the US is very alarming affecting families and sometimes forces them to file for bankruptcy. There is constant change in new technology and its updates, increase in insurance (premiums) and cost of outpatient care. The new machines and technology are very useful even though sometimes costly; they are used for prevention, diagnoses for diseases, for treatment, research and for cure. These machines used in the hospitals and clinics undergo the problem of wear and tear. It takes up on the health care cost for mostly maintenance and for the re-use of these machines. The cost of high insurance premium also gives rise to uninsured families in the US for example. It causes less doctor’s visits because they are not able to afford it. Sometimes would decrease the number of people who are able to receive prevention and early detection of certain diseases in tend increases the number of tests that need to be done after missing the early stages of some preventable diseases. There are some aspect of increasing cost in the US health system, such as bills processing and most of the administrative work. Instead of making all sort of documents for a particular patient and by also sending so much cash on papers, supplies, labor and some inventories. The health care industry must find a way to go paperless and recycle for example, Insurance companies must re-think on how to reduce premiums for most people who are able to afford insurance care, think more for the people than to make profit. New technology can be used by making affordable machines to serve the same purpose or even better. It right to put in place good policies to reduce the alarming increase in health care so that all will be able to afford and enjoy what it really means to have access to care.

Quantity over Quality Health Care

Quality care is receiving the medical attention patients deserve. Doctors are doctors for a reason. If doctors only cared about money, and not people’s health, they should have been businessmen. Primary care is the start to quality care, but most doctors just want to fit in as many patients as possible- more patients more money, but not more care. Primary care doctors should spend more than five minutes with their patients and provide a comprehensive exam. If patients can examine themselves, which soon patients must resort to because doctors aren’t caring for them, they wouldn’t go to a doctor and wouldn’t have to pay for it with their time and money. Most people without insurance suffer because of America’s profit driven system. I believe people who have quality care paid for quality care. This means, people who are not capable of paying such high fees suffer from low-mid income as well as poor health and health care, which include the majority of our population.

I think America spends enough on health care, but most of that is wasted to pay for expenses that don’t involve caring for one’s health. Since when did patients have to suffer from overtesting, medical errors, high administrative costs, hospital inefficiencies and other unnecessary areas? The only person that benefits from overtesting is the doctor, at the patients’ expense! The only thing the patients get out of their visit is an unnecessarily high bill. It is not the patients’ fault that doctors and hospitals cannot maintain their offices. It is also not the patients’ fault that doctors goofed. Hospitals are meant to be clean and doctors are meant to keep it clean. If doctors can ask the patients about their history, patients should be able to ask doctors about their own history, mainly about “did they wash their hands.” So why should patients have to suffer their consequences? It is the doctors that should suffer from their malpractice and their unnecessary costs, not the patients. If they spent half their energy to improve on their administration and inefficiencies as they do on improving their profit margin, patients can maybe receive what they are paying for- quality care.

Medicine as a Band-Aid

Spending more money does not equal better health - this is clearly true in the US. On the supply side of health care there is obviously a long list of unnecessary waste ranging from defensive medicine, administrative costs, malpractice insurance and lawsuits, doctors not washing their hands enough, etc. But this isn't the whole picture.

The demand side of the equation needs just as much reform. I was pretty shocked after reading this article in the NY Times "Big Food vs Big Insurance": http://www.nytimes.com/2009/09/10/opinion/10pollan.html?_r=1&adxnnl=1&emc=eta1&adxnnlx=1253081165-y35BhkGbk5zqTRcphZywfg. I'm just pasting in the text because the author is much more eloquent!

"To listen to President Obama’s speech on Wednesday night, or to just about anyone else in the health care debate, you would think that the biggest problem with health care in America is the system itself — perverse incentives, inefficiencies, unnecessary tests and procedures, lack of competition, and greed.

No one disputes that the $2.3 trillion we devote to the health care industry is often spent unwisely, but the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained, as a study released last month says, by our being fatter. Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet.

That’s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry.

According to the Centers for Disease Control and Prevention, three-quarters of health care spending now goes to treat “preventable chronic diseases.” Not all of these diseases are linked to diet — there’s smoking, for instance — but many, if not most, of them are.

We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care....

Cheap food is going to be popular as long as the social and environmental costs of that food are charged to the future. There’s lots of money to be made selling fast food and then treating the diseases that fast food causes."

The American way of eating has become the elephant in the room in the debate over health care.

Also check out this related article: "Getting Real about the High Price of Cheap Food" http://www.time.com/time/health/article/0,8599,1917458-2,00.html

"But cheap food is not free food, and corn comes with hidden costs. The crop is heavily fertilized — both with chemicals like nitrogen and with subsidies from Washington. Over the past decade, the Federal Government has poured more than $50 billion into the corn industry, keeping prices for the crop — at least until corn ethanol skewed the market — artificially low. That's why McDonald's can sell you a Big Mac, fries and a Coke for around $5 — a bargain, given that the meal contains nearly 1,200 calories, more than half the daily recommended requirement for adults. "Taxpayer subsidies basically underwrite cheap grain, and that's what the factory-farming system for meat is entirely dependent on," says Gurian-Sherman."

Obesity accounts for 10% of all health care spending?!? 30% of the rise in costs over the past 2 decades? But the US government has spent $50 billion in the past 10 years subsidizing corn (and indirectly fast food)? I think we need to re-evaluate our contradictory policies, examine their long-term and indirect impacts, and be consistent in our objectives. Obesity (and health behavior) is clearly the elephant in the room but merely blaming overweight individuals is not the solution. Prevention isn't just about getting a MMR vaccine or about a yearly physical but is about changing our lifestyles, which could and should be encouraged through public policy. For example, requiring restaurants to post nutrition facts visibly on their menus, or company bonuses for maintaining a healthy weight, etc. We could also tax gasoline and improve our public transporation...gas is about $8-9 per gallon and many more people bike/use public transit. Also, we need to give the health care industry financial incentives to prevent chronic diseases. Otherwise, costs will continue to escalate, whether we reform health care or not. Chronic disease is no longer synonymous with old age either - young adults and even teens and children are increasingly being diagnosed with diabetes, hypertension, etc. In my field (Gerontology) there is some speculation that the current cohort of children may be the first generation to have a shorter life expectancy than their parents. Ironically, as technology improves, we are able to keep the sickest alive which lowers population health but simultaneously raises costs. But if we can change the incentives, "suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits." (Michael Pollan)

Lastly, here's a link to an article about T.R. Reid's new book (the guy from the Frontline video) "Healing of America" :
http://www.nytimes.com/2009/09/15/health/15book.html?ref=health
And an interview with him on NPR:
http://www.npr.org/templates/story/story.php?storyId=112172939

Sorry for the ridiculously long post! But I'm in Texas this week so you won't have to hear me blabbering on and on in class:)

Moving to Taiwan?!?

Hey everyone---

So...I think we are definitely spending enough money, maybe even a little too much. Or perhaps our money is just not being divided into the right places? I think that the US needs to take a step back and realize what are our priorities in this country?? Health care and education should be on top! (Thats another issue though-) So...I think that we need to focus on primary health care for all, especially those who are unemployed and uninsured at the moment-and I also think that if other countries, Taiwan for example...can look at all the wrongs and rights other countire have made with health care systems, and form their own...WHY CANT WE?!?!?! ....I think that its a culture thing pretty much-and we are too selfish and money hungry in this country to learn from others-we have to be "better than everyone else" or something like that...but HAHA are we really at this point?? I THINK NOT. haha...

Also, quality health care should mean that everyone has access to medical treatments, primary care, etc...no matter your socioeconomic status, race, anything! The way I see it is...ok so suppose right now...mostly the wealthy get the best treatments right? Well...suppose the "poor or middle class" people walk around carrying some disease--even the uninsured/unemployed--and they cant do anything about it because of lack of medical care...wellllll...this could affect all the OTHER people living around them..which could spread...and eventually lead to the "wealthy " people-are they aware of this!?!?

We're spending enough

It seems that both articles had a fairly negative view of the financial part of our health system. The Washington Post article used the example of cardiovascular disease as a case study in medical care to follow how our advances are increasing the costs. Over time, these costs will come down, as the technology for creating stents becomes cheaper and as the various drugs come off patent (Plavix, Zetia, etc).

It seems that these questions always come down to a cost benefit analysis. Unfortunately for planning purposes, the benefits are measured in other units than dollars. Is the cost of a slightly more expensive drug worth the 0.5% decrease in mortality? Who makes those decisions? Right now, the market makes it. And the people will pay. We don't want to let people die, even those in pain with little or no chance of recovery. Some of the most expensive, least likely to work treatments are for those patients with little chance of recovery, and we are trying to eke out a few more months. There needs to be some regulation of those decisions, cost benefit analysis and decision trees. We need to make it easier for patients to decline the more invasive options, and easier for doctors to take the less invasive approach when deciding between two treatment options.

There is an adage in medicine "When you hear hoofbeats, think horses, not zebras" which is to say that common things are common. However, we are all trained to make sure that its not a zebra, because there is always a case of "you should have known, but you missed it". This does come down to defensive medicine, which is related to malpractice, but not only malpractice. Its looking into a patients eyes and knowing that they are just the same as your sister, your father, your daughter or your son, and wanting to make sure that you are doing what is best for them. Public health pushes us to think of the big picture, how trends affect medical care and which treatments are the best for the most people, but we as individuals don't like statistics. We play the lottery because we think "I know that for most people, that is true, but what if this one is different". I don't think that mentality is going to change.

As for the idea that happy health care is good health care, I agree for different reasons than other people have stated. Happy people are less likely to sue. People happy with their health care are less likely to seek care elsewhere and have repeat tests. Multiple studies have shown that in cases of medical errors, the best course of action for the practitioner is to admit the mistake, be forthcoming and express remorse. Saying you're sorry isn't the same as admitting guilt. The idea being to develop that relationship with the patient and keep them happy.

There are always little things we can do to keep costs down: like the ideas of choosing lighter colored rooftops and keeping your tires filled to combat climate change, the idea of increasing handwashing and decreasing nosocomial infections and medical errors is incredibly important. Some of the mechanisms in place to make those things happen may not be the most efficient/cost effective (hmmmm....JCAHO requirements), but are certainly a step in the right direction. Free vaccines and health care maintenance/preventative screenings are also a key step in the right direction, and I was happy to hear Obama talk about it.

The NY Times article listed "Not following doctors orders" as one of the main costs, but didn't address it in the body of the text. I assume this means patients not following recommendations. I have no idea how they came up with that number, but I think it would be more if it included public health initiatives. If only it was easy to quit smoking, lose weight, get more exercise, cut fat intake, use condoms, wash our hands.....

Dan Shaer

The articles are generally straight forward and reiterating information we already know. EVERYTHING contributes to the high costs and huge bill of health care ($2.2 trillion). It's a matter of what aspects are the most costly, what can be reduced, and what is considered a waste. The CNNmoney.com article (the "critics" one) claims that up to $88 billion is wasted on ineffective use of technology. The Washington Post article claims that we get what we pay for, better health care through better technology. I do agree that the more breakthroughs and improvements we have in our technology, the better treatments and preventions will be, thus less health problems eventually. I also believe in the concept of "you get what you pay for". However, I do think that there is some wasteful expenditures on unnecessary "technology". I still think that money should be spent on technology (I am a strong supporter of advanced technology), but on more beneficial ones.
As President Obama said in his address to congress last Wednesday, "We've estimated that most of this plan can be paid for by finding savings within the existing health care system — a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier."
Why do MRI scanners cost significantly less in Japan than they do here in the U.S.? The Japanese pay $98 for an MRI scan. In the U.S. they pay around $1200 (these figures are from last week's blog articles). The government should regulate such costs.
As a future doctor I'm sure that I would like to keep my practice up on technology if that technology improves treatments as well as makes my work more efficient. For example, in dentistry there is new technology that takes a 3D digital impression of a patient's teeth and creates an accurate wax impression in the lab using a special wax printer. This replaces the old fashioned alginate impressions (the nasty-tasting slimy material) which are much more prone to errors, are time consuming, and are uncomfortable for the patient. The costs may be higher but the results are priceless. This is the kind of technology that I consider legitimate spending.

Technology advances in everything--EXCEPT OUR OWN HEALTHCARE IT SYSTEMS? WHAT?

After reading the two articles, my sentiments about our healthcare system falls somewhere inbetween the supporters and the opponents. While I do agree that we have to cut down many of our budget costs, I do not agree with Dr. Garson's take in the CNN article. He said, "But any money that is spent on a patient that doesn't improve the outcome is a waste." My concern is how can improving outcome truly be measured when it comes to long-term impact? It is really hard to make value judgments to what improves outcome, especially when it comes to preventative care.

Quality care to me means patients feeling happy about their experiences when they see their doctor or when they stay in the hospital. Quality care doesn't necessarily just mean improving outcome because someone can come out of a hospital feelilng better physically, but they might not be happy emotionally or fiscally even, which may negatively affect their health (and outcome) later on. However, I do agree that we need to cut costs.

The main problem with our healthcare system is its inefficiency in terms of a poor infrastructure and high administrative costs. How can we be spending so much on certain technologies (like treating heart attacks), while forgetting to apply that same technology to our IT systems? Why can't we apply that technology right now on standardizing insurance claim forms? Why can't we apply that technology towards making it mandatory to have electronic health records and drug entry? We have that technology, and we need to spend some money now to save later. By computerizing everything, it allows us to save money on mistakes of ordering extra tests and such.