DISQUS

Maggie Mahar · 2 years ago

This is a great round-up--I'm keeping it for my file.
I would add today's piece on Bloomberg News http://www.bloomberg.com/apps/news?pid=20601109.... regarding insurers' stepped-up efforts to sell cheap, high-deductible coverage to "young immortals." It's worth noting that under one policy, the patient pays 20% of his ER bill AFTER paying the high deductible. The Bloomberg story also notes the industry's profits.
Thanks for mentioning the book.

Alan · 2 years ago

Good roundup and bravo for stating your bias. I agree with your premise that the system is bad but fundamentally disagree with your conclusion.

Let's look at the assumptions being discussed
- we're spending too much for healthcare in the US
- the current decision makers are not making the best decisions
- limiting spending and changing who makes the decisions will improve the results

What you are fundamentally arguing is that some person remote from the the point of care can make a better decision about whether someone deserves access to a certain drug or procedure better than the doctor and the patient can AND if the patient doesn't like it, tough. Today, if you're health insurance provider won't pay for something, you can still pay for it yourself. In Canada, you can't - by law. When the government comes into an industry, you merely trade one set of behavioral incentives for another - and lose a lot of freedom in the bargain.

For an extreme result of where things can go, look at the recent move to forbid access to certain types of procedures to smokers in Britain.

So, I fully support your investigation of the alternatives to what we have today and hope you find some compelling paths for us to follow.

Just remember, that if you haven't lived in one of those blessed OECD countries that are obviously more enlightened than the US, then tread carefully about your assertions of life under such a system. Data at the aggregate level doesn't equal data at the individual level.

Living under such a system is far from a panacea. Perhaps the US can find a different path forward and your research will contribute to that.

David Hamilton · 2 years ago

Thanks to Maggie and Alan for their comments. I do highly recommend Maggie's book, by the way -- it's an excellent and highly readable introduction to major problems in U.S. healthcare. I'll have other recommendations and perhaps even some mini-reviews as I get deeper into other tomes on the subject. I'll also have more to say on the future of insurance down the line.

Alan, you raise some good points about the potential pitfalls of centralizing healthcare decisions. On the other hand, the outcomes data I'm referring to -- particularly the research of Dartmouth's John Wennberg and Elliott Fisher -- strongly suggests that doctors and patients aren't doing a great job of selecting the most appropriate care either. (Maggie Mahar wrote about the Wennberg-Fisher work for Dartmouth Medicine earlier this year.)

One solution to the problem is “evidence-based medicine,” in which researchers rank the efficacy of procedures and drug treatments after subjecting them to rigorous controlled clinical trials. These sorts of studies can result in top-down guidelines issued from afar, but applying more analytical rigor to the question of which treatments work and which don’t surely can’t hurt. Of course, such evidence can also be used to drive reimbursement decisions, and that’s a stickier subject that I’ll happily punt on for the moment.

laytonlang · 4 months ago

I am a National Healthcare Consultant who possesses years of experience with health policy reform. Based upon the past and current conduct of the key stakeholders, I am convinced that the primary participants are not prepared for the onerous and labyrinthine journey that lies ahead to meet Mr. Obama’s three health reform policy objectives. I maintain that we will have to experience a catastrophic event to compel all parties to the figurative table for substantive cooperation. I define such an event to be similar to the recent General Motor’s bankruptcy that brought the American auto industry to its knees. Here is an industry that has been aware of its internal problems for years, but had not been able to resolve the issues because the stakeholders’ desires were diametrically opposed. Once, GM emerges from the bankruptcy, I anticipate it will be a leaner company focusing on designing automobiles that travel over 100 miles per gallon, that cut emissions by 60% , and even reshape our American foreign policy. We will no longer amalgamate with regimes and foreign powers based upon potential oil reserves, but, instead, affiliate with countries that pledge an allegiance to our ideals and people. In sum, the health care industry needs to experience a symbolic bankruptcy to bring it to its bottom, which would rescind all parties’ hidden agendas and allow healthcare reform to flourish.