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Showing posts with label healthcare costs. Show all posts
Showing posts with label healthcare costs. Show all posts
Friday, September 7, 2012
What does $750 billion in wasted spending look like?
Here is an infographic (I know) from the Institute of Medicine who just released this report. According to it, we are wasting $750 billion annually in unnecessary healthcare costs, and here is the breakdown. Note the ~$250 billion on overdiagnosis and overtreatment. Now,what are we going to do about it?
If you like Healthcare, etc., please consider a donation (button in the right margin) to support development of this content. But just to be clear, it is not tax-deductible, as we do not have a non-profit status. Thank you for your support!
If you like Healthcare, etc., please consider a donation (button in the right margin) to support development of this content. But just to be clear, it is not tax-deductible, as we do not have a non-profit status. Thank you for your support!
Thursday, June 28, 2012
ACA: The reports of its death were greatly exaggerated
This is a big day for President Obama's signature legislation, the Affordable Care Act. The Supreme court upheld its constitutionality, and the punditdom thinks that further challenges are unlikely. On the other hand, if Romney takes the White House in the next election... Well, you can guess what will happen then.
It has been interesting to watch the run-up to this decision. Most recently I have been amused by surveys finding that on the one hand many American people are in favor of the pre-existing condition inclusion (this part of the bills forbids insurance companies to discriminate against people with prior health conditions), as well as the provision that allows young adults to stay on their parents' insurance policies through a certain age. On the other hand, reportedly the majority of Americans are against the healthcare law, and most also oppose the individual mandate provision (this is the part where everyone has to buy insurance or pay a tax). Given this imbalance in the public opinion, a more pertinent survey should have assessed how well people understand these provisions in the first place. And this would have had to establish how well the public gets our whole healthcare "system."
To start from the beginning, any healthcare system can be judged on three criteria:
1. How accessible is it?
2. Is it of adequate quality?
3. How expensive is it?
The answer to the first question provides one of the rationales for the individual mandate. Currently there are about 50 million people without health insurance in the US, and, hence, without adequate access to the system. Many of these people are the young and the healthy who gamble on staying young and healthy. And many are consigned to relying on expensive emergency care when this gamble fails. Some of them go bankrupt trying to pay for it, while others become "safety net" cases, where the institution that cares for them swallows the costs. These institutions do get some public dollars for providing safety net care, but not nearly enough to break even. Since many of the 50 million don't buy health insurance because they cannot afford it, the healthcare bill provides a way to create more affordable insurance products.
The answer to the second question is not related directly to the individual mandate. Since much of this blog is devoted to the issues of healthcare-associated harm, I do not wish to belabor this point here. Suffice it to say that the bill does try to address this catastrophic situation, though it remains to be seen if it will succeed.
The third question is the crux of the story. Many have said that the escalation of healthcare costs is unsustainable, and I subscribe to this notion: I am not sure how much more than $2.6 trillion/year we want to pay for this insatiable beast. Yet judging by the near-revolt that "death panels" rhetoric caused, the citizenry is not interested in being thoughtful about what services make sense. The vehement knee-jerk to the "R"word shuts down the discussion before it even starts. So, OK, how do we pay this ever-increasing bill? Moreover, since we are all happy with the government mandate for all insurance to pay for pre-existing conditions, how do we propose to pay for this additional coverage? Short of printing money (not generally a good idea) or creating a single-party payer system that regulates these expenditures, the only way is to broaden the pool of revenue. The way the ACA has proposed to broaden this pool is through the very individual mandate that is anathema to our American way of life. But without it, there is no broadening of coverage, and there is no paying for every intervention that we seem to feel entitled to.
I doubt very much that the ACA will substantively contain healthcare costs. I even doubt that it will solve the quality problems, but I am willing to wait and see on that. This bill is but s band-aid on an arterial bleed. However, I do believe that upholding this legislation allows us to take the first steps toward a reasonable national dialog about the kind of healthcare system we need. This dialog will not be helped by stupid surveys that reinforce our willful ignorance. We have the opportunity to move this conversation to a higher level, where people begin to understand the issues we are up against more deeply. Let's take it.
If you like Healthcare, etc., please consider a donation (button in the right margin) to support development of this content. But just to be clear, it is not tax-deductible, as we do not have a non-profit status. Thank you for your support!
It has been interesting to watch the run-up to this decision. Most recently I have been amused by surveys finding that on the one hand many American people are in favor of the pre-existing condition inclusion (this part of the bills forbids insurance companies to discriminate against people with prior health conditions), as well as the provision that allows young adults to stay on their parents' insurance policies through a certain age. On the other hand, reportedly the majority of Americans are against the healthcare law, and most also oppose the individual mandate provision (this is the part where everyone has to buy insurance or pay a tax). Given this imbalance in the public opinion, a more pertinent survey should have assessed how well people understand these provisions in the first place. And this would have had to establish how well the public gets our whole healthcare "system."
To start from the beginning, any healthcare system can be judged on three criteria:
1. How accessible is it?
2. Is it of adequate quality?
3. How expensive is it?
The answer to the first question provides one of the rationales for the individual mandate. Currently there are about 50 million people without health insurance in the US, and, hence, without adequate access to the system. Many of these people are the young and the healthy who gamble on staying young and healthy. And many are consigned to relying on expensive emergency care when this gamble fails. Some of them go bankrupt trying to pay for it, while others become "safety net" cases, where the institution that cares for them swallows the costs. These institutions do get some public dollars for providing safety net care, but not nearly enough to break even. Since many of the 50 million don't buy health insurance because they cannot afford it, the healthcare bill provides a way to create more affordable insurance products.
The answer to the second question is not related directly to the individual mandate. Since much of this blog is devoted to the issues of healthcare-associated harm, I do not wish to belabor this point here. Suffice it to say that the bill does try to address this catastrophic situation, though it remains to be seen if it will succeed.
The third question is the crux of the story. Many have said that the escalation of healthcare costs is unsustainable, and I subscribe to this notion: I am not sure how much more than $2.6 trillion/year we want to pay for this insatiable beast. Yet judging by the near-revolt that "death panels" rhetoric caused, the citizenry is not interested in being thoughtful about what services make sense. The vehement knee-jerk to the "R"word shuts down the discussion before it even starts. So, OK, how do we pay this ever-increasing bill? Moreover, since we are all happy with the government mandate for all insurance to pay for pre-existing conditions, how do we propose to pay for this additional coverage? Short of printing money (not generally a good idea) or creating a single-party payer system that regulates these expenditures, the only way is to broaden the pool of revenue. The way the ACA has proposed to broaden this pool is through the very individual mandate that is anathema to our American way of life. But without it, there is no broadening of coverage, and there is no paying for every intervention that we seem to feel entitled to.
I doubt very much that the ACA will substantively contain healthcare costs. I even doubt that it will solve the quality problems, but I am willing to wait and see on that. This bill is but s band-aid on an arterial bleed. However, I do believe that upholding this legislation allows us to take the first steps toward a reasonable national dialog about the kind of healthcare system we need. This dialog will not be helped by stupid surveys that reinforce our willful ignorance. We have the opportunity to move this conversation to a higher level, where people begin to understand the issues we are up against more deeply. Let's take it.
If you like Healthcare, etc., please consider a donation (button in the right margin) to support development of this content. But just to be clear, it is not tax-deductible, as we do not have a non-profit status. Thank you for your support!
Friday, April 6, 2012
Infographics: devil in details
I got an e-mail yesterday asking me if I would be interested in displaying an info graphic on my blog. After a few back and forths, I decided to do it. After all, a picture is worth a thousand words. But as with everything, buyer beware: the devil is in the details.
A couple of caveats:
1. I cannot back up all of the numbers myself, and the references at the bottom seem to represent single source data, rather than the totality of the evidence. So take with a grain of salt.
2. There are a couple of notable errors in the graphics:
a. The graphic on other first world nations' spending says that the US spends 2x what they do in Japan. What the graph shows is that this is the case as the proportion of the GDP (also the x-axis is not labeled as such). So, the statement is not entirely accurate.
b. In hospitals overcharging, the caption states that hospitals charge 200% more for meds compared to ex US. The number adds up to 100% more, which is 2x.
3. In general, there are actually some valid reasons why we pay more for stuff in the US. I do not, for example, know if the international data are adjusted for various economic factors, such as purchasing power.
4. The statement that doctors are overpaid is a laugh -- take it from someone who has been in the trenches. I worked dawn till dusk and beyond, nearly every day of every week. I was making barely enough to keep food on the table and a roof over our heads. No lavish vacations, no BMWs, etc. It is not the MDs that are overpaid. Go to the C-suites and corporations, and then you are getting warmer.
Despite the disagreements that I have with the data, I thought it might be a good point of discussion. Would love to hear your thoughts about it.
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Created by: Medical Billing and Coding Certification
If you like Healthcare, etc., please consider a donation (button in the right margin) to support development of this content. But just to be clear, it is not tax-deductible, as we do not have a non-profit status.
Thank you for your support!
A couple of caveats:
1. I cannot back up all of the numbers myself, and the references at the bottom seem to represent single source data, rather than the totality of the evidence. So take with a grain of salt.
2. There are a couple of notable errors in the graphics:
a. The graphic on other first world nations' spending says that the US spends 2x what they do in Japan. What the graph shows is that this is the case as the proportion of the GDP (also the x-axis is not labeled as such). So, the statement is not entirely accurate.
b. In hospitals overcharging, the caption states that hospitals charge 200% more for meds compared to ex US. The number adds up to 100% more, which is 2x.
3. In general, there are actually some valid reasons why we pay more for stuff in the US. I do not, for example, know if the international data are adjusted for various economic factors, such as purchasing power.
4. The statement that doctors are overpaid is a laugh -- take it from someone who has been in the trenches. I worked dawn till dusk and beyond, nearly every day of every week. I was making barely enough to keep food on the table and a roof over our heads. No lavish vacations, no BMWs, etc. It is not the MDs that are overpaid. Go to the C-suites and corporations, and then you are getting warmer.
Despite the disagreements that I have with the data, I thought it might be a good point of discussion. Would love to hear your thoughts about it.
Created by: Medical Billing and Coding Certification
If you like Healthcare, etc., please consider a donation (button in the right margin) to support development of this content. But just to be clear, it is not tax-deductible, as we do not have a non-profit status.
Thank you for your support!
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