Comments on: Improving America’s healthcare cost consciousness A slice of lime in the soda Sun, 26 Oct 2014 19:05:02 +0000 hourly 1 By: traduceri romana daneza Mon, 29 Sep 2014 14:07:28 +0000 I will be able to determine whether your nice solenoid is certainly faulty. You think this can be a good indication?All the creator device is certainly: Onan Microlite 1000 model4KY FA26100J S/N: F990 934964You did a person tremendously project involving trying to explain to us all kinds of things you should know relating to this freezer or fridge. Could not now have expected a lot more.

By: Curmudgeon Fri, 26 Aug 2011 17:03:30 +0000 @djseattle, you said what I was going to say, and more eloquently. Felix, we all have much more, ahem, money in the game than we did a decade ago. We can use the web to “educate” ourselves as consumers, but we can never be the same educated consumers as we are when buying a car. Our doctor is our personal expert, and we generally do what he/she says, and will buy all of the additional bells and whistles, even if a chunk of the cost is coming out of our pockets.

By: done Fri, 26 Aug 2011 12:21:23 +0000 Felix: It is important that opinion writers exercise strict discipline in using words like “healthcare cost”, “inflation rate”, “Medicare billing inflation”, “Medicare costs”. These are not interchangeable terms. You understand that, right? We cannot begin to address the problem until we effectively define the problem.

By: djseattle Fri, 26 Aug 2011 04:38:19 +0000 Can we please have a moratorium on use of the phrase “skin in the game” when referring to a patient’s directly paid share of healthcare costs? Because, you know, when it comes to healthcare, and to their family’s healthcare, individual human beings already have skin in the game. It’s called skin. They also have hearts and lungs and eyes and various and sundry limbs in the game. And, frequently, the skin, hearts, lungs, eyes, limbs and so forth of their spouse and children as well. What you are talking about is “money in the game,” under the premise that when it comes to making decisions about how much healthcare to “consume,” individual patients (and the decision-making guardians of minor and incapacitated patients) will have a countervailing “money incentive” to play off against what we might call the “actual skin incentive” in any given round of “the game.” But of course it’s not a game at all, and push come to shove, when it comes to money versus skin (or, say, money versus your child’s skin) you’ll plump for overloading on the skin side every time, just to be safe. That’s pretty much the whole damn problem with “patient-as-consumer” models of healthcare cost control.

That being the case, what evidence do you have that “the one thing this country really needs is much more cost-consciousness when it comes to healthcare,” at least as far as the patient-as-consumer is concerned? Most people in most healthcare plans in this country (including those covered by Medicare) already pay far more than the “tiny amount of their direct healthcare costs” that you cite as a useful trigger for enhanced awareness of their care’s real cost. Co-pays and co-insurance are virtually universal these days, as is a set employee share of the insurance premium itself, which is usually taken as an itemized payroll deduction. (This applies to union healthcare plans as well as those of non-unionized employers; I can personally testify to that fact, having helped to bargain a number of union contracts. In the private sector, “unlimited” benefit plans are effectively dead; in the public sector they are going fast, and to the extent that they ever existed they only covered a small percentage of the insured population anyway.)

So I’d just ask you: What evidence is there that in the US right now the average insured individual has less direct-cost money (not skin) “in the game” compared to the average insured individual in any other major industrialized country? And what evidence is there that this has anything to do with our rate of healthcare cost inflation compared to that of any other major industrialized country? Numbers, please.

By: hsvkitty Thu, 25 Aug 2011 23:00:50 +0000 The Docs are over using diagnostic equipment and medication because they are tired of being sued.

Patients won’t even give Obamacare the chance it needs to startup, so when it is quashed and dead in the water and all healthcare become unsustainable for Government and those unable to afford private insurance… the rising cost of insurance will mean only the very very rich will be able to afford care.

Once Obamacare is destroyed, who are you going to blame?

@ upstater …Obamacare isn’t an Obama-ination, although you obviously like the sound of your buzzword.

Newt shot down single payer in the 90’s and the Republicans have been railing against it ever since. (The insurance companies pay a lot of Insurers money to lobby against those they insure…)

By: nikanika Thu, 25 Aug 2011 22:58:49 +0000 I saw a great Frontline piece on health care in a very poor town in New Jersey. A doctor tried to help a dying man and the police did not seem compassionate for the man. The doctor was outraged and he tried to get crime statistics from the law enforcement to encourage a targeted approach to reducing crime. Well the local law enforcement team told him to kick rocks.

So he decided to comb through hospital billing records to get almost identical information about crime statistics-because stabbing, gunshot wound, and rape victims go to hospitals. What he found was that one percent of the people in the town accounted for approximately 30% of the health care costs. When he plotted this against the addresses he found that about half of these lived in a high rise nursing facility-no real shock there considering how expensive end of life care can be.

The others were generally low income working class people with chronic conditions that were not being treated proactively-so they would end up in the ER frequently. So he worked with social services division to take a targeted approach and get them preventative care, regular check ups to keep on track, cleaning up their household environment-whatever needed to be done.

The town has saved millions of dollars-and this is the poorest town in New Jersey. The doctor’s point is that if he can do it there it can be done anywhere.

Can you imagine what this kind of targeted approach along with say ferreting out fraud or better approaches to end of life care could be?

By: jfruh Thu, 25 Aug 2011 18:11:07 +0000 “Doctors at Partners now order imaging scans through the computer system and are automatically queried about the patients’ characteristics. For each case, the software then provides an “appropriateness” score, reflecting evidence- based protocols for the image requested.”

That sounds great unless you’re a patient with a nagging ailment whose GP has said, “hmm, maybe we should get an MRI on that just to be on the safe side,” and then get a letter from your insurer saying “Our computer says your appropriateness score is too low for us to pay for this.” I’m not saying that in the aggregate this isn’t a good idea, but it’s bound to cause any number of freakouts for individuals, a small percentage of with will be justified. That’s the trouble with applying economic rationality to health care: the stakes are so high that people are often very invested in getting all the info and trying all the avenues they can, even with low probability of results.

By: Ditman Thu, 25 Aug 2011 18:02:07 +0000 “All manner of medicine, it turns out, from CT and MRI scans to antidepressants, have a habit of making people not better but worse.” Insane statement. Having been a diabetic for over 40 years, “all manners of medicine” have saved me from what would have been fatal 70 years ago, prevented kidney disease through blood pressure control, and allowed a fairly normal life through insulin pumpes and real time blood sugar sensing. You don’t need to be hyperbolic to make an otherwise good point.

By: upstater Thu, 25 Aug 2011 17:54:01 +0000 re. electronic health records…

Have you ever had an annual physical exam with a doc that uses a laptop and the canned practice software? Invariably they spend MORE time wading through menus and toggling radio buttons than they do actually examining you. Mt doc has had the software for 4 years and he is a fairly sharp guy — but there is LITTLE doubt in my mind that this degrades patient care because the computer requires more time that the actual exam. If they had a stenographer dorking around with the computer things would go much faster — it is a waste of professional time, IMO.

Electronic medical records are something for the benefit of insurance companies, software vendors and consultants.

Finally if people like Orszag and his ilk are really serious about controlling costs, then they should advocate single payer. Obamacare is an Obama-ination. Shut down private insurers and costs will go down to ex-US OECD averages very quickly.