Health Care Law Massacred in Supreme Court

[KenC]

Heeter's graphic on the past page shows malpractice, and the defensive medicine practiced to avoid it, accounts for 10% of costs.

Hardly trivial when total healthcare spending is $2 Trillion + per year.

The insurance is about 9.9% of that grouping though. It's a little misleading. Defensive medicine isn't really a part of care that I've ever witnessed. If one were to practice defensive medicine, it would only be done on the diagnostic level when you're doing labs or imaging to make a diagnosis. Once you're past that, there's no reason to run expensive exams to figure out what the ailment is.

Even if Malpractice Insurance makes up nearly 10% of each dollar spent, how much can you really reduce it by? A few percent maybe? I agree that tort reform needs to happen, but it's not going to reduce is by that much. Physicians are sued for negligence, but are rarely found at fault. Statistically speaking, each physician will directly contribute to the death of a patient from negligence, and I believe the families are entitled to compensation (though not at the ridiculous levels some get).

[KenC]

Honest question here - since we can all get behind the concept that the root of the problem lies in inflated costs; where is all this surplus profit going? I've heard that the insurance companies aren't necessarily getting uber rich off it. Most doctors are well paid but I think they are entitled to such pay after going through medical school, residency, etc. Yeah, I said it, "ENTITLTED". See, it's not such a bad word. Hard work entitles one to great reward, in my opinion.

But seriously, where and how do we trim the fat? I like and agree with gwb's belief in marketplace competition in theory, but like KenC pointed out, how can we practically encourage such a market to develop? And who's pockets will be the most impacted by trimming this fat? Or is the real root of the problem simply that the American people are too fat?

It's not that there is a huge surplus of profit (unless you're in the device market), it's that our health system is HUGE!!! We have a ton of docs, nurses, CNAs, sono techs, rad techs, lab techs, pharmacists, pharm techs, hospitals, administrators, etc.

The $2.3T we spend per year is sustaining an enormous industry. The one thing that people in the industry need to realize is that if improvements in care and efficiency are established, revenues are going to decline. The fewer resources that are utilized by patients, the less money that the industry as a whole is going to take in. It's odd to think about getting paid less for doing a better job. If diagnostic imaging was only used when really necessary, we would only need about half of the CT, MRI, and X-Ray machines that we currently have... and about half of the staff that currently run them.

[KenC]

Quote:
What can health care providers and insurers do about the rising costs of health care?

There are several activities that health care providers and insurers can pursue, although the intensity of pursuit will vary depending on the provider or insurer. There are three general areas and at least ten specific opportunities to make improvements:

Inefficient and ineffective use of medical services
Development of an evidence-based outcomes repository or database [What Ken has been saying]
Increased incentives for health care provider use of evidence-based medicine and proven preventive measures
Increased information sharing among health care providers and consumers about best practices in terms of cost and quality outcomes

The company I work for (which is the largest health care organization in the US) has spent years working on these tenets. We were the first system in the region to adopt the most advanced EMR system available, and there are clinical treatment algorithms available on the Intranet from just about every specialty department in the region.

[KenC]

Malpractice insurance is a very very small part of overall health care costs.

The most significant costs are mainly our ethical decisions on how we treat end of life care and our current lack of a proper system of preventative care. There is no financial incentive for any medical company really to educate individuals, regulate the food industry, or disconnect granny from the feeding tube.

The only way to bring health care costs down is if every person took the incentive to self-educate and try and live as healthy as possible and then negotiate the terms of their end of life care (before the time comes) so as not to impose extraordinary costs with the expectation that earlier death may result. But since all of that is highly unlikely, then in my opinion, the government has some responsibility to educate and regulate (provided it doesn't restrict our personal liberties), since as I said, no company has an incentive to do so. A person's ignorance in living a healthy life shouldn't have to result in me having to pay higher premiums, but currently it does.

A healthy life style doesn't necessarily prevent the kinds of chronic illness that plague the elderly. For example, my dad has recently developed rheumatoid arthritis. It's an autoimmune disease that has nothing to do with living a healthy lifestyle. He's just under 60yo old now, and it's going to cost a lot of money to treat over the next 20+ years... probably more than he's paid in a lifetime of insurance premiums.

Medicine can't and shouldn't be viewed through an economic lens first. Medicine's number one priority is to improve the health of patients. Yes, there are some treatments that don't seem to make much sense from an economic standpoint, but we also have a ton of really cheap treatments that yield very high outcomes.
Putting a numerical "value" on treatments and rationing them as such will become a very slippery slope very quickly.

[KenC]

mrsleeve, i cant believe im saying this, but...

i think you're being an idealistic bleeding heart liberal.

herb's approach is pragmatic. it's something we really need to consider. is it worth spending a million dollars a month to prolong someone's life 3 more months when they're barely alive?

next thing i know you're going to be signing up for greenpeace.

If the patient population is educated enough about end of life planning, and has the resources to take the necessary steps, I don't believe this will be much of an issue. There aren't an abundance of elderly people that indicate explicitly to utilize all available resources. The problem is when they have no documentation and the hospital is forced (legally) to provide them with "the big guns."

If a 60yo with cancer wants all available treatments, who are we to deny them that?

[KenC]

Yeah, we went through this the past fall. Grandma (my last surviving grand parent) had a brain tumor and was treated over the summer and seemed to recover well. However, when the fall came, she deteriorated quickly and there was nothing that could be done to return her to previous health. Her and her children's wishes were to make her comfortable as possible. She was moved from the hospital to a hospice and then to home hospice care.

Although it's challenging to accept a loved one's coming passing, it also is very selfish to try to prolong infinitely their lives (of very low quality of life) for selfish reasons (wanting them around still). I think that people ought to be responsible and make their intentions for their own end of life care apparent, but that would require many to face the reality that they too have a limited mortality.

You guys did the right thing by honoring her wishes. Thankfully, I haven't yet had to endure any of that.

In regards to your last sentence, I've personally seen people struggle with formulating the documentation. I'm really glad that my parents have everything taken care of already.

[KenC]

^

Thats basically just what I was going to say in response to kershaw.


Not that I think we should spend shit piles of money on those that are about to leave us, with little chance to recover. BUT that said I do think that should be left more to the individual than some govt bureaucrats and bean counters dictating to us what should be done based purely on dollar value. Like heater says, people need to be responsible and proactive with these kinds of things on their own. To be honest I dont know that many people that are over 35 that have not had this talk with their families and made their wishes clear at least in an informal verbal kinda way.


With my self and with most of my family, there are very specific instruction when it comes to long term/end of life concerns. Its well known in my family that there are not to be any extreme measures to be taken to prolong or save one of our lives, unless there is a very very good chance that we will recover to what the person involved would consider a reasonable quality of life

It's a tough topic, but it's good to discuss it with your family as well because their decisions can supersede your documents at times.

[KenC]

Nonetheless, some analysts state that the availability of more expensive, state-of-the-art medical technologies and drugs fuels health care spending for development costs and because they generate demand for more intense, costly services even if they are not necessarily cost-effective.

This is why care in the US will always be more expensive compared to other countries.

I think that there needs to be a larger burden placed on manufacturers to prove X amount of improvement over existing technology, however. There are some new devices and drugs that are miraculous, but there are also some that provide marginal benefit at best for 10x the cost.

[KenC]

KenC, what was the name of the book you had me read? Very informative.

It's called Health Care Will Not Reform Itself. It's written by the CEO of the largest health maintenance organization in the US.

I'll loan it to anybody that wants to read it (just pay postage.) It's pretty concise and well organized. I was able to read it in one sitting. Like Buddy mentioned, it's a really informative read.

Just shoot me a PM if you want it.

[rwh11385]

The insurance is about 9.9% of that grouping though. It's a little misleading. Defensive medicine isn't really a part of care that I've ever witnessed. If one were to practice defensive medicine, it would only be done on the diagnostic level when you're doing labs or imaging to make a diagnosis. Once you're past that, there's no reason to run expensive exams to figure out what the ailment is.

Even if Malpractice Insurance makes up nearly 10% of each dollar spent, how much can you really reduce it by? A few percent maybe? I agree that tort reform needs to happen, but it's not going to reduce is by that much. Physicians are sued for negligence, but are rarely found at fault. Statistically speaking, each physician will directly contribute to the death of a patient from negligence, and I believe the families are entitled to compensation (though not at the ridiculous levels some get).

It's not that there is a huge surplus of profit (unless you're in the device market), it's that our health system is HUGE!!! We have a ton of docs, nurses, CNAs, sono techs, rad techs, lab techs, pharmacists, pharm techs, hospitals, administrators, etc.

The $2.3T we spend per year is sustaining an enormous industry. The one thing that people in the industry need to realize is that if improvements in care and efficiency are established, revenues are going to decline. The fewer resources that are utilized by patients, the less money that the industry as a whole is going to take in. It's odd to think about getting paid less for doing a better job. If diagnostic imaging was only used when really necessary, we would only need about half of the CT, MRI, and X-Ray machines that we currently have... and about half of the staff that currently run them.

Isn't some of that imaging and other testing use to "back up" a physician's diagnosis and to CYA? Is there a systematic approach built to balance the "to be sure" reasoning for an imaging versus "overkill"?

[KenC]

Isn't some of that imaging and other testing use to "back up" a physician's diagnosis and to CYA? Is there a systematic approach built to balance the "to be sure" reasoning for an imaging versus "overkill"?

It all varies hospital by hospital, clinic by clinic. There is no universal standard. But there's also no universal consensus.

There's research going on at OHSU right now to try and determine a CT--less clinical diagnostic algorithm for appendicitis in youth. They're trying to diagnose appy as accurately (through physical exam and lab tests) as with a CT scan. Benefits are two-fold. No expensive CT, and the poor kid isn't exposed to radiation that's equivalent to 100 chest XRs.

There are certainly times, however, that a CT or MRI is necessary for diagnosis.

[z31maniac]

The insurance is about 9.9% of that grouping though. It's a little misleading. Defensive medicine isn't really a part of care that I've ever witnessed. If one were to practice defensive medicine, it would only be done on the diagnostic level when you're doing labs or imaging to make a diagnosis. Once you're past that, there's no reason to run expensive exams to figure out what the ailment is.

Even if Malpractice Insurance makes up nearly 10% of each dollar spent, how much can you really reduce it by? A few percent maybe? I agree that tort reform needs to happen, but it's not going to reduce is by that much. Physicians are sued for negligence, but are rarely found at fault. Statistically speaking, each physician will directly contribute to the death of a patient from negligence, and I believe the families are entitled to compensation (though not at the ridiculous levels some get).

Fair enough, however, I wonder how many less lawsuits would be filed, if there wasn't the promise of a big pay day.

IE, caps and such.

[KenC]

Fair enough, however, I wonder how many less lawsuits would be filed, if there wasn't the promise of a big pay day.

IE, caps and such.

There should be caps.

Figuring out what those are is a whole different beast.

There are fewer people out there chasing an easy payday than you'd think, though they do exist.
The vast majority of those who sue feel that they've been truly injured. The vast majority of those never see a dime because the physician and or/hospital wasn't negligent.
Then you're left with the small portion of those who were legitimately injured due to negligence or a preventable circumstance, and rightfully deserve compensation.

How low do you make the caps to deter the small sliver of sue-happy A-holes, while still reasonably compensating those who were really hurt?

Why can't there be an easy solution?? LOL

[mrsleeve]

trusting that everyone is going to pitch in and do their part?

sounds like communism.

Ummm no personal responsibly is pretty much the opposite of communism

[CorvallisBMW]

Well isn't this interesting:

http://www.reuters.com/article/2008/01/08/us-deaths-rankings-idUSN0765165020080108

France best, U.S. worst in preventable death ranking