Why is Obama saying that our healthcare costs are way too high?

[Anonymous]

Anonymous wrote:I think it's intersting that doctors fixate on malpractice lawyers. What about the insurance companies? Aren't they effectively calling the shots, telling doctors that they can only do X if they've done ABC. Case in point: I went to the ER with a massive headache and vomiting. The doctor wanted to admit me for observation. She could not without doing a spinal tap first! A spinal tap! I have other examples. My doctors complain more about the insurance shackles than defensive medicine. Would some kind doctor explain this to me?

Malpractice lawyers are the only component of cost outside the system. They aren't doctors, hospitals, equipment providers, drug makers, etc. It's easy for everyone to rally together to blame the one thing that is not their fault. But the numbers don't add up. It is one issue, but it is not THE issue. Price is THE issue.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think it's intersting that doctors fixate on malpractice lawyers. What about the insurance companies? Aren't they effectively calling the shots, telling doctors that they can only do X if they've done ABC. Case in point: I went to the ER with a massive headache and vomiting. The doctor wanted to admit me for observation. She could not without doing a spinal tap first! A spinal tap! I have other examples. My doctors complain more about the insurance shackles than defensive medicine. Would some kind doctor explain this to me?

Malpractice lawyers are the only component of cost outside the system. They aren't doctors, hospitals, equipment providers, drug makers, etc. It's easy for everyone to rally together to blame the one thing that is not their fault. But the numbers don't add up. It is one issue, but it is not THE issue. Price is THE issue.

Please suugest where you would cut.

[Anonymous]

Yes, defensive medicince easily accounts for almost half of what we do.
And we DO fixate on the insurance companies. Two things render us powerless there: ERISA and the Sherman anti-trust act. But those in private practice (I choose to be employed instead) have the option of going no-insurance; more and more of my friends and colleagues are doing that successfully these days. So malpractice is still the biggie we can't get around.

[Anonymous]

I heard someone make a point the other day (sorry, cannot remember where - either TV or radio) that if IV line and post surgical infections CAUGHT IN THE HOSPITAL were eliminated there would be a dramatic reduction in cost.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/06/25/BAGELQL66N1.DTL

It is estimated that each year 2 million Americans become infected during hospital stays, and at least 90,000 of them die. MRSA is a leading cause of hospital-borne infections.

The person on the radio/tv argued that each infection caused an addition week hospital stay (not to mention the deaths) at an average cost of $50K per occurrence for hospital/drugs/doctors - That is a boatload of money.

Maybe if the medical establishment took care of this problem (totally preventable) and economical alternatives such as 24/7 clinics were available to the uninsured (instead of the ER) we could see some progress made here.

[Anonymous]

Anonymous wrote:I heard someone make a point the other day (sorry, cannot remember where - either TV or radio) that if IV line and post surgical infections CAUGHT IN THE HOSPITAL were eliminated there would be a dramatic reduction in cost.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/06/25/BAGELQL66N1.DTL

It is estimated that each year 2 million Americans become infected during hospital stays, and at least 90,000 of them die. MRSA is a leading cause of hospital-borne infections.

The person on the radio/tv argued that each infection caused an addition week hospital stay (not to mention the deaths) at an average cost of $50K per occurrence for hospital/drugs/doctors - That is a boatload of money.

Maybe if the medical establishment took care of this problem (totally preventable) and economical alternatives such as 24/7 clinics were available to the uninsured (instead of the ER) we could see some progress made here.

Wow. That is a simplification. MRSA is not totally preventable. NOT. There are tons of illnesses that are hospital acquired that cost money. This is not new. But keep in mind that more people get well in hospitals than get sick there.
While we are on the topic of preventable illness that is expensive, look at HIV. That is where the public could do its job to eliminate transmission (totally preventable), and saved us some money.

[Anonymous]

Anonymous wrote:Yes, defensive medicince easily accounts for almost half of what we do.
And we DO fixate on the insurance companies. Two things render us powerless there: ERISA and the Sherman anti-trust act. But those in private practice (I choose to be employed instead) have the option of going no-insurance; more and more of my friends and colleagues are doing that successfully these days. So malpractice is still the biggie we can't get around.

So let's say I go in for a hernia operation (had one this past winter). How do you add enough defensive medicine to make it twice the cost of a hernia operation in Great Britain? I just don't buy it.

Yes, I imagine if you are in the ER, you order a lot of extra diagnostics here. Or maybe you are neuro and do a lot of extra MRI's (Japan BTW solved that problem buy going to cheap MRI's). Sure, you could say obstetrics goes overboard, but you can't pack every specialty with enough extra tests to double our health care spending.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes, defensive medicince easily accounts for almost half of what we do.
And we DO fixate on the insurance companies. Two things render us powerless there: ERISA and the Sherman anti-trust act. But those in private practice (I choose to be employed instead) have the option of going no-insurance; more and more of my friends and colleagues are doing that successfully these days. So malpractice is still the biggie we can't get around.

So let's say I go in for a hernia operation (had one this past winter). How do you add enough defensive medicine to make it twice the cost of a hernia operation in Great Britain? I just don't buy it.

Yes, I imagine if you are in the ER, you order a lot of extra diagnostics here. Or maybe you are neuro and do a lot of extra MRI's (Japan BTW solved that problem buy going to cheap MRI's). Sure, you could say obstetrics goes overboard, but you can't pack every specialty with enough extra tests to double our health care spending.

Routine surgery is not typical in the big spending. But since you asked, if you are healthy, you should not have needed lab work, but here in the US you get it. Even if you have a minor medical problem, you should not have needed anything. If you got an EKG, someone has to read it, usually an MD, and someone had to pay for the EKG machine, a tech or nurse had to do the EKG. Did your internist have to do an H&P before? The anesthesiologist won't touch you if someone else has not done the H&P, since they don't want to carry the burden as the primary. Neither does the surgeon. If something is missed, they get blamed. You must have seen at least three doctors to have that procedure done. The trail of nurses needed to get paperwork completed is over the top. There is so much paperwork related to malpractice, you would be surprised. Consent after consent. Someone (lawyer) to write those original consents, someone to file them, along with the rest of the chart. That chart has to be locked up, it can be future evidence. Storage of the records if costly, so is converting them to micro. The documentation of jewelry that you brought, a wallet, recent rashes or bruises, false teeth ( we don't want to get sued for a bruise that you got in your garden). Documentation of whether or not sequential compression stockings were put on. The ID number of all the equipment in the room. Documenting takes up time of the nurses, so more staff needed. The counting of instruments, more staff. The use of newer $$$ anesthetics so you don't throw up and get mad. The newest monitors so that the anesthetic is safer. The follow up calls to head off any dissatisfaction. Dictation, that is now done in India, costs. In Europe, many doctors write a little note, and that is it. At the end of it, you get a fat chart. Did a medical device company rep come and help the doctor with some special mesh? If so, that mesh went through a ton of scrutiny $$$. If it fails, people will sue. So the mesh makers need insurance $. I'm not done, it goes on. I have not even approached the other stuff that has to be done according to regulation. That is another chapter. There are a ton of people behind the scenes that you never see. Please be thankful of the care that you received from the team.
Then, here is the biggie, did the hernia need to be done?
Also, cheap MRIs are not as accurate, you can miss things, you get sued.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes, defensive medicince easily accounts for almost half of what we do.
And we DO fixate on the insurance companies. Two things render us powerless there: ERISA and the Sherman anti-trust act. But those in private practice (I choose to be employed instead) have the option of going no-insurance; more and more of my friends and colleagues are doing that successfully these days. So malpractice is still the biggie we can't get around.

So let's say I go in for a hernia operation (had one this past winter). How do you add enough defensive medicine to make it twice the cost of a hernia operation in Great Britain? I just don't buy it.

Yes, I imagine if you are in the ER, you order a lot of extra diagnostics here. Or maybe you are neuro and do a lot of extra MRI's (Japan BTW solved that problem buy going to cheap MRI's). Sure, you could say obstetrics goes overboard, but you can't pack every specialty with enough extra tests to double our health care spending.

Routine surgery is not typical in the big spending. But since you asked, if you are healthy, you should not have needed lab work, but here in the US you get it. Even if you have a minor medical problem, you should not have needed anything. If you got an EKG, someone has to read it, usually an MD, and someone had to pay for the EKG machine, a tech or nurse had to do the EKG. Did your internist have to do an H&P before? The anesthesiologist won't touch you if someone else has not done the H&P, since they don't want to carry the burden as the primary. Neither does the surgeon. If something is missed, they get blamed. You must have seen at least three doctors to have that procedure done. The trail of nurses needed to get paperwork completed is over the top. There is so much paperwork related to malpractice, you would be surprised. Consent after consent. Someone (lawyer) to write those original consents, someone to file them, along with the rest of the chart. That chart has to be locked up, it can be future evidence. Storage of the records if costly, so is converting them to micro. The documentation of jewelry that you brought, a wallet, recent rashes or bruises, false teeth ( we don't want to get sued for a bruise that you got in your garden). Documentation of whether or not sequential compression stockings were put on. The ID number of all the equipment in the room. Documenting takes up time of the nurses, so more staff needed. The counting of instruments, more staff. The use of newer $$$ anesthetics so you don't throw up and get mad. The newest monitors so that the anesthetic is safer. The follow up calls to head off any dissatisfaction. Dictation, that is now done in India, costs. In Europe, many doctors write a little note, and that is it. At the end of it, you get a fat chart. Did a medical device company rep come and help the doctor with some special mesh? If so, that mesh went through a ton of scrutiny $$$. If it fails, people will sue. So the mesh makers need insurance $. I'm not done, it goes on. I have not even approached the other stuff that has to be done according to regulation. That is another chapter. There are a ton of people behind the scenes that you never see. Please be thankful of the care that you received from the team.
Then, here is the biggie, did the hernia need to be done?
Also, cheap MRIs are not as accurate, you can miss things, you get sued.

What are you talking about? I am healthy and early 40's, so the doc didn't ask for any pre-clearance tests. I filled out my health history on a form directly along with my consents. No examinations other than my routine physical were done. Oh, I guess the surgeon poked me once to feel the hernia and told me about the procedure before the nurse scheduled me. I actually had something once (a PAC which was temporary) and I told them this and they did not worry enough to put me on an EKG - which by the way is a pretty basic piece of equipment and shouldn't cost much anymore and takes about a minute to administer and a minute to read. If anyone drew blood from me, it was after they put me out because it didn't happen. They didn't document my possessions because they had me put everything in a bag and sealed it up. No one looked me over for bumps and bruises. I can't say whether the anesthetics are nicer than the ones they use in the UK, but as for the mesh - c'mon, it's mesh and every country buys the stuff, so if we are paying more for it then we are just subsidizing the world's product development. It was an outpatient procedure, in by 7, out by twelve or 1 with discharge instructions, an ice pack, and some pain meds.

Maybe I couldn't see everything going on behind the scenes, but I did not see a raft of extra procedures. I understand that there is waste due to litigation threat, but it just doesn't add up to the cost of our health care, either in this case or in the studies on defensive medicine. It's an issue, but not the issue.

[Anonymous]

The mesh is more expensive here. We sue more, so we pay more. Remember silicone breast implants? There is an added fee now for potential liability. Your procedure was simple, but if you had some disease like diabetes that was undiagnosed, and the operation was done and the mesh got infected because your blood sugar was high, and you became septic...you might have sued. That has something to do with the testing. The equipment, including the EKgs are very costly.
Years ago LIFE magazine did an article about how many people are involved in the care of a patient getting bypass surgery. It was a large staff. They all need to get paid. How many could be eliminated if there were no lawsuits? Maybe 1/3.
My friends in Britain say that they do take more chances, and there is more guessing. They admit that there are more errors, but in the end, more people get care since the resources aren't drained. They have ways of dealing with bad outcomes there by disciplining staff.
Most of the the studies about cost related to malpractice are done by special interest groups like trial lawyers. They really seek to minimize the impact. They look at direct costs, rather than the culture that comes with the fear of litigation, which tends to run things up.
I just had a patient die who was about 90. I would say that we threw everything at him, the works, just to keep him alive until his family could be contacted to agree to take him off life support. In other places, the doctors can decide. He lingered in the expensive care unit for 24 hours, just because we had to wait for the family. That could have been a law suit if we went ahead without their consent. These are everyday occurrences.

[Anonymous]

Anonymous wrote:The mesh is more expensive here. We sue more, so we pay more. Remember silicone breast implants? There is an added fee now for potential liability. Your procedure was simple, but if you had some disease like diabetes that was undiagnosed, and the operation was done and the mesh got infected because your blood sugar was high, and you became septic...you might have sued. That has something to do with the testing. The equipment, including the EKgs are very costly.
Years ago LIFE magazine did an article about how many people are involved in the care of a patient getting bypass surgery. It was a large staff. They all need to get paid. How many could be eliminated if there were no lawsuits? Maybe 1/3.
My friends in Britain say that they do take more chances, and there is more guessing. They admit that there are more errors, but in the end, more people get care since the resources aren't drained. They have ways of dealing with bad outcomes there by disciplining staff.
Most of the the studies about cost related to malpractice are done by special interest groups like trial lawyers. They really seek to minimize the impact. They look at direct costs, rather than the culture that comes with the fear of litigation, which tends to run things up.
I just had a patient die who was about 90. I would say that we threw everything at him, the works, just to keep him alive until his family could be contacted to agree to take him off life support. In other places, the doctors can decide. He lingered in the expensive care unit for 24 hours, just because we had to wait for the family. That could have been a law suit if we went ahead without their consent. These are everyday occurrences.

OK, I might buy 1/3, although I think the number is 1/10. But even that's not enough to explain our costs. As for errors in the UK? Outcomes measures look comparable to ours. And my procedure was simple but then most procedures are simple. BTW the malpractice award sizes are comparable there, too.

Your point about end of life costs is good, but let's face it, it's not the lack of discretion in a situation here or there that makes those costs high. It's that, for good or bad, we as a people choose to blow a whole bunch of money near the end of life, even when it is not going to go anywhere. That's a problem, but it's not a malpractice problem.

I think the best researchers on the true cost of malpractice are at Hopkins, and they say the high estimate for the cost of malpractice / defensive medicine is 9% of expenditures. I cited the primary author in an earlier post.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The mesh is more expensive here. We sue more, so we pay more. Remember silicone breast implants? There is an added fee now for potential liability. Your procedure was simple, but if you had some disease like diabetes that was undiagnosed, and the operation was done and the mesh got infected because your blood sugar was high, and you became septic...you might have sued. That has something to do with the testing. The equipment, including the EKgs are very costly.
Years ago LIFE magazine did an article about how many people are involved in the care of a patient getting bypass surgery. It was a large staff. They all need to get paid. How many could be eliminated if there were no lawsuits? Maybe 1/3.
My friends in Britain say that they do take more chances, and there is more guessing. They admit that there are more errors, but in the end, more people get care since the resources aren't drained. They have ways of dealing with bad outcomes there by disciplining staff.
Most of the the studies about cost related to malpractice are done by special interest groups like trial lawyers. They really seek to minimize the impact. They look at direct costs, rather than the culture that comes with the fear of litigation, which tends to run things up.
I just had a patient die who was about 90. I would say that we threw everything at him, the works, just to keep him alive until his family could be contacted to agree to take him off life support. In other places, the doctors can decide. He lingered in the expensive care unit for 24 hours, just because we had to wait for the family. That could have been a law suit if we went ahead without their consent. These are everyday occurrences.

OK, I might buy 1/3, although I think the number is 1/10. But even that's not enough to explain our costs. As for errors in the UK? Outcomes measures look comparable to ours. And my procedure was simple but then most procedures are simple. BTW the malpractice award sizes are comparable there, too.

Your point about end of life costs is good, but let's face it, it's not the lack of discretion in a situation here or there that makes those costs high. It's that, for good or bad, we as a people choose to blow a whole bunch of money near the end of life, even when it is not going to go anywhere. That's a problem, but it's not a malpractice problem.

I think the best researchers on the true cost of malpractice are at Hopkins, and they say the high estimate for the cost of malpractice / defensive medicine is 9% of expenditures. I cited the primary author in an earlier post.

The Brits do not have the large volume of claims. The average settlement may be the same, but our numbers of claims are exponentially higher with much higher total payouts. So comparing apples to oranges. BTW, they are getting more defensive there, so I would expect their costs to go up. Their court system still slows patients down, since you have to pay the lawyer before the case can be filed.

Cost of end of life care has something to do with few doctors having the balls to approach patients or families and tell them to call it quits.

[Anonymous]

OK, I might buy 1/3, although I think the number is 1/10. But even that's not enough to explain our costs. As for errors in the UK? Outcomes measures look comparable to ours. And my procedure was simple but then most procedures are simple. BTW the malpractice award sizes are comparable there, too.

Your point about end of life costs is good, but let's face it, it's not the lack of discretion in a situation here or there that makes those costs high. It's that, for good or bad, we as a people choose to blow a whole bunch of money near the end of life, even when it is not going to go anywhere. That's a problem, but it's not a malpractice problem.

I think the best researchers on the true cost of malpractice are at Hopkins, and they say the high estimate for the cost of malpractice / defensive medicine is 9% of expenditures. I cited the primary author in an earlier post.

But 10% is a very large number. That would make a big difference. Even though I think it is really higher, closer 30%.
Our system is more expensive partly because all professionals in the US are paid more, including lawyers, doctors, engineers. Medicine is full of professionals. We could cut costs in every/any professional setting and just pay everyone less! That makes little sense.

[Anonymous]

Anonymous wrote:

OK, I might buy 1/3, although I think the number is 1/10. But even that's not enough to explain our costs. As for errors in the UK? Outcomes measures look comparable to ours. And my procedure was simple but then most procedures are simple. BTW the malpractice award sizes are comparable there, too.

Your point about end of life costs is good, but let's face it, it's not the lack of discretion in a situation here or there that makes those costs high. It's that, for good or bad, we as a people choose to blow a whole bunch of money near the end of life, even when it is not going to go anywhere. That's a problem, but it's not a malpractice problem.

I think the best researchers on the true cost of malpractice are at Hopkins, and they say the high estimate for the cost of malpractice / defensive medicine is 9% of expenditures. I cited the primary author in an earlier post.

But 10% is a very large number. That would make a big difference. Even though I think it is really higher, closer 30%.
Our system is more expensive partly because all professionals in the US are paid more, including lawyers, doctors, engineers. Medicine is full of professionals. We could cut costs in every/any professional setting and just pay everyone less! That makes little sense.

It's important, but that 10% only buys us a 2 year reprieve. Health care costs are growing at around 5-6% every year, at least on the employer side. I can't say how fast the other pieces (medicare/medicaid, employee portion, or charity) grow.

[Anonymous]

Much of the growth in spending is due to the aging baby boomers. They are using a ton of services. It will get worse.

Besides malpractice, US patients consume more when they are sick. For example, just about every woman in this country delivers a baby with an epidural, compare that with less than 15% in the Netherlands, and 15% in Britain. That is just one example, but try telling a laboring American woman that we want to curb spending so, no epidural. Not this population.

[Anonymous]

Let's get to the heart of it. Everyone is paid for each test, procedure, etc. they do. The more you run, the more you make. Sure, some of that money goes to outside lab companies, but plenty doesn't. The whole system incents overuse.