Data on inefficiency:

[Sun Devil 92]

http://media.washingtonpost.com/wp-srv/nation/pdf/healthreport_092909.pdf

The U.S. spends more money on health care than any other nation in the world.
According to Medicare actuaries, the U.S. will spend nearly $2.3 trillion on
medical care in 2007, representing approximately 16.7 percent of the nation’s
Gross Domestic Product (GDP). These National Health Expenditures are
expected to grow to 20 percent of GDP by 2015. Many experts believe that a
significant portion of our health care dollars are wasted, with estimates
suggesting that up to 30 percent of total spending could be eliminated without
reducing health care quality.

***************************************

I have always found this claim troubling.

There is no industry I can think of that could survive that kind of inefficiency.

I have not read this article through and through, but it does represent one of the bleathing points of the far left during this whole debate (as the percent of GDP did too.....and has not changed...if anything has gone up).

So, what are people saying now ?

 

[Sun Devil 92]

[Crickets]

Just wondering.

 

[dblack]

I'd like to see data on how much of that is spent on end-of-life treatment. I suspect it accounts for most of the difference.

 

[dblack]

I'd also say that I don't see why it's a problem. If that's how people want to spend their money, it's none of my business.

 

[Arianrhod]

I'd like to see data on how much of that is spent on end-of-life treatment. I suspect it accounts for most of the difference.

That would be predominantly a Medicare issue (although long-term care insurance was not as widespread in 2007 as it is now, and kidney dialysis is automatically covered by Medicaid), I'd imagine it wouldn't have that much of an impact on the premiums you refuse to pay for the health insurance you refuse to get.

That said, the Kaiser Foundation weighs in again:

10 FAQs: Medicare’s Role in End-of-Life Care

It should be noted that screening and early diagnosis (one of the advantages of people having affordable health insurance) can treat many illnesses in the early - less expensive - stages, improving health and longevity and costing the taxpayer less.

 

[Sun Devil 92]

I'd like to see data on how much of that is spent on end-of-life treatment. I suspect it accounts for most of the difference.

I think that is a good conversation point.

But I don't know how that relates to efficiency.

We're you thinking overall spending differences ?

 

[Sun Devil 92]

Many experts believe that a
significant portion of our health care dollars are wasted, with estimates
suggesting that up to 30 percent of total spending could be eliminated without
reducing health care quality.

This is the point I am looking for updates on.

From what I recall, this has to do with medical billing.....and what else I don't know.

What do these so-called experts see.

Obamacare was supposed to help this (reduce it).

Has it ?

 

[dblack]

I'd like to see data on how much of that is spent on end-of-life treatment. I suspect it accounts for most of the difference.

I think that is a good conversation point.

But I don't know how that relates to efficiency.

We're you thinking overall spending differences ?

I'm saying that I don't think more spent on health care necessarily indicates inefficiency.

 

[Greenbeard]

Until you develop some interest in learning the background on where this problem comes from and why, you're never going to be able to answer these kinds questions, understand what's changing now, or fully grasp what the ACA is for. You won't get beyond the superficial unless you actually want to.

The simple answer yes, the ship has started to turn. This is changing. Why and how are much more involved questions.

 

[westwall]

I'd like to see data on how much of that is spent on end-of-life treatment. I suspect it accounts for most of the difference.

Honestly I have no clue but as is true with any government scheme when it is others peoples money the government bureaucrats are universally incompetent, or getting kickbacks to turn a blind eye. Plug in any year you like and you will find cases like this, and there are thousands of them that go un discovered.

Government is very poor at governance, pure and simple.


Ex-Pharmacy Owner Pleads Guilty In $9M Medicare Scam
Ex-Pharmacy Owner Pleads Guilty In $9M Medicare Scam

 

[Arianrhod]

I'd like to see data on how much of that is spent on end-of-life treatment. I suspect it accounts for most of the difference.

Honestly I have no clue but as is true with any government scheme when it is others peoples money the government bureaucrats are universally incompetent, or getting kickbacks to turn a blind eye. Plug in any year you like and you will find cases like this, and there are thousands of them that go un discovered.

Government is very poor at governance, pure and simple.


Ex-Pharmacy Owner Pleads Guilty In $9M Medicare Scam
Ex-Pharmacy Owner Pleads Guilty In $9M Medicare Scam

He got caught and convicted. What's your point?

 

[westwall]

I'd like to see data on how much of that is spent on end-of-life treatment. I suspect it accounts for most of the difference.

Honestly I have no clue but as is true with any government scheme when it is others peoples money the government bureaucrats are universally incompetent, or getting kickbacks to turn a blind eye. Plug in any year you like and you will find cases like this, and there are thousands of them that go un discovered.

Government is very poor at governance, pure and simple.


Ex-Pharmacy Owner Pleads Guilty In $9M Medicare Scam
Ex-Pharmacy Owner Pleads Guilty In $9M Medicare Scam

He got caught and convicted. What's your point?

My point is Medicare is incredibly poorly run. Every year the citizens of the USA are handed a gigantic shit sandwich that they have to pay for. Propagandists like you and greenbeard ignore the very real fact that government run medical care is bad. And expensive as hell to boot. All facts that you two ignore. Why?



Medicare Funds Totaling $60 Billion Improperly Paid, Report Finds
$60 Billion Medicare Funds Improperly Paid, Report Finds

 

[Arianrhod]

My point is Medicare is incredibly poorly run.

Then you'll be glad to know that one of the provisions of the PPACA has been to make it more efficient.

And you still haven't explained why you feel the KFF subsidy calculator is "propaganda."

 

[Sun Devil 92]

Until you develop some interest in learning the background on where this problem comes from and why, you're never going to be able to answer these kinds questions, understand what's changing now, or fully grasp what the ACA is for. You won't get beyond the superficial unless you actually want to.

The simple answer yes, the ship has started to turn. This is changing. Why and how are much more involved questions.

Efficiency then = X

Efficiency now = Y

How do X and Y compare.

Seems pretty simple to me.

As for "the problem" I've highlited above....I'd like to hear just what that problem is.

Even that hasn't been defined to my liking.

 

[Sun Devil 92]

My point is Medicare is incredibly poorly run.

Then you'll be glad to know that one of the provisions of the PPACA has been to make it more efficient.

And you still haven't explained why you feel the KFF subsidy calculator is "propaganda."

A "provision" ?

Don't make me laugh.

One of the provisions was supposed to be allowing people to keep their doctors.

 

[Arianrhod]

My point is Medicare is incredibly poorly run.

Then you'll be glad to know that one of the provisions of the PPACA has been to make it more efficient.

And you still haven't explained why you feel the KFF subsidy calculator is "propaganda."

A "provision" ?

Don't make me laugh.

One of the provisions was supposed to be allowing people to keep their doctors.

That was a sound bite. The provisions are in the actual legislation:

Text of H.R. 3590 (111th): Patient Protection and Affordable Care Act (Passed Congress/Enrolled Bill version) - GovTrack.us

 

[dblack]

My point is Medicare is incredibly poorly run.

Then you'll be glad to know that one of the provisions of the PPACA has been to make it more efficient.

And you still haven't explained why you feel the KFF subsidy calculator is "propaganda."

A "provision" ?

Don't make me laugh.

One of the provisions was supposed to be allowing people to keep their doctors.

All hail, provisions!

 

[Greenbeard]

As for "the problem" I've highlited above....I'd like to hear just what that problem is.

At the risk of oversimplification, the root cause of most of what people consider to be "waste" and "inefficiency" tends to be two interrelated things: how the major health care purchasers (insurance companies, employers, and the government) reimburse for care and how how health care providers organize themselves to capture that reimbursement.

Everything flows from that. Unnecessary services people get, duplicated tests, lost information or lack of coordination between doctors treating the same person, use of a higher-cost intervention that doesn't actually add any value over a lower cost alternative, medical errors, lack of incentive to drive out the unexplained variations in care delivery your report focuses on.

Providers get paid to to do discrete things (though not all things), volume is revenue. Patient health and outcomes have historically never, even in an indirect way, been priced as an output good and, as a result, spending generally isn't correlated with health outcomes. Financial viability for the provider requires churning out more and more health widgets because each has revenue attached to it. Under that system, if you as a provider found a way to deliver better care more efficiently, you would lose money. Because a patient being or getting healthier more quickly eliminates revenue streams.

For instance, here's a well-known health system explaining their dilemma a few years back:

Unfortunately, health care providers today are paid for precisely those care delivery episodes that quality improvement seeks to reduce. As Intermountain teams implemented clinical management, clinical outcomes improved and costs fell. However, our payments also fell—often even further than our operating costs. For example, although improvement in Intermountain’s appropriate elective induction rates saved the citizens of Utah more than $50 million per year through reduced payments, Intermountain’s costs fell by only about $41 million. Intermountain thus lost more than $9 million per year in operating margins. Implementing better care required us to invest in education, work-flow redesign, and new data systems. As we improved, the resources to drive further change disappeared.

Improving efficiency and doing right by their patients actually worsened their financial picture.

Here's Robert Mecklenberg and Gary Kaplan from Virginia Mason Medical Center boiling it down even more succinctly in a very comprehensive look at these problems the Institute of Medicine put together a few years ago:

The current reimbursement model easily cancels savings achieved by providers when it fails to fund effective low-cost interventions and provides full reimbursement for unnecessary care.

Most of the design features one would bake into a high-performing care delivery system (coordination across doctors and care settings, collaboration, integration, etc) are impeded by the way those payments flow. Function follows form. The way that payment system is set up determines what health care providers can and will do when they provide services to patients.

If it's a smart idea to reach out to and provide additional supports to a patient after a hospital discharge (say, to prevent an easily avoidable readmission a week or two down the road), if there's not a discrete billable service associated with that function, it's not going to happen. Providers have to chase billable units, and those have historically not had much to do with how good the care delivered is or how the patient is doing. That is what's been standing in the way of organizing the delivery system such that it's set up to do all the things everyone knows are better for patients in the long run.

When people talk waste and inefficiency in the health system, this is what they're talking about. The resulting fragmentation is why tests and services get duplicated unnecessarily, this is why things get missed when patients move between providers or care settings.

You say you can't think of another industry that could survive that kind of inefficiency. Indeed! That's because most industries aren't set up to reward inefficiency and penalize efficiency. That's the perverse incentive structure that needed to be addressed. This is where the real action has been for the past five years or so.

 

[Sun Devil 92]

My point is Medicare is incredibly poorly run.

Then you'll be glad to know that one of the provisions of the PPACA has been to make it more efficient.

And you still haven't explained why you feel the KFF subsidy calculator is "propaganda."

A "provision" ?

Don't make me laugh.

One of the provisions was supposed to be allowing people to keep their doctors.

All hail, provisions!

Somehow I suspect that Arhod went shopping for a car and was told her car would have an eight when in reality it she got a four cylinder......she would not call that a soundbite.