OT: excess cost in US health care

The New Yorker dated the 11th May 2015 has an interesting article on pages 42 through 53. It's title "Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it".

It's a good article. What caught my particular attention was a throwaway line - "Waste is not just consuming a third of health-care spending: it's costing people's lives".

That "one third of health-care spending" is pretty much the extra cost of US health care compared with French, German and Dutch health care.

Do read it.

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Send me an e-mail if you can't get hold of it.

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Bill Sloman, Sydney
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Bill Sloman
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thanks for posting this article

Mark

Reply to
makolber

Sloman concentrates his energies on ragging the USA. That way, he avoids finishing his oscillator.

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John Larkin         Highland Technology, Inc 
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John Larkin

I read the new yorker piece, not bad. The author (Atul Gawande) has written other interesting stuff about medicine. There's no doubt the cost/ motivation structure of our health care system could use some work. (You'll have to read the article for that last statement to make sense.)

George H.

Reply to
George Herold

Drawing attention to an article in The New Yorker isn't exactly "ragging Am erica". The New Yorker is one of the more impressive examples of US culture at it's best - and John Larkin one of the more depressing examples of US c ulture at it's worst.

The oscillator is maturing. The latest version is rather neater than the or iginal, Spehro Pefany has been subjected to a bodged variation on it as a p ossible solution to his inductor monitoring problem - turning something des igned to work at 16kHz into something that sort of works at 900kHz has been interesting. It won't have solved Spehro's problem, but it has entertained me.

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Bill Sloman, Sydney
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Bill Sloman

We (my family and employees) use Kaiser Permanante. The doctors are salaried, and we pay a fixed monthly fee for all our health and deltal and eye care, plus a small (usually $10) co-pay per visit, zero for annual checkups. Drugs are generic, small co-pay per refill, and mailed to us if we want. Refills are a couple of clicks on a web page. We are encouraged to email our doctors, if they don't call us at home first and pester us. The care is superb. If the doctor wants us to get a blood test or an EKG or an injection or an xray, she send us to get it immediately in the same building. The Obamacare law specifically discourages such providers.

My MD is superb. And friendly. And cute. She has every incentive to keep me tested, immunized, medicated, exercized, and out of the hospital.

The insured+fee-for-payment model is terrible. But it makes the doctors and insurance companies rich, so that's what the politicians allow.

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John Larkin         Highland Technology, Inc 
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John Larkin

To me, the take away was the comment re: "information asymmetry". How can you have "responsible consumers" (i.e., how can The Market be expected to "work") when such a condition exists?

Look at folks who go to get an oil change and come home $400 poorer (recalling my next door neighbor's experience)? Another neighbor is *tickled* that the dealership "checks other things" and "makes recommendations" for OTHER service that he should consider! "And, they even give us a FREE loaner (vehicle) while they work on the car!" (there's one sitting in their driveway at the current time; saw it here two weeks ago, as well! Helluva lot of "service" required for those new, "quality" vehicles!! :-/ )

[Do people *really* think these things are "free"? Who do they think is bearing the cost for that -- me? (who doesn't even use the dealer!)]

Think about most visits to an MD -- brief, terse, "matter of fact" ("I know what's right for you, just trust me..."). And, how easily intimidated most folks are -- not even asking for clarification of terminology, etc. And, rarely, asking "How will my life experience change after following this course of treatment?")

I rarely "consume" healthcare (aside from routine preventative things). Yet, when I visit my MD, I'm usually with him for an hour or more as I grill him over the details of his Dx, likely causes of the problem, potential outcomes, why this treatment is NOT indicated but this other IS, etc. Of course, he gets paid the same for his lengthy visit with me as he does for the 10 minute visit with the patient before me!

[I make up for this by bringing "goodies" in to his office periodically; a cheesecake two weeks ago, cookies over the holidays, homemade bread, etc. Suffice it to say, most folks in his office smile when they see me!]

I am amazed at how he manages to "stay current" with medical research. (Though, I guess he would be amazed at how I can stay on top of new electronic components, etc.) Because I engage him intellectually and demonstrate an understanding of the information that he is attempting to convey, many "office visits" are unnecessary: I just phone the office and self-diagnose; he responds with an Rx or other treatment regimen without having to waste my/his time, etc. And, if he tells me to come in, there's a *reason* for it -- that he shares with me.

OTOH, I have heard (what I consider to be horror) stories from friends who are treated impersonally (different doctor) and run through the system as if the provider was "working piece-work" (he is!). This appears to be more common among my "less affluent" (gentle term) friends. Surgeries that I never would have agreed to, long term medications that probably are unnecessary, etc. And, no noticeable difference in quality of life.

Where's the "check" on those actions? If, OTOH, *you* could peek at the data the actuaries have accumulated, how would your decisions change? "Historically, this procedure has had a net improvement inquality of life X% of the time; it has had no effect in Y% and has had deleterious effects (ranging from blah to blah) in Z% of all cases. And, YOUR DOCTOR'S RECORD is ....."

If you change the system to incorporate these realities, then you are "rationing care".

OhMiGosh! DeathPanels!!!

Reply to
Don Y

I love the passive voice--"change the system" and "to incorporate these realities," by which you mean the same guys who couldn't make a website are going to take over, 'decide' things for you, and better than you could yourself.

You betcha.

On the information asymmetry, your cell phone maker has tremendously better information about the product than you. Does that prevent you from choosing a cell phone?

Of course it never hurts to do a little reading to be an informed consumer first, whether it's a cell phone, or health care. After all, those phones can be expensive.

Cheers, James Arthur

Reply to
dagmargoodboat

I wasn't aware that MD's had designed the website! Perhaps we'll have IT guys deciding on the actual *care*?

Do you think that your MD (and the others in that monopoly) is acting with 100% of YOUR best interests -- and YOURS ALONE -- when he prescribes a treatment regimen for you? That he's NOT thinking about his profits, stock holders, "manager", etc.?

Does my neighbor actually think that the guys at the (car) dealership are making all these service recommendations because they *care* about him, personally? ("Gee, they always *smile* when I walk in..." "Yeah, my butcher smiles when *I* walk in -- because I buy several hundred dollars of prime cuts at each visit!")

You don't *need* a cell phone. And, you can control your use of it.

I couldn't prevent myself from catching Chicken Pox from someone else who had failed to get care when they should have (do you really think I would knowingly walk up to someone who had a contagious disease and make contact with them or something they may have handled?)

[I work out of the house, so my physical contact with "others" is probably less than 1/10th of what most folks have!]

So, advocate *educating* people. Even those who can't AFFORD the education! So folks *don't* come to work when they are ill. So they seek prompt care when they think they *are* getting sick. Get prenatal care so they aren't clogging up the ER for the times when *I* need to "step to the head of the line", etc. So they don't EXPECT miracle cures for diseases/conditions that have none. So they don't expect a magic pill to compensate for their years of self-neglect. etc.

[Cuz we *surely* can't refuse to give the overweight, smoking, drug-addicted, couch-potatoes, poor diet, etc. access to TOP NOTCH care!]
Reply to
Don Y

This isn't about MDs designing the care, either. It's about what Gruber liked.

I'm glad they're making money. That way they'll still be there if I come back.

We have a mutual interest--if I'm not better and happy, they lose.

I don't need mammograms, nor any of the rest of Obamacarp either. None of these are reasons to embrace more expensive, less-responsive Obamacarp.

You really think people stupid, don't you? They're perfectly able to shop and decide already.

They make all sorts of complicated decisions right now as to how to take best advantage of public funds, insurance, etc.

Cheers, James Arthur

Reply to
dagmargoodboat

I think it was you who said "Treat your doctor like an employee."

I worry about some of my people, who might not be happy with their providers for some reason, but won't speak up. If you call Kaiser, or better yet fax them with a complaint, they go into high gear, get you another doctor ASAP or whatever.

I've gotten one, I hope now two, docs disappered from Kaiser.

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John Larkin         Highland Technology, Inc 
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John Larkin

Atul Gawande's earlier articles about Medicare in Texas exposed what a shambles that socialized program's management is. (Medicare was paying doctors in one of two equal, adjacent Texas towns twice as much per capita for Medicare as in the town next door.)

Gruber hits on that in his presentations. The reason is that Medicare is an awful administrator, and simply pays (or doesn't) with nary a thought.

(That disparty, mercifully, has vanished since the six years since Gawande's expose.)

The effects discussed in the new article, however, are easily addressed without Obamacare, and in fact more easily without than with. Obamacare simply offers more Gruber-visions for improvement, where Gruber's in no position to judge.

If there were cost-feedback to the person actually consuming the care, then hospitals and doctors are driven to improve their products and services far better than we could ever imagine.

That produces millions and millions of expert experimenters--people in the trenches who actually DO it every day--constantly scheming better ways to do their jobs, to care for people.

Gruber's way produces a few rigid templates with a lot of overhead, plus federal subsidies.

I'd rather have hospitals & doctors thinking day and night how to up their game, than Gruber's law telling them how to organize and practice their trade (and them trying to game the rule).

Cheers, James Arthur

Reply to
dagmargoodboat

Yep. If you want to know the options, why not ask? "Hey doc, what are my choices, and what does each one cost?"

Don't be shy--the doc's the expert. That's what you're paying for.

That's awesome. As it should be.

I like Kaiser. Subscribed for a while. Mom worked there. And I dated one of their nurses, a real sweetie.

Cheers, James

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dagmargoodboat

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John Fields

What are you guys paying per employee/family? Not sure if I can get into some biz group plan as a self-employed out here but we are paying a whopping $886/month (it roughly doubled since Obama took office) and co-pays greatly increased in the last four years. Out of pocket max is $5k/person and $10k/family. I don't mind the out of pocket but find that the premium is too high for that. Essentially we live healthy and only need catastrophic coverage. Which Obama of course has disallowed for ordinary working people.

Care is good and our current doctor is good. But ... Kaiser's customer service is in my opinion bad. Twice we were quoted wrong and received bills for payments that _they_ said were included and once much cheaper. Kaiser really needs to improve that part of the system, it's too secretive. The chargemaster must be opened and patients must be able to obtain written or at least emailed estimates. Just like almost every other reputable business does. Even my dentist gives me a written estimate and honors it. If he discovers an oh-oh and cost would go up he tells me right then and there, not a few days later via a surprise bill.

Yup :-(

And the screwed up tort law makes the trial lawyers rich which is why Dems do not want to touch that.

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Regards, Joerg 

http://www.analogconsultants.com/
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Joerg

The problem for Pansy and me is trying to figure out causalities. Do I really need these meds? What does each one actually do? What are the side effects? She put me on statins, with I suppose good statistical reasons, and they turned out to be sort of wrecking my life. I had to perform months-long experiments to see what their effects actually were. You almost need a very slow lock-in amplifier sort of experiment to see what the causalities are; the noise level is high and the time constants are unknown.

She gets a little annoyed with me when I do those experiments (like, quit taking that blood pressure stuff for a couple of months and see what happens) but she's getting used to it.

One problem with the US medical system (maybe with others) is, I think, too many drugs are dispensed, and too little attention is applied to dosage, effects, and side effects. As an engineer, I can do quantitative experiments on myself, but a lot of people can't, and a lot of MDs don't have time.

Mo, who has worked for hospitals her entire career, just switched to my Kaiser. She was stunned by the quality and efficiency. A fixed fee to keep people healthy is the opposite of the fee-for-services model.

The problem with a national health system (besides the obvious politics) is the lack of choice or competition.

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John Larkin         Highland Technology, Inc 
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Reply to
John Larkin

Most of the products that we design work first time, rev A boards, no prototypes, usually no kluges. THAT is perceving reality!

Never considered it. Life is fun and the Earth is beautiful, and it looks like it may snow a bunch this winter. I'd have to be facing some grim terminal disease or something to think about that.

How do you keep busy? How's that music career coming along?

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John Larkin         Highland Technology, Inc 
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John Larkin

I'll have to find out. It depends on age. I'm on Medicaire now, and I pay something like $300 monthly to Medicaire (used to be lots less) and $75 to Kaiser for the Part D goodies. Co-pay is $25 or sometimes free; most of my emps pay $10, which is weird.

Not sure if I can get into

I think Kaiser is less appealing for individuals. I know of groups of people forming bogus companies to get the Kaiser group rate. It takes four, I think

Kaiser doesn't bill me, or my employees, for health services; the company pays a fixed rate per person per month. People pay a small co-pay when they show up for a visit.

Right. Obamacare didn't dare touch the efficiency issue, or threaten the really big money streams. There could well be a death spiral brewing.

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John Larkin         Highland Technology, Inc 
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John Larkin

Medicare? Wow, you sure look younger than 65. $300 for Medicare without the part D is going to be tough for many retirees.

I won't do that because then the goons come and want to fleece, collect minimum corporate tax and all that.

That is part of the problem with our health system and that in many other countries. A company or some other entity acts as middleman and the whole transparency goes down the tubes. We recently needed a new dentist because our old one closed down and retired. So I asked a state worker what they pay for crowns, root canals and so on (they get Cadillac care including dental, courtesy of the taxpayer). "No clue, I only know what our co-pay is and that isn't much".

If the spiral happens, and I also believe there is a high chance that it does, the only realistic way out would be the nanny state single-payer system. Some people say that is an intended consequence.

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Regards, Joerg 

http://www.analogconsultants.com/
Reply to
Joerg

Bebe does that. She's a genius.

$300 for Medicare without

It's high because I'm still employed and have a decent income. The government giveth and taketh away.

The Feds don't tax bogus companies!

Yup, designed to fail.

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John Larkin         Highland Technology, Inc 
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John Larkin

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