The outcome of the Blue Wave of November is starting to be felt. The article, while from Chicago, opens with Washington State and California as examples. In case you haven’t been following, newly elected Governor Gavin Newsome is off to an incredible start. He ran on healthcare as a major issue, and is already starting to deliver.
Whatever could go wrong with this proposal? Everything. A long time goal of the Koch Brothers and the Libertarian right wing, the Trump administration seems bent on carrying out this ill advised plan. If you are a vet, and value the notion of being supported for your health costs in the future, you better come out against this now. The proposal shifts money from a low cost federal government model to a high cost, low value private world of care where you will be milked for your savings. This is a recipe for disaster. What might be done to fix the situation? Shift money from military spending to the V.A. It would cost far less. One less fighter would add billions to the V.A. now. No new taxes needed. But I’m not a vet. Ultimately, it’s not my battle. It’s yours. I’ll remind you of a quote from a Republican operative, Grover Nordquist”,”
“Our goal is to shrink government to the size where we can drown it in a bathtub. “
As we start 2019, I thought I would bring in some fundamental issues that we have been facing and continue to face, both in Jefferson County and nationwide. In reading through a variety of articles recently, I came across a couple of articles that pretty clearly identify the state of healthcare in the US.
The first is an old study, but one that has been updated and used frequently in presentations. Lest start with the original study first.
The Physician’s for a National Health Program published a 1991 study from the Harvard School of Medicine that validates what many of us, the critics of modern hospital management, have been instinctively feeling all along. The situation, updated in a more recent slide deck, here, gives the current situation.
The problems of hospital administration are endemic. You can hear it every time there is a hospital commissioner meeting each month. Only good news is presented. Bad news is couched in doublespeak if it’s ever raised at all. No mention of the medical bankruptcy rates in Jefferson County (they are on the rise). Never raise issues that are problems or concerns or face being ostracized by your peers. From executive suites of hospital management making vastly more money than the surrounding towns they serve, to the rubber stamps of hospital commissioners that simply are uninformed and like staying that way, or aren’t willing to challenge anything of a controversial nature, to medical professionals who cosy up to the administration to make themselves feel better about their positions of authority and stop any change agents ending up as hospital commissioners. It all feeds the continuation of a system that is fundamentally out of control on costs. It’s not just JHC it’s the whole broken system.
Here’s the underlying data sets of one aspect of our current, deeply broken system.
The 1991 study found that “the spending on hospital administration is 117% higher than Canada and accounts for about half the total difference in healthcare spending between the two nations…If healthcare in the United States had been as efficient as Canada’s between $69 to $83 Billion dollars would have been saved. ” It has only gotten much worse since then.
Enough to pay for healthcare for all Americans without cutting the beloved military budget that so many Americans feel is beyond questioning, even as it consumes more than half of all governmental expenditures.
It goes on to state: “Recent health policies with the avowed goal of improving the efficiency of care have imposed substantial new bureaucratic costs and burdens.”
There are other issues at work beyond this, such as pharmaceutical costs, etc, but this goes to the core of this leg of the stool. Perhaps the stool should have three legs, For Profit Insurance Companies, Pharmaceutical companies, and hospital administration. But read it yourself and draw your own conclusions.
“CONCLUSIONS: The administration structure of the United States healthcare system is increasingly inefficient as compared to that of Canada’s national healthcare program. Recent health policies with the avowed goal of improving efficiency of care have imposed significant new bureaucratic costs and burdens.”
The data has been updated through 2014 with data from the Department of Labor Statistics. It only got vastly worse since 1991. What happened between then and now? Well, computer use exploded. Is that the problem? During this time we also had both Democratic and Republican Presidents and Congress. And we had an explosion of medical insurance growth.
This recent study covers updated information related to hospital administration costs.
The United States far outspends Canada on health care, but the sources of additional spending are unclear. We evaluated the importance of incomes, administration, and medical interventions in this difference. Pooling various sources, we calculated medical personnel incomes, administrative expenses, and procedure volume and intensity for the United States and Canada. We found that Canada spent $1,589 per capita less on physicians and hospitals in 2002. Administration accounted for the largest share of this difference (39%), followed by incomes (31%), and more intensive provision of medical services (14%). Whether this additional spending is wasteful or warranted is unknown.
The United States spends nearly twice as much per capita on health care as Canada: $7,290 per person in the United States in 2007 compared with $3,895 per person in Canada (aOrganisation for Economic Co-operation and Development [OECD] 2009a).
Despite this higher spending, however, U.S. health indicators continue to lag behind those of Canada. In 2006, infant mortality was 6.7 per 1,000 live births in the United States, compared to 5.0 per 1,000 in Canada. In the same year, life expectancy at birth was 78.1 years in the United States and 80.7 years in Canada (OECD 2009a)
…Some studies stress administrative expenses; estimates suggest that U.S. administrative costs are 46% to 71% higher than Canada’s (Aaron 2003; Woolhandler, Campbell, and Himmelstein 2003). Other studies propose that higher prices paid for services are the primary driver of greater spending (Anderson et al. 2003). Pharmaceutical costs are higher for branded drugs (Danzon 1992; Graham and Robson 2000), and physicians earn more in the United States as well (Newhouse 1992). Still other studies have examined the volume and intensity of health care services received.
another study, from Princeton
Hopefully, if you have interest in this issue, you can look through these studies and come to your own conclusions. Some critics state that we won’t get better healthcare by having single payer or some other blanket coverage. I’m unclear, given the current system and it’s documented bad outcomes compared to other countries, how this is possible.
But it seems increasingly like only those who can afford healthcare get it and an increasingly large share of Americans can’t afford coverage, or get coverage and become impoverished by being taken to court to pay for services that they never could afford in the first place. By the way, both here in Jefferson County and nationwide, medical bankruptcies are on the rise. They are unheard of in all other industrialized countries.
If you are worried about this state of affairs and want to do something about it, there will be an election for Matt Ready’s seat this year.
Background: Many people in Jefferson County have been discussing the rising price of drugs, including retired physicians, pharmacists and patients. While the President has made bold statements that have never materialized into actions, (and only seem to provide a buying opportunity to purchase drug stocks at a discount during the 24 hours after the tweet), the industry has chosen to continue to raise it’s prices. Many horrific stories are starting to appear on NPR and the mainstream media.
Here’s an overview of some ideas on why this is happening.
While I am very leery of KING now that they have been taken over by an extreme right wing ownership team, this is a good overview of where we are at now and some of the issues.This ends with the woman reporter describing what happened to her when she had her child. High out of network costs that took her years to pay off.
I have found in my conversations with Americans that very few have any understanding of how bad American health care is compared to other industrialized countries. While it’s true that we have great medical professionals, the actual cost to deliver that care is much higher than other similar countries, the outcomes are much worse. Here is a ground level view of a real patient who fled America because of her inability to afford care, and what she found in France.
With a growing number of people being sent to collections here in Jefferson County by JHC, this article points out a very interesting issue of whether the “contract” between a patient (especially one coming into an E.R.) and the hospital is a legal and binding contract for billing purposes. Can you have a binding agreement if the client/consumer doesn’t know the price they are paying when they sign the consent agreement?