Next topic proposal (3/20 or possibly 3/27) a deep dive into health-care

As I understand it, there’s not been a topic picked for this week.

This is one that deserves more than a week and will be in the news for a while.  So we might do what we’ve done from time-to-time–take a week to find resources and have some initial discussion and then really dig in, the following week.

The Right is poised to “repeal and replace” the ACA, but really is only tweaking it and making it–depending on your perspective–a little better (reduction in debt, lower prices in three or four years) or a little worse (higher prices for 2 years, millions without insurance and a fast route for the already insured to become uninsured –big rise in premiums if your insurance lapses for a short time).

But neither Obamacare nor Ryancare addresses the systematic problems that make our healthcare costs so much higher than all other developed countries and our outcomes so much worse. This graph from a SlateStarCodex post on “Cost Disease” shows how bad things are.

The US cost/benefit curve through about 1980 matched the rest of the developed world. Then the rest of the world continued on (roughly) one trajectory, while we went our own (crappy) way.

A healthcare reform advocacy group showed a documentary “Fix It: Healthcare at the tipping point” in East Blue Hill, last night. I, and several other Beyond Labels regulars and irregulars were there. It was thought-provoking.

Some data from their site:

The documentary is told from a business perspective, rather than a social justice perspective. It argues that health care costs are making US businesses non-competitive and burning up money that could be going into public services and infrastructure.

Here’s a link to a short (but still pretty long) version o f the documentary. It’s on YouTube and people talk slowly so you can speed it up by 1.25 to 2.0 x and still get the message, only faster. Click the gear icon, then Speed, and then choose the fastest speed that still makes sense. Also Right Arrow and Left Arrow will skip forward and back a few seconds. And don’t forget to click the box at the lower right to make it full screen.

The documentary was developed by Richard Master, CEO of MCS industries. The company is privately owned, based in Pennsylvania, and has revenue over $100M (Hoover/D&B estimates nearly $200M).  He’s written a letter explaining his motivation and findings, here.

I think they’ve identified one big part of the problem, one that’s not addressed by Obamacare or by Ryancare.

But I believe that there are other very significant cost and quality issues that they don’t address.

This article talks about the costs and demotivating effects on doctors of horrible medical record systems (and most are horrible). Their bad design costs doctors time and energy–and often produce worse medical outcomes, not better. And they don’t interoperate. WTF? This is not 1953, folks. There are standards for data exchange and system interoperation everywhere. Why not here?

The regulatory and intellectual property system surrounding pharmaceuticals combine to produce perverse incentives, higher costs, and aggressive promotion of worse medication (new, and under patent) over better ones (patent expired, along with profit.) See SlateStarCodex here and here.

And for a really worthwhile read, a research paper from the Federal Reserve Bank of St. Louis (hardly a radical Left organization) summarizing the economic case against patents–pharmaceutical and otherwise. This chapter from the book “Against Intellectual Monopoly” argues against the claim that the pharmaceutical industry would cease to operate to society’s benefit without patents.

Then there’s the perverse interaction between the public, the legal system, and the medical system. Lawyers are happy to sue doctors when things go badly–even when it is clear that there’s been no malpractice. That’s because doctors and their insurance companies would rather pay off a claimant than endure a long, expensive battle. People are eager to want to blame someone for bad outcomes and greedy for what they can get. As a result, doctors order unnecessary tests and procedures as a defensive measure. And we pay the price.

The administrative costs pointed to in the documentary are a large part of the problem. But if we want to fix healthcare (and we must, to make our businesses competitive and public services more affordable) we may as well fix all of the problems.

Time for some radical thinking.

 

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