Glenden BrownDefine the problem first
Health care is a major problem. The US spends far more than other nations - not just in terms of hard dollars but in terms of percentage of our GDP. We get worse outcomes for our spending - including some 15% of our populaton without health insurance, which is the same thing has not having access to health care.
Proposals to expand health insurance to cover everyone address part of the problem, but I wonder do they really get at the core of the problem. Look at it this way - even people with health insurance face a system actively trying to prevent them from getting treatment. Doctor’s offices have to juggle untold numbers of different insurance plans, programs, billing systems and payment systems. Health insurers have vast beauracracies designed to do one thing - keep from paying for treatment. The problem isn’t the knowledge and ability of American health care providers - it is an entire system designed to keep patients and providers from working together. Complex, arcane billing rules are designed to set patient and provider at odds with one another. The problem isn’t, as some folks have suggested, that Americans have too much health care insurance and get too much “gold plated care.” The problem is that the average American who has insurance has to fight to get treatment against his/her health insurance company.
At the same time, Americans have a deficit of health care knowledge. We as individuals and as a culture make bad health choices - we eat unhealthy diets, we smoke too much, we don’t exercise enough. People who are at risk for adult onset diabetes often have only a vague idea of how to prevent it. STIs and unintended pregnancies are epidemic compared to other developped nations. We make poor health choices.
The problem, it seems, isn’t just Americans without insurance. The problem isn’t machinery or technology or know how. The problem isn’t patients demanding treatments they don’t need. The problem isn’t what Americans know or don’t know about health. All those things contribute, but we have an adversarial system that prevents providers and patients from collaborating to improve individual’s health, and by extension, our national health.
I think success in reforming American health care will come when we change the ways in which patients and providers work together.
March 10th, 2008 at 8:54 pm
Actually Glendon the Robert Wood Johnson Foundation numbers the # of Americans without access to health care at 72 million. So we are pushing 25%.
Canadians as a people are outliving Americans by some 22 months now on average. They spend 2300 dollars a person to insure everyone. We spend 4500 dollars pp, and have what we see here all day.
Why the disparity? My own thoughts is that single payer insurance that is not for profit creates the bulk of their savings.
Though Canadians have fewer bells and whistles in their health system, they do get everyone in to see doctor about every 6 months and in this way keep tabs on emerging conditions in patients. Universality enables this. Not going because you cannot afford it is much less of a consideration there.
Doctors can also view lifestyle choices and discuss the consequences of them with patients on a regular basis.
Due to this methodology, they spend far less money dealing with diseases that have been left unattended and then brought to care at their end stages. We here spend a fortune on this kind of care.
It takes to much space here, but the professionalism of their fiscal management is to be observed, as each district gets its budgets monies once a year, the financial managers if shrewd can invest on Wall Street, Canadian companies, and of course in studies that make for more efficient care without negatively affecting patient outcomes.
Other accounts they leave to budget day to day expenses. All of this is based on the Districts own actuarial studies and emerging projections of the districts needs.
Needless to say, some of the Health Districts in Canada have quite a pile of money, as mastered degreed and Ph.d financial managers run them…, working in concert with other districts, and the saavy doctors that have business acumen, in each one.
One of the amazing things that happens because the competition is internal, rather than external, is that districts and their managers share information on their success, and failures. Here, we compete against one another much more. Great for widgets, bad for health care. The Spirit of the endeavor is wrong from the management end.
It is far from perfect…, but if we can find 22 million(At the systems inception) Americans that would pull together to provide care for all, in a place that has the logistics and diversity of Canada, I’d eat my laptop.
March 10th, 2008 at 9:11 pm
pop - I hadn’t seen the 72 million figure. That’s scary. In terms of regular treatment - years ago I studied the Irish system of health care. They provided nurse practitioners in addition to doctors who saw patients on a regular basis, catching serious illnesses far sooner, reducing the cost of treatment. The up front cost is higher than here but the long terms costs incurred far lower.
A while back Sara at Orcinus did a series on Canadian healthcare that touched on many of the themes you’ve raised. She also said much what you said - it’s not perfect but it’s a damn sight better than what we have in US.
March 10th, 2008 at 9:18 pm
The success is in the Spirit of how the job is undertaken despite any deficiencies in bells and whistles. Make no mistake they have them all, just not as many. Here is doesn’t matter if your doctor won’t recommend a treatment and the technical testing, if you can’t afford it, or have deficient insurance.
What is a health care system for, if it isn’t for maximizing quality of life, and patient outcomes? Answer this honestly, and we will well know what is wrong with US sick care.
Consider this; If a cost cutting measure has any chance of negatively affecting patient outcomes, it is not considered. Doctors make this call in conjunction with business professionals that have a good idea what the doctor is talking about. It is a specific profession to be this business end of the doctors knowledge, and aid and assist in creating protocols. It is all in the Great Wide Open, for all to see.
March 10th, 2008 at 9:22 pm
Percentages are tough to use, as in health care, each person is a problem, a sick life, not a percentage of defective products off a production line. The statistics are misleading.
10 people with shortened lives, or living in misery due to someones desire to save money for whatever reason, is 10 times that misery on their families and all they know, work for, the whole bit. Business concepts have their place, but should be secondary.
March 11th, 2008 at 8:52 am
You know what doesn’t help? DeVerl Longley and his band of scalawags who run electedhotties.blogspot.com. That’s who. These nincompoops propose to put elected officials’ pictures on their website in weekly polls to let people vote about who is hotter. This is nuts!!
And it doesn’t help anything. Can you belive this?!?!>>!!??!?
March 11th, 2008 at 10:44 am
I believe everything. I don’t believe anything.
March 11th, 2008 at 11:28 am
Nuts but appropriate, as they really are of no use other than to look at Jack.
August 1st, 2008 at 9:42 am
That’s pretty cool
A while back Sara at Orcinus did a series on Canadian healthcare that touched on many of the themes you’ve raised. She also said much what you said - it’s not perfect but it’s a damn sight better than what we have in US.
Jade Borg
http://www.gpjobsaustralia.com/