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Eshoo: No plans for health care town hall?
Original post made
on Aug 17, 2009
As people pack town hall meetings across the country on plans for health care reform, Rep. Anna Eshoo, D-Menlo Park, has not announced plans to hold a similar meeting with her constituents during Congress' August recess.
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posted Monday, August 17, 2009, 11:21 AM
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Posted by Concerned Parent
a resident of Menlo Park: The Willows
on Aug 25, 2009 at 10:07 am
Some additional thoughts/comments:
1)better care/lower cost-what's not to like. I guess I'm not convinced that it's that simple. I suspect the health care consumer does sacrifice something (longer waits, denial of some care, etc.). Most of these things are a balance. At present, the US is skewed toward a do everything immediately approach. This likely does result in some waste and as a society we need to be able to wait with back pain for the MRI or CT or just get pain meds empirically. Our culture and expectations will require some major adjustments to go here (see the latest from the Repubs about "Senior rights"-basically locking in the problems that got us here). On the other hand, there are unmeasured costs/taxes associated with a capped system (which is absolutely necessary if you want to contain costs). This is done with taking people's time as they wait throughout the system. Check out the ER at any county hospital and this will be borne out. So I would argue that if you take:
b)no additional cost
c)maintenance of current standards of medical care
you can get two of the three but not all three.
2)better outcomes for less money. This is often touted and again I'd prefer to look at methodology rather than one number. For example, looking at straight stats for infant mortality, Cuba does much better than the US. The annual expenditure per capita for health care is on the order of <$500. Sounds great as a sound bite. But..it turns out that the abortion rate in Cuba is significantly higher than in the US, particularly for late-term, high risk pregnancies. It turns out that within the Cuban system, the concept of informed consent is quite limited and patients are expected to do what the MD says. It turns out that infant mortality numbers are something the government tracks with great interest and touts as an indication of the superiority of their system. Now in the US, if there is a 30-week premature baby delivered, that baby may be treated in a very expensive neonatal intensive care unit and may die anyway. Now rather than being counted as a "stillborn" as it might be in Cuba (because it never survived childbirth), it will be counted toward infant mortality as well as having run up a large bill (these cases can easily cost $500K-$1M). Since the numbers are (thankfully) pretty low (3-6 infant deaths per 1,000 live births), an individual case can make a significant contribution. Since these deaths occur at such a low age, they also markedly drag down life expectancy estimates. So "better medicine" could result in a 3 month improvement in someone with lung cancer, but this will minimally impace life expectancy stats (since it usually affects those over 50), whereas a significant number of young deaths (say from car accidents, gun shot wounds, etc.) can markedly bring down averages. One could argue that we could move toward universal prenatal care and stop intensive neonatology, understanding that between the high risk pregnancies in the US from infertility treatment, teen pregnancies, etc. there will be some babies that won't survive and not count them as live births. The result would be less money spent and "better"stats, though we might not like the result.
3)Costs won't go up- one issue not often discussed is why costs go up. While it is easy to blame doctors, hospitals, insurance companies, and so on, the flip side of that is the cost of medical progress. Presumably as a society, we like medical innovation. The options available for treatment of heart attacks, strokes, many cancers, are light years ahead of where they were 30 years ago, but they are expensive. It will be a challenge to balance cost containment with innovation as they pull in opposite directions. For drug development, I've seen estimates that it costs $1.5 billion and takes 10-15 years to develop a new drug. As the opportunities become smaller and the conditions more challenging and FDA requirements more stringent, I would sadly expect this number to go up. Now whether costs can be kept to the level of inflation as opposed to running ahead is a different issue. If you go to the UK, there are new cancer drugs that aren't covered which is an example of not adopting new technology. Can new approaches/technology cut costs? In some cases perhaps, but history tells us that usually costs go up. Something else in this vein, is that the US has been the major place for development of new drugs (because we pay more than other countries). It is unclear to me what the new paradigm will be but I suspect that the world will conclude we've reached a point of diminishing returns in terms of pharma and that may be that. Good for you if you have a treatable condition, but not if you don't. Ideally, the market could be skewed to incent pharma to develop truly novel drugs rather than me-too drugs in large markets, but that's for another day.
4)Medical bankruptcies. I would disagree that any study, no matter how flawed is better than nothing, however, rather than looking in the American Journal of Medicine, I would scour the health economics literature. From what I can tell there, there is no study reporting anywhere near even 50% of bankruptcies/foreclosures resulting from medical bills. What numbers I could find from a brief search show that 13% of filers had medical bills of >$10K, 40%<$5K, 20%<$1K. I'll agree that any number is too high and also that the hypothetical 1% is very likely lower than reality. My point, though was that there is a big difference between 1% and 60%. If you are talking about 15,000 people, that may be too many, but it likely pales in comparison to the number of people going into foreclosure or bankrupcy as a result of the economic downturn. The conclusion there is that if you focus on medical costs as a major force behind bankruptcy, and make a major change based on that and don't take care of something else (The economy) which may play a much larger role, you are less likely to alleviate the problem. One more note regarding the study. If I did a parallel study and looked at the number of people who owed taxes and went into foreclosure or bankruptcy, I suspect I would find a significant percentage. Would I then conclude that this was the primary cause and therefore completely revise the tax code? At a minimum, I'd want to know how many individuals owed taxes, yet didn't go into bankruptcy, before making any conclusion.