http://www.nytimes.com/2014/07/15/upshot/why-improving-access-to-health-care-does-not-save-money.html



Reader Comments:

Don McCanne

San Juan Capistrano, CA
The supposedly inevitable trade-offs between access, quality and cost ignore one important intervention regarding cost. The health care financing system in the United States is unique in its profound, costly administrative waste due to the highly inefficient, fragmented financing through a multitude private insurers and public programs (and no programs at all for the uninsured).

Merely changing to a universal single payer program or a national health service model dramatically reduces costs without having a negative impact on access and quality. The future trajectory of cost increases would be shifted downward - achieving that elusive bending of the cost curve. That is one way other nations provide truly universal health care at a per capita cost averaging only half of that of the United States.

In fact, the monopsonistic purchasing of a public program can actually improve quality by obtaining greater value in health care purchasing.

Some of the savings that would accrue by changing to a universal program such as an improved Medicare for all would be redirected to much needed improvements in access.

The important bottom line is that we really can achieve improved access, improved quality, and lower costs by structural reform of our highly dysfunctional financing system - a system that was only expanded by the Affordable Care Act.


Darlene
Albuquerque, NM

This author makes a compelling case that the ACA will not decrease costs because there are trade-offs among access, quality and cost. What he ignores is that we also have another system, Medicare, operating simultaneously, that provides good access and quality and manages to limit cost with little trade-off. In addition, it serves the population that consumes the greatest share of health care. You, good reader, know the difference. This article shows, once more, why we need a single payer system for all.

http://www.nytimes.com/2014/07/06/sunday-review/long-waits-for-doctors-appointments-have-become-the-norm.html?hpw&action=click&pgtype=Homepage&version=HpHedThumbWell&module=well-region®ion=bottom-well&WT.nav=bottom-well&_r=0

One small consolation of our high-priced health care system — our $2.7 trillion collective medical bill — has been the notion that at least we get medical attention quickly.

Americans look down on national health systems like Canada’s and Britain’s because of their notorious waiting lists. In recent weeks, the Veterans Affairs hospitals have been pilloried for long patient wait times, with top officials losing their jobs.

Yet there is emerging evidence that lengthy waits to get a doctor’s appointment have become the norm in many parts of American medicine, particularly for general doctors but also for specialists. And that includes patients with private insurance as well as those with Medicaid or Medicare.

Merritt Hawkins, a physician staffing firm, found long waits last year when it polled five types of doctors’ offices about several types of nonemergency appointments including heart checkups, visits for knee pain and routine gynecologic exams. The waits varied greatly by market and specialty. For example, patients waited an average of 29 days nationally to see a dermatologist for a skin exam, 66 days to have a physical in Boston and 32 days for a heart evaluation by a cardiologist in Washington.

The Commonwealth Fund, a New York-based foundation that focuses on health care, compared wait times in the United States to those in 10 other countries last year. “We were smug and we had the impression that the United States had no wait times — but it turns out that’s not true,” said Robin Osborn, a researcher for the foundation. “It’s the primary care where we’re really behind, with many people waiting six days or more” to get an appointment when they were “sick or needed care.”

The study found that 26 percent of 2,002 American adults surveyed said they waited six days or more for appointments, better only than Canada (33 percent) and Norway (28 percent), and much worse than in other countries with national health systems like the Netherlands (14 percent) or Britain (16 percent). When it came to appointments with specialists, patients in Britain and Switzerland reported shorter waits than those in the United States, but the United States did rank better than the other eight countries.

http://www.pnhp.org/print/news/2014/june/us-doctors-migrating-north

By Wendy Glauser
CMAJ (Canadian Medical Association Journal), June 19, 2014

TORONTO -- With the prospect of greater pay, fewer bureaucratic headaches and the opportunity to provide better care for patients, the number of American doctors migrating north is rising, according to Canadian recruiters and Canadian Medical Association data.

Susan Craig, president of the Toronto-based physician recruiter, Susan Craig Associates, said that Canada is becoming "increasingly attractive," while John Philpott, the Halifax-based chief executive director of Can-Am Recruiting, noted "interest is doubling each year for American doctors" seeking to move north.

Increased pay is the main driver of this interest. Philpott said family physicians, pediatricians and psychiatrists can make $100,000 more in Canada, on average, compared to the U.S.

According to data from the Canadian Medical Association, the number of U.S.-trained physicians grew less than 3% from 1996 to 2005 (up from 493 to 506), but jumped 42% from 2006 to 2014 (508 to 721).

The increase would be much higher, however, if estimates distinguished between specialists and family doctors, as the majority of U.S. physicians crossing the border are in family medicine, said Philpott.

In the U.S., thanks to insurance company loopholes and technicalities, American family physicians aren't paid up to 30% of the time, whereas under a single-payer system, only about 2% of his billings don't covered, explained Dr. Sajad Zalzala, a U.S.-trained family physician who moved to Windsor, Ont., in 2012.

http://www.washingtonpost.com/blogs/wonkblog/post/the-hard-truth-about-health-care-government-works/2011/05/19/AGcE95KH_blog.html

Everyone knows — or should know — that the United States spends much more than any other country on health care. But the Kaiser Family Foundation broke that spending down into two parts, the government’s share and the private sector’s share (both measured as a percentage of total gross domestic product), then compared the results with figures from 12 other countries that are members of the Organization for Economic Cooperation and Development. And here’s the shocker: Our government spends more on health care than the governments of Japan, Australia, Norway, the United Kingdom, Spain, Italy, Canada or Switzerland.

Think about that for a minute. Canada has a single-payer health-care system. The government is the only insurer of any note. The United Kingdom has a socialized system, in which the government is not only the sole insurer of note but also employs most of the doctors and nurses and runs most of the hospitals. And yet, measured as a share of the economy, our government health-care system is the largest of the bunch.

And it’s worse than that: Atop our giant government health-care sector, we have an even more giant private health-care sector. Altogether, we’re spending about 16 percent of the GDP on health care. No other country even tops 12 percent. Which means we’ve got the worst of both worlds: huge government and high costs.

http://www.businessweek.com/articles/2014-07-03/hospitals-are-mining-patients-credit-card-data-to-predict-who-will-get-sick

Imagine getting a call from your doctor if you let your gym membership lapse, make a habit of buying candy bars at the checkout counter, or begin shopping at plus-size clothing stores. For patients of Carolinas HealthCare System, which operates the largest group of medical centers in North and SouthCarolina, such a day could be sooner than they think. Carolinas HealthCare, which runs more than 900 care centers, including hospitals, nursing homes, doctors’ offices, and surgical centers, has begun plugging consumer data on 2 million people into algorithms designed to identify high-risk patients so that doctors can intervene before they get sick. The company purchases the data from brokers who cull public records, store loyalty program transactions, and credit card purchases.

Information on consumer spending can provide a more complete picture than the glimpse doctors get during an office visit or through lab results, says Michael Dulin, chief clinical officer for analytics and outcomes research at Carolinas HealthCare. The Charlotte-based hospital chain is placing its data into predictive models that give risk scores to patients. Within two years, Dulin plans to regularly distribute those scores to doctors and nurses who can then reach out to high-risk patients and suggest changes before they fall ill. “What we are looking to find are people before they end up in trouble,” says Dulin, who is a practicing physician.

http://members.jacksonville.com/business/columnists/2014-06-30/story/guest-column-support-medicare-all

My party, the GOP, is running for election this year on the slogan “repeal and replace Obamacare.”

I agree, but the question is “what will be the replacement?” My answer is Medicare for all.

From a moral standpoint, due to expansion of access to health care, the Affordable Care Act is clearly better than what we had previously. The Medicaid expansion provision, which unfortunately was made voluntary by a politicized Supreme Court, does a lot to help very low-income people who cannot afford insurance premiums.

On the other hand, of the 8 million who signed up for Obamacare nationally through the exchanges, many just switched from existing “limited” insurance policies.

In Georgia (my home), 22 percent of the population (one of the highest rates nationally) was uninsured before Obamacare.

Even if all 8 million had been uninsured, tens of millions are still without insurance and will be for the near future. This fact is especially true in red states like ours that have inexplicably chosen to turn back federal money to expand Medicaid, a purely political decision.

Further, because the Affordable Care Act is built on the defective private insurance model, it will never be very effective or efficient.

And with no Affordable Care Act public option, insurance companies will take advantage of consumers. For example, in the Albany, Ga., area, there is only one insurance company available via the exchange, Blue Cross. Incredibly, rates there are higher than they are in Beverly Hills, Calif.

<snip>

So why do I want to see more government involvement in our health insurance system via Medicare expansion to everyone? Because as opposed to many government programs, Medicare works well. Based on their experience, taxpayers (especially senior citizens like me), like Medicare.

And it is efficient, cutting out marketing and overhead expenses. Medicare has overhead expenses of only 3 percent compared to 20 percent-plus for private insurance companies.