Testimony
In testimony for a hearing on “Healthcare Coverage and Access,” Karen Davis talks about the need to “extend health insurance coverage ... and contain costs.” If you think about it, that’s an oxymoron. If you suddenly add say, a million people with health insurance to our system, expenditures would skyrocket. People who don’t have health insurance tend not to get healthcare. If you give them a health credit card, guess what! They’ll use it, and the total costs of healthcare in this country will increase dramatically. We must think more broadly about how to provide healthcare to those who need it without increasing overall costs. Now, there’s a challenge.
Under “efficiency,” the testimony focuses on the use of technology. In some ways, this is a false God. True enough, there are productivity increases to be obtained from technology, but the entry cost is high. Most U.S. physicians practice is small offices where the purchase of an electronic record system would be hard to justify. Furthermore, if you computerize a poor system, you end up with an electronic poor system. The system of care could be dramatically improved without even plugging in the computer.
I watched an old movie tonite where the CEO dictated a letter to his secretary. I laughed at how archaic and inefficient that was and then recalled that most U.S. surgeons still dictate their operative notes.
Ah, Denmark, where everyone loves the healthcare system. (It’s free.) Primary care docs work 9 to 5, and government clinics handle nite and week end calls. (And by the way, they’re paid extra not to actually see the patient.) Guess what DK would do if times got tough or they wanted to start a war in Iraq? That’s right, they’d cut back on healthcare.
True, there are lessons to learn from other countries, but most of the knowledge transfer goes the other way. I don’t see many (any) consultants coming from Europe to help U.S. hospitals do a better job.
Two basic truths:
1. Central planning doesn’t work. The Russians learned this, but the concept just won’t die.
2. Large systems tend to be inefficient. There are economies of scale, but there are limits. There should not be more than one step between the person making the decision and the healthcare provider.
Under “efficiency,” the testimony focuses on the use of technology. In some ways, this is a false God. True enough, there are productivity increases to be obtained from technology, but the entry cost is high. Most U.S. physicians practice is small offices where the purchase of an electronic record system would be hard to justify. Furthermore, if you computerize a poor system, you end up with an electronic poor system. The system of care could be dramatically improved without even plugging in the computer.
I watched an old movie tonite where the CEO dictated a letter to his secretary. I laughed at how archaic and inefficient that was and then recalled that most U.S. surgeons still dictate their operative notes.
Ah, Denmark, where everyone loves the healthcare system. (It’s free.) Primary care docs work 9 to 5, and government clinics handle nite and week end calls. (And by the way, they’re paid extra not to actually see the patient.) Guess what DK would do if times got tough or they wanted to start a war in Iraq? That’s right, they’d cut back on healthcare.
True, there are lessons to learn from other countries, but most of the knowledge transfer goes the other way. I don’t see many (any) consultants coming from Europe to help U.S. hospitals do a better job.
Two basic truths:
1. Central planning doesn’t work. The Russians learned this, but the concept just won’t die.
2. Large systems tend to be inefficient. There are economies of scale, but there are limits. There should not be more than one step between the person making the decision and the healthcare provider.
