Healthcare Efficiency

Yes, Rose, we have problems, but costs are not “skyrocketing.”  In fact, the rate of rise in healthcare costs actually diminished this year, and the gurus are still trying to figure out why.  The point made many times in writings here is that we could have the same healthcare at lower cost if efficiency were a priority.  And the driving force for efficiency is competition.  Right now, health plans are competing for patients.  Instead, providers need to compete on price.  Then, costs will come down and service will improve.  

And yes, we have the best healthcare in the world--at least, we have the potential to provide the most technically advanced healthcare.  Unfortunately, that potential is not always realized.  Sometimes, maybe most of the time, but not every time.  And that because no one is in charge to ensure that the right things happen every time.  

Render unto healthcare those things that belong, and infant mortality is way down the list.  When I was a student, the highest infant mortality in the state of PA was in the area around Temple University Medical school.  No shortage of good healthcare at no expense, but pregnant women didn’t walk across the street to get it.  The big gains in life expectancy have come from sanitation and immunizations, not from healthcare.  The current frontier for life expectancy is environmental pollution.   Among the factors cited by Karen Davis, survival with breast cancer is pretty clearly related to healthcare, and we are perhaps best in the world in that statistic.
It used to be said that anyone who wanted government to run healthcare had never mailed a letter.  Actually, the Post Office does pretty well these days, but they have some competition and aren’t really a government agency.  Central planning doesn’t work.  Not for economics, and not for healthcare.  

Isn’t it interesting that doing the best thing for our elderly is also the least expensive, but we don’t do it.  That’s a lesson for us all.  As Dylan Thomas wrote:
    “Do not go gentle into that good night.
    Rage, rage against the dying of the light.”

Posted by Dr. Robert Burney at 09:48 PM | Permalink | Comments (0)

The fastest growing segment of the US population is those over 85.  The country with the fastest rate of rise in healthcare costs is Japan, and the reason is their aging population.  Mary Jane Koren of the Commonwealth Fund testified before congress 15 Feb on the issue of Caring for Aging America.  She cites impressive statistics on the magnitude of the problem and urges us to think about this population in terms of their medical needs rather than chronological age.  

Certainly someone needs to think creatively about our current practice of warehousing the elderly en route to the mortuary.  Certainly, as Dr. Koren suggests, people meed more help with anything as they get older.  However, some of this we do to ourselves--or rather, to our parents.  That which we get help doing today, we will no longer be able to do tomorrow.  It is easier to dress a child than watch him try to dress himself.  However, the penalty for doing it for him is that he never learns to do it himself.  The same is true, in reverse, for the elderly.  When you hire someone to mow the lawn or clean the house, you soon give up the ability to do those things yourself.  As we push the elderly to their meals in wheelchairs, we deprive them of the ability to walk.  We also obligate our healthcare system to pay someone to push the wheelchair.  And that, of course, is the tie with efficiency.  We use fewer resources caring for those elderly who mostly take care of themselves, but it takes great patience and planning to make that happen.  

This concept of learned helplessness applies also to the mind, to the decisions we make every day from what to wear to what to have for breakfast.  Many studies suggest that mental exercise preserves mental function, but our general approach is to do the mental work for them, thus pushing them into the spiral of learned mental helplessness.

Health should mean more than just survival.  As we consider how to deal with our elderly citizens, we should enable them to take care of themselves.  Their lives will be better, and the rest of us won’t have to pay the bill.  That’s a win-win.

Posted by Dr. Robert Burney at 08:51 PM | Permalink | Comments (1)

Last week, Exekiel Emanuel and Victor Fuchs co-authored a column in the Washington Post, “Beyond Healthcare Band-Aids.”  They cite and dismiss various proposals for healthcare reform as building “on what everyone agrees is a broken system.”  Well, I’d guess most would agree we have some problems in healthcare, but anyone who thinks the entire system is broken has never seen the DC public school system.  

With all its faults, we have the best healthcare system in the world.  American diplomats who have lived overseas and experienced healthcare overseas want to come home when they’re sick.  The State Department requires pregnant employees to come home to deliver.  Not that it’s always better here, but the odds favor that conclusion.

The biggest criticism of Emanuel and Fuchs (and others) seems to be the uninsured.  So, it’s not really the healthcare system that’s broken, it’s the system for providing healthcare to the uninsured.  Unfortunately, plans to correct this focus on providing health insurance rather than healthcare to the uninsured.  We have this vision that equates uninsured with “poor and needy.”   In fact, some are just overgrown teenagers who believe themselves immune to illness.  (Guess I missed that vaccination someplace.)

Nevertheless, they rightly state that providing insurance for the uninsured will, “...in the short run ...require ever more money to cover the uninsured, and in the long run the unabated rise in health costs will quickly revive the problem of the uninsured.”  They also correctly note that US healthcare “suffers more from inefficiency than lack of funds.”  And further that it “provides strong financial incentives to preserve such inefficiency.”  

Unfortunately, after dispensing such wisdom, they espouse solutions that can be summarized as “central planning.”  The Russians tried this when I was a kid, and it didn’t work very well.  Emanuel and Fuchs want to create a Medicare-like system that would cover the rest of America, financed by increased federal taxes and administered by a new bureaucracy.  

In their next column, they’re going to reform the US auto industry.  Only General Motors will be allowed to produce cars, and federal taxes will purchase cars for everyone. 

Posted by Dr. Robert Burney at 08:09 PM | Permalink | Comments (1)