A recent article in the Washington Post by Robert J. Samuelson presents healthcare statistics, which he interprets as meaning that:
Following are some quotes and my comments.
The central problem isn't cost or insurance, per se, it's increasing healthcare value to the patient/consumer. That means improving the poor quality and inefficiency of care, so that we all receive only the care we need, delivered in timely and effective manner, without waste and over-treatment, and with a focus on integrating "well-care" (prevention and self-management) with sick-care. High value implies lower cost since poor care cost more and delivering only the minimal necessary care typically results in better outcomes!
And there's no way to increase healthcare value without dealing with the knowledge void. That is, our healthcare community is drowning in oceans of information, yet no one knows the best ways to prevent health problems and treat them cost-effectively, especially when you take individual differences into account. Better health information technologies are needed, as is a collaborated effort to develop, disseminate, and deliver cost-effective evidence-based care.
There are many ways to interpret these numbers; for example:
I would suspect that those with good health insurance or personal wealth receive more costly care. Nevertheless, I agree spending is excessive due to inefficiencies and ineffectiveness, as well as broken economic models.
Relying on patients to judge the value of care received— considering all the complexities, options, and nuances —is simply ludicrous. What we need is valid scientific outcomes research and clinical guidelines before accepting such claims!
So, what's being implied here? If you have bad genes; if you live in poverty—in a crime-ridden, drug-infested—and can't afford healthy food, a safe place to exercise, or become drug addicted; if you're old and have chronic conditions … then what? You don't deserve good healthcare? All prisoners do! See this link: http://curinghealthcare.blogspot.com/2007/09/worthiness-socialized-medicine-and.
I don't think many people view universal healthcare as being unlimited care for which others pay. It should not be about getting something for nothing. Instead, it should be about assuring that everyone gets the quality care they need at an affordable price.
Private insurance companies don't focus on improving care quality; they're out to make profit for their shareholders by (a) minimizing payments to providers, pharmacies, and suppliers, and (b) by reducing the amount of care rendered in whatever way they can. They'd prefer to drop all members with serious (i.e., expensive to treat) illnesses because they are driven by the profit motive.
Concerning the young and healthy uninsured, it would be inexpensive to cover them via a government run single-payer system (e.g., HR 676 – "Medicare for All") since they would not require much care.
While I interpret the numbers Mr. Samuelson presented in a different way, we actually agree, in part, about what has to be done. I offer a blueprint for comprehensive healthcare reform—the Wellness Plus Solution—available on our Wellness Wiki at http://wellness.wikispaces.com/The+Wellness+Plus+Solution
From a philosophical viewpoint, radical reform of our healthcare system in the ways I describes requires that we, the American people, take a good hard look in the mirror to examine our culture's priorities and values. Why? Well, consider the following Commonwealth Fund report:
In other words, our healthcare system is broken; healthcare in America is gravely ill and we should be looking at ourselves--our cultural values, priorities, and economic/political/business models--to understand why things have gotten so bad!
To cure our healthcare system, and to begin fixing many of our other domestic and foreign problems, the American people ought to be willing and eager to look far beyond ourselves and family and focus on giving much to others in a way that makes our country and world a better world for all.
This sentiment was reflected in link above (about medical homes), which points out that the teams of doctors who hit "medical home runs" for the patients have an exceptionally compassionate nature that drives them to go that "extra mile" for their patients. I quote:
This observation is consistent with last week's post: We Ought To be willingness and eagerness to give (sacrifice) much in ways that makes this a better world for all. Unfortunately, this runs counter to the ideals of the "Me Generation" and the American consumerist way of life, which are destroying our society by rewarding and encouraging short-term self-centered hedonism (my pleasure now!), ego-based materialism (e.g., judging human worth in terms of one's bank account), and Machiavelli's " the end justifies the means" philosophy to business ("buyer beware!").
The good news is that compassionate people with awareness and understanding are bucking this tendency! THEY are the ones who Ought To be gaining financially by, for example, paying primary care physicians for taking the time to know their patients deeply and for going the extra mile to prevent illness and deliver high-value care, as well as investing in more and better clinical outcomes research.
While this is the only sane way to proceed, there are many tough challenges to enabling and rewarding healthcare providers who go the extra mile and offer high-value services. See, for example, a recent post by Josh Siedman titled Perils of Pay for Performance (P4P) at this link, which discusses the difficulty establishing fair and valid performance measures, and the consequential perverse incentives of today's P4P programs. One commentor added that we don't have the detailed information needed to understand the unique needs of each patient and thus cannot know if an individual is getting the right personalized care, even if it's right for other patients with the same diagnosis. Also see this link to our Wellness Wiki.