Moyers Interviews Robert Reich on Who Runs Government
The Cost Conundrum
| Who really calls the shots? What will you do about it? Do you know enough to react smartly? We trim, blend, and append three 2009 articles from: (1) Bill Moyers Journal, June 12, on Reich; (2) t r u t h o u t, Jun 16, on insurers by Kevin Zeese (executive director of ProsperityAgenda.US); and (3) Econamici, Jun 7, on collaboration by Polly Cleveland. |
by Bill Moyerse, by Kevin Zeese, and by Polly Cleveland
- Moyers Interviews Robert Reich on "Who Runs Government"
Robert Reich: Private insurers spend a lot of money trying to avoid sick people. Marketing and finding groups of people who are relatively healthy and low risk. They contest a lot of claims, not only our claims but also doctors' claims.
A public insurer would have economies of scale, being so large it could negotiate low drug prices and low premiums. Competing with the private insurers will squeeze their profits.
The pharmaceuticals, the American Medical Association, and the private insurers, Blue Cross/Blue Shield and so on, have got lobbyists and public relations professionals and lawyers swarming over Capitol Hill. They also can easily drown out the public's voice. In trying to pay for healthcare Obama wanted a limit on deductions for the very wealthy. A lot of these very wealthy are Wall Streeters. They reacted so strongly that the Democratic leadership said, "No, we can't possibly do that."
- Congress May Transfer Hundreds of Billions in Tax Dollars to Insurers
Americans spend more than $2 trillion on healthcare every year -- more than 18% of our GDP. Premiums and out-of-pocket costs for individuals and families continue to skyrocket.
Why the present system is so expensive: hospitals need massive billing departments creating bigger administrative staff than nursing staff, doctors spend 20% of their overhead on dealing with the insurance industry, unnecessary treatments and tests, malpractice litigation, etc.
Not only did the AMA oppose single payer -- supported by 60% of doctors, according to a survey of the AMA data base -- but also the weak public insurance option. No wonder the AMA is shrinking rapidly. While not long ago it represented 70% of American doctors, it is now down to only 30%.
If you don't want to see another massive transfer of wealth to the insurance industry while Americans continue to lack health care, you need to take action.
- The Cost Conundrum
In the June 1 issue of the New Yorker, Dr. Atul Gawande investigates "The Cost Conundrum" (click here): why some cities in the USA have much higher medical costs per person, and often poorer outcomes. He lands in the dusty border town of McAllen, Texas, located in the lowest income county in the US. McAllen also has one of the most expensive health care systems in the country, second only to Miami. In 2006, Medicare spent $15,000 per enrollee here, twice the national average. Despite the poverty, McAllen offers gleaming modern medical facilities. But health outcomes are relatively poor, compared even to nearby El Paso with similar demographics.
Gawande quickly identifies the explanation: over-treatment and under-prevention. Doctors order unnecessary tests and treatments, while failing to encourage simple prevention, like immunizations or monitoring of diabetics. Since every procedure carries some risks, over-treatment means poorer outcomes. Motivation for over-treatment is pretty obvious too: doctors make greater profits, especially when they build their own clinics. And there’s no money in prevention. So, here’s the real mystery: why don't all doctors over-treat and under-prevent?
Places like Rochester Minnesota, dominated by the Mayo Clinic; Seattle, Washington; and Durham, North Carolina provide world-class treatment at costs below the national average. Doctors in such places pursue a more collaborative approach to treatment, sharing information and equipment, tackling common problems like error prevention, and sometimes sharing reimbursements. At Mayo in particular, where doctors are on salary, whole teams of doctors evaluate patients.
Why the difference? It comes down to local history and norms of behavior. In McAllen, apparently, some fifteen years ago the lure of profit overwhelmed traditional physician concern with simply providing good service.
American medicine suffers from a system failure. As long as we pay doctors for piecework, patient by patient, procedure by procedure, profit motives will tend to overwhelm good medicine. The alternative is collaborative medicine, which measures and rewards success according to good statistical outcomes -- such as hospital infections avoided, medication errors prevented, or diabetics trained to eat healthier diets.
The Obama Administration is struggling to include in its plan a public insurance option to compete with private insurance. Meanwhile, liberals demand “single payer.” Yet as Gawande points out, McAllen relies chiefly on Medicare and Medicaid, making it already de facto single payer. Whatever the final shape of Obama’s plan, it will fail unless it redirects incentives toward collaborative medicine.
JJS: To bring down costs even more, let’s clean up the environment, which would stop stressing out our immune systems, and let’s expand leisure for everyone, which would stop stressing out us. We can reach both goals via geonomics. That is, when we require members of society to pay land dues, they tend to use land efficiently and not pollute. And when we endow members of society with shares of recovered “rents”, then we all can afford to work less. With geonomics in place, we might not need any socialized medical attention at all.
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Jeffery J. Smith runs the Forum on Geonomics.
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Also see: High Medical Costs In Part Are Supply Driven
Taxpayers for Common Sense and Clawback name names
Paying More, Getting Less |
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