I’m surprised you don’t have Dr. Jack Wennberg from Dartmouth (and the Dartmouth Atlas) on the call. He is one person that understands how the variation of medical care varies by locality!

Or how you don’t have Dr. Al Mulley from MGH/Foundation for Informed Medical Decision Making on the call. He and FIMDM have been responsible for creating “programs” that talk about the best medicine has to offer and the impact it has on patients.

Too bad..

Want to cut health care costs? One place to start is to charge uninsured patients no more than what is reimbursed by the lowest paying health insurer. Right now they sometimes charge two, three or even four times the what is paid by the insurer. Then offer a 25% discount for patients who pay with a credit card since the eliminate the need for the hospital to sic its 25% administrative red tape monster on the patient.

one thing u could do, is start eliminating the middle man and all those HMO’s who promote the notion of specialize and charge for each one u go to. im fairy young and pay way more money than what is provided. my friend broke her arm and had to see the doctor, than saw a specialist than refer to another specialist, and yet again, than back to the specialist, and back down the line to the doctor just for him to say it looks like u need sugury while the specialist and doctors were getting paid(specialist more than doctor) to say the same thing in the first place. It crazy i pay all this money for health care and even if i get sick or hurt i still have to pay even more.

beware if the market or wall street starts running into the health care system, we will have a bubble than complete lack of reasonable health care prices, even know its extremely high.

Mike the market already runs the health care system, that’s why we have this mess. This show looks like a non-starter. We will never get this done right, never.

The whole thing is a mess, we spend more than any other country and have one of the worse health care systems in the industrial world. Well it’s not a system it’s a market.

Lets include dentistry in this as well as good dental care goes hand in hand with health care.

So far none of this is new! Jack Wennberg at Dartmouth has been researching this for years and publishing his research. Perhaps I am missing something….

Let us add six more experts, consultants, lobbyists, and assorted wizards behind the curtain. Maybe we can eliminate doctors and health care providers from the system all together.

Let us take DNA swab samples from birth.
Then every malady could be diagnosed and troublesome and costly slaves could be eliminated before they tax the health care system and the minds of all our experts.

You definitely need to do a follow-up program with physicians as guests. This discussion suggests to me that physicians and hospital administrators around the country never read JAMA NEJM or journals in their specialties. No doubt this is true of some but hardly the whole profession! This topic is fodder for close to a whole week’s programming! E.g., just one small aspect, how would this approach encourage creative exploration of new methods and techniques–seems to me it would DIScourage.

Let us load the DNA information of every man, women, and child into a national databank for the sake of efficieny. Then let’s trust all of these very smart people in the government to use these records properly.
Further, let us implant a chip in every person so that they can be tracked to see what they are costing our system.

As I am listening to this conversation I am struck how absurd it is. It’s the Insurance and Pharmaceutical companies not the doctors that are at fault here, they charge huge amounts money for crappy service.

By the way if you break your leg, it can end up costing over 30k if you need an operation. Something is wrong with this picture. Everything cost to much. You need Tylenol they charge you for the whole bottle instead of what you need.

We are the only industrial country in which people file for bankruptcy for health care bills.

A friend has invented an amazing device for reducing both costs and patient morbidity and is trying to license her patent

http://tinyurl.com/Handheld-Medical

Wish somebody would pick it up.

Electronic medical records, sophisticated testing equipment, “remote” contact with patients — it all makes sense and adds to efficient care. But please let’s not lose sight of some BASICS: we need to balance high-tech with high-touch. When did you last see a doctor, especially in a hospital setting, LOOK at the patient’s eyes, LISTEN to his words (and pulses, and heart rate), TOUCH his hands, TALK directly with the patient and not across the bed to a colleague or family member? Usually, the M.D. looks at the test results, and writes or cancels an order, and moves on to the next patient. Doctors need more training in good old-fashioned “bedside manner,” which can often reveal more about a patient’s condition than any test can.

Everyone should read Skinner’s book “Beyond Freedom and Dignity”…

Medical care is already “rationed” by virtue of the policies of health insurance companies imposed on patients via “co-pay” burdens. Co-pays go up, patients avoid additional medical care.

This does appear the way to reform the system. Digitizing medical records is a canard and a subsidy to the Insurance companies. I am assuming that it can be done competently and cheaply. I am also surprised that the GOP doesn’t support it.

The people I know who have worked with databases frequently spend their time trying to fix inneffective inncacurate systems. Some physiccians I know will not rely on the information that it provides because they will want to verify the accuracy of the decisions that the patient’s preceding physician made.

If you do some follow up shows you should include physicians and computer experts to get an accuarte picture.

Most physicians work hard avoid mistakes. Some don’t make them. Sometimes they get roped into suits anyway, in one instance even when he was on vacation in a different state.

You should have provided yourself enough time to cover this issue thoroughly, ma’am.

so, finally, the question is asked – by a caller – what will prevent these “guidelines” from becoming cookie-cutter care. unfortunately, jane cuts her off and doesn’t follow up.

your guessed alluded to a study that minimizes the amount of health care costs atributed to malpractice insurance, but she failed to mention the impact and thus COST incurred to how health care is delivered due to FEAR of malpractice. My wife who is a Surgeon often feels pressure to order very expensive tests, scans, admission, etc.. because she realizes that if something DOES go wrong, the attorneys will question every little step she made and insist that these tests were performed whether her judgement requires them or not. THAT is VERY expensive.

I completely agree with Chuck’s comments. Both Dr. Wennberg and Dr. Mulley would be excellent contributors to this conversation.

Perhaps I missed this, but has anyone addressed exactly how the President’s plan could be any worse than corporate run HMO’s/insurance companies who now make many decisions? We’ve all been complaining for the past many years that we distrust these folks and criticize them for limiting our physicians from the number of minutes they can schedule in for each patient to what tests or treatment they can prescribe. We’ve criticized this system for taking medical judgement from the medical community and placing it in the hands of profiting non-medical people. Even physicians have voiced frustration. Can the proponents of the new plan address how this aspect will change? Or will it be only a new gate keeper?

The efficiency of outcomes plans as part of the stimulus bill will only apply to those patients covered in all or in part by public health insurance (medicaid, SChip, medicare, Tricare). Private insurance generally follows the government lead, so, if it is cost-effective, we can expect to see an effect for all insured. The equity in access to healthcare that is already problematic in this country will be exacerbated by this plan: a new market will crop up — for those who can afford it. And there will be insurance companies and doctors who will be ready and able to provide the services you want — for the right price. This is already the case in many of the European nations where health care is rationed.
Studies have shown that in both European nations and in the US, there is income inequity in healthcare favoring the wealthy (for office visits) and the poor (for hospital care).

We need more GP’s, there are not enough of them with offices in neighborhoods, like they have in Germany, France and Great Britain.

We have to many specialist, we don not use preventive medicine as a guide to the health care system (market)
We wait until people are critical to treat them instead of getting them to change lifestyles.

Then there is our national diet, corn syrup and junk food. To many people eat crap and corn syrup is in everything, and I mean everything. The food industrial has to be part of this as well. The way we eat is a huge problem, look at the rise in type 2 diabetes which is going to become the number one health care issue in years to come.

Speaking as an internist and the daughter of an internist I have no problem with the government being involved in evidence based medicine. In regards to computerized record keeping for my father who died at 80 and who was still providing care via a number of free care clinics because he loved his profession almost until the day he died would definitely have quit medicine sooner with the introduction of computerized medical records. Since he was a solo practitioner until he formally retired at 71 and therfore had no pension to fall back on, retiring sooner would have been extremely difficult for them (and now my mother as he has died) particularly given what has happened to 401K’s in the last year. From my perspective, computerized records have huge advantages but my main problem with the majority of them is they are clearly slanted towards the companies who will be reviewing the records for billing purposes. A huge amount of material is repeated form note to note and the real meat of the note, i.e. the rational behind the thinking and the ultimate leading diagnosis are almost lost in the excess verbage. The real meat of the note is needed to communicate the thought and conclusion are lost in lists of repeated review of systems and family histories that have almost no relationship to the current problem. Where is the efficiency in that type of record? And I agree with a number of the above notes. Where are the physicians in this discussion?

Cynthia Short
Burlington, VT

It would be good if you read HR676 in the US House Of Representatives. This is a bill that combines the single payer medicare idea for everyone, with guidelines based on evidence rather than profit to control costs. It is an excellent bill and has the support of the Physicians for National Health Program founded by Harvard Medical School doctors. Whenever single payer is discussed it always is put down by journalists as that government stuff with a subtext that it must be inferior. Look at the VA studies by the Rand corporation and you will find that a single payer guideline driven health care system cost 60% of what the private system gives with better quality.
Most Mass. congressional reps are cosponsors of this bill

[...] bill puts more than a billion dollars toward research to cut health care costs by standardizing treatments. Today, On Point talks with the big thinkers shaping the [...]

Interesting discussion. Sounds like the medical care industry (includes insurers)are starting to recognize what manufacturing has known for some time, operations have to be managed with a “balanced scorecard”, or everything gets out of whack. The concept is simple: there are always trade-offs between COST, QUALITY, and DELIVERY. The difficulty is in finding the optimum balance. In this discussion, we are hearing a traditional framework where cost and quality rise to the top of the priorities in the trade-off decision. That skews and has skewed medicine ever since HMOs came to the fore-front with a bias to controlling costs, and pitted itself against the patient and doctor bias towards quality. This on-point piece reintroduces into discussion the notion of “Delivery” into the balanced scorecard.

Delivery is about achieving efficiency by eliminating waste in the process. Achieving efficient Delivery and asserting this into the discussion is necessary because without it, cost constraints (or fears, as in lawsuits) or unnecessary steps justified by Quality of care concerns skews away from the notion of effective outcomes as the goal. Efficiency does NOT necessarily mean costs go up or down or that quality is automatically sacrificed. The discussion is about achieving a cost-effective balance.

It would have been helpful if the experts had given even one example of these purported “efficiencies.” Same goes for the “extra steps” that would be targeted for elimination.

That’s just the kind of glaring omission that makes us civilians nervous when the conversation turns to “eliminating waste” and “controlling costs”. After all, it’s the same pious language the HMO’s and insurance companies have used all along to deny and limit care.

We already know how to keep people healthy – prevention, diet, exercise, prompt access to care – remote interventions by ‘quality programs’ run by insurers are simply a way of eliminating the physician and lowering cost – this is medicine practiced by non physicians with little direct contact with patients – it is a poor substitute for the physician who begins a health assessment even as he/she evaluates your gait and general appearance as you walk into the exam room, knows your family and social history, who has a professional and emotional connection extending over years of caring for a community of patients -who will get dressed at 2 AM and spend the night evaluating and caring for a critically ill patient – The heads of HMO’s and BIG INSURANCE INC have a stake in keeping the ENORMOUS PROFIT MARGIN THEY ENJOY – the increase in the cost of health care is really AN INCREASE IN THE COST OF HEALTH INSURANCE -

Here’s the question I would pose to those who are trying to stand in the way of health care reform: Who is it that LIKES the current set up? As a doctor, I can say it’s not us. We actually care about our patients, and seeing them suffering, routinely, not just from their illnesses and injuries, but also from the hardship and pain involved in trying to pay for and navigate the contorted maze of their healthcare system. Patients aren’t happy … they complain about it all the time. Hospitals aren’t happy …… they strain under the weight of financial burdens that are made heavier and harder to deal with every year.

Which leaves? Insurance companies (seem to be doing well). Drug companies (seem to be doing well).

I support Mr. Meltzer’s claim that doctors’ have the pen that writes the orders that spur this money spending into gear, but that pen is used in a system that is geared to make the wrong people benefit. Patients should be doing well, and if insurance and drug companies can also do well within such a system, that would be fine.

The discussion of efficiency is great but governmental involvement is not. The thought that this federal board is “harmless” and will not dictate care is an illusion. Within a period of 5-7 years, these guidelines will become expected mandates, taking critical decision making away from the patient and their doctor. Those who argue that these guidelines will not dictate care are blind to the fact that the government is already the single biggest payer of health care and that money drives health care. What the government decides is efficient care will become the care we are all given. Choice will be out of the picture.

Also lost in this discussion, is the fact “efficient” doctors will likely choose only the healthiest people to care for so that their “numbers” look good. Patients with complex, costly problems will be swept aside or passed onto public or university hospitals to deal with. In the end this limits access to care for patients. Fpr the doubters, this is already happening. If you look at the CMS online “rankings” these hospitals rank lower than private hospitals. The same will happen with physicians when we are ranked by the federal government as well.

bloomberg data on the base salaries of 3 out of 4 top executives at Aetna, Cigna, United HealthCare list their annual salaries EACH at between $15,500,000 and $21,000,000 – this is typical of the industry – does anyone see a problem here? United HealthCare/Ingenix has just lost a suit in which it was challenged for providing artificially low ‘reasonable and usual fee’ ranges on which to base out of network physician payments – anyone still want their medical care to be run by the same kind of greedy folk who brought us the financial meltdown?

A short note from France: To be able to possess a “long-term” visa,
one has to have a health insurance here.
Not a spring chicken, I still pay only 390.00 Euros a year.Everything
covered,that includes 30,000.00 Euros for hospitalisation.
(Do you see why,and for whom socialism is a dirty word in the US.)
Ant questions ?
Stef

Most of you are trying to reform a system that is already out of your hands by means of giving those in power more power. I believe that the only way to take back what is ours, so to speak, is to put the responsibility of our own health care back into our own hands, once again.

I believe at the root of our failed system is the fear of dying, which we all will face, and passivity that says we won’t survive unless we rely on someone more learned. The whole medical system is designed to make us dependent and therefore in debt to the state of our physical health–and often our emotional health, although, not in question. Our desire to avoid the inevitable–death–and our passive nature that has made us dependent, is at the root of a system that wants to now consume us.

I am out of the system–uninsured–and rely on my ability to understand and put into practice a routine of good health practices including exercise, proper diet, balanced living and a spiritual awareness. This often involves office visits at my own expense to doctors that know me, inform me and pass on to me the tools of improving my health. I also have to be willing to let go of comfort foods and to seek my Lord and His miraculous hand to help me to break self-destructive habits. All of these combined keeps me on a path of good health with the resources necessary to maintain it.

Because I am of reasonable health, my comments do not include those of critical health in need of chronic care. To those the system was invented and should be in place. But to us of reasonable health, with the ability to monitor, maintain and improve our own health, we are a burden to this system and should be removed. Let health care be in place for those that need it. Let information, a more active involvement and spiritual guidance be in place for when the times comes where we need help. It will be found.

Concerned Onlooker if you get hit by a bus tomorrow I hope you realize that the “lord” ill not be paying the hospital bills. You will, and an accident like that could cost way over 100k and being uninsured you will libel for all of it.

All the spiritual guidance in the world will not save you from the reality of financial ruin of a serious illness or accident.

This statement below is so absurd it does not even warrant a response. However I think decent affordable health care should be a right and not a luxury.
It would also save everyone a lot of money in productivity in the workforce, and companies from the expense of health insurance if we had a good national health system.

“To those the system was invented and should be in place. But to us of reasonable health, with the ability to monitor, maintain and improve our own health, we are a burden to this system and should be removed.”

This statement shows how silly people can be, trust in invisible phantoms and God will not keep you healthy.

UNIVERSAL HEALTHCARE!!!!!

HEY! AMERICA…Allo?…Allo?

This is another testimony on the american”melting pot” that is not melting and the survival of old Bogeyman(socialism!!)

More homogeneous societies have no problem with providing universal healthcare for their populations and it’s also good for business.
People talk a lot about christian values in this country,Universal heathcare should be one of them. it’s even cheaper in the long run.

Once again we blame everyone but ourselves for the problem. Instead of doing something about our own bad habits that cause chronic illness, we turn once again to the government. Reforming the system without Americans reforming their habits will once aqain end in trouble. Bad habits cost billions in medical bills.
* Smoking: very expensive and long term care.
* Alcohol: very expensive and affects more than the
person drinking. Add the cost of wreck
injuries,law enforcement,property damage.
* Drugs: tons of money wasted.
* Obesity: We are getting fat. Diabetes is growing.
* Illegals: California can tell you how much they cost
in free medical care. Research how many
ER’s and hospitals are closing due to them.
* Law suits: Ask a doctor what he pays in malpractise.
* Insurance: The cost of the freebees are factored in.

I am a EMT,in a volunteer service. We provide medical and ambulance service at no charge to our community. We rely on donations only. I see the expense and misery of chronic disease that could be prevented by good habits. ER’s must take people who walk in. We must transport a person if they request it to a ER, even if it is not an emergency situation. Go to a ER and look in the waiting room and see how many emergencies are sitting there. We have transported people with, indigestion, drunks, headaches, drugs, diabetics who will not follow instructions from their doctors and even a man who complained his big toe hurt. Out of the nearly 400 calls a year, most are not emergencies requiring the ER.
If America could cut out all the abuses this would help our Health care problem. Yes! reform and improve, but Americans get off of your butts and stop adding to the problem. Will Government intervention dictate and prevent the bad habits of people? Probably not!

you need to check out the B H Obama comments.
Are they real or a hoax???????

Once again, otherwise intelligent people start talking nonsense as soon as they hear the word “Europe”. One of the callers asked whether we’re reinventing the wheel, when European systems are already very efficient, and the guest immediately assumed the question was about the “single payer” issue. As I understood the question, the caller was referring to the extensive application of best practices research in some European systems, which we just might learn from if we could bear to acknowledge that somebody somewhere in the world might occasionally do something a little better than we do it in the US.

Took until David, the EMT’s comment, to read what I was looking for — the other link in this health care chain: PATIENT RESPONSIBILITY! I overheard a conversation between a woman and her friend. Woman was about to go in for knee replacements. She was overweight, on blood pressure meds, and had a coffee cup from Micky D’s at her elbow. I’d like to see a tiered set-up that rewards those who maintain a healthy weight; maintain, through diet and exercise, healthy blood pressure, cholesterol levels. Yes, there are chronic illnesses that cannot be prevented. But there are plenty whose origins are directly linked to lifestyle. The system shouldn’t have to pay for those irresponsibilities. Come up with a plan that provides catastrophic care, basic preventive and maintenance care and rewards those users who make
long term health choices that obviate the need for the cures that are, in essence, end runs around poor personal health habits and choices. For instance everyone gets 1000 health points. Smoke? You lose fifty. Enroll in smoker stopper programs, gain 100. Succeed in quitting gain 250. Probably too simple.

Hi
I was listening to your guests on health care last evening and have some comments. First, the whole show was liberals expounding the liberal point of view. Isn’t it the liberals who introduced the Fairness Doctrine? But there is one point I like to make that even a liberal can understand. The government is going to handle it? Like they handled the Social Security Trust Fund (aka Bill Clinton’s raid)? Like they handled NAFTA (aka Al Gore vs. Ross Perot – guess who was right?)? Like they handled Freddie Mac and Fannie Mae (1999 Housing Secretary’s intro of 100% financing with no job)? Like they handled oversite of the NYC banking cabal? Or, how about 72 trillion dollars of unfunded forward obligations that can never be meet. The worst run organization, the U.S. government, is now going to run health care. Unbelievable.

I listened to your expert guests and was amazed.

We understand what the government plans to do and hear the stated goal but, at this point, there is a disconnect. If, sometime in the future, everyone’s health records are digitalized, (which is mandatory) what then?

Everything will be ready for the government to tell doctors and hospitals how to treat us and government will not do that…………! Come on boys! A little “get real” is called for in your discussions.

[...] [...]

We need to get more people to pay for their own insurance. It’s not that expensive for a basic health insurance policy, but we have too many people that want the “other guy” to pay for their medical needs. It should be a law that requires everyone to have medical insurance. If they can’t pay for it up front, the government and the private sector should step up and provide a basic medical insurance plan. Then require those people get a second job to pay their fair share of the cost. Nothing is free in life.