Monday, December 5, 2011

How Big Is Health Care Waste?

How large is the health care drain on this country? We already know at the rate its costs appears to be increasing, roughly 16% a year, it'll consume nearly all of our GDP within a very short time - maybe 20 years. The problem inheres in the source of the over-spending or as some call it "health care waste". Logically, the aim is on so-called 'entitlements' (a word I disdain) such as Medicaid and Medicare, but that doesn't necessarily mean that no waste exists in the private health care system! In fact, the private system is ranked 37th in the world by the World Health Orgnization, in terms of care delivered for the dollar.

Dr. Donald Berwick, appointed by President Obama by special recess appointment nearly 16 months ago, to be in charge of Medicare and Medicaid, has insisted (in a recent news interview before his term expires at the end of the month) that "20 to 30 percent of health spending is waste". He defines waste as something which yields no benefit to patients and that much needless spending is the result of "onerous, archaic regulations enforced by his agency".

He then elaborates a bit more, naming the following culprits as prime contributors to the waste:

- overtreatment of patients

- the failure to coordinate care

- the administrative complexity of the health care system

- burdensom rules

- fraud

Berwick didn't elaborate on the "rules" aspect, but one presumes this covers assorted provisions, such as in Medicare, to have elder patients re-admitted for assorted treatments, such as for pneumonia recurrence. I don't know what the answer is here, but it can't be simply to halt any further re-treatments, or re-admissions. There are instances where a patient may be improving on leaving the hospital and then has a relapse. Do we just let the patient die, or do we re-admit for more intensive treatment? Does the answer depend on his age? Say like if he's 85 or more (like my dad was when he died of complications from pneumonia) do we just say (as Hedge Fund Billionaire Peter G. Peterson): "Well, you've already had enough of a life, so if you can't afford to pay any more for your care, sorry, then we gotta pull the plugs!"

To me, this is barbaric, and also unnecessary! For one thing, all Dr. Berwick's hand wringing and frustration aside, we already know the sources of most health care waste.

Let's take cancer treatments, and specifically radiotherapy - say using radiation therapy to treat prostate or breast cancer. Right now, as things stand, each separate radiotherapy treatment merits a separate charge on a hospital bill. To me, THIS is wasteful! Repeated thousands of times it adds nearly two billion to the yearly health care tab. What we ought to have, if radiotherapy is prescribed, is one fixed rate for the program of treatment. The same applies to the administration of chemotherapy. So, if a patient requires some 15 treatments of chemo, he or she pays only once for the program prescribed, not for each time! That is over-charging!

Nor is this unusual, as it's a practice already followed in Germany and Japan. In the case of the Japanese they publish a yearly schedule of all the fixed rates to be charged for all manner of procedures. No physician or specialist is allowed to charge beyond what the schedule allows. This is the same in Barbados, where universal health care is provided and patients are only expected to make a co-pay.

What are other sources of waste?

One of the biggest is indeed administrative expenses, or what I call "paper pushing". But these are much larger in the private sphere (nearly 1 of every 3 dollars consumed by administration) than in Medicare, which accounts for only about 2% of admin fees. Thus, Medicare is not wasteful other than in the fraud - which accounts for nearly $30 billion a year, and for which much more attention must be paid.

A manner of waste also occurs in terms of Medicare's drug expenses. I have always argued that, rather than paring down Medicare providers' fees (which would merely have the effect of more seniors denied care or acceptance by physicians) it makes more fiscal sense to allow the program to bargain for the lowest cost drugs like the VA does. Where's the harm? The only conceivable reason this choice isn't on the table is to offer up the program as a profit bonanza for Big PhrMa!In effect, the government - to appease its corporate benefactors and lobbyists in PhrMa- is prepared to "milk" the Medicare cow into insolvency to do it! But by allowing a bargaining such as for the VA, nearly $200b could be saved over ten years.

Another form of deliberate waste, and designed as such, are all the "Medicare Advantage" plans. These were conceived as part of the Bush 2003 Medicare Act to bleed standard Medicare into insolvency by creating a private competitor within the Medicare system. Thus, thanks to the pushing of Lobbyists (then repuke handmaidens for the corporatists) like Billy Tauzin, a "Jekyll and Hyde" law was prepared - with standard Medicare for the less well off, and Medicare Advantage for the better off.

The problem, as the Government Accounting Office (GAO) has noted, is that the privatized version is bleeding off nearly $12 billion more each year and hence speeding the whole program - standard Medicare especially, into insolvency! This was to have been dealt with by Obama, in terms of cutting it completely out, but last I heard it was off the table: to many protests from the private lobbyists who are causing the most waste overall.

Sadly, the worst mistake Berwick committed in his interview on Thursday was in comparing the public's comprehension of Obama's Affordable Health Care Act to the NASA Apollo program. Berwick insisted that just as Americans supported manned missions to the Moon without knowing the details of rocket science, they ought to support the new law because of its ultimate destination. (I.e. health care for nearly all),

But that is plain old illogical bollocks and false analogy! Of course, the details of rocket science (especially to get to the Moon) would only be understood by the very few - mostly specialists in the field, with degrees in astrodynamics and aeronautical engineering from Caltech, MIT or wherever.

But we aren't talking about a narrow, highly specialized technological field of endeavor, we are talking of a law that impacts public policy and specifically public health! This ought to be understood at least by EVERY manjack of normal IQ (90-110 for most standard IQ tests). Indeed, the only reason it would be so "complex" at all, would be to obfuscate or HIDE the details. But the American people, as adults, deserve to see the details, not permutations or contortions of them.

Hence, it is the job of whoever writes the law to do in plain English, if there's nothing to hide. In the case of rocket Moon shots, the average American can't be expected to grasp the details of thrust, the essential hundred or so rocket equations that make a large delivery vehicle possible, or the nuances of celestial mechanics which assure a craft reaches its destination.

We don't need excuses, then, what we need and want is a plainly -written law that will also finally make the repukes shut up and cease their efforts to overthrow it!

No comments: