The NYT On Healthcare

Here at OTB Steve Verdon and I have published a number of posts on the subject of healthcare and healthcare reform, possibly beating certain aspects of the subject to death. This morning the New York Times published an editorial on healthcare and healthcare reform that echoed a number of the points that Steve and I have been making and, needless to say, by and large I found it quite sensible. The Times characterizes the problems with our system as follows:

  1. The most significant problem with our current system is that it costs too much. This is important because the trajectory of cost increases is not sustainable.
  2. The main reasons that our costs are rising so fast is that we pay doctors and hospitals significantly more than they are paid in other OECD countries.
  3. The supply of healthcare varies markedly in different parts of the country.
  4. A dismayingly small proportion of actual medical practice is evidence- or outcome-based.
  5. HMO’s have not been particularly effective in restraining costs.
  6. Our system is slow to adopt information technology compared to other comparable systems.
  7. Americans pay more for pharmaceuticals than do the citizens of other OECD countries.
  8. We have fewer primary care providers per 100,000 than other OECD countries.
  9. The solution to our system’s problems preferred by many Republicans may not do much to reduce costs, particularly not in a way consistent with public health.
  10. The solution to our system’s problems preferred by many Democrats may not do much to reduce costs at all.

I put most of my reactions to the editorial here. I look forward to Steve’s reactions to the article. Steve, feel free to update this post as you see fit.

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Dave Schuler
About Dave Schuler
Over the years Dave Schuler has worked as a martial arts instructor, a handyman, a musician, a cook, and a translator. He's owned his own company for the last thirty years and has a post-graduate degree in his field. He comes from a family of politicians, teachers, and vaudeville entertainers. All-in-all a pretty good preparation for blogging. He has contributed to OTB since November 2006 but mostly writes at his own blog, The Glittering Eye, which he started in March 2004.

Comments

  1. Anderson says:

    So we need more doctors competing and driving their costs down, it would seem? Which in turn would seem to imply more medical schools and more med students?

    It would also seem prudent for the feds to pay tuition for those med students willing to serve as primary-care physicians in needful locations; some of this goes on now, I believe, but increasing the scope of the program might help.

  2. Tano says:

    As per #10,

    The editorial mentions that many dems really want a single-payer system, and then they list three reasons why such a system would save a lot of money – “…would let the government offset the price-setting strength of the medical and pharmaceutical industries, eliminate much of the waste due to a multiplicity of private insurance plans, and greatly cut administrative costs”.

    How could you possibly claim that their conclusion was that this “may not do much to reduce costs at all.”

    They did say that it was not a panacea – whatever that means.

    It does seem to me that in addition to the mechanisms for savings listed above, such a system offers the best handle by which to reduce costs in the other ways that they discuss.

  3. just me says:

    It would also seem prudent for the feds to pay tuition for those med students willing to serve as primary-care physicians in needful locations; some of this goes on now, I believe, but increasing the scope of the program might help.

    This happens at both the federal and state levels. My sister in law went to med school in Ohio, and they picked up her med school tab as long as she stayed in the state of Ohio for five years after completing her residency program. Although I think that program is for any kind of specialty, because she is a general surgeon, not a primary care physician.

    But these programs exist, I just wonder if some of them aren’t pinpointing the right specialties.

    I do know another big constriction point isn’t so much the med schools themselves but the number of available residency slots available. Not sure exactly where the funding comes from for the various slots, but if the feds wanted to get involved funding primary care residency programs might be money well spent.

  4. Dave Schuler says:

    From the editorial:

    But a single-payer system is no panacea for the cost problem — witness Medicare’s own cost troubles — and the approach has limited political support.

  5. underground says:

    I work with financial aid instead and the statistic is that the average Med. School graduate is sitting with about $200,000 in debt at the time of graduation. Sure there are some grants and scholarships – but they rarely pay the full price, they are highly competitive, and/or require a medium-term commitment at reduced wages. Add in insurance for the errors and lawsuits and suddenly its not hard to see why doctors charge so much money.

    There is an issue that people aren’t covered, but I can also attest through personal experience that the system has a problem even if you’re covered and have plenty of cash (simply extending universal coverage won’t fix these issues, only reward doctors/pharmaceutical/insurance companies.) Through surgeries, prescriptions, and a dozen specialists I remained undiagnosed with Celiac Disease for more than ten years. There are literally millions of Americans dying early and at risk for diabetes, cancer, and auto-immune diseases because of Celiac, yet its only diagnosed properly 3% of the time after an average delay of eleven years.

    Why? I have no idea, but is it a coincidence that there’s no pharmaceutical cure for the condition that goes undiagnosed? They had no problem implying IBS, CFS, anxiety or anything that is treated perpetually with a popular pill, but they never once mentioned Celiac. I only found out about it later from an art teacher who had met people struggling with my same set of symptoms.

    Now, ironically, I haven’t used my insurance in years and I’m in the best health of my life. I wish I had a political/structural solution but for me the answer has been proper diet, exercise, and being an informed medical consumer. Doctors don’t like it when you research your own symptoms, but I think its very important to stay involved and aware.

  6. M1EK says:

    Somewhat tangentially referred to in the previous comment, but I’ll state it explicitly: there’s a very high chance that increasing the supply of doctors would result in more medicine being practiced, and not necessarily at a lower price. People don’t have, nor have they ever had, enough ability to be able to tell when a doctor is recommending something necessary or something optional which might help in 1 out of 100 patients but will definitely help 100 out of 100 doctors.

  7. Some of the points made in the NYT list are valid, however some are based on myth. The link below goes to another NYT article published on Nov 4 by N. Gregory Mankiw, Professor of Economics at Harvard. His article, which includes supportive research and links to additional studies, concludes that many of the claims made about health care today are untrue and incorrectly reported, resulting in an inflammatory debate based on lack of knowledge.

    http://www.nytimes.com/2007/11/04/business/04view.html?pagewanted=all

    It’s worth the read to be fully informed.

    So far as the claim that a government controlled, single-payer system will reduce cost and increase quality, which is not covered in Mankiw’s article, that’s not an assumption born out of experience. An historical review of similar claims and attempts to do the same reveals enormous waste and fraud whenever it’s been attempted, for no gain or improvement, eventually leading back to privatization of the industries under government control. The most recent example would be the airline industry. One can also point at organizations such as NASA and certain aspects of the military. In every instance when the government took control, quality plummeted while costs soared, with most of the money going to the bureaucracy. Health care would be no different and probably would be irreparably damaged in the process.

    The solution will probably be a national, single-payer health plan for all Americans at the most basic level, blended with tax incentives to promote widespread use of information technology in health care, as well as tax incentives to enable most Americans to purchase private health coverage beyond the most basic coverage. This is a cooperative, symbiotic approach to covering all Americans that will probably work if our politicians ever give up on the power grab going on today and do what’s best for the people of this country.

    Mike McBride

  8. Dave Schuler says:

    Somewhat tangentially referred to in the previous comment, but I’ll state it explicitly: there’s a very high chance that increasing the supply of doctors would result in more medicine being practiced, and not necessarily at a lower price. People don’t have, nor have they ever had, enough ability to be able to tell when a doctor is recommending something necessary or something optional which might help in 1 out of 100 patients but will definitely help 100 out of 100 doctors.

    I think that’s probably right if we increase the number of doctors being graduated by 10%. I’m not sure it’s as true if we increase the number of doctors being graduated by 100%.

    Plus there are more ways of increasing the supply of healthcare than increasing the number of doctors.

    However, if anyone can come up with a way of restraining the trajectory of healthcare expenses with neither fiat pricing nor an increase in the supply of healthcare while increasing the demand for healthcare, I’m all ears.

  9. Michael says:

    However, if anyone can come up with a way of restraining the trajectory of healthcare expenses with neither fiat pricing nor an increase in the supply of healthcare while increasing the demand for healthcare, I’m all ears.

    Why must we increase the demand for healthcare? More specifically, why must we increase the demand for healthcare providers?

    As underground pointed out, sometimes being an informed patient is better medicine that 100 doctors. If we can increase the general medical knowledge of the average citizen by 100%, that would do more for our system than increasing the number of doctors by 100%.

    How about adding basic medical skills to the list of life-skills classes taught in High School? I learned CPR in High School, but not the difference between allergies and a sinus infection, or the common cold. How many people will see their doctor today, only to be told it’s just allergies? How many will have a common cold, and will get put on antibiotics anyway, even though they are useless for a cold?