Wednesday, December 03, 2008

Why We are Losing Our Edge

Here's the bottom line:
The United States today devotes 16 percent of its gross domestic product to medical care, more per capita than any other nation in the world. Yet numerous measures indicate the country lags in overall health: It ranks 29th in infant mortality, 48th in life expectancy and 19th out of 19 industrialized nations in preventable deaths.

You can paint it blue with pink polka dots and you can call it socialism or even communism but the reality is that we are being screwed by our lack of a progressive health care system. Our current system costs more and treats less than comparable systems worldwide, and as a result America is less competitive and much less healthy.

"Our health-care system is fraught with waste," says Gary Kaplan, chairman of Seattle's cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he says.

Not only is American health care inefficient and wasteful, says Kaiser Permanente chief executive George Halvorson, much of it is dangerous.

Those harsh assessments illustrate the enormousness of the challenge that awaits President-elect Barack Obama, who campaigned on the promise to trim the average American family's health-care bill by $2,500 a year. Delivering on that pledge will not be easy, particularly at a time when the economic picture continues to worsen.

Read that last sentence one more time and then ask yourself why, if over half our costs are wasted wouldn't delivering on the pledge to reduce our costs merely be as simple as removing the waste in the system? It is not like we are blazing a path in the wilderness with the idea. You can see working models in every other industrialized nation in the world. They have a working system, why can't we? Here's an example of why we are only getting 50 cents on the dollar when it comes to health care in America, it shows you where that huge amount of money goes that doesn't improve our health care - into drug and insurance company pockets:

The study cost $130,000,000 and included 42,000 patients. It compared the effectiveness of four types of blood pressure drugs: a calcium channel blocker, an alpha blocker, an ACE inhibitor, and a simple diuretic. The diuretic performed best. It was the sort of finding worthy of celebration. Health costs are too high, and rising too quick. Our flabby society gets bad readings when it straps on the blood pressure cuff, and soon enough we'll all be on these drugs. And here were study results saying that the diuretic, a generic drug which sells for pennies, outperformed its pricey, patented competitors. So what happened? Not a whole lot [...]

Diuretics sales jumped, but only by a few percentage points. "[They] should have more than doubled," says Curt Furberg, who chaired the study. And in a world where doctors prescribe medications based on a simple reading of the latest evidence, maybe they would have doubled. But we don't live in that world. We live in a world where pharmaceutical companies have big budgets and sophisticated public relations teams. Pfizer, for instance, put up $40 million to ensure that their Cardura, their alpha blocker, was included in the study. That proved a mistake. Patients on Cardura were more than twice as likely to require hospitalization for heart failure [...]

The basic reality was this: The pharmaceutical companies had a skilled team and a lot of money promoting their drugs. No one was promoting the generic diuretics. Folks looking to things like comparative effectiveness review to save the health care system should take the story seriously. Evidence is only effective if physicians use it. And right now, they have no real reason to use it. Even in a system this expensive, there's no internal incentives to aggressively cut costs. Maybe it's time there were. If doctors were paid by capitation -- if they got a fixed amount of money per patient, and they kept whatever they didn't use, as happens in England -- it's hard to imagine they wouldn't have been more interested in these study results.

So, let's say this one more time - the best answer for the American health care system is to remove the profit incentive that drives all this waste. Drug companies and insurers spend less on care and more on administrative and public relations costs because that's where the profit is. The raw reality is that they have absolutely no incentive to deliver better care, and the sad part is that they make less profit when they do. The ugly truth is that until profit can be completely removed from the system, there will not be meaningful progress on health care. We progressive pinko commie socialist hippies are constantly being told that single payer just isn't politically viable, and meaningful discussion is driven into the ditch and everybody then starts talking about removing waste and improving "efficiency" which is just double talk around the real issue which is "fat cats getting fatter making money off of our need for medical care."

The lack of a single payer health system in this country, like that in the rest of the civilized countries in the world, is possibly the biggest issue facing this country. It is part of the problem surrounding the auto industry. It is part of the problem on why we can't compete with other nations industrially. It is a huge part of why a large part of our population is going to bed hungry at night. It is part of the reason 50 million or more American children are not getting a fair chance at growing up healthy and able to compete on a level field with others. It is huge contributor to most of what ails our nation today. We need it fixed and fixed now.

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