14 July 2009

A good read on health care

The conversation is heating up on health care reform. We'll be hearing lots of industry jargon in the next few months, especially about the so-called "public option." It will be difficult to stay on top of it all.

This recent article from the New Yorker is a good primer on how soaring health care costs are at the heart of the debate. The author, Atul Gawande, suggests that providers have undergone a subtle shift in the past 20 years, one that has created an environment of overuse. Unfortunately, more tests and more surgical procedures haven't produced better results, Gawande argues. They do make providers more profitable. And they drive up costs for insurers, consumers and the governmenet.

Doctors and hospitals, among others, disagree. Take a look and decide for yourself. Because a key point Gawande makes is that a lot of these high costs are local; they vary from one area to another based on the philosophy of the local system of providers. It made me wonder what the costs might look like if someone crunched numbers for York County the way Gawande did for the two towns in Texas in the article.

Are we more or less profit driven here? What would your guess be?

Update, 11:41 a.m. July 15: The U.S. House introduced comprehensive health care reform legislation this morning. Here's an analysis of the bill from the Congressional Budget Office. I'd love to hear somebody in the health care business take a whack at explaining the good and bad of this.

- Dan Fink


Deron Schriver said...

Overutilization of healthcare services is one of the biggest cost drivers, but it has many causes beyond just profit motives. Defensive medicine (fear of lawsuits), lack of adherence to evidence-based treatment guidelines, and patient pressures all play a role too.

While it would be hard to argue that there isn't at least some profit-driven medicine in York, I don't get the sense that it's as pervasive as places like McAllen, TX. It would be interesting to see what the average cost per Medicare beneficiary is in York County.

YorkCounts said...

Good points on other factors. And on the Medicare question, that seems like it might make for a good YorkCounts Indicator - on the assumption that the figure would be one measure of the cost of health care in York County. I wonder how readily available - that is, would it be free - the data would be.

Deron S. said...

Dan - I'll take a stab at explaining the good and the bad. The bill really isn't health care reform. It's health care financing reform. Changing who pays for care will not reduce costs to the extent that we need it.

We need to change the way care is delivered and how (as opposed to who) it is paid for.

One of the good parts is the allocation of funding to wellness and prevention. Our obesity rate continues to rise and it's leading to a whole host of chronic conditions throughout the population. The latest figures I have show that obesity costs us $300 billion per year. That figure is actually from 2006. I'll bet it's pushing $400 billion by now.

I don't feel we should be spending $100s of billions to $1 trillion on an already expensive healthcare system. We need to get rid of the waste in the system and use that savings to pay for universal coverage.