A thoughtful notion is making the rounds.  The idea is that doctors should share information with patients that would let the patients participate in decisions in a meaningful way.  That sounds like a terrific idea.

The risks with that are that surgery-happy doctors will provide surgery-biased information to patients.

Let me give an example of that in the following hypothetical dialogue.

Doctor:  You’re experiencing chest pain caused by a partially blocked artery.

Patient: That sounds scary.  What should we do?

Doctor:  We can do watchful waiting, but I cannot guarantee you won’t have a heart attack soon, one that could be lethal.  Or, I can put a stent in the blocked artery.  A stent would open up the artery and may prevent a life-threatening heart attack.  Do you want me to try to prevent a life-threatening heart attack?  Or, do you want us to wait, take some pills, and see what happens?  I cannot guarantee you won’t die if you choose to wait.  No guarantee at all.

Patient:  How soon I can have my potentially life-saving stent?  Today?  Now?

As we move the direction of shared decision making, let me propose a few measurements of success:

1.  A 50% drop in heart bypass surgery.
2.  A 50% drop in spinal fusion surgery.
3.  A 50% drop in stents.
4.  A huge drop in CT scans, over a 50% drop.

For shared decision making to be successful, the doctor will need to provide unbiased, objective, and up-to-date information in a way that the average person with a 10th grade education would understand.

Christopher Weaver wrote a good article in the WSJ called Agonizing Choices for Heart Patients.  It is a story about faulty defibrillator implant leads failing and even leading to patient deaths.  Some informed patients are choosing to have these implants removed.  To read the full article click here.

As regular readers of Cracking Health Costs know, this is yet another in a long string of extremely expensive health care mess ups.  My question is where is the accountability for these things?

How do you know if you can trust your doctor to do the right thing for you? To give you objective and informed advice?

About one-third of all health care costs in the US are for hospital charges.  IF we are going to get a grip on runaway health care costs something has to give with hospital charges.

It’s fascinating that we have fewer hospital admissions per thousand than some of our peer countries but the cost per admission in the US is extreme.

A site promoting a new book called “AmericanHealth Scare” by Richard young, M.D., provides a list of why our hospital charges are so high.

Here is a quote:

• Too much spent on marble counter tops and gold swan faucets
• Too much spent on layers of administration
• Too much spent on technology…[cardiology suites, gamma knives, etc]
• Too many people running around filling out Joint Commission reports

Here is a link to the site where you can see the full list and view some fascinating comaparative charts.

Some organizations are ballyhooing health-reform-induced cuts in health insurance to the tune of $1 Billion per year.  That’s about $3 per person per year, which means the average American could buy an extra bagel once a year.

If we were able to rid the system of wasteful health care spending we could save about $600-800 Billion per annum…or about $2,000.00 per person per year.  That means the average American can save money for their kids’ college expenses.

The choice is clear.  Buy a bagel or save for college?  Let’s get real.

“Somewhere in the near future, a lot of people are going to be standing around asking ‘what happened with U.S. healthcare?’ And there are going to be a lot of people standing around with dumbfounded expressions on their faces because they had no vision of the road ahead”…so reads the opening lines of a post on Chris Gregory’s blog.

Chris combines a good sense of humor with irony, pathos, and a keen eye for seeing around corners.

To read the rest of this post click here. 

Discussions about covering “pre-existing” health conditions occur frequently among health policy people. One frequent thread is that health insurers should not be allowed to deny coverage to people with pre-existing health condition. After all, aren’t those the people who need health insurance the most?  Sounds reasonable, doesn’t it?  Problem is that proposition is really not reasonable.

Let me explain.  For any kind of insurance to work right, the “contingent event” can not have already happened before you buy it.  In life insurance, the contingent event is the death of the policyholder.  You can’t buy life “insurance” on someone who has already died.  For homeowners insurance, you can’t buy fire insurance after the home has burned.

Same for auto insurance.  Imagine a scenario in which you could wreck your car and then buy auto insurance to cover it.  I for one would drop my auto policy on the spot.  You probably would too.

In health insurance, the contingent event is a significant covered illness.  When a health insurance policy is forced to cover people who have “incurred” a covered disease, whatever it is, it’s not insurance.

What is it then?  Remember health insurance is a pool of policyholders run by a carrier which may or may not make profit.  If that insurance pool covers people who have incurred significant health problems prior to joining the pool, for whatever reason, it stops being insurance and becomes a wealth transfer from the other policyholders…a wealth transfer plain and simple, but not insurance.

This is the true reason that we can never quite come up with a good way to pay for care for the uninsured who have costly health problems in an insurance context.  When we want health insurance to cover people with pre-existing conditions, the proper thing to suggest is to stop providing insurance and replace it with some kind of wealth transfer mechanism.

Additionally, letting people buy insurance after they’ve become sick leads to what economists call moral hazard.  Some people who would otherwise have purchased health insurance will then wait until they’ve become sick to do so, thereby driving up premium costs and creating a destructive adverse selection loop.

Of course if everyone was forced to join a health insurance plan, this issue would disappear.

There are good people who have lost their health insurance and can’t qualify to buy a health policy. We need a solution. But let’s start calling it what it is. We’ll make better progress if we do.

Regular readers of Cracking Health Costs will know that there is an overabundance of redundant and unnecessary health care being provided today.  Much is not only unnecessary but outright harmful to patients.

Brian Klepper’s site, Care and Cost, has a great article in which this is discussed and which contains good discussions of solutions. It is entitled, “Dr. Cassel Sets Out The Mission of the Choosing Wisely Initiative.”  Click here to read the full article.

In that article, the author, Christine K. Cassel, says that she thinks it “…is more important that we focus on the causes of that waste—namely overused tests and procedures that are not supported by evidence and don’t improve patient outcomes.”

Further she says, “As trusted voices in our health care system, it is [doctors'] responsibility to our patients to make sure they get only the care they need and that from which they will benefit.”

I could not agree more.  Too bad there is so much harmful care today.

In recent years a number of medical researchers in the US have been found to have biases.

Americans assume that if the FDA approves a drug, that drug will do no harm.  Unfortunately there have been too many instances in which that proposition is just untrue.

The WSJ published an article today by Gautam Naik which sheds light on this problem.  The article is called “Analytical Trend Troubles Scientists”.  Click here to read the full story.

Writes Naik, “A vast array of claims made in medicine, public health and nutrition are based
on observational studies, as are those about the environment, climate change and
psychology.”

Observational studies, as opposed to randomized controlled trials, the gold standard of scientific research, are fast, inexpensive, and may be fraught with bias.

Observational studies are at the core of why we see so many conflicting and contradictory reports on subjects like the advantages or disadvantages of taking vitamin E supplements, fish oil pills, butter versus margarine, etc.

” ‘You can troll the data, slicing and dicing it any way you want… a great deal of irresponsible reporting of results is going on,’ ” says  S. Stanley Young of the U.S. National Institute of Statistical Sciences in the article.

Young is correct, too, in saying we see an abundance of poor reporting on these things in the media globally.

I was persuaded to take vitamin E supplements myself for many years based on observational or otherwise bad research, until good research showed vitamin E supplements in certain quantities over time increased users’ death rates.  How’s that for a switch?

Best advice:  Caveat emptor.

This scam involved 107 doctors, nurses, and other health workers who had bagged about $452 million.  Kudos again to the Obama administration for getting serious about health fraud.

IF THEY ARE DEFRAUDING MEDICARE LIKE THIS THEY ARE PROBABLY DEFRAUDING YOUR PLAN TOO.  It’s time for benefit managers to get scam artists like this kicked out of your networks.

To read a WSJ article on this click here.

A huge amount of attention has been paid to insurance company loss ratios and how health insurance company profits and expenses are just too high in the eyes of policy people and regulators. (I’m so not sure I agree with this, by the way.  Why?  The fact is, in the last 30 years over a thousand health insurers have gone broke or abandoned the market, none because it was making too much money. A few examples of carriers that abandoned health insurance are Metropolitan, Hartford, Prudential, Mutual of Omaha, Equitable, and New York Life.)

Nevertheless, let’s take an objective look at just how big the problem really is.

Brian Klepper’s Care and Cost site posted an article by Robert Laszewski explaining the facts.  Let’s just say all the attention to this topic is just fiddling while Rome burns.

To quote Mr. Laszewski, the attention to this issue “saves consumers $1.3 billion!!!!”

This may save consumers an average of about 1.5% of premiums yet health costs are expected to rise an average of 6-6.5% next year, according to the article….again, fiddling while Rome burns.

Will it drive yet more insurers to abandoning health insurance? That remains to be seen.

The real problems with health care in the US remain waste, over-treatment, over-diagnosing, errors in diagnoses, poor coordination between specialists, overuse of CT scans, preventable patient deaths, etc., etc.  My vote is let’s tell politicians to stop fiddling around and get down to real business.

Hospital spending for newer and better equipment can be constructive or destructive.  The destructive part occurs when hospitals race to buy bigger, better, and shinier equipment when the need for such goodies doesn’t exist.  Build it and they will come is the philosophy.  It often works by leading to more redundant testing, “over-diagnosing”, and “over-treatment”.

Michael Booth wrote a good article, with the headlines above, in the Denver Post about a battle for patients in Colorado.  To quote, “The fierce battle for patients between Poudre Valley Health System and Banner Health is a glorious competition for quality and convenience across northern Colorado. Or it stands for all that is wrong with the careening spending in the U.S. health system.”

Click here to read to full article.

My bet is you’ll vote with the careening health care spending point of view.