Two Years On: Obamacare

Interesting article in today's NYT about Doctor's panels saying that many medical tests are unnecessary and account for 1/3 of our overall health care expenses.

http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html?_r=1&hp

 

No question this is true. Two reasons it happens: (1) CYA by doctors from malpractice suits; (2) Doctors getting paid flat fees by insurance companies for certain tests, so it's a for-profit scheme. I think this has been curbed in some ways. Can't remember.

Man, there's a name for the CYA purpose, and I can't remember what it is. Something like "protective tests," but that's not exactly it.

 

I was reminded of that Atul Gawande article in The New Yorker that talked about the unnecessary tests for Medicaid and Medicare patients. He showed that different areas of the country had much hire rates of tests than others.

 

Don't forget the doctors who perform amputations to collect the reimbursements from the government.

 

No need for all the test. Just give grandma a pain pill.

 

[L]et's take the example of something like diabetes, one of --- a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed.

...

End-of-life care is one of the most difficult sets of decisions that we're going to have to make. But understand that those decisions are already being made in one way or another. If they're not being made under Medicare and Medicaid, they're being made by private insurers. At least we can let doctors know and your mom know that, you know what, maybe this isn't going to help. Maybe you're better off, uhhh, not having the surgery but taking, uh, the painkiller.

 

What is your argument against end-of-life care?

Lots of evidence that experimental treatments and such actually shorten life compared to comfort care at that point.

 

The number of tests do drive up costs, and a lot of them are done for CYA purposes.

But, people are going to like the fix to the problem -- less tests, less care -- a lot more than the problem.

I'm not even saying it's wrong, but people are going to freak out when they learn what it's going to take to lessen health care costs.

Getting healthy 20 somethings to purchase health insurance isn't going to cut it.

We want it all.

 

Some good studies have been done with medicaid patients, comparing costs in various area's of the country to the quality/ outcome of care. They showed that some of areas with highest rate of testing had the poorest results and areas with lowest rate of tests and procedures had much better results.

 

One of the primary factors is likely to be that the same breast cancer case would be detected earlier in the U.S. than in the U.K., thereby starting the clock on the five-year period much earlier. The actual outcomes may well not differ much, and what difference there is may well be negated by the additional time spent undergoing invasive and painful treatment. (And no, I don't have specifics. Just a theory.)

I'll never for a minute claim that the NHS is perfect, and its cancer figures are not among its best qualities (though they are steadily improving, an improvement I expect to be derailed by the Tory party's shameful obsession with being MORE like the U.S.).

But you know what else I know about the NHS? I know for damn sure that this would never have happened: http://drjengunter.wordpress.com/2012/03/28/cancer-v-the-constitution/