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    Health care cost crisis - how about some comparison shopping?

    Our own Orlando yesterday posted an unbelievably tragic story regarding her mother and how our health care system completely failed her and her family. It's a powerful tale, one whose basic premise unfortunately could probably be told by way too many people in this country, and everyone needs to read it.

    But trying to put aside the raw emotions for a moment - albeit, a nearly impossible task when discussing people's health and/or finances - this is a crisis where the answers will not come easy.

    Make no mistake, at an expected 17-18% of this year's GDP (highest in the nation and up from 7% in 1970), health care is an issue that needs to be solved ASAP, esp. in light of our deficits and other economic problems, but it's not just about creating a public option. That needs to happen, but without other reform, it won't do anything to solve the crisis.

    If anything, a public option by itself could exacerbate the main problem, which is that costs are spiraling out of control, and to do that, we have to know the reason why the sector continues to see rising costs when most other sectors in the economy are seeing deflation.

    Is it a problem with supply - too few doctors, hospitals and resources, and should we loosen up the rules that regulate the provisioning of services? Do all the layers of bureaucracy and regulation add a heavy burden of costs on treatments that would otherwise be much cheaper? Is it because our patent system - and the people who complain about price control have to realize that patents are not the perfect example of free markets at work - allows drug manufacturers to gauge people with no alternatives for too much and too long?

    Is it demand - do we use the system too much, too frivolously - and do we do that because doctors push unnecessary tests on us, or because they and we don't enough focus on prevention, or are we just too unhealthy.

    One relatively simple thing that I would love to see done is to increase the transparency of information within the health care system. Think about the process of how you now buy a TV. The resources you have at your fingertips are so immense. You can compare prices, check out warranty policies, read reviews, and go basically anywhere to get the best deal possible. Is it any wonder that prices for TVs fall significantly every year?

    Now think of the process you go through when you want to buy health care services. You probably pick a doctor close to where you live who's in your HMO network. You may be able to find out which college your doctor went to and her age but that's about the extent of the info you have, unless you have a rec from a friend or family member.

    And when it comes time to treatment, for the most part, you do whatever the doctor tells you to do. Second opinions or comparison shopping are basically non-existent. Adequate information is rarely given.

    I'd love to see HMOs use the power of the Web to give people a lot more information about doctors, including allowing/encouraging patients to post reviews and being a lot more transparent about prices and policies.

    The problem isn't really about when you have an obvious - or what should be an obvious - issue like Orlando had with her mother - clearly, the failure to correctly diagnose was a disaster and I believe we have an obligation as a society to treat patients like her without forcing families to eat up their entire savings.

    That treatment may be costly, but my guess is that the core structural issue of upward spiraling costs lies more with relatively healthy people who use and abuse the health care system. Because the way the system now works, we rarely even think about the cost of services being performed on us. If we did, and we were forced to pay those costs out-of-pocket, we may think twice about what we were doing, or would at least do a little comparison shopping before we agreed on the proper course of treatment.

    And doctors certainly don't think about minimizing the costs or maximizing the efficiency of treatment, and if anything, are sometimes perversely encouraged to administer more expensive tests or prescribe more costly medication.

    A recent fascinating article in the New Yorker that focused on the costliest city in America in terms of health care dollars spent per capita - someplace in Texas, I don't remember the name - suggests the system is broken because of the way doctors get compensated, notably how they are encouraged to perform unhelpful tests to maximize their income. Rationing sounds heartless but may be necessary.

    Frankly, I don't understand all the complexities of the system, or have a real clear sense how to fix the crisis - the idea that comparison shopping will be a panacea is laughable, I know. But I do hope something dramatic is tried. In this case, the devil we don't know can't be worse than the devil we do know. The devil we know is leading this country to its financial ruin.

    Unfortunately, so many powerful interests are doing quite well under the current system, thank you very much, and are thus uniformly aligned against real, significant change that I am very doubtful that anything of significance gets accomplished.

    It's really depressing to see this same old movie get played out over and over again.


    Just found a link to one progressive organization with some interesting ideas on how to contain costs and increase efficiencies in the health care industry - and it appears I am wrong - chronic diseases like the Alzheimer's Orlando's mother suffered from do make up the lion's share of the costs (although clearly Alzheimer's does not - yet - fall into the category of a prventable disease).

    And what's clear is that any comprehensive discussion of reforming our health care system must include Medicaid and Medicare reform.

    How to Cut Costs? Efficiency and Prevention

    6: Factor by which administrative costs of the U.S. health care system are higher on a per-person basis than costs in comparable nations.

    $100 billion: System-wide savings that could result every year from harnessing information technology like personal electronic health records and electronic prescribing.

    $65 billion to $130 billion: Estimated economic value the United States could gain in better health outcomes if all Americans had health coverage.

    75: Percentage of health care costs that result from chronic diseases, many of which are preventable or can be treated before people are very sick.

    1-3: Percentage of our health dollars spent on prevention.

    $1 billion: Annual amount that could be saved by providing flu vaccines to all elderly Americans.

    $1 trillion: Amount that could be saved in Medicare spending over 25 years if our national obesity level returned to 1980s obesity rates.

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