Tuesday, June 16, 2009

Health Care Dollars Dilemma

What kind of health care system we may have.

Health care dollar costs rhetoric heats up presenting a dilemma for some. Increasingly articles on the topic are published such as this recent one “The Cost Conundrum” by Aatul Gawande in the June 1st New Yorker. Thanks to Bob Frank who infrequently writes at “Eclectic World” for bringing it to my attention. The article is lengthy but filled with specifics and an overall view of the attitudes and influences that are being brought to bear on health care quality and costs in America today. The author cautions what kind of health care system we may have. Your time will be well spent reading Mr. Gawande’s article as he describes what specific towns can “…teach us about health care.”

Mr. Gawande begins by investigating health services in a certain Texas community he describes as being “…one of the most expensive health-care markets in the country.” He provides the dollar figures Medicare spent there in 2006 as being “…fifteen thousand dollars per enrollee…almost twice the national average.” Another well known Texas city spends half as much. What could account for this difference? You might be surprised what he learned.

Mayo Clinic in Grand Junction, Colorado, operations are also presented where he reports medical problems went down and quality went up. He adds, “…costs ended up lower than just about anywhere else in the United States.” He names communities from Danville, Pennsylvania through Wisconsin, Salt Lake City to Northern California utilizing similar operational approaches as Mayo who demonstrate comparable results.

Arguments from both the expensive and the least expensive systems proponents are not immune to the negative features of each approach their opponents cite. Both supporting groups agree we all want quality care and at the lowest cost especially knowing that overall we have runaway health care costs whose payment we cannot sustain. But what kind of system do we want? How do we get that system and are there sacrifices?

Our present mishmash of public and private medical insurance systems while trying to deliver quality care to meet patients needs is also being expected to maximize the individual provider’s reimbursement rate, Mr. Gawande writes. I’ve certainly experienced and been aware of some of the pressures that can be brought to bear in that regard. There can be a bit of a conflict between providing quality health care and income generation for some. Restrictions are instituted, corners are cut. I want to stress that many in the medical and related professions have resisted all that as have I.

I remember only too well years ago when service cuts were being made. Medical practitioners were admonished to refocus from merely providing quality care to additionally focus on the financial aspects of their work to augment declining income. Insurers and practitioners honed those business skills. Some business people took over medical groups dictating their own orientation. Medical people did become business people, too, with varying priorities in the quality/financial arena.

Mr. Gawande’s article illustrates various aspects of combining desired quality health care with a business orientation. He contends a team approach for quality care and revenue generating such as the Mayo Clinic’s system is more likely to provide us a viable health care plan.

Health care’s providers as well as consumers – that’s us – must adjust our thinking to realities Gwande documents including the whole idea that “more is better.” Seems in medical care as well as other areas of life that concept is not necessarily true. Maybe, we should all keep in mind seeking all the medical tests or procedures known to be available for any given problem is not always the better part of wisdom.

Doctors order most tests because they need to know the results which will effect a patient’s treatment. That's certainly why I recommend some procedures and medical consults. Physicians are also often pressured by patients and/or family members to provide tests for personal reassurance. Also, like it or not, given this sue happy society in which we live, the wise medical practitioner may need the occasional documenting test to justify his or her actions when treating unclear ever-changing medical complications, especially when coping with contentious individuals.

Mr. Gawande examines a broader picture here relative to just what kind of health care system we want. He views the issues as far more critical than whether or not we have a single-payer system, a public-insurance option or the mix of private and public as we have now. To best understand the stakes he describes you must read his article. His account is very readable, revealing the thought processes at work with the health care doctors and administrators he describes as presenting representative attitudes prevailing throughout the medical world in our country.

Many of us have spoken out loudly and clearly that a single-payer system is desired. Some have cited systems such as exist in Canada and Great Britain as models. I can endorse those models only if the major weaknesses of those systems are corrected in any such system we might adopt here:
1. provision for timely delivery of services,
2. provision for only specified short term duration treatment waits for a special group of medical diagnoses not directly life-threatening.

I definitely want our nation to have a system in which everyone receives health care. I also think functional sensory or augmentative systems are essential basic needs for each individual. What that means is:
1. people need dental care, teeth (artificial or otherwise) so they can eat and talk intelligibly.
2. people need vision care, glasses so they can see.
3. people vitally need to be able to hear, aids if they choose, so they can understand.

Augmentative communication systems are vital for many that are not always readily available.

We need to closely track what our current leaders are doing relative to the insurance system adopted for us. We definitely must have some action. Frankly, I believe we all deserve an insurance system at least as good as what we provide our Congressional Representatives and Senators. They’re all better equipped financially to pay for their own insurance and medical bills if they had to than most of us. Given their failure for so many years to resolve our health care system problem we cannot avoid the truth before us that they just aren’t performing well in their jobs. Now is the time to hold their feet to the flame on the health care system issue.

We won’t be remiss if we communicate our views by whatever means is at our disposal to those we’ve placed in office to carry out our wishes.


  1. Frankly, I believe we all deserve an insurance system at least as good as what we provide our Congressional Representatives and Senators.

    Here, here!

    Fire up that charcoal grill, dear, feet are on the menu!

  2. Thanks for the summary, Joared. I agree that more health care is not necessarily better. It may not even be "as good".

    My advice to anyone for whom testing is advised is this: Ask what you and/or the health care provider will do differently for knowing the results of the test. Only when we know the answer to this question can we be said to be making an informed decision on whether we should have the test or not.
    Cop Car

  3. Thank you for writing this important post. I read the article and had intended to do a post on it, but yours is so much better than I could have done. We need more that just a single payer system; we need reform on how doctors are paid. The Mayo Clinic offers an excellent example of hot it can be done right.

  4. Wasn't that article fascinating?
    I like what you say about how people need attention to their tetth, vision, and hearing. Your readers might be interested to know that cheap hearing aids work just fine for most age-related hearing loss.It's analogous to reading glasses.

  5. Joanred, This post ought to be on TGB blog. We have much to learn from your thinking plus your closeness to healthcare systems.

    In addition to alerting our views to those representing us, we need advocacy groups to start looking at the parts as you have.

    I've been saying for a long time that there's no need for a visit to my doctor every three months when it's really about keeping his practice going. So, I've been stretching out the time between visits: I'm a "well" old lady.

  6. Pattie: I just don't understand why our "folks in D.C." aren't championing for us the same insurance coverage as they have. Think some have tried to do right by us and we need to know who they are and give them credit.

    Cop Car: Excellent question to be asking in a proposed testing situation.

    Darlene: By all means write on the New Yorker article. There was so much content you could probably zero in on some pertinent specific aspects to which I merely alluded. I think your perspective would definitely be of interest.

    Hattie: What you say about seeking inexpensive glasses with magnifying type lenses and simple hearing aid amplification of sound can be successful for some of us. I do recommend a medical visual check and certified audiologist hearing test to rule out any possible medical problems. I've been lucky I could buy inexpensive magnifying glasses and so far, haven't needed sound amplification for hearing.

    Naomi: I agree about advocacy groups to closely examine the specifics of what health plan is proposed. Some of what I want might have to be added later in order to just get a plan through. But,I do get antsy that anything not included from the beginning might never be.

    Maybe another question we should ask our doctors is why they need to see us at the frequency they specify. The frequency my Doctor requests to see me has varied from year to year and with the nature of my ailments/treatments.

  7. I hear everyone on the frequency of medical visit requirements, and agree that it is an issue. I saw the same dentist for nearly 25 years, 9 of which I lived in other states. I told him that I would see him when I could and when I needed - not when his boat payments were due! He retired and it took me a while to settle on another dentist; but, I told her up front that there would be no routine x-rays or routine appointments. Both of them were/have been great about it!

    Eye appointments are a different thing. I do try to see the eye doc every 12-18 months. Right now, I'm creeping up on cataract surgery. The left eye was ready the last time I saw Doc - 14 months ago. He advised that I wait a couple of years to allow the right eye to be completely ready, and do them both relatively at the same time; although he said that I could have had the right eye done 14 months ago.

    The internist asks that I come in annually, unless I've seen her for something else (such as poison ivy) in between - at which time she resets the clock. She has the pharmacist from whom I buy the statin drugs alert me as to when it is time to come in. She keeps track of my liver function, that way.

    Each of us differs and should set up a schedule (or no schedule) as suits our own health and anxiety level.
    Cop Car

  8. Cop Car: Agree each of us needs our own schedule based on our particular health needs. This is a good topic for further discussion.

  9. thanks for this. i especially like you stressing the basic needs--dental, vision, hearing--must be covered for all.

  10. m.e.: Yes, meeting these sensory needs is SO important. The years I've spent working with children, but primarily from youth through all other adult ages has shown me just how vital basic sensory needs and being able to communicate is to quality of life and functional daily living.

  11. Yes, Congress has to tackle this now, during Obama administration. Your post holds a good summary for letters to our reps. Thanks.

  12. Joared, you make a hell of a case! I agree with others here, this is an informed and impassioned perspective that needs to be heard by all. I was amazed and gratified by how well a decent system works when I was in Australia. The care, timing, medical technology, and rare litigation covered me for two years. Why a nation would resist a reasonable health care system is insane. Send your post to Congress and the White House. You go, girl!