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Subscribe to RSSIf banking were like health care, it would take days to get money out of an ATM because the records would be lost. If airlines were like health care, pilots would decide on their own which safety checks to make, if any. If shopping were like health care -- well, you get the picture.
It’s a mess, the Institute of Medicine says in a report released on Thursday. The U.S. health care system wasted $750 billion in 2009, about 30 percent of all health spending, on unnecessary services, excessive administrative costs, fraud, and other problems. As many as 75,000 people who died in 2005 would have lived if they got the kind of care provided in the states with the best medical systems, the Institute found.
The report, issued just as candidates for Congress and for president make health care reform a central part of the national debate, doesn’t pull any punches. The panel of experts assembled by the Institute, an independent body that is supposed to provide a non-partisan last word on important issues, leaves no doubt that U.S. health care now is anything but the best in the world.
"The threats to Americans' health and economic security are clear and compelling, and it's time to get all hands on deck," says Mark Smith, president and CEO of the California HealthCare Foundation in Oakland and chairman of the panel.
"Our health care system lags in its ability to adapt, affordably meet patients' needs, and consistently achieve better outcomes."
But there's hope. "We have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning health care system that will provide higher quality and greater value," Smith says.
“What I am seeing around the country is that people are absolutely committed to reform,” says James Conway of the Harvard School of Public Health and the Institute for Healthcare Improvement in Massachusetts, who served on the panel.
“Whether you look at the Republican platform or the Democratic platform, you find in pretty strong language the importance of developing a high quality health care system.”
One of the biggest problems is that health insurers, hospitals and health systems don’t learn from their mistakes, the report says. Half of all health care professionals still neglect to wash their hands properly before seeing patients, even though it’s one of the main causes of infections that kill tens of thousands of patients every year.
An organized system that finds out what went wrong and where, and then provides for the health system to correct those mistakes right away would save money and lives. It’s possible in a computerized world, but it’s not happening on a systematic basis. Hospitals that report every single infection and ruthlessly track down where it came from have found they can cut infection rates to zero, for instance.
Yet just this week the Centers for Disease Control and Prevention reported that a third of Americans have high blood pressure and only half of them have it under control. There are dozens of drugs to treat it, not to mention diet and exercise methods. It took 13 years for one of those drug types, the beta-blockers, to become the standard of care even after they had been clearly demonstrated to work, the report says.
What’s missing, the report says, is coordination. “What I see is people doing a little bit of this and a little bit of that. Everyone has their little initiative. And back at the ranch, the doctor, the individual provider, is drowning in the sea of initiatives,” Conway says. “What is missing is a much more systemic and collective response.”
The report points to two main problems. “One is the increasingly unmanageable complexity of the science of health care. During the past half-century, there has been an explosion of biomedical and clinical knowledge, with even more dazzling clinical capabilities just over the horizon,” the report says. But the current system doesn’t help providers learn this material and it doesn’t give them any incentive to apply it.
“Second is the ever-escalating cost of care, which is widely acknowledged to be wasteful and unsustainable. Unless ways are found to provide more efficient, lower-cost health care, more and more Americans will lose coverage of and access to care.”
Conway praises the Massachusetts health care system, which he says is organized with the patient in mind. The report also says government initiatives, such as the Patient-Centered Outcomes Research Institute (PCORI) and the Center for Medicare & Medicaid Services Innovation Center are good ways to test and apply proven treatments and methods for paying for health care.
“Until we organize the health care system around the people we are privileged to serve, we aren’t going to figure it out,” Conway said. “I don’t think we have done that before -- we haven’t organized it around the person with cancer. That would be a remarkable change.”
Some ways to get there? Let people see what various treatments cost up front. Employers, who cover the health care costs of 55 percent of Americans, can help, too, the report says. They can use their buying power to demand high-quality, high-value health care, and get their employees involved in wellness programs.
So what would happen if shopping were like U.S. health care? "Product prices would not be posted, and the price charged would vary widely within the same store, depending on the source of payment,” the report says.
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The problem with health care is it is a program with no goal. Just fix problems as they come up. This leads to uneeded expensive fixes for things that could have been prevented. we need a national HMO that focus on keeping people healthy. Physicals, preventitve meds, accidents, surgeries with 80% or better success rates and end of life care (hospice not expensive treatments). These could all be provided and paid for by a deduction off of your pay. Get businesses out of the equation entirely. I am an engineer not a doctor yet I decide what is good insurance for my employees? That is the blind leading the blinder. The government should cover the basics at no point of service charge (single payer system would work for simple services). if people want more than they could go to the private insurance market
There are far too many hidden costs in healthcare. Nobody walks into a medical facility with any clue as to what their services cost. The US healthcare industry take advantage of this fact, knowing they can charge you whatever they want after the care has been delivered.
When I get my car repaired, the repairman opens a book and tells me how many hours of labor are required to complete the job. They cannot charge more than that. The same principle should apply to healthcare. Some will whine that the level of care will suffer, but it won't. Other countries like Switzerland and Japan do this and they offer fantastic care because it requires healthcare organizations to compete.
Gee, and I thought simply giving health insurance to 30 million entitled people was going to cure everything...
Organization, affordability, communication and accountability, all areas cited as needing reform here are all key components of Obama's health care proposals and all anathema to the conservatives and Republicans who think any attempt at reforms that call for organization and affordability or accountability is the same as government control or socialized medicine. It's the same ridiculous logic that they use for any proposal. It's also amazing how the conservatives and Republicans keep using these reports to harp on Obama's failed promises or policies when the facts are US health care is in a mess and the economy is not growing as fast as it should because the conservatives and Republicans have caused such gridlock and delay with their refusals to compromise or cooperate that the majority of Obama's initiatives that have survived Congress are just now beginning to take effect. Even though the study is non-partisan I guarantee you the proposals most health care experts would suggest to fix the system are ones conservatives and Republicans would automatically label as socialism without even considering them because that's just the way the conservative mindset and today's Republican mindset works.
To blame others is easy, no matter which side of the politics. We should take care of ourself. Why does the government interfere with healthcare, retirement...
Because businesses take advantage of people because they are greedy so you need government regulations. If businesses weren't so greedy we wouldn't need to regulate them. But they are. So we do.
Terry;
Are you speaking from Planet Earth? If not then I should like to travel to that marvelous planet where you live.
Healthcare is not, or should I say should not be, a political object. Healthcare should be standardized, monitored, and the elite should not have better options than the poor. Prisoners receive better healthcare than working citizens with insurance. I blame the insurance companies and the AMA for the riduclous cost of healthcare. As well as our legal system with some of the inane law suits we've allowed people to file and win. I'm not talking about true negligence or incompetence, but the ambulance chasers and claims that were the patients lack of responsibility for their own actions.
Research and development needs to focus on affordability, sustainability, and the government needs to get rid of 75% of the red tape. A few of the posters here sound like if you get sick, you should die, which is not the case at all. Medicine should be practiced by those who truly want to help people, not get rich off of the profession. Greed really comes into play.
Penny;
You sound like a truly wonderful person... I wish that the Earth was populated by people like yourself... Unfortunately, it's not!!
I wish people would do research and think before speaking. The IOM report is full of a lot of crap. some of the statements are ridiculous if you look at the actual research. It's like saying cell phones are found at 90% of accident scenes so cell phones are responsible for 90% of accidents. Stupid!
Medicine is not a mess. Medicine deals with people who are sick. Some who are very sick. If someone falls out of bed and dies on the same admission does that mean they died because they fell out of bed?! Oh, and falling out of bed is counted as a medical error!! That's how the numbers get so high. But restraining people is a huge ordeal in the hospital. So how do you stop someone from getting out of bed and falling? Similar examples abound.
Imagine medicine is like shopping. Someone goes to the store. They want clothes. There are no prices but why do they care they aren't paying (directly). Everyone else is paying. Guess what they want? The Gucci, the Armani, the Cadillac. Why wouldn't they... it doesn't cost them. So the company paying for it then says jeez, we aren't going to pay for all this, the store can charge whatever they want. We will just pay for the mittens and hat. Not the rest of the suit. Simple economics. Have people put money in a savings account and use it on health care. You just watch how frugal they will be. Unfortunately, our beloved (not) congress screwed this up because they can't stand to have a place where untaxed money can reside.
I see patients all day long who demand MRI's for example. 95% of MRI's are unwarranted! If I don't do one they either sue or go elsewhere. Guess what their first question would be if they had to pay. "Do I really need it?" I see 50 un-necessary MRI's a week ordered by physicians who do it as a reflex for defense and patient relations. That's one Dr. in one week. $47,000 PER WEEK in one office.
Then imagine that if the store doesn't give the customer everything they want they could get sued if they miss 1 something in 50,000. Or if the government told them they had to provide certain stuff by regulation or if the store had to have TEAMS of people who's job was not medicine, but risk management. Worrying about regulations, inspections, lawsuits. And you wonder why medicine is so expensive and difficult to follow.
Lawyers, society and the government did this. Medicine works (mostly). It can be fixed but not by people who don't praqctice in the community (the IOM).
Sorry for being verbose but this is a sore spot.
Yup. One of my coworkers lost her husband 2 years ago to pancreatic cancer. After they already knew it was terminal, and he was under hospice care, he demanded a CT scan. His doctor asked why, as all involved already knew his cancer was terminal, and that there was nothing further they could do except to keep him comfortable. "I just want to know where it is." And hey, his insurance covers it, right? Well, no, not exactly - the insurance company does not cover further diagnostics when the patient is under hospice care, as it is assumed all necessary diagnostics already point to the condition being terminal. But, the patient demanded it, and my coworker, whom I love, but I know she can make scenes when she's upset, backed him up on this. So, this guy got an expensive CT scan just to tell him what everybody already knew - he was dying. Somehow or other, the doctor got the insurance company to pay for it. So, everybody with Anthem Blue Cross and Blue Shield got to pay for this completely unnecessary CT.
I'm a nurse, got a patient right now with a brain tumor,which is bleeding, we know that because he gets regular CT scans, NO treatment, there is none. And now his wife wants him to have wants new hearing aides
I worked around health care for 25 yrs. The fraud, incompetence, over billing, etc is incredible. I really like you poor folks who are so tangled in your partisan concepts. You don't have a clue. It makes it so easy to manage/control you by keeping you bickering amongst yourselves like children. The problems in health care run from you own doctor/nurse to the very top. This system is corrupt at every and all levels. The problem is none of us really care. We simply don't want to know which, of course, make us very much a part of the problem.
It is no surprise that it is a mess. My Girlfriend who will be unnamed works for the healthcare field. Under-staffing, cuts in pay, and unethical decisions are now the staple. She is one of the good ones who follows doctors orders to the letter; while her co-workers tip toe around the situations. Obama-care has nothing to do with the system; he enacted it only in recent months and it will take years to fully implement the plan. Greed is the main problem in the health care field. My experience of listening to the daily struggles of my beloved, shows just how bad Capitalism has put money and profit, over the care of people. This directly translates to your future; what we do to our people now, will be done to us, it's that simple. We need to care for ALL Americans; we will be stronger for it. Nobody can complain or come back with witty anecdotal revelry because what I am saying is the truth, we the people, need to actually represent, we the people. Now, I don't want comments of stupidity; I have had too many of those from morons who seem to think being funny is actually doing any good. Controlling my comment with stupidity doesn't work either; I really don't care if you are one voice speaking rubbish about things you know nothing about. We have to act right now and see the healthcare system for what it is...a broken, greedy system, NOT geared for the well being of anyone who needs care. Obama-care seeks to change all of that and I for one don't want to be in a real situation, with my life in the balance, and they decide to not treat me because of money, or over treat me because they want more money. It's about care people...remember that when you are old and grey and your nurses care less about you than the cigarette the want to smoke. We can fix the system so ALL people live happily and healthy.
If you think that healthcare is a mess now, wait until the Affordable care act (Obamacare) is fully implemented. Not only will you have to pay a tax for not having insurance, the cost of insurance will quadruple from the current level.
Obamacare went about sovling the medical problem the wrong way. Instead of going after the Doctors, he should have gone after the real problem, the insurance companies, the medical conglomerates and the illegals that are killing our country
And it will stay a mess because all we are going to get as citizens are the opposing political sides beating the crap out of each other, year after year, and nothing is ever done about it. They all talk a hell of a game, we will still see the same problems years from now.. all because dum and dumber cant agree on jack!
The number one problem with our healthcare system is the profit motive. Even so called non-profits are in the business of making money, and that ultimately leads to higher costs because of the mistakes made by people who are valued more for how cheaply they'll work than what actual skills and abilities they have. My wife is an RN with 20 years experience, about half of that in nurse administration, her employer just hired a new DON over my wife, based solely on money, he was fresh out of a 2 year college with an RN and less than one years actual nursing experience total. He also get's paid 1/3 of what they would have had to pay my wife.
Their first inspection under his watch was horrible, all problems that can be laid directly at his feet.
These comments are entirely non-sensical.
Are you suggesting that all the nurses who worked for the DON suddenly forgot how to pass an inspection when he got there (perhaps they should look for a gas leak) OR that he instructed them to fail (in which case he really was a bad hire). Otherwise how can "all problems" of a failed inspection be laid at his feet? Perhaps the new guy was supposed to do everything himself?
And what does this have to do with profit motive - did his incentives package include bonues inversely proportional to success (in which case I think he's been a success - but I'd really look after your higher-ups)
Why is there no reference or discussion in this article about the current health care legislation going into affect and how that will help or hinder? This article really says nothing other than that the status quo sucks, which we already knew. How is the president's law going to change it, and what can be added to make it better? You would think that would be relevant subject matter.
The problem is everyone and everything is a problem.
Our health care system is still world-class...but Democrats are to blame for why it's not as good as it could be.
--before the failed Medicaid and Medicare programs were instituted, the US ranked higher worldwide and health care cost much less.
250,000 deaths/yr. due to preventable medical error and what do we hear in the media? Tort reform, if anything. How many of the dead were uninsured? Where were the insurance companies of the hospitals and doctors responsible for these preventable deaths? What does it say about a system where a lawsuit has to be filed before an insurance company will respond? And then the settlement is confidential? What does the American Lawyer organization think of all these deaths without representation? In the more than 10 years that I have asked the FBI and state of Nebraska and countless news media and medical universities (including Harvard School of Public Health) to investigate three unnecessary surgeries and a medical fraud scheme, I have yet to see one medical investigator come to my door. This will be yet one more announcement condemning the American healthcare system at the conclusion of a 5 day symposium held at a magnificient 5 star hotel involving grotesquely overpaid and clueless figure heads.
whoever wrote this article is clueless. We have wonderfully accessible healthcare !! Last week we did $50,000 open heart surgery to a man they found in a ditch !! (he was homeless). What other country in the world does that? A $30,000 lung procedure to a welfare drug addicted man. Those of us in the medical field know the problems are all of the above. these problems will all become much worse as baby boomers retire and more people become obese and develop heart disease, diabetes, and cancer. They will blame it on their doctors, their parents, or not having preventative care. Which last time i checked the message is everywhere (diet, exercise, and a healthy lifestyle) but not enough people embrace this. Just looking around i see so many lazy, obese, unhealthy people that i just know they will be future unhealthy, unhappy, and financially strapped people medical treatment needed is overwhelmed by the number of sick, their complexity and money available.
I am a surgeon and oncologist and I can state without any discomfort that the IOM is not an institution to be taken seriously. The IOM, like so many other policy institutes, is about he aggrandizement of its members. To suggest that the US is anything other than the best medical care in the world is patently absurd. But saying we are great and could be greater doesn't lead to research dollars or headlines.
I have lived in Europe and worked in Africa, Europe and the Middle East and if you think there are problems here you have simply to try to get care anywhere else (if you are sick).
The claims of lives that could have been saved from doing things differently is classic Monday morning quarterbacking, and like MMQing there is no way to verify if any of these claims is actually true. Interestingly the converse IS true - "ruthlessly tracking down every infection and source" can not possibly reduce infections to zero - unless you can sterilize every surface - which you can't because some of the surfaces are people (who can't be sterilized -until embalmed anyway).
But perhaps the best insight into the mentality of these folks is the following which I have cut and pasted from the article:
"And back at the ranch, the doctor, the individual provider, is drowning in the sea of initiatives, Conway says. “What is missing is a much more systemic and collective response"
So apparently the solution to too many initiatives is ....more initiatives!! Does it surprise anyone that the press and government love these guys?
Even WHO doesn't recognize the US as the best. We certainly aren't the best. We don't even have the best life expectancy. Being part of the best means being affordable as well.
There are great doctor's all over the world. I've lived outside of the US as well and there are many countries that have far better healthcare than here in the US with doctor's who are much smarter. What I've noticed is many of those fine doctor's in other countries don't care about money as much as US doctors and actually care about the well being of their patients instead of the ....get them in and get them out and bill their insurance... mentality with a lot of US doctors. I can't tell you how many times US doctor's would have their hand on the doorknob while I was asking a question after them only being in the room for 5 minutes.
You're title is great - since the freedom of speech does (apparently) grant you the right to espouse opinions without the support of data. I would love to know how you came to the conclusion that the other doctors are "much smarter" or "cared less about money" (was this a systematicaly applied assessment of their IQ and then an objective look at their philanthropy- or perhaps just an statement of unsupported opinion. I am not knocking other countries physicians (I have multiple international collaborators), but there is a reason that most medical journals of impact are written in English.
If you want to know how your health care team impacts your life you must compare apples to apples. WE have a much more heterogeneous population than almost anyone in the world. We also have epidemic rates of obesity, smoking, drug abuse, inactivity and other problems that impact directly on health care. These problems are largely beyond the control of your doctor - unless you want him/her to tell you what to eat, when, how much what indulgences you can/can not take. If you abdicate all freedom to your doctor (here or elsewhere) you will probably live longer.
I did exactly what you did. State my opinion based on my experience.
Just because you state you're a doctor doesn't make you right.
As a nurse when the article stated, " Reduce all infections to zero," was when I gave up. Just how do you sterilize that nurse from head to toe before she/he walks in the room? Now how do you do that in less that 10 minutes? Cause thats all the time I got for that patient!
And how could I have forgotten....It's time now for another meeting....so we can TALK about infection control!
Well, in that Obama removed 500 billion from Medicare and the scammers spent 750 billion on waste with no one watching the till, I'd say in about a year, your primary care Doctor will be a thing of the past. You'll be a number on the line getting top notch advice from a Physicians Assistant or office clerk. God Bless These United States of America and God Bless Barack Obama and thanks for Obamacare which will certainly be the last nail in your coffin.
The most advanced country in the world.
Take it back.
Healthcare costs have been a problem for the last 25 years. Especially in the late 90's until now. When I had our first child in 1965, our Dr. charged us 100.00 for the delivery. Hospital costs were around 300.00. 5 days! I don't even remember if we had insurance at the time. It was not an issue. My parents, before me did not have Medicare until 1964 or 5, I believe. We were a low income family and the surgeries that my father had before he was on Medicare were paid out of his own pocket. He also died by the time he reached 69, of colon cancer. The research and development of medicine and technology is partly responsible for the cost of our care today. The fraud that is being tracked and eliminated is helping to control some of the ever increasing costs. So when I hear people attacking President Obama for his plan for our healthcare system, I try to remember how far medicine has advanced and all the people who put in long hours taking care of all the people requiring care be it in the Dr. office or in a hospital or in our thousands of nursing homes caring for our elderly. Our children will carry on and make it even better for the American people. God bless America.
WHOOP TE DO... and now a long comes Obama care!!! Ain't life (or soon the lack thereof) getting interesting! Just pray you stay healthy.
Health care in America leaves me questioning the competency of some of those providers. A friend of mine that suffers from diabetes recently developed severe problems after having his medicine changed by the physician that was treating him. He developed complications that resulted in repeated trips to the hospital due to swelling in his limbs and complications with his heart. after repeated blood tests he was diagnosed with congenital heart failure and was sent home under the care of Hospice after being told that he only had a month or two to live. While under the care of Hospice the nurse observed that a medication that had an extremely high sulfur content worsened the symptoms. This was after his having spent weeks at a time in the hospital under a doctors care. The nurse determined that he was having an allergic reaction to the sulfur and took him off of the medication and his condition immediately improved and he is once again starting to walk again and the swelling has disappeared. He still has a way to go toward a full recovery but is steadily improving thanks to the nurse attending him. If not for her the treatment prescribed by the doctors at the hospital who were supposed to have the knowledge and equipment to diagnose him properly would have killed him instead.
This is how health care is supposed to work, doctors diagnose and prescribe, nurses treat and monitor, reporting back to the doctor. An allergic reaction to sulfur is an uncommon complication that would not have infulenced the doctors original decision. What is lost in this story is that there is a reason that the doctor made the change in medication to begin with. They, ( the doctors,) dont just change medications because they had nothing better to do that day. And the hospital nurses more than likely didnt catch it because of their patient load. But the hospice nurse had the time because under home care, there is a reduced patient load. Before one questions the competency of these providers look to see how many patients that they are expected to care for.
I don't think it matters what political party is in control, our president can not fix any of this. I have a mother fighting lung cancer, she never smoked a day in her life. She worked on a farm most of her young life then she worked in a factory until she retired. She was born and raised in this country, raised her family here, bought property, paid taxes, all of the things she was suppose to. My parents both worked hard all their lives and never applied for government assistance. They raised 4 kids of their own and quite a few that belonged to other people that didn't have time for them. My mother deserves the best health care possible, but she is on medicare...we are having to change her Dr because of the way the company that took over is doing the billing now for her chemo, she can no longer afford her portion. I think this is wrong, no elderly person that has been here all their life & worked & paid taxes should have to suffer because of our crappy medical system.
We need a single payer system, or set up the system like Taiwan, Canada, or South Korea. All of these countrys have a system for all their people not just the rich. France, Germany, England have good systems and all we can do here is have teabaggers scream socialism. We need to have the rich pay a propper share of thier taxes and have the funding for schools increased, elementary to university.
I agree whole heartedly, but, the second you mention the words "single payer" you are automatically a commie or socialist. This clearly reflects on how pathetically the US public skrewl system has failed America's masses. It is really bad when 95% of the population can't tell your the difference between a monopsony and a central economy.