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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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- Americans hate health reform but like what it would do
- Countries with the most expensive healthcare
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We're a company formed by 2 ER doctors to try and solve that "no pricetag" problem - we created Amazon for healthcare - know what you're going to pay BEFORE you buy it. And cash-pay non-insured patients don't get hit with HIGHER prices because we asked the doctors to consider how much work and money it takes to get money back from insurers and offer the amount they would have gotten in the end.
Win-win, right? Join us in fighting the healthcare revolution -- healthcare needs way more than reform!
We're two ER doctors who are working towards the solution of "no price tag" and also giving the uninsured a break by offering a website just like shopping for plane tickets or a hotel -- know what you're going to pay before you buy and buy right there.
We talked to doctors and let them know how much it costs them just to get paid by insurance and to offer the price of what they would have ultimately get paid by insurance. -- take a look: SnapHealth
Win, win right?
Join us in fighting the healthcare revolution -- it needs WAY more than reform.
So let me get this straight. In the USA, a patient gets to overpay by 200-300% for medical services, and there is a 50% probability that the attending Physician is "MENTALLY ILL".
If you are sick and seek a cure for an ailment, You are better off seeking out a Witch Doctor to perform a PAGAN RITUAL. Or just smoke some REEFER.
Until we quit providing health care from unrelated silos, nothing will change. The incentives to provide better care are not aligned and hospitals, physicians, freestanding centers, insurance companies and others manage for what is in their best interest. That best interest may or may not be the patient. For many years insurance companies refused to pay for screening mammograms because it was cheaper to care for a late stage breast cancer than to provide prevention for millions of women...only with government intervention did that change. And just to take away some of the blame for the healthcare industry, we patients aren't doing our part either! We practice poor health behaviors, don't manage our own health, and only care about health care when we need it. We say that we don't need government intervention and yet we clamor for free care when we can't afford insurance, lose our job, or reach Medicare age. If we don't need health care right now, we pull a Ron Paul follower and say others can just die if they can't pay or just go to the hospital and let the rest of us pay when the hospital cost shifts to paying patients to cover those who don't or can't pay. After a 40+ year career, I am so frustrated that our health outcomes can't hold a candle to countries like England, Canada, Sweden and others with a National Health Service that so many US citizens criticize. And for those of you who don't want a National Health Service, just turn down Medicare and try to buy your coverage on the open market with your voucher promised by the Republicans!! There are choices if you are wealthy in a country with a National Health Service, you can use the NHS, buy private insurance or use cash to go elsewhere for care if you like. In case you haven't noticed, some of our US based insurance companies are sending their patients out of the country for costly care!
I believe that the current system of rates "negotiated" by insurance companies, rates demanded by Medicaid and free market rates is probabily illegal under one or more of the various Civil Rights laws. Some lawyer with lots of courage and ambition, knowing that fame and fortune will flow from a solid win, could find one or more "protected groups" are being discriminated against.
Using the Federal Courts may be the only way to reform the current system. Too much money is at stake for any of our legislatures to touch this issue under any circumstances.
Well good news, some insurance companies have had to rebate some money back to subscribers, since under Obamacare they have to show they are spending 80% of premiums on actual medical care or give the money back. And insurance rates only raised an average of 4% this year, wow, that's the smallest raise I can remember in I don't know how long.
It's a shame the President had to compromise and keep the Health Insurance Industry in the equation. That being said...his Obamacare is doing it's job to have more people covered and it looks like it is working to keep down costs too, unfortunately we need to find a way to lower costs and still have excellence in care...There is definitely a lot of fraud and waste that needs to be stopped. I'm interested in seeing what the results of the part of this bill that seeks to allow students interested in becoming GP's or family doctors to go to med school without becoming so awash in debt, too.
After reading the comments and having experienced first hand the operation of the American health care system I have to come to only one conclusion; Death comes to all of us, some sooner than others and it comes via various ways. Nothing, no care-giver, insurance company or government can save us from death. If we had a health care system that provided care to everyone at no cost it would not negate death, yet people still demand; It's our right to live, we should be saved. If someone doesn't feel right and goes to a doctor tests are done. "Well, you have this and that ailment and your insurance doesn't cover it." Lol, "It shouldn't matter, save me, that's your job as a doctor." What I find amazing is how good our health care system is in spite of that, we go to the ER we get treated and nobody is put out on the street to die. I was laid off, didn't sign up for COBRA, lost my insurance. I passed out in a store and woke up being tended by EMC's. I told them I didn't have any insurance and no money. I was taken to a local hospital, went through the MRI drill and it was determined that I had encephalitis. I told people repeatedly that I had no insurance and no money, and, unemployed. I was treated, spent time at Vanderbilt hospitals Stallworth Rehab Center. No insurance, no money, no job. Anyway, I had no divine claim to fame, just a average citizen but I was still cared for. So, lol, tell me about how bad our health care system is. Lol, I remember when one woman came to get my insurance information and I told her that I didn't have any, so, best to just let me pass on. "We will NOT allow that, that isn't why we're here."
And how many people went bankrupt and lost their homes to pay for health care? The American Nightmare. While Congress with a terrible approval rating gets great care on our dime, and is corrupt. This MUST change, and it has nothing to do with socialism -- it has everything to do with being civilized.
I bet giving millions of americans more paperwork and an insurance card will fix all of this.. Thanks Mr President for this wonderful solution to a convoluted problem... How long can we stand by and allow elected officials to be public examples of moronic decision making.. Insurance is not the answer.. really fixes to the system and giving people real access to health care that is affordable.. not just giving them a insurance card that no providers accept and the people don't know how to use.
I assume you wrote the same sarcastic comment to Mr. Romney....when he created the health care mandate for his group of people. Or to the republicans in 93 when they wrote up their contract with America.
What? You didn't? Wow that's a shocker lol
Universal health care or the same health care our wonderful politicians receive. Problem solved!
can't be the same healthcare the politicians receive.. No one understands how the system can not handle that many more insured people drawing from the resource of the insurance they would be using.. Who's going to answer the precertification calls, the miscalculated billing questions.. Who would be able to process the billing and claims that are being received by that many millions of people?
They need to create a system that offer free preventative and minor urgent care for all Americans and allow those that can afford health insurance and all the privileges afforded to picking their own doctors and timelines for treatments would be a much better idea to start with.. these people need more access to care not just a insurance card to hold like a security blanket
Just the insurance companies profiting at the hands of the sick. Just look to Blue Cross/Blue Shield. Their headquarters-indoor swimming pools/gyms for their employees, among others; but when it comes to their clients, they get the shaft.
I am delighted that this IOM report is causing such a huge amount of discussion about the runaway COSTS of healthcare. I am glad it also includes suggestions for how to improve the situation.
One point that is rarely made in discussions about the spiraling cost of healthcare is the fact that there are, indeed, many treatments out there that are really effective AND inexpensive, in addition to having very few side effects. Yet, because these treatments are not yet the "standard of care," and more specifically, are not manufactured by large pharmaceutical companies, doctors don't routinely prescribe them. But thankfully, because of patient successes with these treatments, more and more doctors are beginning to prescribe them.
I believe that these treatments could play a huge role in saving healthcare.
In my book, HONEST MEDICINE: Effective, Time-Tested, Inexpensive Treatments for Life-Threatening Diseases, I highlight examples of treatments like these.
One of the treatments I write about in my book is Low Dose Naltrexone (LDN), used off-label for 25 years by many doctors for autoimmune diseases, such as MS, Lupus, Rheumatoid arthritis, Crohn’s disease, etc. LDN costs $40 a month (maximum) through compounding pharmacies. (Naltrexone was approved in the mid-1980s by the FDA for another purpose—drug and alcohol addiction—at TEN TIMES THE DOSE that doctors are now using it off-label for autoimmune diseases.)
On the other hand, the most commonly prescribed MS medications cost $2000-$4000 a month and have horrible side effects.
I would like to see treatments like these (I call them “patient evidence-based” treatments) considered more often by doctors. In addition to helping thousands of patients who are not being helped now, they could save our healthcare system a huge amount of money.
Thanks so much.
Julia Schopick
HonestMedicine.com
Sigh. I work in the trenches in the ER. I wrote a novel called ROOM FOUR recently in an attempt to satirize the bureaucracy. Truth is stranger than fiction, but...
In July, my PCP and I decided I should do a sleep study for sleep apnea. His office recommended a specialist whose office called me. They asked, on the phone, what medications and vitamins, etc. I was taking and also took my BCBS insurance information. I set up an appointment for August and, on arriving in the office was given about 10 pages to fill out, including insurance information they had not only gotten from me previously by phone: they had just photocopied my insurance card! AND...another listing of my medications! When I finally met the specialist she said, "Your PCP faxed us a list of your prescriptions." Then came the first of two sleep studies at a local hospital. I got a phone call asking, "Have you ever been treated here before?" I said yes, in 1996 and around 2000. When I read my BCBS ID # off she said, "That's exactly what we have on file." Then I went for the study and filled out another 10 pages including insurance information and medications list! A week later, last Thursday, Sept. 20, I went for the second sleep study - SIX DAYS after the first one in the SAME hospital. This time there were only 8 pages of information - including insurance ID and medications - to fill out. UNBELIEVEABLE! No wonder Americans waste 25% of health care costs on paperwork compared to 1%-3% in other nations!
I am a physician and I agree with the statement about US healthcare. Instead of just plain talks or complaints, you should always discuss with your doctors about your care. You should ask whenever you are not sure about the cost and the benefit of a procedure or medicine. You should demand from your elective officials, not your doctors, to make heathcare more affordable. You should report any suspicious billing practices. You should hold hospitals and big insurances accountable, not your doctors, because you choose your own healthplan and hospitals.
As a physician, I believe I work in the broken healthcare delivery system but I did not help build this system. Nor did I help manage it. I am trained to help provide care to patients regardless pf their ability to pay. I strive to provide the quality of care to each and every patient in this broken system.
The first thing I would demand is the end of medicare training doctors and limiting the numbers to 30k residents per year. Half of which are female who have kids and don't provide anything to the pool or competition. thats less than roughly 600-700 per state half being specialists who rack up referal money and jack up MRIs, xray and ct cause they like the gravy train. Let the state do it and quadruple the number of provider or more. You wouldnt like it cause it would cut your 250 per year so why go there. Doctors are the last people to ask about cutting costs. Glorified automechanics with techno gizmos.
“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.”
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What naivete! There were "former" insurance V.P.s who "resigned" to work for Senators and Congressmen crafting Obamacare to make sure the system stays profitably inefficient. I think Obamacare is a MAJOR disappointment EXCEPT for the fact -as the head of Johns Hopkins Hospital said on PBS- that Congress is owned by the healthcare special interests, so the good of the American people comes second to gouging by the industry. Consequently only small steps at a time will be made to bring America's health care industry up to a par with those of even Taiwan. Yes, we can do hi-tech operations they can't, but for general health care, we're awful. And neither the GOP or Dems care, because they're well paid not to. Why else would Paul Ryan (hundreds of thousands of healthcare industry dollars donated to his Congressional campaign since 2011) try to use "vouchers" when government-run Medicare gives 13.3% MORE bang for the buck than private insurance.
no health system is perfect. all are run by people. people are fallable. of the worlds systems the british national health service is the oldest and one of the best. recently rated better than germany. canada and the u.s.a. of all systems rated internationaly the most efficent. people here in the uk just cannot understand why you put up with your system . any mainly private-for profit arrangement of health care will be biased against the patient. ask any american living over here . most like our system a lot.
THe institute of doctors protecting doctors pay ...Gimme a break.