Original Message: ----------------- From: Robert Seeberger [EMAIL PROTECTED] Date: Fri, 25 May 2007 20:44:13 -0500 To: brin-l@mccmedia.com Subject: Re: U.S. health care
----- Original Message ----- From: "Dan Minette" <[EMAIL PROTECTED]> To: "'Killer Bs Discussion'" <brin-l@mccmedia.com> Sent: Friday, May 25, 2007 5:18 PM Subject: RE: U.S. health care >> It will have to be addressed by some sort of health care rationing. >> The only question is when and how. We may not be there now, but there >> will be a point at which we cannot afford to give the best health care that's >> available to everyone....even if that's the focus of the entire >> economy. >> How we do that rationing is a very difficult decision. This is one >> reason that I think we should start working towards the most reasonable >> rationing system we can have as soon as possible. >What I gather from what you are saying Dan, is that the people who pay >for the health care system are going to have to settle for less in >order to preserve the status quo otherwise. I am taking "health care >rationing" in it's simplest terms here, and doing my best to avoid >extrapolation of your words. So please expand on this if I am >misunderstanding you. I think you may be. Right now, we have a make shift form of health care rationioning. It includes HMO rules, general insurance limitationsexclusions by employers, admissions decisions, etc. Everyone is not getting the best care they can. If they did, we'd be spending more on health care. Even so, heath care spending as a fraction of GDP is rapidly rising in the US. Bewteen 1960 and 1990, it rose from 5.1% to 13.4%. This growth led to intererst in health care reform. But, as HMOs and other insurance companies started to work on costs, the percentage held essentially flat through the '90s. By the end of that period, they had found virtually all of the cost savings from these techniques, and costs rose again. In '06, it was about 16% of GDP. It is projected to go to 20% in 2015. I don't have total numbers beyond that, but Medicare costs, as a function of GDP are expected to triple by 2045 and increase 4-fold by 2080. Now, a lot of that is the increased number of baby boomers who are elegible, but that's a real expense. A third of GDP is a reasonable estimate. And, this is extrapolating from a situation in which there is means based determination of the quality of health care....and the fraction of insured patients falling. If we were to continue that, there gap between the haves and have nots will just increase. >I've worked in a few hospitals here in Houston and everyone of them is >undergoing large expansions. One is left to wonder who is paying for >all this construction if not the end customers. In every hospital I >have worked in, doctors are daily treated to sumptuous meals (for free >of course) in a lavish (as compared to any other hospital facility) >dining room. And the food served is of a quality not seen in any other >part of the hospital, prepared in a separate kitchen solely for the >doctors. I've seen this at St. Joseph, a relatively poor hospital, and >at M.D. Anderson, a rich state run hospital. I'm not arguing that there is not a lot of money flowing into health care. I'm arguing that the supply of money is not unlimited. I also know, from a friend of mine who was in charge of Northwest Medical Center, that hospitals are cutting corners where you can't see. The snazzy look of major medical center hospitals is part of the marketing...and thus makes money. There are enough wealthy people who will pay extra for the best to make that make sense. But, a good regional hospital has to watch costs carefully in order not to lose money. She's worried that care is close to suffering. Part of it is the paperwork overhead that staff must deal with. Patient care is usually a small fraction of the total staff time. >I know this to be the case at the other hospitals in the Houston >Medical Center because my company works in pretty much all of them. >If one were to drive through the medical center and observe all the >construction (every bit of it medical expansion) one would be hard >pressed to understand how we would need medical care rationing. >A walk through the parking lot where doctors park their >vehicles.......well....they are obviously not worried about fuel >efficiency. Well, I see the other side. I had a neighbor who was a blood specialist..and couldn't find work in his specialty. He supplemented his income as a doc-in-the-box, at an urgent care center. He made $50/hour for doing this. That's less than temp agencies charge for draftsmen. My brother-in-law's practice is just getting by. He does drive a SUV, but they bought it used, it has 130k miles on it, and he has to drive on roads that are often covered with deep snow (they have gotten as much as 10 meters of snow one year). The right specialists in the right hospitans can still make tons of money. But, physician saleries are not the casue of the increase in costs now. The present increase is, to first order, a reflection of all the new things we can do. The US pays for most of the expensive innovations in medical care. New technology is much more pervasive here than elsewhere. Care for those who's insurance can afford it is unparalleled. But, this is not reflected in measures of health. There are numerous reasons for this. One of those is that we spend a lot more in certain areas of health care, but do not provide it for everyone. Let me give an example: stroke reversal. Zimmy talked about a procedure that costs about 50k which can reverse strokes. It's very intensive, but is showing great sucess. If this is used routinely on everyone who might have had a stroke, we add a lot to medical costs. Intensive care at the end of life is another case. We are developing the technology that might allow us to postpone death for an indeterminate period of time. If everyone took advantage of this, then we'd be spending a growing percentage of GDP just on this. Dan M. -------------------------------------------------------------------- mail2web.com What can On Demand Business Solutions do for you? http://link.mail2web.com/Business/SharePoint _______________________________________________ http://www.mccmedia.com/mailman/listinfo/brin-l
