NEWS COVERAGE OF HEALTH CARE

This article starts off right but never mentions the huge disparities between U.S. costs per capita and the rest of the developed world. I suspect that could be a big selling point for serious reform.

Is universal health insurance on the horizon?
Some in Congress see 'socialism,'
others seek to remake insurance market

ANALYSIS
By Tom Curry
National affairs writer
MSNBC
Updated: 3:06 a.m. MT Aug 17, 2007

WASHINGTON —It isn’t streamlined, it isn’t logical, but America’s cobbled-together system of paying for medical care does cover 85 percent of the population.

Whether the new president is a Republican or a Democrat, a redesign will be difficult to pull off. Insurance companies, pharmaceutical firms and medical device makers, all of whom have a vested interest in averting radical change, are big campaign contributors and are strongly represented by lobbyists in Washington.


There is a reader Q&A section and one of the answers did mention the disparity in costs.

Answered by economist Karen Davis, president of The Commonwealth Fund:

A: The U.S. spends more than twice as much per capita on health care than the average of other industrialized countries. So why shouldn’t we expect to have the best, highest-performing health care system in the world?

One important reason we fall short is our fragmented health care system, which contributes to uncoordinated care, waste, and inefficiency. More than one quarter (26%) of U.S. adults and more than one-third (36%) of uninsured U.S. adults went to an emergency room for a condition that could have been treated by a regular doctor in 2005. This is two and three times the rate reported by British respondents (12%) and four and six times the rate reported by Germans (6%).

This is not surprising, as the U.K. has been a leader in health information systems to enhance the ability of physicians to monitor chronic conditions and medication use. The U.S. spends far less on health information technology—just 43 cents per capita, compared with about $192 per capita in the U.K.

Another important reason for our poor showing on many measures is that payment systems for health care in the U.S. reward providers for giving more care — not better quality or more efficient care. We need to realign our payment systems to reward efficient, high-quality, well-coordinated, and patient-centered care.

The U.S. is the only country that does not provide universal coverage. This makes our health system much more inefficient, and creates barriers to care because of cost. Countries that do well tend to have strong primary care systems, universal health insurance coverage with comprehensive benefits, and increasingly the better countries have good health information technology systems—and both the U.S. and Canada lag way behind on health IT.

Here's a doctor's answer to essentially the same question:

Answered by internist and health policy expert Dr. Ashish Jha:

A: The answer is not simple. There are many factors that lead to the fact that our health care system is the most expensive in the world.

First, we pay more for many things, such as physicians’ salaries and drugs, than most people in the world. So even if we used the same amount of services, our health care system will cost more.

But we also do a lot more here – more tests, more surgeries, more procedures – than nearly anywhere else in the world. You might ask if this is good or bad. In many ways it’s a good thing. Just ask anyone with chronic hip pain from osteoarthritis whether it was good to get a hip replacement.

We also, unfortunately, have a lot of unnecessary care, such as surgeries and tests that are not likely to benefit patients. While this is something that we would all like to eliminate, it would be hard to do so without rationing care.

This extra testing can result from doctors practicing defensive medicine to avoid malpractice suits. Studies have shown that this accounts for no more than 2 percent or 3 percent of health care costs, which amounts to about $40 billion to $60 billion. That is a lot of money, but it still doesn’t justify the notion that malpractice reform would have a dramatic effect on health care costs.

Another factor that drives up the price of health care is the fragmented payer system. The average doctor might be dealing with 15 different insurance companies, so he needs to hire people to take care of billing.

I’ve seen varying estimates on what these administrative costs are – some as high as 25 percent of the total health care costs. Probably a more realistic estimate is 7 percent to 10 percent. This is not trivial and it’s a place we might be able to save a lot of money.

As to your point about the high cost of drugs, drugs account for about 10 percent of all health care costs. Is this too much? Well, we live in a capitalist economy, and although it is tempting to try to reduce pharmaceutical companies’ profits, you might also reduce their incentives to develop new drugs.

The same thing applies to the salaries of doctors and nurses. If we aggressively cut them back, the best and the brightest of the next generation may not choose to go into medicine. Training takes many years and there is a lot of debt accumulated in the process.

As for the impact of illegal aliens on the cost of health care – this is a red herring. The amount of services used by them is trivial. If they were blocked from using services, you wouldn’t see any change.

Here's a great Q&A:

Q: How accurate or inaccurate is Michael Moore's assertion that the Canadian, French and British health care systems are better than the U.S. system?

— Melvin Pitts, San Antonio, Texas

Answered by economist Karen Davis, president of The Commonwealth Fund

A: International health system comparisons by The Commonwealth Fund, the Organization for Economic Cooperation and Development (OECD), and the World Health Organization (WHO), do support the assertion that the U.S. health system does not perform well compared to other industrialized nations in many areas.

While research shows there is room for improvement in every country, in Commonwealth Fund surveys the U.S. comes in last overall in five key areas of health care — access, quality, equity, efficiency, healthy lives — compared with five other countries (Australia, Canada, Germany, New Zealand, and the U.K.).

And the Fund’s National Scorecard on U.S. Health System Performance shows that the U.S. falls short in several areas:

* The U.S. ranks 15th out of 19 countries on mortality from conditions “amenable to health care” — that is, deaths that could have been prevented with timely and effective care.
* Out of 23 countries, the U.S. ranked last on infant mortality, with a rate of 7 infant deaths per 1,000 births, more than double the rates of the top three countries.
* Forty percent of U.S. adults and 57 percent of adults with below-average incomes reported in 2004 that they went without care during the year because of the cost — four times higher than in the U.K.
* The U.S. spends the most on administrative costs: 7.3 percent of national health expenditures, compared with 1 percent in France, 2.6 percent in Canada, and 3.3 percent in the U.K.

The news is not all bad, however — in our surveys the U.S. did do best on preventive care and waiting times for surgery and specialized care. And improvement is possible, with national leadership and commitment to a high performance health system.

The bottom line is, considering that the U.S. spends far more than any country on health care, we do not get good value for our health care dollar.