Sunday, September 26, 2010

New, New, New

New site, New approach, New thoughts.
There is too much under the "healthcare" umbrella to talk about in one locus.  We'll pick a few issues and perhaps start a dialog on some of them.

Sometimes, big, bold, and only partially true statements stir thought and comment.  Hope so.
 Here's one:  At the start of the debate over healthcare reform, Peter Orzag (and others) listed two major problems with healthcare in the U. S.  1. We had 47+million people who didn't have access to healthcare, because they had no health insurance.  2. Healthcare costs too much.  Note here that I didn't say we are spending too much (which is also true), but that healthcare, per se, costs too much. 

The legislation was referred to as "Healthcare Reform" but it is actually Health Insurance reform.  Most of the law affects insurance companies, with little or no effect on the providers of care.  OK, not entirely true, but I told you that up front.  Still, the emphasis is on insurance.  Nothing in the law will lower the cost of a visit to the doctor or an appendectomy.  The legislation corrected many of the problems with insurance and certainly brought most of the 47 million Americans without access to healthcare into the fold.  But we still have to address the cost of care.

By the way, I'm not sure the term "insurance" fits what we Americans call "health insurance," but that's another subject for another day.

Now that we have brought almost everyone under the "insurance" umbrella, we need to address the cost of healthcare services before we go broke paying for them.  Almost all of what is written today on this subject proposes ways to provide less care and hence have fewer patient encounters to pay for.  If we take better care of patients with asthma, they will make fewer visits to the ER and need fewer hospitalizations.  True, but the overall numbers on preventive care are not impressive.  Yes, it's a good thing to do. Yes, we're already doing that.  No, doing more will not reduce our expenses in the short run--maybe not at all.  Besides, this approach still leaves the occasional ER visit in the VERY EXPENSIVE category.  Now, suppose we did all the recommended preventive strategies AND worked to reduce the cost of individual processes of care.  It can be done.  Savings of 20% are easy by applying process improvement tools, such as LEAN.  More is feasible, but come back next time for why it isn't working. 

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