May 01, 2005

One More From the Weekend

From former CBO head Dan Crippen, a capsule summary of why Medicare finances are heading for trouble:

"First, the lion's share of Medicare spending is going for a relatively small number of people. Second, we are wasting time and money by not having a coordinated care system for these big users. Third, we lack the information needed to guide our caregiving. Fourth, we continue to drive up costs by overusing hospitals and preventing nurses and technicians from doing routine work that doctors now needlessly perform."

Despite the headline assigned to his piece, Crippen is talking about how to fix Medicare, not the health care system as a whole. It's not hard to see why Medicare's problems would be harder to craft a legislative fix for than Social Security's, yet offer more room to save money without radically altering the service provided by the program.

Posted by at May 1, 2005 11:59 PM | TrackBack (2)

Medicare is merely a symptom of the overall crisis in medical care in this nation. The rest of the industrialized world spends far less on health care than does the US, and achieves results as good if not better than our own health care system.

Of course, the rest of the industrialized world doesn't have a stroke when you say the words "socialized medicine."

Posted by: p.lukasiak at May 2, 2005 01:14 PM | Permalink to this comment Permalink

Isn't it funny that we reconise that regular maintenance of our car ensures its effective efficient operations and costs us less, yet because of the prohibitive cost of medical care and medical insurance many people (and often those most prone to disease due to lifestyle and other socio-economic factors) have to wait until they're struck down by illness before they seek medical care - at a far greater cost that prevention would have been in the first place.

It seems to me that one of the biggest issues with the free market economies most of the western world moved towards in the 80's and 90's have confused cost with investment. Investing in a health well educated work force would cost a hell of a lot less in the long run than picking up the pieces as we are now...

I'd like to think that we've moved to a point where public service and efficiency are no longer mutually exclusive concepts.... Hopefully one day we might develop a better framework for implementing social investments in a way that provides improved health and productivity in a measurable effective way - that delivers ROI to those who invest in it - the tax payer.

Posted by: Aran Brown at May 3, 2005 01:41 AM | Permalink to this comment Permalink

Has anyone examined the extent to which other countries have an organization similar to the AMA, which seems to be dedicated to restricting entry into the medical field and maximizing the income of current practitioners.

One of Crippen's key points is the extent to which we could potentially save money by allowing some routine procedures to be performed by medical specialists other than doctors, outside of hospitals.

Aran - I'm not sure that changing the culture is as easy as you seem to posit. I believe that much of the difference between the US and other countries is explained be lifestyle choices - and education does not seem to have had much of an effect to date. In particular, when one looks at different outcomes between different demographic subgroups, diet and lifestyle differences probably play a bigger role than any other differences. I'm not sure how government can change that...nor I am sure that I want the government to have the power to be able to do so.

Posted by: Neil S at May 3, 2005 04:33 PM | Permalink to this comment Permalink

Hi Neil,

THanks for your comment. I'm not necessarily positing for culture change - but making comment on the attitude of Governments towards social spending. Most Western Governments view social spending as costs - not as social investments. Such a mind shift in government towards a policy of social investment - with its emphasis on ROI on spend, I would have thought would be a long overdue shift of focus.

Privatisation of medical care leads us to a situation where the wealthy (who by and large are probably less likely to need health care anyway) can afford health care, where as the poor and working classes have to scrape by with whatever (usually substandard) health care the government provides. Net end result if of course is that the labour that we often rely on to drive our economies has lower productivity levels and higher rates of illness than they would under a better subsidised medical system. Which ultimately means less tax revenu in the long run.

Now I'm the first to admit its a pretty big generalisation I'm making, but it basically sums up a Social SPending = Cost approach. Unfortunately the ROI on a social investment type approach would take a lot longer to realise - if any politicians ever had the gumption to promote and try to explain it to the general populace anyway.

I think in the very long term the current approach will fail (when combined with the same sort of aproach to education, policing and the like), but there will be a lot more pain before we get to a point where we realise a social investment approach makes much better sense - which also encourages and efficient delivery of service!

Posted by: Aran Brown at May 4, 2005 04:33 AM | Permalink to this comment Permalink
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