Democratizing Healthcare
I haven’t been blogging nearly as much as I did five years ago, largely because my early blogging was all about trying to figure out “what the heck is up with the American healthcare system???” and it’s now been two years since I had any new realizations. Here’s a summary of that, then some quick hits on recent and upcoming events.
No, wait – this part turned out long, so I’ll continue tomorrow with the “quick hits.” For today, here’s the baseline I reached two years ago.
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I’ll leave you with this thought for the weekend.
After years of study of healthcare around the world, listening to an immense number of arguments about what’s important and what works and doesn’t, it’s all summed up in this one picture. The Y axis is life expectancy; the X axis is cost. This graph has been tweeted furiously and often lately by health journalist @DanMunro. (More on him below.)
You can easily see that US health costs per capita are way, way, way out of whack with the rest of the world. And, the life expectancy we get for it is years worse than the countries that cost 2-3x less.
Some will argue bitterly that the facts aren’t relevant, or a hundred other arguments. I’ve lost interest in those arguments, because they’re all about rationale, and no rationale is worth a damn if the outcomes they’re trying to explain don’t match the rationale.
This is the latest in the Speaker Academy series, which started here. The series is addressed to patients and advocates who basically know how to speak on a subject but want to make a business out of it. I’ll try to be clear to all readers, but parts may assume you’ve read earlier entries.
I’m really not happy to be writing this, but push has come to shove. Two thirds of my expense reimbursements are past due, and fully a third of them are more than 90 days out. I’ve seen some people stretch payments at times, but I’ve never seen anything like this.
The stories I’ve been getting about “gosh, sorry, there’s nothing we can do about it” or “gosh, the only person who can write checks went on vacation” or “we only print checks on Thursdays and she was out when she came back from vacation” are familiar, but this year they’re much more common. What’s up, healthcare? Is The Big Ugly coming home to roost?
I wrote about The Big Ugly last year:
… something I’m starting to call The Big Ugly – a wave of suffering that will happen as the medical industry contracts, and everyone tries to find ways to maintain their income. Unfortunately when an industry shrinks, everyone can’t maintain the same income. As anyone knows who’s seen an industry die (like mine, typesetting; or steel in America, or what Detroit went through), it’s painful. Good people get hurt, and organizations fight for survival.
It’s interesting, because the people I work with, for the event are good and almost entirely on time with paying my fees. But expense reimbursements? They seem to go through a different approval and payment process. I mean, things get lost in the expense rabbit hole, and even my good-to-work-with friends are unable to extract them.
Original post here was June 2013. Or, jump to the Nov 2015 update below.
Latest in my series Let patients help, cost-cutting edition
I’ve blogged several times about the greatest truth I’ve learned about the business of medicine. It’s the title of a 2006 Health Affairs article by Princeton economist Uwe Reinhardt: The Pricing of US Hospital Services: Chaos, Behind a Veil of Secrecy.
The cost chart at right shows what’s happened since Reinhardt’s paper appeared, in the middle of the chart. It’s what you’d expect if slush is flowing around with nobody watching.
Today I was reminded that it ain’t just hospitals. :-)
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Last week I got my annual checkup. There were two separate problems in my hospital’s appointment system, so I ended up leaving too late to get the simple lab work my doctor had ordered; I said I’d get it done at a local lab.
Today I visited AnyLabTestNow, a chain with a local office. I called ahead, and for walk-in self-pay, it’s $49 for the chemistry panel I needed (Calcium, CO2, etc) and $49 for the cholesterol, total $98. And a $10 off coupon, on the site! Just $88.
Or not.
Here’s the next episode in what I’m starting to call “The Big Ugly” – a wave of suffering that will happen as the medical industry contracts, and everyone tries to find ways to maintain their income. Unfortunately when an industry shrinks, everyone can’t maintain the same income. As anyone knows who’s seen an industry die (like mine, typesetting; or steel in America, or what Detroit went through), it’s painful. Good people get hurt, and organizations fight for survival.
Medicine’s certainly not going to die – we need it – but the Institute of Medicine says (see links below) we have massive overspending, and when the overspending shrinks, that too will hurt.
Today’s Boston Globe has the newest item: Hospital charges bring a backlash:
Patients, angered by surprise surcharges that hospitals tack on bills for doctor visits, are increasingly challenging these fees — sometimes even refusing to pay.
Hospitals say the charges cover their overhead, but the fees are sometimes added to the bill even when patients are treated in offices miles away from the medical centers. …
The Globe published a story in January about a patient charged $1,525 in operating room and facility fees for a minor skin procedure. Yeah, the doctor charged $354 for her services, and the hospital (Lahey Clinic) added $1525 of overhead. Another patient is quoted as sounding like (amazingly) an empowered consumer:
“I am willing to spend my money for my doctor — I am getting expert care,’’ said the New Hampshire resident. “I am not willing to pay $500 to sit in a waiting room.’’
Watch for more stories of overhead charges, and more, as organizations gasp for air, and ask consumers to bear the burden. See other stories in the links below, like the chain that put its E.R. docs on quota.