If You Build It They Will Come - For Treatment

David Leonhardt of the Times discusses overinvestment in health care.

Tyler Cowen sketched out some doable heath reforms in mid-November but let's reprise them.

Comments

[sylvia]

Yes I agree somewhat with that second article. Actually, I am not a big believer in medical care in general. So far at this time anyway. I am kind of Amish that way. I think you are going to go when you are going to go. Of course with the exceptions of the obvious medical necessities. So a little cutting back on (excessive) treatment might not be such a bad thing.

[Rob Crawford]

Actually, I am not a big believer in medical care in general.

Good for you! Now shut up about it.

[MikeS]

According to Leonhardt, at the Times, Americans are already getting too much care. He claims that the excessive care people in Richmond were getting, did little or nothing to improve their overall health.

In the U.S., everyone is entitled to medical care whenever they enter an emergency facility whether they have insurance or any ability to pay at all.

So, why are we planning to spend $2.5 trillion providing extra medical care to the uninsured if it really doesn't improve their health?

[jorod]

Illinois limits the supply of hospitals. This has led to huge bribery cases involving the highest levels of government. Government control flies in the face of basic economics.

[Ignatz]

RC, since the unmentionable is Amish (no Mennonite cracks OL)about things let us not forget to shun like the dickens.
Shunning is good for the soul and the troll.

[Rob Crawford]

RC, since the unmentionable is Amish (no Mennonite cracks OL)about things let us not forget to shun like the dickens.

I'll keep that in mind.

(Interestingly, one of the best college professors I had was Mennonite. He taught electrical engineering, particularly digital electronics.)

[matt]

I think we will see clinics rising across the border in Mexico, where the costs are half of what they are here. They already exist for things like plastic surgery and dentistry.
We'll see some new programs like MexInsure that will ensure more rapid care of the patient.

We could also see many more doctors opting out of the system and doing pure private practices, as has been happening with boutique practices already.

[Soylent Red]

So, why are we planning to spend $2.5 trillion providing extra medical care to the uninsured if it really doesn't improve their health?

One of the key tendencies of the lower classes is the tendency toward fatalism. Things happen to you rather than you affecting the world around you.

That mindset leads to a devaluing of medical treatment, particularly preventative medical treatment. Why should you waste time or money on things like annual dental checkups or PAP smears when you "can't do nuthin' 'bout it anyway"? These are the people who will wait until the very bitter last instant to go to the hospital with a heart attack.

Anyway, those who are most likely to benefit from freebie health care are going to be the same group that is both least likely to use it until problems are severe, and most expensive to treat when they finally do come in because they don't take care of themselves.

$2.5T? I guarantee you it will be much, much more than that.

[Jack is Back!]

Matt,

Not only the border but also the big cruise ships will soon start offering "medical" cruises. You book your surgery or physical on a 7, 10, 14 or 28 day cruise. You recuperate in the splendor of the Carib ocean with little day trips to Grenada (where the medical school gives you cut-rate rates for the students to practice on your bladder, spleen and whatever else is wrong with you). Disney will probably end up being the St. Jude's of the Sea and I see the QM2 as an alternative to either Cleveland Clinic or Mayo. I intend to mention this to my Mayo doctor next week and see if I can postpone my colonoscopy until we can fit it in on a transatlantic cruise this August. Whadaya think?

[Sue]

$2.5 trillion providing extra medical care to the uninsured

Aren't we spending this and still leaving 18 million uninsured?

[Clarice]

JIB--sounds perfect to me.

[sylvia]

"One of the key tendencies of the lower classes is the tendency toward fatalism. "

Another tendecncy for the upper class is to believe that there is an elixir for every ail. Sometimes the lower classes in the past lived longer without the "treatments" of bleeding and such from doctors in the old days.

Let science prove it. So far the success rate for cancer and heart disease and automimmune, Alzheimers, Parkinsons, diabetes, cystic fibrosis, kidney disease, ALS (did I forget anything?)... not that great. Until the science is there, no use in believing in elixers.

[Jane]

Me too. Sign me up!

[ROA]

Medical outsourcing already exists. Just Google "medical vacations."

[Elliott]

Won't they just propose medical tourism laws to fix the "problem"?

[Soylent Red]

You're right sylvia.

Until the science is settled on the efficacy of preventive care, regular checkups, and public health measures that have been in place for 100 years, we, of the upper class, should foist no medical care, or "elixirs" as you so aptly put it, on the lower classes.

Solves the healthcare problem in one fell swoop. "The science isn't proven!" It's really an idea whose time has come. I suggest you pick up the phone, at once, and suggest it to your Congressman.

You'll find his listing under Zaphod Beeblebrox (D-Alpha Centauri).

[Steve C.]

David Leonhardt is confusing cause and effect. Is he really arguing with a straight face that restricting supply of any good lowers the costs of purchase?

And further, he refers to this magical Dartmouth survey of Medicare costs and effectiveness. Is this the sole benchmark we will use to remake 1/6th of the economy? I'm sure there is probably some good data and analysis in the study. But we are not talking about the cost differential between making widgets in New York versus Houston. There are way too many variables, starting with the fact that we are talking about humans, not machines.

I don't know much about medicine, but I do know that any competent process analyst would start by asking how you can eliminate non value added functions. How many health care dollars at the practice level are being used to pay for functions that do not deliver value to the customer? Been to a doctors office lately? Ask yourself how much of the admin time and computers are used for "managing" information necessary to get the doctor paid versus inputting and collating health information that the doctor can use.

Scale that up to the level of any hospital. Now add in the thousands of people throughout city, county, state and national governments. Not to mention the insurors.

The problem is not how many MRI machines and how much they cost to operate. The problem is that the burden of overhead costs far outweighs the actual effective dollars of cost delivered to the consumer.

But don't worry, under Obamacare we are going to "make it up on the volume".

[matt]

I don't know if a colonoscopy is advisable in 20' seas, even on the QE3, Jack.....maybe they'll anchor just outside the 3 mile limit like the casino ships did back in the 20's and run shuttles.

Patients can play the slots while they recover. Now that sounds like a profitable business.

[Rob Crawford]

You'll find his listing under Zaphod Beeblebrox (D-Alpha Centauri).

Democrat? Really?

Always struck me as more of a Libertarian: "If there's anything bigger than my ego around, I want it caught and shot now."

[matt]

43, Rob

[Pofarmer]

Graduate more Dr.s.
Then, build more clinics and Dr's offices. Make them compete, they'll find ways to be efficient to get the $$$$$. You can't do this from the top down.

What I'm actually concerned about right now, at least in the health care front, is that he lowering of payments will cause a collapse in rural health care as Dr.s say screw it.

[Rob Crawford]

43, Rob

ITYM, "42".

Or, "What is six times eight?"

[Rob Crawford]

What I'm actually concerned about right now, at least in the health care front, is that he lowering of payments will cause a collapse in rural health care as Dr.s say screw it.

Really? Rural?

Because if I were a doctor, I'd be looking for someplace with a low cost of living, the possibility of barter, and people used to the idea of services being scarce.

I think urban medical services are more likely to atrophy.

[Old Lurker]

Living in DC is colonoscopy enough for me, JiB!

OK, Ignatz, I've beaten the Mennonite thing to death I guess. Then again, seeing the Troll Reunion going on here today, maybe not enough.

[Jane]

I think more likely is docs closing private practices and working for hospitals which will raise the cost of health care enormously AND make it more scarce.

[bunky]

I wonder when "legal reform" will be taken up? 'Cuz ya know there's a CRISIS in the Anerican legal system.

[Rob Crawford]

I wonder when "legal reform" will be taken up? 'Cuz ya know there's a CRISIS in the Anerican legal system.

Plus there is a Constitutional right to representation and access to the courts. Not so much for medical care and hospitalization...

[Jack is Back!]

Does anyone know if the so-called "health reform" bills include dental? The reason I ask is that I took my son to his first dental appointment yesterday - a pediatric dentist. Its a husband/wife combo with about 6 techs and assistants. They were totally digital and 21st century with a very efficient layout. There were 8 patients waiting when we got there and there were at least as many in the waiting room when we left. He got a checkup, cleaning, instruction on brushing etc. plus a total exam and charting by the dentist himself. Took all of about 40 minutes. Extremely productive and informative. They then set up a followup appointment to restore one of his baby teeth from a small cavity indicator. When I got home I saw an email on my computer from the practice giving me a breakdown on what they would do next with my cost less the insurance.

My point here is that for me both a recent Mayo experience and my son's dental experience the rare one off. What the heck is the rationale for doing anything except to allow the private sector like the husband/wife dental team to stay more productive, more competitive and more serviceable? Somebody needs to banish the LBJ proclamation that "politics is the art of the possible" and replace it with the medical advice of "do no harm".

[Ignatz]

--OK, Ignatz, I've beaten the Mennonite thing to death I guess. Then again, seeing the Troll Reunion going on here today, maybe not enough.--

OL,
The thing about shunning is, to work properly it's kind of all or nothing.
And with the heterogenous personalities and views at a place like this it's not hard to spring a leak, and then it's Katie bar the troll.

[Clarice]

Steve C, in the back of my mind are reports of hospitals in given municipalities (DC was one) building redundant and expensive facilities for diasgnosis and treatement. IIRC insurance companies responded by refusing to pay some of the hospitals' overhead for these redundancies and a number were just shuttered.

Apparently the NYT has found an instance where that didn't happen but around here I think competititon and insurance company mandates have kept excess capacity and excessive expensive equipment way down. Cut into it and rationing service will not be so sublime.

[Neo]

If you put aside the partisan view of a "win" for Obama/Democrats, does anybody really think that this bill (or any of the bills) has any lasting ability to make the US (or the world yada yada) a better place ?

It certainly seems not.

[pagar]

Neo, that is the same thing I see. Nothing this administration does seems to be done with the idea that it will make the US a better place.