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A Short Course in Brain Surgery

Tuesday 24 Jun 2008 | Blog-Editor | Health care, Leftism |

4 Responses to “A Short Course in Brain Surgery”

1. 1) |  Top | Jun 25 2008 | Banescu

   I wonder if Michael Moore would care to comment or address this ugly secret of the “socialized medicine” idol he embraces and worships with such vigor and blind passion. Yeah right! Have pigs started to fly yet?

2. 2) |  Top | Jun 26 2008 | Jim Holman

   Chris writes: “I wonder if Michael Moore would care to comment or address this ugly secret of the “socialized medicine” idol he embraces and worships with such vigor and blind passion.”

   It’s no secret. Articles like that show up every week in the right-wing press. But one anecdote does not a healtcare system make.

   The U.S. spends over 15 percent of GDP on healthcare. Last I looked, in Canada it was about 10 percent. U.S. life expectancy is around 78 years, in Canada around 80 years.

   For uninsured patients in the U.S. waiting times can be very long. Uninsured patients can wait months for clinic visits. They can wait a year or more for “elective” surgery such as gallbladder or hernia operations.

   My guess is that the Canadian system is somewhat underfunded, and if they put a little more money into it waiting times could be greatly reduced. We spend 50 percent more of GDP and end up with shorter life spans.

   In the U.S. billions of dollars go toward administrative overhead. Hospital patient accounts offices are staffed with legions of billing clerks and others who bill and collect money. On the other side are legions of insurance company clerks. Administrative costs in the U.S. are far greater than in Canada.
   http://content.nejm.org/cgi/content/abstract/349/8/768

   The Canadian system isn’t perfect, but our system is rapidly becoming unaffordable. If you like clerks and bureaucrats the U.S. is the place to be. Full confession: I fed at the healthcare trough for 21 years. I was happy to have the job, but always felt that the money would have been better spent on direct patient care. But Chris, I’m happy to hear that you were on my side. I appreciate it.

3. 3) |  Top | Jun 29 2008 | Michael Bauman

   The administrative costs to which you refer are often there because of government regulation. So when govenment regulation causes problems, the solution is, of course, more government regulation. Makes sense. After all, its only fair, right?

4. 4) |  Top | Jun 29 2008 | Jim Holman

   Michael writes: “The administrative costs to which you refer are often there because of government regulation.”

   I was thinking in particular of all of the paperwork involved in billing and collections. In 1983 I worked as an account analyst in the patient accounts department of a large teaching hospital. At that time there were around 100 employees in that department, none of us involved in direct patient care. And this was just in one hospital. Multiply that by all the hospitals in the country, combined with billing clerks in thousands of clinics around the country, and you begin to get some idea of the numbers of people involved. And that’s just the hospital side. On the other side are all the insurance companies.

   I continued working there, eventually spending eight years as a data analyst in the financial department. Hospitals have to work with literally hundreds of insurance companies. Hospitals have contracts with many of these companies, and the contracts are often complex, involving payments based on per diems, DRGs (diagnosis related groups), flat rates, percent of charges, passthru costs, and so on, depending on the type of care given. It is a very complex system, and there is a cost to that complexity.

   After that I spent 10 years as a senior systems and business analyst in the Logistics department. There, hundreds of patient supply items had to be billed and accounted for, and hospitals purchase expensive systems in order to track all of that. Many other departments also had to generate patient revenue transactions, sometimes manually.

   When you consider the sheer volume of effort and the hundreds of thousands of people around the country, both in hospitals and insurance companies, involved in this activity, you begin to realize that massive cost that all of that involves. And none of it has anything to do with direct patient care.

   Leaving aside the typical unfruitful debates over socialized medicine, etc., I think perhaps we can all agree that reducing that non-value-added activity would free up more money that could go to actual medical care. It can’t be eliminated but surely there are ways it could be reduced. The best way I’ve heard of is with a single payor system. The details of how such a system would work are open to discussion. But it’s the best idea I’ve heard of. If you have another one, I’d love to hear it.

   In that sense government can have a role, and already has had a role. This occurred through the development of standardized electronic billing systems, medical coding systems such as CPT and ICD codes, standard billing documents, and so on. Without that we would have a monumentally chaotic system.

   That doesn’t mean that a single-payor system would be run by the government. Even Medicare reimbursement is typically contracted out to private third parties. But whatever healthcare reforms are going to occur, the government will definitely have a role.