Controlling healthcare costs is just not possible

[w¡n9Nµ7 §£@¥€r 123]

The uproar over the on-again, off-again guidelines on when women should have mammograms is proof of the blindingly obvious: Health-care reform that actually controls costs -- rather than just pretending to do so -- would be virtually impossible to achieve.

I say "would be" because none of the voluminous reform bills being shuttled around the Capitol on hand trucks even tries to address a central factor that sends costs spiraling out of control, which is that each of us wants the best shot at a long, healthy life that medical science can offer. Just as all politics is local, all health care is personal. Skimping on somebody else's tests and procedures may be worth debating, but don't mess with mine.

Intellectually, it's simple to understand why it might make sense for women -- those who have no special risk factors for breast cancer -- to wait until they're 50, rather than 40, to start getting mammograms. The analysis by the U.S. Preventive Services Task Force, which made the recommendation, looks sound. According to the panel, a whopping 10 percent of mammograms result in false-positive readings that can lead to unjustified worry and unneeded procedures, such as biopsies. In a small number of cases, women are subjected to cancer treatment or even a mastectomy they didn't need.

This harm, the task force reasoned, outweighs the benefits of discovering relatively few cases of fast-growing, life-threatening breast cancer in women in their 40s through annual mammography. It is also true that waiting to begin regular mammograms until a woman reaches 50 -- and reducing the frequency to once every two years, as the task force recommended -- would save a portion of the more than $5 billion spent on mammography in the United States each year.

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The problem lies in those relatively few instances when a mammogram does find that a woman in her 40s has a life-threatening tumor, and when early detection saves her life. This scenario may be fairly rare, but it happens. Given the option, many women would rather be safe than sorry -- and safe costs money.

The analogous dilemma for men involves prostate cancer: Should men have a blood test for prostate-specific antigen (PSA), and, if so, how often? An elevated PSA level suggests, but does not prove, that prostate cancer might be present and tells nothing about the progression of a possible tumor.

For me, "test or no test" is a no-brainer: African American men are at elevated risk for prostate cancer, so I have had my PSA level checked at my annual physical since I was in my early 40s. So far, so good. But if the level were to spike and a tumor were found, I'd have to decide whether to treat it aggressively -- with radiation or surgery, both of which involve complications and risks -- or undertake a period of "watchful waiting." Many prostate cancers progress so slowly that the patient grows old and dies of something else before the tumor becomes an issue.

In other words, some men will get PSA tests year after year, then ultimately have expensive cancer treatment to cure a disease that ultimately would not have threatened their lives. The American Cancer Society recommends that doctors discuss the pros and cons of PSA screening with their patients, but it doesn't go on to recommend that all men be screened. In March, two studies were published in the New England Journal of Medicine. One said PSA testing saves lives; the other said it didn't.

But PSA testing has become so routine, like mammography, that I doubt many would be willing to give it a pass. Each of us should ask ourselves: How much expensive, unnecessary, high-tech testing and treatment am I willing to have our out-of-control health system pay for to save one life, if the life in question might be mine or that of a loved one? The honest answer, I think, is: a whole bunch.

The honest solution is a word that cannot be spoken: rationing. Our system already rations health care based on the individual's ability to pay. Insurance companies ration some tests and procedures based on age, risk factors and what often seems like whim. This ad hoc rationing doesn't work very well, and nothing in any of the reform bills even tries to address the basic consensus that makes spending continue to rise: Put a lid on everybody else's costs, but don't touch mine.

http://www.washingtonpost.com/wp-dyn/conte...9112302898.html

[one...two...tree 2,762]

T.R. Reid's Frontline special, Sick Around the World, showed that for most other countries, legislatures set the prices for the services (Japan, Germany to name two). For example, MRI's are incredibly inexpensive in Japan because the negotiated price set by legislatures forced the companies that make MRI machines, much cheaper.

[w¡n9Nµ7 §£@¥€r 123]

T.R. Reid's Frontline special, Sick Around the World, showed that for most other countries, legislatures set the prices for the services (Japan, Germany to name two). For example, MRI's are incredibly inexpensive in Japan because the negotiated price set by legislatures forced the companies that make MRI machines, much cheaper.

No HCR is better than a system where Congress mandates prices.

[one...two...tree 2,762]

T.R. Reid's Frontline special, Sick Around the World, showed that for most other countries, legislatures set the prices for the services (Japan, Germany to name two). For example, MRI's are incredibly inexpensive in Japan because the negotiated price set by legislatures forced the companies that make MRI machines, much cheaper.

No HCR is better than a system where Congress mandates prices.

TBH, I'm not sure exactly how the process works - whether it is a commission or whether by Congress. In Germany, there are doctors who complain that they can't make enough money, but in Japan, the pricing system seems to work well.

[w¡n9Nµ7 §£@¥€r 123]

Medicine must always pay very well, that's how you retain quality... not by making MRI's cheaper. You need the best and the brightest.

[spookyturtle 9,466]

Medicine must always pay very well, that's how you retain quality... not by making MRI's cheaper. You need the best and the brightest.

We do need the best and brightest to keep cutting edge quality.

Edited November 24, 2009 by spookyturtle

[one...two...tree 2,762]

Medicine must always pay very well, that's how you retain quality... not by making MRI's cheaper. You need the best and the brightest.

Japan's quality of medicine is very high.

[Mr. Big Dog 10,747]

T.R. Reid's Frontline special, Sick Around the World, showed that for most other countries, legislatures set the prices for the services (Japan, Germany to name two). For example, MRI's are incredibly inexpensive in Japan because the negotiated price set by legislatures forced the companies that make MRI machines, much cheaper.

No HCR is better than a system where Congress mandates prices.

TBH, I'm not sure exactly how the process works - whether it is a commission or whether by Congress. In Germany, there are doctors who complain that they can't make enough money, but in Japan, the pricing system seems to work well.

In Germany, people complain a lot. Not just the doctors.

[Pooky 3,929]

Medicine must always pay very well, that's how you retain quality... not by making MRI's cheaper. You need the best and the brightest.

Japan's quality of medicine is very high.

And virtually bankrupt.

[one...two...tree 2,762]

Medicine must always pay very well, that's how you retain quality... not by making MRI's cheaper. You need the best and the brightest.

Japan's quality of medicine is very high.

And virtually bankrupt.

Says who?

[Pooky 3,929]

Medicine must always pay very well, that's how you retain quality... not by making MRI's cheaper. You need the best and the brightest.

Japan's quality of medicine is very high.

And virtually bankrupt.

Says who?

And the table shows what, exactly? Not solvency, that's for certain.

[one...two...tree 2,762]

Medicine must always pay very well, that's how you retain quality... not by making MRI's cheaper. You need the best and the brightest.

Japan's quality of medicine is very high.

And virtually bankrupt.

Says who?

And the table shows what, exactly? Not solvency, that's for certain.

It shows that if we adopted a similar health care system, we'd save a lot of money and help our economy.

Aging populations

Although the Japanese elderly population is almost double the U.S., a segment of the population which requires most healthcare expenditures, the actual amount of healthcare expenditure in Japan, as a percentage of the overall population, is almost half that of the U.S.

Related to this is the fact that drug expenditures in Japan are about half of the U.S. (although this may not include Japanese herbal medicines which don't count as prescription drugs). The Japanese elderly population is aging at a faster rate than the U.S., so these healthcare expenditures are bound to increase quickly. According to JETRO, by 2050 it is projected that one out of every three Japanese will be a senior citizen, meaning a need for greater medical and nursing care services.

Due to the rising pressure of Japanese healthcare costs as a result of the rapidly aging population, the Japanese Ministry of Health plains to raise the volume of generics in the market, according to Med Ad News. This level, today about 7.3 percent of total pharma sales, is expected to grow to 30 percent by 2012, meaning that this sector will grow considerably at the expense of branded innovator drugs.

http://wistechnology.com/articles/5140/

[Pooky 3,929]

Medicine must always pay very well, that's how you retain quality... not by making MRI's cheaper. You need the best and the brightest.

Japan's quality of medicine is very high.

And virtually bankrupt.

Says who?

And the table shows what, exactly? Not solvency, that's for certain.

It shows that if we adopted a similar health care system, we'd save a lot of money and help our economy.

Aging populations

Although the Japanese elderly population is almost double the U.S., a segment of the population which requires most healthcare expenditures, the actual amount of healthcare expenditure in Japan, as a percentage of the overall population, is almost half that of the U.S.

Related to this is the fact that drug expenditures in Japan are about half of the U.S. (although this may not include Japanese herbal medicines which don't count as prescription drugs). The Japanese elderly population is aging at a faster rate than the U.S., so these healthcare expenditures are bound to increase quickly. According to JETRO, by 2050 it is projected that one out of every three Japanese will be a senior citizen, meaning a need for greater medical and nursing care services.

Due to the rising pressure of Japanese healthcare costs as a result of the rapidly aging population, the Japanese Ministry of Health plains to raise the volume of generics in the market, according to Med Ad News. This level, today about 7.3 percent of total pharma sales, is expected to grow to 30 percent by 2012, meaning that this sector will grow considerably at the expense of branded innovator drugs.

http://wistechnology.com/articles/5140/

I didn't dispute that. I want to see the US adopt a single payer system.

But Japan's medical professionals are paid nowhere near what their US counterparts make. The iron grip on procedural costs are causing chaos with balancing the books and the system the Japanese use for prioritizing patients basically treats every case equally.

And the system is running out of money, as the push to generics might have clued you into.

A single payer system in the USA does not need to be so draconian to work.

[mawilson 2,133]

How about requiring that doctors and hospitals publish their prices *before* treatment is given?

Healthcare costs are so high in part because they are hidden. Excess consumption of health

services occurs when patients and doctors collude, resulting in an "all-you-can-eat buffet"

syndrome so long as a third party pays.

[w¡n9Nµ7 §£@¥€r 123]

How about requiring that doctors and hospitals publish their prices *before* treatment is given?

And pharmacies. I was just thinking this today. I went to the Shoprite pharmacy to fill a scrip. I handed the scrip to the cute girl behind the counter, she took the scrip and asked me to come back in 10 minutes. I thought, how much? But she had walked away.

Edited November 25, 2009 by w¡n9Nµ7 §£@¥€r