[Vision2020] Universal Health Care

[Ron Force]

Grist for the mill. From the NY Times:


January 21, 2012
The Money Traps in U.S. Health Care
By PHILIP M. BOFFEY
Why does an appendectomy in Germany cost roughly a quarter what it costs in the United States? Or an M.R.I. scan cost less than a third as much, on average, in Canada? 
Americans continue to spend more on health care than patients anywhere 
else. In 2009, we spent $7,960 per person, twice as much as France, 
which is known for providing very good health services. And for all that spending, we get very mixed results — some superb, some average, some 
inferior — compared with other advanced nations. Why this is true isn’t 
easily answered. 
Health reform is supposed to control costs, but there is no simple 
avenue of attack. Our aging population has played a role in driving up 
medical costs, but Germany, Italy and Japan have much bigger percentages of elderly people while spending much less per capita on health care. 
The spread of health insurance, which shields patients from price 
sensitivity, has played a role in driving up our spending. But almost 
all other advanced industrial nations cover virtually everyone, while we leave 50 million uninsured. 
Administrative costs are high here — no surprise given the hordes of 
clerks and accountants needed to deal with insurance paperwork. And 
technological advances, which are sometimes highly beneficial and 
sometimes not, often cost a lot more than standard treatments. 
(Surprisingly, American doctors lag far behind their counterparts abroad in using electronic health records, which can help avoid costly errors 
and duplications.) Insurance companies’ profits and the high pay of 
their executives may account for some of the cost differences with other countries, but there is little good data on this. 
A recent report from the Organization for Economic Cooperation and Development, a 
34-member group that includes the most advanced industrial nations, 
concluded that spending is high here partly because the prices charged 
by American doctors and hospitals are higher than they are anywhere 
else. 
The International Federation of Health Plans, in its 2010 comparative price report, documented just how large the price differential can be for a wide 
range of services. While it’s difficult to get data that is truly 
comparable from one country to another, the trends show Americans paying a lot more than people in other countries for the same services. 
Measuring how effectively we spend health care dollars is hugely 
complicated. But cross-national surveys offer some clues. We’re good at 
giving patients what they want — if they ask for it. So Americans can 
see a specialist or get elective surgery a lot faster than patients in 
other countries, according to surveys by the Commonwealth Fund. The 
surveys also show that Americans are more likely than people in other 
advanced nations to experience medical errors or problems with 
uncoordinated care, and to forgo care because it’s too expensive. 
The O.E.C.D. report rates America at or near the top for survival rates 
in breast and colorectal cancer but slightly below average in cervical 
cancer. We rank in the middle of the pack in the percentage of heart 
attack patients who die in the hospital within 30 days of admission. And we have alarmingly high rates of hospital admissions for asthma and 
uncontrolled diabetes — an indicator that many patients don’t have good 
primary care, which can prevent costly hospital stays. 
Most other advanced countries hold down prices through government 
regulations. We set prices in Medicare and Medicaid programs. But in 
private markets, reform has to rely on other means, such as financial 
incentives for providers to curb costs by coordinating care and 
improving efficiency. One demonstration program significantly reduced 
spending by bundling payments to hospitals and doctors to cover all 
in-patient services connected with heart bypass surgeries. 
The idea at the heart of the reform law is that such strategies, once 
proved effective, could be carried out on a large scale — and eventually bring total spending under control. 
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