Consumer Power Report #225

Speaking of one standard for the Feds and another for everybody else, Ron Bachman writes up the results of his trip to Germany where he dug deep into the German system. He writes, “We listened to federal and state officials, doctors, hospital executives, members of the Bundestag, a health journalist, and German policy experts. They told us that the German system is the fourth most expensive system in the world. Their costs are rising rapidly and are unsustainable.” He says he pressed these people on what were the three best characteristics of the German system, and they could come up with only two – Solidarity and Progressive Financing. “Quality, access, cost effectiveness, choice, and convenience were never mentioned.”

He goes on to say that, 90% of the population is in “compulsory statutory social health insurance through 170 plans (where) there are waiting times for office visits, delays for elective hospital care, and postponed care if quarterly medical budgets are exceeded. Choice of physicians/surgeons is limited and private hospital rooms are not available.”

Ten percent of the population is “covered by 50 private insurance plans. Those with private coverage get to the head of the line for appointments, have access to private hospital rooms, and use of ‘master’ surgeons and leading specialists for care.” Ron writes, “I asked, who are those individuals and how many Germans get the private coverage as complimentary? The response was that federal government employees, state employees, professors, and others are defined as civil servants.” They make up 80% of those enrolled in these private plans.

Not all pigs are equal on this plantation(farm).

Now that ObamaCare is the law of the land, the New York Times is getting around to questioning some of its underlying assumptions. One article that got a lot of attention now that it is too late, was a criticism of the Dartmouth Health Atlas study of Medicare spending. You will recall that Dartmouth looked at Medicare spending in the last six months of life and found that some localities spent a lot less than other locations. They concluded that IF every location spent the same as the cheapest ones, and IF the spending patterns of the dying elderly could be applied to everyone, THEN we could save 30% of total health care costs.

Never mind that the entire premise was absurd, Obama’s OMB Director Peter Orszag took that factoid and ran with it. To the point of predicting that health care reform would not only preserve Medicare forever but also improve quality and balance the federal budget.

Now Reed Abelson and Gardiner Harris write in the Times, “In selling the health care overhaul to Congress, the Obama administration cited a once obscure research group at Dartmouth College to claim that it could not only cut billions in wasteful health care spending but make people healthier by doing so.” But, oooops — “the Dartmouth researchers themselves acknowledged in interviews that in fact it mainly shows the varying costs of care in the government’s Medicare program. Measures of the quality of care are not part of the formula.”

It adds, “Even Dartmouth’s claims about which hospitals and regions are cheapest may be suspect. The real difference in costs between, say, Houston and Bismarck, N.D., may result less from how doctors work than from how patients live. Houstonians may simply be sicker and poorer than their Bismarck counterparts.”

The article goes on to quote Elliot Fisher, MD, one of the Dartmouth researchers, as saying, “We never asserted and never claimed that we judged the quality of care at a hospital — only the cost.” Uh, huh.

It’s a good article, but it still misses the most devastating critiques of this pseudo-research, such as the withering reviews by Dr. Buz Cooper and others. Is there any chance the N.Y. Times will begin to look beyond the propaganda coming from the White House?

Even Health Affairs is beginning to catch on. It published an article by Kristin Carmen and others that calls into question one of the other panaceas underlying ObamaCare, the whole effort to dictate medical practice based on bureaucratic standards.

The authors are alarmed, but they still don’t quite get it. They begin by saying, “Many studies have shown that some health care provided in the United States is inappropriate, inefficient, and unsafe. Passage of the Patient Protection and Affordable Care Act of 2010 has now laid the groundwork for major reforms, including greater use of evidence-based medicine, shared decision making, comparative effectiveness research, evidence-based benefit design, and transparency of cost and quality information. We refer to these diverse efforts as evidence-based health care.”

They accept this all as gospel truth without ever questioning their underlying assumption. In fact, the evidence they use for the initial statement – that health care in the U.S. sucks – is mostly the junk science published by the Institute of Medicine in “To Err is Human,” and “Crossing the Quality Chasm.” We have debunked this on many occasions, to little avail.

No wonder, then, that they are surprised that the American people understand what is going on better than the academics do. Yet they understand how consumer buy-in is essential to any new initiative – “Their attitudes and beliefs about evidence-based health care, and their understanding and acceptance of it, will help determine its success or failure. If consumers don’t understand it or reject it, or if they see it as an invalid basis for making decisions about providers and treatments, the most ambitious goals of this movement may fail.”

They go on –

Increasingly, consumers are being asked to use evidence to manage chronic conditions, choose between treatment regimens, and select providers and health plans. In some respects, consumers are rising to the challenge. Research shows that decision aids, which provide information about options and outcomes, can help increase consumers’ confidence with decision making and improve their understanding and knowledge of treatment options. If consumers are more involved in decision making generally and self-management of health conditions, the results can be improved adherence to treatment, increased use of screening, increased patient satisfaction, better health outcomes, and lower health care costs. At the same time, many consumers’ values, beliefs, and behaviors remain rooted in traditional expectations about the doctor-patient relationship and the medical care system. The dominant role of physicians in determining patient care has been a fact of medical care delivery for many decades.

Most of the article is frustration that people are not as enlightened as academia about having bureaucrats control everything. They know that consumers are essential, but they don’t know how to get them to do what academia dictates.

Perhaps they should consider ways to empower, not control, people.

It is already old news, but AHIP has issued its latest survey of HSA enrollment. The survey found that 10 million people were enrolled in HSA-qualified coverage as of January 1, 2010, an increase of 25% from a year ago. The states with the greatest numbers enrolled were California (1,018,000), Ohio (651,000), Florida (639,000), Texas (637,000), Illinois (575,000), and Minnesota (361,000). The states with the greatest market penetration were Vermont (13.8%), Colorado (9.2%), Minnesota (9.2%), Arkansas (8.2%), Indiana (8.1%), and Ohio (8.0%).The report includes details on average premium, average deductible, and market segments.