Giving a Whole New Meaning to “Big Brother”
In Camden, N.J…just 1% of the people who used the city’s medical facilities accounted for 30% of the costs. One patient had 324 hospital admissions in five years, costing insurers $3.5 million.
Another fellow, weighing 560 pounds, with both an alcohol and cocaine problem, spent more time over a three-year period in the hospital than out of it. But thanks to work by a crusading doctor, Jeffrey Brenner, the man was pulled back from the brink, cutting his hospital visits dramatically…
Brenner wants to put social workers in “hot spot” buildings so residents can be coached daily about their diet and exercise and harangued to quit smoking. He cajoled the 560-pound alcoholic drug addict to resume church attendance…
Brenner is a private citizen doing heroic work. But if this model were to be nationalized, you would in effect have agents of the government serving as lifestyle coaches and health “mothers.” Surely you don’t have to be a “tea partier” to find that creepy.
More by Jonah Goldberg in Los Angeles Times on Atul Gawande’s article in The New Yorker.
It sounds like this guy is really performing a community service. However, I would prefer a private organization provide this type of service rather than government agency of community social workers. I tend to agree it is a little like Big Brother to have social workers housed in the community spying on people. Also, a private charity can easily make decisions based on cost versus benefits. I’m afraid a government agency could expand with little regard for whether its efforts are even working. Over time the program might perpetuate itself for the benefit of the people employed by it.
It has been documented in research that there are social unmet needs in our communities, particularly in older adult population. One of my first research papers looked at ambulance recidivism rates and transports to emergency departments for older adults in a particular community. In two separate 16-month periods I found a repeat rate of 30%. Current research is looking at utilizing EMT’s to evaluate the patient’s environment, as EMS providers are one of the few health providers to actually view the patient in the home. Social workers then evaluate the patient and help the address the unmet needs. Not only could this improve the quality of life for these patients, reduce their utilization of emergency department by addressing the underlining issues, but lower cost. There wouldn’t be a need for social workers looking for business, just receive referrals when people request help.
The first step is identification, which the means exist. Subsequently, if a market of private businesses competed to offer and address the unmet need in our communities, patients could theoretically receive care they once found in the hospital in their home, and cheaper.
I didn’t realize anyone considered Camden, NJ, as a model for anything.
While I realize I’m beginning to sound like my parents, I must ask — What the blazes ever happened to the concept of personal responsibility???
There’s nothing wrong with analyzing geographical data and taking lower cost preventive steps to prevent higher costs. E.g., EMS identifying residents at risk of repeat tansport calls & referring them to an appropriate agency, service organization or charity.
Private insurers already have task forces to manage high cost cases. Who was payor for this guy? Medicaid? Medicare?
When we read the dystopian literature, from James Madison through George Orwell, we learn that the threats to free, civil society, are not the obvious evil-doers but the “do gooders”:
“I did this for one person (or a small group). Why doesn’t everyone else behave as they ought? If the government gave me the money and power, I could get everyone to behave better.”
What the good doctor should understand is that if the government mandated these services nationally, the quality would decline as they became subject to the perverse incentives of state bureaucracy.
I second John Graham’s comment.
Some guy takes the initiative to research spending, finds that it is heavily concentrated (no surprise), and then works to reduce spending while improving care. hat is called creepy?
Steve