Response to Peter Orszag
This is Buz Cooper at his blog:
Peter Orszag….. cited the fact that knee replacements are much more frequent in Milwaukee than in Manhattan, and he's right. But….. Milwaukee's greater use of knee replacements is not because nefarious doctors are bilking the system and that 30% of health care spending could be saved by stopping such waste.
The reason is that Milwaukee is within a cluster of states with high rates. They extend from Idaho to Michigan and from Kansas to North Dakota, but they don't stop there. High rates continue into Saskatchewan, which sits atop North Dakota and has the same high rates, and into Ontario, which sits above Michigan and shares Michigan's high rates. Knee replacement rates in these states and provinces average 70% higher than in regions with the lowest rates….. Saskatchewan and Quebec are as different as North Dakota and New Hampshire. How interesting that two neighboring countries with two different health care systems have identical patterns of geographic variation – a phenomenon that knows no borders…… more.
This is a great article, and points out one of the primary problems regarding comparative effectiveness.
It was interesting that the article referenced over-used of knee replacements in the Upper Midwestern United States. Dartmouth found Medicare expenditures in areas of Florida were twice the spending per senior as Minnesota.
It will be difficult to reduce regional variation in treatments that are ingrained from cultural norms. That is why it is so important for seniors to control more of their own health care dollars. When seniors control more of their own funds, they can decide which services hold value and which ones they consider a waste of money. With little skin in the game, seniors have fewer reasons to question whether invasive treatments might be better treated through drug therapy.
This is very interesting. It’s a perspective I’ve never seen before.
The main rsaoen we are focused on cost-cutting is that a huge portion of our health care costs are administrative. We have to pay profits to private insurers. In New Mexico we have a public private partnership (i.e., the state subsidizes low income New Mexicans to purchase a private plan). When my county explored the possibility of a mill levy to purchase this low cost insurance for our residents, we realized we could buy as much access if we chose to forgo the 3 to 1 Medicaid match and the insurance, and instead put unmatched money directly into primary care. We couldn’t justify taxing poor people to pay the high overhead caused by for-profit insurance. To add insult to injury, our largest employer is Wal-Mart. So we would be imposing a property tax on poor people to buy insurance for Wal Mart employees simultaneously contributing to the enormous salaries of insurance and Wal Mart execs.As I said before cutting costs and cutting spending are not the same. Why would I pay $1 million for something I could buy for $250,000 I once heard about a bagel and cream cheese that cost about $500. The cream cheese was laced with gold flakes. I would personally prefer a $5 bagel with chives and lox. Not everything that glitters is good for you.BTW, Stephanie Miller stated today that we are paying between $400 and $1,000 for a gallon of gas in Afghanistan. Think of how much health care we could buy for that.
It is refreshing to hear a losaenabre response to the american health care hysteria. I am a Canadian health care worker, currently living and working in Canada with previous expereince working and living in the US. Even with employment in a healthcare system there were many times when I worked in the US that I had NO health care coverage. It would have been cheaper to get medivaced back to Canada if I was ill. I am astounded at the fear of some people in the US to the idea of health care for all. I really don’t think they understand exactly what their insurance companies are providing them (or not providing them) and the restrictions placed on thier health care. In fact, most US health insurance companies are much more dictitorial, controlling and restrictive than even the most conservative insurance provider in Canada. Sure our system is not perfect, but it is still a far sight better than what is available in the US for the average middle-classed family.