Destroying the best health care system

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The great myth that some opposed to health care reform propagate is that we have the best health care system in the world and any reform effort will destroy it.  Nicholas Kristof destroys this myth in an Op-Ed piece in the NYTimes. 

The argument goes our health care is the best so reform will only destroy it.  Except that we are 31st in life expectancy, 37th in infant mortality, 34th in maternal mortality.  I could go on but check out Kristof's column yourself. 

The biggest problem I see is the reliance of the masses upon cable news or radio to learn what the truth is.  I do not suggest that anyone take Kristof's take as the reality find out the facts for yourself. 

For example I had a friend send me an email about how the health care reform bill was going to make seniors get end of life counciling.  You know Ms. Palin's idiot rant.  I didn't listen to Palin or any of the so called experts in the email - I went to the Library of Congress' web site and searched though the bill in question for myself. 

Kristof provides the reference to where is data come from:  The Robert Wood Johnson funded study by the Urban Instiitute How Does the Quality of U.S. Health Care Compare Internationally? Thus, one need not read my or Kristof's spin. 

As my dad told me as a kid don't believe what people tell you find out for yourself.

SMP

Watch and wait - a treatment approach

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The September 22nd issue of the Wall Street Journal has an interesting column by Melinda Beck, "Getting Well: It's About Time."  To make it simple this about about how so much waste is involved in our health care system because we are impatient.  For many conditions one would do best to just wait.  In a previous blog I present an anecdote about Dr. Paul Glasziou using the best treatment for his 2 year old's otitis media, "watch and wait".  Ms. Beck cites a few different doctors who note the value of such a non-treatment approach. 
There are a bunch of great quotes in this piece:

• "Most people's bodies and immune systems are wonderful in terms of handling things—if people can be patient," Ted Epperly 
•  "I have a mantra: You can do more for yourself than I can do for you," - Raymond Scalettar

The estimate is 1/3 of the US expenditures on health care would be saved if we did less, when appropriate.  Ms. Beck presents a list of when one shouldn't wait such as signs of stroke, heart attack, majory injury etc.
 The bottom line is better health care decisions on both patients' and doctors' parts would save us a ton.

"The art of medicine consists in amusing the patient while nature cures the disease."
Voltaire (1692-1778)

SMP

Baseball and health care - evidence based care

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As I hear more debate (or is it partisan rancor - I mean despite obvious lies not one Democrat disrespected the office of the President and yelled to President Bush liar) regarding health care reform I am reminded of a remarkable Op-Ed piece from the NY Times (of course) by the strangest of bed fellows: Billy Beane, Newt Gingrich And John Kerry.  For those who do not know Beane is the VP and General Manager of the Oakland A's, I might be wrong but I figure everyone else knows former Congressman Gingrich and Senator Kerry.

Just brings Garrett Morris as Chico Escuela on SNL- "Baseball be berra good to me"

Why would baseball be a benchmark for health care?  Because baseball is a game of statistics and coaching decisions and in particular staffing decisions are made by using those statistics.  The use of a newer way of looking at baseball statistics is what Beane is known for.  It is called sabermetrics. And the point of this op-ed is better health care is possible if we use the data, i.e. evidence based health care.

SMP

Malpractice 3

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In today's CT Post, Robert A. Levine, MD writes an Op-Ed on health care reform and malpractice. I have to say that when I saw the headline I thought this was going to be another kill the lawyers piece that I see so often. Or maybe another Republican-like plan to restrict the amount of jury awards to people actually harmed by negligent care.
Instead, Dr. Levine presents a cogent argument about what is wrong with our current system and suggested objectives that any reform measure should include.
I would post a link to his article but unfortunately the publishers of the CT Post have never read "What Would Google Do?" (WWGD is a great book by Jeff Jarvis which would argue that the CT Post should put the whole content of the newspaper on-line for free - remember what has Google every charged you? ZERO).
Dr. Levine's five objectives in any system intended to address medical negligence and malpractice are:

1. Decreasing the incidence of negligence and improving quality of care
2. Properly and rationally compensating individuals who have been significantly injured as a result of negligence
3. Removing incompetent physicians from patient care
4. Punishing physicians guilty of negligence
5. Having a process both patients and physicians believe is equitable.

As I've noted in previous blogs about malpractice a large problem isn't frivolous suits but negligent care. Dr. Levine notes that many who are seriously injured never receive any compensation because they don't file suit. Currently too many bad doctors, regardless of the specific profession continue to practice or shall I say malpractice.
Hopefully, any plan to come out of Congress doesn't just limit the amount paid out in malpractice cases for all that will do is ensure that some patients who really need compensation don't get it.
SMP

Preventing Deaths From Treatable and Preventable conditions

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The health care debate rages on and most of the discourse seems to be full of opinions that are bereft of data. A recent NYTimes editorial notes that an Urban Institute study shows that American health care does somethings right and others wrong. The Times editorial highlights the fact that American health care seems to fail at preventing deaths from treatable and preventable diseases.
While the most jingoistic Americans are blind to the quality problems in our health care system, the recognition that the American health care system could do better has been known for a long time. One of the most through studies about quality of American health care was published by the Institute of Medicine over a decade ago.
Crossing the Quality Chasm: The IOM Health Care Quality Initiative

The IOM Definition of Quality is one I think everyone should keep in mind:

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

With so many people complaining that they don't want the government to decide on health care decisions, I wonder why we have assumed that insurance companies, for whom less payments to health care providers means more profit, are some how better than the government without profit motive would do. Whether it is the government or a for profit company making decisions on what health care interventions are appropriate and should be paid for, it would be nice if this definition of quality were foremost in everyone's mind.
SMP