Donald Berwick lays out the difference between the Obama approach to cutting health care costs in Medicare and the GOP approach to cutting health care costs in Medicare:
“There are two ways to save money,” Berwick told the journalists meeting. “One is to cut and the other is to improve.” He cited hospitals that have dramatically reduced patients’ bed sores and another that adopted efficiency steps from Toyota to save millions of dollars while also delivering better care. “The aim is to make the best the norm,” he said.
Berwick said the health law provides other tools to improve health care quality and delivery. These include accountable care organizations, in which doctors and hospitals coordinate patient care, and the newly created Center for Medicare and Medicaid Innovation to “nurture invention” that will lower costs and raise quality.
He also pointed to a patient safety initiative the Obama administration announced this week to reduce preventable hospital-acquired infections and complications. It could save 60,000 lives and cut Medicare costs by an estimated $50 billion over 10 years, officials estimated.
Berwick is an internationally recognized expert on patient-centered health care. With Berwick’s recess appointment, conservatives immediately swung into campaign mode, cherry-picking statements he has made over the course of a long and distinguished career to portray him as a wild-eyed rationing socialist. That’s the sum total analysis of Berwick and the cost-cutting measures in the PPACA. Two statements, two cites.
Conservatives are fighting tooth and nail in Congress to defeat every existing and real mechanism to reduce Medicare costs while shouting “hey, look over here!” and shoving Paul Ryan onto the stage, where Ryan waves a piece of paper around to convey URGENCY and FISCAL CONCERN.
It’s a kindergarten-level con. And, they’ve worked this kindergarten-level con successfully since they gained a majority in the US House.
Observer
Kay, they’ve been doing this since 1968.
General Stuck
They’ve worked the con for at least three decades now, but as a slow con, not a full frontal assault on the mark, which is always the average American when all is said and done. Maybe it will keep working this way for them, but the thing about lies is, when you deploy too many at once, it becomes nigh impossible to keep servicing them all in a plausible way.
Evidence of such is the Orange man looking more and more like a Conciliary to the Mob, rather than a Speaker of the Peoples House. Delivering one offer than can’t be refused after another, and then withdrawing the threat to burn down the country at the last minute. Then waking up with Unicorn Head in his bed one morning.
After a while, The Godfathers are gonna get them a new bagman.
btw, another great post on this topic Kay. You rule on health care wonk.
Kay
@Observer:
Oh, they’re frauds. No one on the Right had any objection to Berwick prior to the PPACA.
I’m afraid their absolute bankruptcy on ideas is going to chase everyone good out of government.
I think it’s already happened on the Right. Now they’re going after the center and the Left.
Kay
@General Stuck:
I don’t think Berwick is going to be confirmed, which is a shame. I think we’d all benefit from “patient-centered” health care. It’s like they’re deliberately chasing competent and committed people out of government.
Zifnab
I wish it was a kindergarten level con. But I’ve never met a kindergartener who was able to occupy the seat of every major news program and newspaper Op-Ed.
If the antics are kindergarten-level, the dispersement methods are military grade. You’ve got a national movement designed to disseminate misinformation, disgrace intelligent and non-partisan public servants to score cheap political points, poison the discourse with cheap bumper-sticker slogans about “Soci-ma-alism!” and “Death Panels”, and generally fuck every rat in sight.
Mandramas
Do you know that medical wages are 300% higher on America that on the rest of the world?
Martin
@Kay:
Like? That’s exactly what they’re doing. If Bush’s FEMA pick didn’t make that abundantly clear enough…
The best way to convince the public that government is too big is to make government incompetent.
The Republic of Stupidity
Wouldn’t hurt any to root out all the deliberate fraud and over billing… too… also…
Friend of mine recently had an unusual, one day medical emergency that did require some testing and an overnight stay, but NO surgery, no lingering after affects, and no techo-solutions…
Just a one night stay, some tests, and observation…
The cost for ONE night’s worth of treatment?
Forty four-frickin’-thousand… $44K… one night…
I kid you not… $44,000…
Yes… it was a Sutter hospital…
kay
@Zifnab:
That’s true. Good point.
I’ve been reading Berwick for a while, though, and he’s getting better…ah, shorter. “Two ways”.
He’s dumbing it down! Pretty soon it will be CNN-level!
The Republic of Stupidity
@Kay:
There’s no ‘it’s like’ about it, Kay…
They ARE deliberately chasing competent and committed people out of government… they WANT government to fail completely… so they can shut it down forever and privatize everything…
The Moar You Know
@The Republic of Stupidity: And Sutter, sadly, is the living Exhibit “A” for why any model of healthcare reform that does not include, at a minimum, conversion of all health-care providers to a non-profit model will not and cannot work.
Without removal of the profit motive and in the total absence of any meaningful regulation, you’ll end up – inevitably – with the Sutters of the world forming their regional monopolies and charging quadruple (at a minimum, they’ve been shown to do far worse) what the theoretical “free market” cost of those goods and services would be.
kay
@The Republic of Stupidity:
Can you imagine, though? You’re a pediatrician. You have and run your wonderful little advocacy group on patient centered health care. Everything’s fine.
Then you somehow end up in DC being cross-examined by 218 versions of Glen Beck.
Who needs this nonsense?
joe from Lowell
I don’t think that’s true.
Their cowering “Barack Obama is teh meanie!” stance since his budget speech blasting the Ryan Plan and laying out his own vision indicates to me that they realize it isn’t working.
Roger Moore
@Kay:
FTFY. The Republican assault on competence is old news.
Martin
Berman is basically saying that health care needs to go the same route as California has taken with energy policy.
There’s always going to be a free-market component to this, so we need to respect the incentives that exist there – which is profitability – from the individual to the corporate level. California’s gambit was to create a set of policies that made the energy companies more profitable by selling less of their goods (energy). Basically the state set the energy market revenue at a given size and told the energy companies that if they can convince consumers to use less energy, that the state would allow them to raise rates in order to keep the market at that size, and essentially split the profits between the consumer and the energy company. That’s a great deal because rather than energy companies building new production, they can instead hand out rebates for CFLs and low-consumption appliances, which is far less risky and far easier to change strategies on.
The same kind of approach is needed for health care. Rather than get health care providers to give out more care, they need an incentive to give out less by giving out better care and keeping people healthier. Consider it a strategy of ‘health conservation’. More managed care, less critical. More prevention. More GPs and less surgeons. More mammograms and fewer mastectomies. And the costs propagate outward – fewer high-salary doctors, fewer hospitals to build and operate, and so on.
The cost of the uninsured is paid 10x over later in critical care. A BIG chunk of the expected Medicare cost reduction comes from the mandate because we KNOW that people start putting off medical treatment a few years out from hitting age 65, deferring costs until they can stick it on Medicare. Minor treatments that are avoided at age 62 become major treatments at age 65, but even though they’re major, they’re cheaper because Medicare is good insurance and what a lot of 62 year-olds have isn’t good insurance (or any insurance). This is measurable, and it’s significant. How much will the mandate fix? Probably as much as 5%-10% of physician visits and 5% of treatments. Those are costs that are almost totally zeroed out of Medicare.
HyperIon
kay wrote:
uh-oh.
wave bye-bye, sir.
Bruce S
Ryan’s plan is – in purely economic terms a total fraud, morality aside.
http://titanicsailsatdawn.blogspot.com/2011/04/no-joy-in-medicareville-more-on-funny.html
The endgame in Ryan’s plan is uncontrolled rise in health care costs with seniors paying over 2/3 of their insurance costs out-of-pocket. Or go without…
If anyone thought that Allen Grayson was hyperbolic during the Great Health Care Debates about the GOP “plan” of “Die Quickly!,” in the light of Ryancare, he – at the least – must be considered prescient rather than shrill.
In the current New Yorker, George Packer writes correctly that: “In politics, the side with a fixed notion of ends and an unscrupulous approach to means always has the advantage.” This is the essence of the GOP strategy.
kay
@Martin:
Just think about how completely insane that is. I know they do it, Martin, but, God, this system is fucked up.
“I’ll just limp along here until I hit 65. No, really, I’m fine“.
Roger Moore
@kay:
I think the best way of thinking about it is that we treat health care as a necessity for seniors but a luxury for younger people. Both parties recognize that this doesn’t make sense, but their responses are opposite. The Democrats want to treat it as a necessity for younger people, and the Republicans want to treat it as a luxury for seniors.
NonyNony
@Martin:
People thought PJ O’Rourke was joking when he said “Republicans are the party that say government doesn’t work and then get elected and prove it”, but in fact he was laying down the party’s long-term goals pretty accurately.
kay
@Roger Moore:
I’ve said this here before, but I don’t think either of those two groups are most concerned about Medicare (younger people and older people).
The people who are now in their fifties are going to be the most upset about the GOP’s “health care plan”. IMO, they were really (justifiably) seriously rattled by the economic collapse. I just don’t think they’re going to accept ending Medicare, because it’s one of the few things they can count on.
I get a perverse pleasure out of that (if I’m correct,and I think I am) because all of those overpaid GOP political consultants are just wrong, and pegging Ryan’s plan to 55 and younger won’t do them a bit of good, politically. I think they’re hitting the people who are the most worried.
MarkJ
The problem is that our press corpse is, at best, able to spot a pre-school level con. The Rethugs can pull a kindergarten level con over on them indefinitely.
NonyNony
@kay:
One of my first reactions to Ryan’s plan was that I hoped the fact that he put in the “I’m going to buy off seniors by specifically exempting everyone over 55” got a lot of play for exactly this reason.
Because every time the GOP runs an ad defending his proposal and pointing out that if you’re over 55 you keep your Medicare everyone between the ages of 50 and 55 will get a reminder that the GOP wants to throw them to the wolves and they aren’t going to ever be able to retire because they’ll never be able to afford health care without a job.
If you want something to whittle away the support of the over 50 crowd, nothing could be better than saying “we want to add MORE insecurity about when you’re going to get to retire” to their lives right now.
Roger Moore
@kay:
I guess I was unclear. When I said “younger people”, I meant “non-seniors”.
mds
@The Republic of Stupidity:
Unfortunately there’s only one Florida governorship open at a time.
Arclite
One thing I find missing from all this healthcare talk is PREVENTION. If medical procedures are becoming more expensive, it makes sense to do fewer of them.
The food we eat has been shown to have an incredible impact on our health. But the foods that are good for us, like organic food, fresh fruits and vegetables, and whole grains are more expensive than a lot of processed foods. Food companies design food “products” that satisfy our most base desires for foods that are scarce but valuable in nature: sweet, salty, and fatty. Too much of these have been shown to cause or exacerbate many diseases: heart disease, cancer, diabetes, etc. Many of the concentrated additives like sugar and fat are subsidized, when they should be taxed so people consume less.
The federal gov’t is outspent a thousand fold by food advertising. $10m was spent in 2009 to promote healthy eating, while food advertising was $10 billion. The result is that Americans are more overweight than in any time in our history, and the subsequent rise in disease is measurable.
cckids
Lest anyone think that the ‘reducing bedsores” won’t save that much money, have an example: In Feb. of 2008, my son (a quadraplegic), arrived at a local, non-profit hospital with an upper respiratory infection and subsequently, a collapsed lung. They had no beds available in ICU, so he was left in the ER, on the ER beds, for 3 days, rather than being transported by ambulance to their sister hospital, 10 miles away, where beds were available. In the course of those 3 days, he developed a bedsore right by his tailbone. It quickly turned into a stage 4 (going to the bone), because their “pressure sore person” was on vacation, & they couldn’t call someone in from outside. His lung & infection were cleared up in 3 days, with antibiotics to continue at home. The bedsore, though, is still with us.
For the past three years, we’ve had: a wound vac (negative pressure therapy, rented), 3 x a week visits from a home health care nurse to change the vac (because the company requires that it be done by a nurse), 2 x a month visits to a wound care specialist, at least 6 rounds of IV antibiotics for infections developed in the wound, a colostomy (to prevent feces always getting in the wound), a permanent catheter, 5 MRI/bone scans, 2 in-office surgeries to re-open it (because it had closed at the surface, but was open under the skin), quarterly blood tests, and I can’t count how much in supplies & medications. For a while, we also had a rented alternating pressure air mattress, but the company that runs Medicaid in NV decided that since the wound wasn’t better with it, he could do without it (??) against all medical advice.
Total bills? I cannot imagine that it is less than 40-50,000 per year. Because an ambulance ride to another hospital was too expensive. THAT is the way a private company runs a Medicaid program.
And, of course, none of this begins to address the human costs my son, and the rest of our family has paid, and is still paying.
Ruckus
@The Republic of Stupidity:
That’s got me beat by a bunch. Mine was an hour and a half waiting (only one in the waiting room!), an x-ray(5 min with the tech), less than 4-5 minutes with a dr. and the bill was over $3500. And yes a Sutter place. I know there is overhead and all but $350 per minute?
Wait, I did the math. $44000/1440 minutes(24hr) = $30.56 per minute. If you count waiting time mine was $38.89 per minute. $30/minute is $1800 per hour. That’s way past lawyer territory.
Hospitals charge these exorbitant amounts and settle with insurance companies for much less (more like actual costs) and get to write off the rest. Makes their tax bill much less and allows them to say they lose money every year, all the while staying in business.
Ruckus
@kay:
Am that 61 yr old without insurance. Can. Not. Afford. No how, no way, end of discussion.
I’m just hoping that I make it to 65 and that everything is fixable. It is the shitty end of the shitty stick. And everyone, including me pays for it. I’m not asking everyone to do that, I’d love to have insurance or better yet health care.
It seems a normal life starts to go down that slippery slope starting about 55. It picks up speed about 60 or so and all of the problems multiply, adding one on top another. It makes life suck. And as many have pointed out it is fixable at much reduced costs, monetary, social and personal.
Ruckus
@cckids:
That just sucks.
And that’s the tale isn’t it? It isn’t that there should be a profit in the system, it’s that every single line item has to be profitable or it can’t happen.
Sending your son to another hospital may have cost (and I’m guessing) $500? Three days in the ER should have cost more than the ambulance ride and 3 days in a standard room. But the line item was too high so not no but fuck no. And now he’s sick for months on end at a huge cost increase.
JCT
@cckids: How horrific — and in my experience, not uncommon. Folks with disabilities or complex baseline needs have a spectacularly high complication rate in EDs. The staff are usually not well-trained and it is very easy to push things off from shift-to-shift . Usually my very first goal when someone comes through the ED is to get them OUT.
@Ruckus:
Yup, you should see the differential on my billing sheets between “billed” and “collected” – I’m an academic so I am not directly involved in the admin/billing side, but the difference is startling. Yes, Virginia, this is why “going to an emergency room” is not *free* — that money has to be recouped somewhere…
Ruckus
Kay
We may need to come up with a different name than a con. That is of course what it is but we are not paying with just money, we are paying with lives as well.
That takes it out of the realm of con and into the area of criminal fraud or negligence. Or at least it should be able to be called that. IANAL and all of that.
Ruckus
@JCT:
Of course it has to be paid for. The point is that a lot of hospitals seem to run at a tax loss for years and years but the lights are on and the employees get paid. If you jack up the costs way above the actual losses from the uninsured or the insurance reimbursements you can say you lost money and you need more to cover those while at the same time paying lobbyists to fight healthcare change, because the system really does work if you are the one exploiting it, as opposed to the ones being exploited.
ETA And by your post I see that many in the ER are not well trained and yet the costs are horrendous. Do we need better training? Would charging more money solve the problem? We’ve been throwing money into this pit for a quite a while and the best is that the employees are not well trained in the place we use because there is no other?
No one of Importance
@Arclite:
“the foods that are good for us, like organic food”
There isn’t an iota of evidence that organic food is any better for us than the other kind. Better for the environment, yes. But you’re going to be no more healthy shelling out for often dodgily labelled organic fruit and veg than stuff grown with nasty old phosphate fertilisers.
I’m greatly in favour of people eating better food, if for no other reason than it simply tastes better if you make it from better ingredients. But I am very much opposed to anyone trying to sell the message that wasting money on ‘organic’ produce is better for someone’s family, especially if that someone is on a limited budget. It simply is *not* better.
There is also little evidence to suggest that fresh fruit and vegetables are preventative in their own right (much to the surprise of scientists and medicos who’ve been pushing this line for many years.) Reducing the amount of fat etc by replacing crap foods with fresh veg is definitely going to help, but you can’t eat big macs and a bowl of lettuce and think that’s going to stave off the heart attacks and cancer.
mclaren
@Arclite:
You can quibble with the issue of whether so-called “organic” food (which typically contains as much pesticides and other toxic chemicals as regular supermarket giant-farm agribusiness foods, according to the tests) is better for you than ordinary produce and meat.
But you’re missing the point.
Arclite is on to something here. He’s pointing out the fantastically unhealthy nature of American fast-food culture. Those french fries at McDonalds? Unbelievable amounts of fat there. You don’t even want to know the witch’s brew of toxic chemicals in those “non-dairy milkshakes.” And when it comes to those burgers at Burger King and Carls Jr. and all the rest of those fast food drive-thru places, your mind would boggle at the sheer amount of slaughterhouse waste products and recycled fecally-contaminated leftovers that get dumped into what’s laughingly known as “burger” in American fast food.
Take a lot (if you can stomach it) at this article from the Fast Food Nation site about the hellish contaminated toxic food waste that goes into a typical American fast food “burger.”
opie jeanne
@kay: Jeez, I never was like that with Kaiser, but now that we’re on Blue Cross/Blue Shield I totally understand that attitude.
JCT
@Ruckus:
The basic problem is that most EDs (especially in the large city hospitals in NYC where I trained and now work) are used for *everything* (because people don’t have health insurance and/or proper preventative care) — thus, they are usually in a state of controlled chaos. No ED was ever meant to take care of people for days on end and the disaster with cckids’ son occurred because of his long stay in the ED. It is not surprising that none of the ED nurses had a clue as to how to care for a quadriplegic patient for several days. He never should have been in the ED for that long….
Lurker
@opie jeanne:
I have limited experience with both insurers, but I’m on Kaiser right now. If possible, I’m interested hearing more about your personal experience. How does Blue Cross/Blue Shield compare with Kaiser Permanente?
opie jeanne
@Lurker: We had Kaiser coverage from 1969 until this year. It took a little getting used to, but the program has improved dramatically and in Southern California we really liked it. In Northern California, not so much. The bean counters have too tight a grip on the NorCal system, or they did when we lived in that area. Where it was the absolute best was in Orange County, at the Anaheim Lakeview facility, the La Palma facility (might be just outside of Anaheim), and the Euclid facility.
We have been off of Kaiser since January 31. My husband fell in the garage (doing something really stupid) while we were still on Kaiser and broke the ends of a couple of fingers. I took him to the local ER (Urgent care?) and we just got the bill for that visit. The clinic billed Kaiser for an outrageous amount of money, $745 for the visit and X-rays, including $70 for a tetanus shot and $41 to give it to him.
The follow-up ran $125 for an office visit.
Our co-pay is set at $20, which we paid for the follow-up visit. Kaiser settled with them and our final bill was for $15.
Mr opiejeanne liked the doctor he saw for follow-up so he went to see him to establish a relationship. He’s 64, I’m 61. We both saw the doc, about a week apart, and paid our $20 each. The doc sent my husband for a bunch of tests, routine stuff. We got the bill for his visit and there was a substantial overcharge (around $150 total) with the note that we were not responsible for the part our insurance wouldn’t pay. We also got the bill for the labwork, $275.27, and insurance only paid $168.53 so we were on the hook for $82.14.
With Kaiser we never saw this sort of stuff. We never got bills like that. They run their own labs, you check in and there was no charge. No charge for vaccines, either. If you need ER treatment it cost $50, which was really just to shoo away the hypochondriacs. Kaiser is a system that works well for preventive medicine, and we never had to ask for a second opinion because most of the time the docs would automatically get 3 or more for anything that seemed a bit serious. We had a couple of scares in those 41 years, for us and our kids, and it was good having specialists called in. You can have your own doctor or you can change doctors within the system without anyone getting their feathers ruffled.
We both take meds for BP now and we used to pay $10 for each prescription, although they did charge me a lot more when I was being treated for Hepatitis C and was on Ribavirin and Interferon and Pro-Crit. The Ribavirin and Interferon cost no more than $35 each, and I saw the wholesale price for them and at that time it was $3000 for a month’s supply of one and $1200 for the other. The price fell dramatically over that year I was on it, but I never paid more than $35 each.
When I saw the new doc the insurance company was charged more than their max and they sent me the same note that we were not responsible for the difference. Ah, but I’m a female so he wants me to go for a mammogram, and I have become extremely suspicious that he owns part of the lab he referred me to… which I suppose is ok, and I am due for it, but I’m worried about what this will cost us. He also wants me to have a colonoscopy and I am not eager to do that either. I don’t know if we can afford all of this standard care.
My husband is a cancer survivor, prostate, and the meds he would like to take (think about it) are pretty expensive under this new system, not sure they’re covered at all since they are considered “elective”.