Obama’s Unhealthy Choices

Mr Samuelson has curiously omitted malpractice costs from the problem of total healthcare costs. Malpractice costs drive up total costs in several ways. The direct costs of the insurance can be over $100,000 per year per doctor and the consumer surely pays for that eventually. Litigation fears also stimulate the doctor to use the newer, more expensive drugs, schedule more frequent visits, order more tests, and stop seeing problematic patients.
This is a health care cost that can be fixed. Let's seen some legislative action.

I think to cope with this ever growing health care spending is to give the seniors health education so to improve thier health quanlity to reduce agerelated diseases! certainly not the way to increase budget!
I am a antiaging researcher,I am 80 years now,but i am very healthy I go to doctors office only for my health exam!! If I can do it why not others!
For the past 6 years I already published 5 books regarding antiaging(in Chinese only), my book has been recommanded by Beijing China National Library, my last book had been published in China by the Jinlin publishing Co.
If I can do anything for this country I am willing to be the volunteer to teach seniors to better health!
Email:uvchen@gmail.com

This is all well and good and certainly explains the dilemma that Obama faces in reforming Health Care in the US. But I submit (as a Cardiologist), that Health Care reform will be impossible without tackling Obesity.
Obesity, in my opinion, and supported by numerous studies, is the underlying causative factor in hypertension, diabetes, hyperlipidemia, cardiovascular disease and death. It is implicated in the development of certain cancers and psychiatric diseases, such as depression, and other illnesses as well. The result of these chronic conditions on Health care costs, not to mention the overall health of the Nation, is staggering.
The US leads the world in obesity. The average american is 30 pounds overweight and the problem is worsening. Lack of activity, lack of discipline, long term failure of popular diet plans, and fast food chains are primarily responsible. The average caloric intake per person in the US exceeds all other industrialized counties. Obesity is a recognized epidemic.
The management of health care costs will never succeed in an environment where obesity is allowed to flourish and the cost and responsibility for obesity is shared with the patient. The same cost sharing has been utilized for smoking and other high risk habits, and should be applied to obesity even more so.
President Obama will not be successful in trimming the fat off Health Care until Americans learn how to trim their own fat. Modifying one's eating habits is imperative.

Very interesting information, certainly; yet the conclusion - which I read as a 'free market' approach focusing on costs as they are apportioned today - cannot work as long as the playing field is not more level. Health care is not hamburgers; it is not just any old commodity. When my recent cancer diagnosis was made, I DID NOT go to the most prestigious institution because I could not get there easily. I went local. I did not ask around for cheap because my doctors had recommendations I trusted. Of course I'm using my own judgment in attending, and if something is not working I will act. But as a person facing a very serious issue, I do NOT see it as my job to explore cost options. I see that as something the government should have some hand in arranging, I see us setting up a system that will not pay for itself immediately, but which has a clear plan - like greening our buildings. Maybe there is a 'highway system-like' process to make it work. Whatever it is, I do NOT want the 'business model' being the basis for taking care of people, many of whom cannot afford the system.

Glaring omissions from a discussion of healthcare costs:
1. Liability. A New York orthopedist or gyn pays 105,000$ a year for malpractice coverage. A neurosurgeon pays 240,000$. We all do huge numbers of expensive tests, as well as entertain huge numbers of expensive patient whims because we can lose everything in a suit. Easy problem for government to fix but will a Democrat anger the Trial Lawyers?
2.Code-based billing structure. I pay over ten percent of my gross collections to companies that help me bill. This is a huge, federally mandated structure of byzantine complexity. It supports armies of specialists--both in private industry and public offices. The accepted "7% administrative cost contribution" is an artificially low number. The solution is again easy at the federal level but given the federal drive toward more complex Electronic Health Records (which is financially, not quality-driven) it is doubtful savings will come from here.
3.The Medical-Industrial Complex is an expensive reality--and should be mistrusted. The billions of insurance company profits that have been taken out of the loop that used to go between doctor and patient add to healthcare expense without producing healthcare. Marketing by medical companies, becomes a major factor in continuing medical education, Only in a liability-sheltered environment can docs do something about this.

Why is it that no one ever mentions the huge factor of liability in driving up the cost of health care? Capping awards and punishing frivolous law suits it would be a good start towards reigning in cost and it would be immediately noticeable. The albatros of liability is the main reason for the ordering of so many Cat scans and other costly tests and the inflation of overhead. I will answer my question: most policy makers are attorneys and totally commited to protect their livelihood and those of their own. And this is not scapegoating.

Great editorial, glad to see somebody talking about tough health care choices.

Something that has been missed is that there are certain areas of health care which aren't addressed well today and which if they were could save a huge amount of money despite additional costs for treatment. One big example of this is mental health care. People with serious mental health problems often cause a huge amount of trouble for the courts, law enforcement, and everybody around them.

Take for example people with Borderline Personality Disorder. Apparently about 18 million people in the US have BPD by the latest studies. These people are often victims of child abuse and turn into spousal and child abusers themselves, passing often severe psychological damage on to their own children and spouses who then in turn suffer and likely cause more problems for other people. They cause so much trauma and damage to others that if there's any reasonable way to get the more troubled of them some real help, the savings could so far outweigh the costs.

I read an interesting assessment of how that illness may account for so much costs in courts, law enforcement, lost wages, etc. that if money was actually spent to provide therapy and medication to help these people, the savings could be $150 billion per year if it were to work really well. It was at http://angiemedia.com/?p=582 . While I'm skeptical that there's any way to really nail down the numbers precisely, it seems like the idea is plausible.

The current system is also expensive because of people like my family. We go to the doctor for anything because we currently have excellent insurance through my employer and never know when/if that will end. I feel like we have to investigate any little problem that we could probably just watch and wait on because insurance could end at any time!

This was a excellent article about how we have too much of everything. Too much advertizing , too much surgery, too many emergency care centers. Frankly this all started with the Clinton attempt to solve s"sickness care" and helth maintenance. It was done very poorly and resulted in HMO CEOs getting paid more that any physician ever did before. There need to be controls on this free-for-all in escalation. 90% greater knee replacements than any other country--absurd waste. Some of these are my friends who are walking not better know than before surgery! RJS did not mention the leagal problem which increases the cost of care at least 10-20%. LWP MD

We are a McDonalds fast food instant gratification society that is unwilling to take responsibility for our own actions and unwilling or unable to use some common sense in our approach to health care. This has fueled the rapid expansion of facilities and serves in the name of "Not for Profit" in which there is no inherant goal to reduce costs. Since there is motivation for the Health Care industry to continue to escalate costs, the only way for us to gain control over those costs is if we change our attitude about our need for health care services and take responsibility for our personal well being.

Why do I have 5 hospitals within 20 minutes of my house (Population of 200,000)? Why do I have 15 walk-in clinics within 10 minutes of my house? The Medical Community offered it and the consumers decided it sounded good and it became a consumer demand. If the hospitals and clinics were not continually full they would not keep building more.

It is a lot like Government, It is less that we need cheaper heath care, but that we need significantly less healthcare. Both could easily be cut in half with out a real reduction in the quality of our lives.

Another critical difference between the developed countries we compare ourselves to and the US is the ready availability of lawyers reading to sue a physician (I am one) if something goes wrong. Why are we doing so many more scans than other countries? One of the reasons is that patients are always ready to sue if something that could have been detected earlier is not. As a result, we get more scans and more tests and less watchful waiting. Some would call this thoroughness while others call it "defensive medicine." In either case, it costs money. Liberals such as Professor Samuelson always ignore this facet of healthcare costs since tort reform would impact a major democrat funding source, trial lawyers, as well as our perceived rights as Americans to sue anyone at any time. I am not saying that tort reform is the entire answer, but let's at least be honest and factor it into the equation. It is not just the malpractice premiums we pay, but the way our practice patterns change to protect ourselves, Again, we can argue that more thoroughness is good, but let's acknowledge that it costs money.

We Americans need to realize that countries with "Unversal Heath Care" have a second heath system for those who can afford it. Eventually, we're all going to die of something. There will always be a rich person who can afford to live a year or two longer maybe and there will be a poor person who will die a year or two earlier. Attempts at preventative care become too expensive to be universal. Healthy people do whatever they want and it's too late for sick people. Government can't change the basic equation. Americans will never put up with that much government control. Insurance companies won't pay for everything an American will feel entitled to. In my opinion the best we can hope for is some basic government sponsored, via tax rebates or whatever, level of healthcare and an understanding that to get better than that, you have to earn it somehow so that you can pay the premium for a better plan that not everyone will have. We may have all been created equal, but there was no guarantee we'd stay that way. We need to learn to live with reality and eventually die with some dignity and stop believeing that somehow we're all entitled to eternal life if medical science can provide it whatever the cost. Then the government can start debating what basic minimum healthcare can be provided and how to pay for it, but don't count on new knees and hips when you're 80.

My wife and I pay $14,000 per year for individual PPO insurance policies, and are terrified to use them because of the high deductibles and likelihood of getting canceled unless we are practically falling off of our chairs in pain. If you somehow manage to reduce this to $10,000 per year (i.e., saving the 1/3 overspending that the study suggests), you're not going to materially impact our willingness to seek out functional health care except in cases of absolute need. Is this really - really? - the real-world outcome you want to see for 300 million American consumers after your infliction of direct economic pain is fully absorbed?

The worst part about it, as I saw in this feature elsewhere (http://www.flypmedia.com/issues/17/#1/20) with Tommy Thompson, is that our health care crisis affects our international standing. If we can't solve it, we not only face a crumbling domestic status (as the health care costs skyrocket and push millions more Americans outside of the system) but also a crumbling diplomatic status. How can we talk down to other countries for not taking care of their public health crises when we cannot even ensure the health security of our own?