Tuesday, May 12, 2009

Putting It Together To Bring Down Costs

President Obama is working hard to address the issues surrounding health care in the USA. Two days ago he hosted a group representing many of the major providers such as physicians, hospitals and pharmaceutical companies. They promised to work to reduce the rate of rise of costs of care over the coming ten years. No specifics were given out. Here is what I would suggest as the first steps.

If we take the comments from my last few blogs and put them together, we see that a few critical forces have come together to push up the costs of care. To be sure, there are other reasons for the rising cost of care and I will address them in later blogs. But these few are they key ones and are the ones to aggressively address now if we are ever to slow the rise of expenditures much less actually bring them down. Here they are:

Our population is aging – simply stated, “old parts wear out.” We have bad behaviors – poor nutrition, overweight, lack of exercise, stress and tobacco with many of these starting in childhood. Both age and behaviors are leading to the development of complex, chronic diseases [heart failure, diabetes with complications, cancer, etc]. This is much different that the acute illnesses that we generally think of such as appendicitis or pneumonia. In those cases a single physician can treat them and the result is a cure. But these chronic illnesses once developed persist for life and they require the expertise of many providers.

These chronic diseases are expensive to treat – today they consume about 70% of all US health care expenditures although this care is going to only about 10% of the population.
But our care system is poorly coordinated and this results in far too many doctor visits, procedures, test and even hospitalizations. That is the reason for the excess costs and these could be brought down with resulting improved quality of care, safer care and more satisfied patients.

What is needed, more than anything else, is a cadre of primary care physicians [or sometimes specialist a physician] to carefully coordinate the care of those with chronic illnesses. Without question, this approach will bring down costs.

Sounds simple and is in concept but the reality turns out to be not so easy


Linda said...

Dear Steven,
Linda Lederman McTaggart here. First Wow! You have done fantastically well with your life. I still have a picture of our 1st grade class with Miss North and until today saw that picture of you in my head.
I have not read all your blogs (but I will) but I have a question for you. I saw Michael Moore's film "Sicko" and was surprised by the Canadian and British people's comments about how good their care was. And there is a part in that film too that has comments by Americans in France about what good care they receive in France but even more important were the attitudes of caring rather than greed of the French people for each other. We hear so much about the supposed horrible care of so called socialized medicine in other countries, I wondered if you have any experience or opinions about the health care in other countries?
Before I was eligible for Medicare my personal health insurance premiums went to over $900 when I was 64. Begin self employed, this caused me to get in debt with taxes. I am a calligrapher, who put my own letters into a calligraphic font on the computer and own (or am owned by) McDarlins and McWags, www.mcdarlins.com.
One of my early pieces, tongue in cheek, which you may enjoy, "The art of medicine consists of amusing the patient, while nature takes it's course.
I remember you were best friends with Charlie (I can't think of his last name)
Hope to hear from you.

Stephen C Schimpff, MD said...


Great to hear from you. I too remembr Ms North and Betsy Ross School and I have that picture. Charlie Uhlmann is an architect and lives with his wife in Los Angles where we saw them recently while visiting our daughter, son in law and grandsons. The various systems in Europe and Canada are different from ours but that does not mean they are inherently bad. They do have long waits for some procedures and surgeries. Most other countries' systems in reality have two classes of care - meaning that all have the federal system available to them but many who so choose have private insurance as well or just pay private doctors directly for their care. My personal belief is that we need some form of insurance for those who otherwise cannot afford it but would prefer to see private insurance and competition; perhaps a tax credit or voucher to buy the insurance. Even Medicare is expensive once you add up Part B, Medigap, Part D and any other coverages. Medical care is very expensive and we need to find ways to bring down the costs. As I suggested, better care coordination of chronic complex diseases would help a lot.

Praise for Dr Schimpff

The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.

-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).