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New America Foundation Discusses State of US Healthcare

By    |   Thursday, 03 Jan 2013 01:49 PM

A panel convened by the New America Foundation (NAF) recently discussed issues related to the quality of care delivered by the U.S. healthcare system, referring to some books that the authors believe should be highly influential in the formulation of policy.

In her introduction of the panel, NAF Director Shannon Brownlee called for more transparency and better access to data on the relative performance of healthcare providers. She mused that Americans seem to be much more accepting of gun ownership as a right than they do of healthcare. (This comparison may not be apt, since the government does not fund the provision of weapons to civilians.)

Brownlee, author of “Overtreated,” compared the healthcare system unfavorably with the rest of the economy as to basic industrial efficiency. Whereas other sectors have streamlined their systems (she might have excepted the financial sector), healthcare is in the Dark Ages.

She noted that the hospital industry is in $1 trillion in debt, the equivalent of a year’s revenues. (This figure could be compared favorably with that of the financial sector, whose embedded losses are estimated at $15 trillion, equal to the entire gross domestic product of the United States.)

Brownlee predicted that the sector would have a difficult time justifying continued expansion in the face of the need to control costs, the assessment of readmission penalties and the adoption of prevention measures designed to keep people out of hospitals.

She suggested that the mortgage crisis stands as “a pretty good dress rehearsal for what happens when a debt market crashes,” and she predicted that the safety-net hospitals would be the first to be squeezed. (By comparison, the federal authorities continue to shower printed money on the safety-net banks; perhaps Obamacare will do the same for hospitals.)

Dr. Marty Makary, author of “Unaccountable” and a surgeon at Johns Hopkins, lamented the erosion of public trust in healthcare, demonstrated by the fact that half of patients seek alternative healthcare, regardless of what their doctors advise them. He raised “the fundamental question of whether the public has a right to know about the quality of their hospitals,” now that data are available that are fair and risk-adjusted.

A startling statistic he cited is that some hospitals have complication rates four times the rate of competitors. He referred the audience to www.hospitalsafetyscore.org.

Rep. Jim Cooper, D-Tenn., presented saving essential programs — Social Security, Medicare and Medicaid — as an imperative that can only be achieved by extensive reform of healthcare. He cautioned that these reforms require action and cannot be accomplished by “magical thinking, political speaking or chickening out.”

He listed the Social Security Disability program as likely to run out of money in 2016, Medicare Part A in 2024 and Social Security itself in 2033. He called this “an acute problem” that requires “truth telling and appropriate action.”

Cooper estimated that every day of inaction costs $11 billion, but he held out hope that the programs he considers essential could be saved if the rate of cost increase of healthcare could be contained at 1 percent above inflation instead of the current 2.5 percent. An example of truth telling would be disclosure of how dialysis clinics make their money.

He expressed support for a premium support proposal by economists Henry Aaron and Alice Rivlin, both senior fellows at the Brookings Institution, and a Medicare fee for service option backed by Sen. Ron Wyden, D-Ore., and Rep. Paul Ryan, R-Wisc.

Dr. Vikas Saini, president of the Lown Foundation, questioned whether healthcare providers are producing procedures or health, but he asserted there is a “staggering opportunity for change to be applied.” He criticized the profession for being slow to change.

Saini suggested that a “base-closing” process be applied to hospitals, but he cautioned that the payoff from greater reliance on prevention than surgery could only be realized over the long term.

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Robert-Feinberg
A panel convened by the New America Foundation (NAF) recently discussed issues related to the quality of care delivered by the U.S. healthcare system, referring to some books that the authors believe should be highly influential in the formulation of policy.
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Thursday, 03 Jan 2013 01:49 PM
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