Monday, September 21, 2009

Health Care article on who, when and how much...

Just to prove I look around for ideas and information, even in places where I'm uncomfortable, here is an interesting article on health care from the LA Times. The article highlights studies by the Dartmouth Atlas Project, a research institute at Dartmouth College, which looked at what Medicare spends on chronically ill patients in their last two years of life, a time when medical costs are highest.,0,2955060.story?page=1

Highlights -

(1) "Studies show that the sickest 10% of patients consume two-thirds of the nation's healthcare outlay. So even small improvements could reap big savings.";

(2) "The national average for Medicare spending on such patients was $46,412, including outpatient care. But in Los Angeles County, the average cost was nearly double that, $84,179...";

(3) "...the highly rated Mayo Clinic in Rochester, Minn. Medicare spends $50,273 on chronically ill Mayo patients in the last two years of life -- 8% more than the national average, to be sure, but still a relatively modest premium given the Mayo Clinic's renowned care.";

(4) "...the tab is especially high for chronically ill patients seen at White Memorial. Medicare spends an average of $130,992 on patients seen there in their last two years of life, the biggest share of it on hospital care... That's nearly three times the national average for similar patients..."

An interesting conclusion you can reach from this article is that it costs more than twice as much to die in an LA County hospital that takes charity patients than it costs to die in the Mayo clinic. Why would it cost more than twice as much in LA County than in the Mayo Clinic? And if 2/3 of all health care costs are paid for 10% of the patients, it's pretty clear where the savings have to come from.

As others continually point out - the US spends more on health care than anyone else and we get less for it. Perhaps the above article include evidence that may lead to at least at partial explanation.

But a point which is not mentioned in the article, which I submit is that a key factor in the equation, is the economic status of the patients. Note that a significant portion of the high cost is generated by care for "the poor". This is obvious, but leads to a statement of fact which is politically incorrect, to say the least.

In a country with the greatest possible conditions where, over a lifetime, an individual can achieve great heights, some (not all, but surely some) simply CHOOSE not to do so. In other words, the individual, personal Life Decisions of "The Poor" are a critical component of WHY they are "Poor"; and why they remain so. As a result of their Life Decisions - e.g., poor decisions; no pun intended - they have positioned themselves to require more and expensive Health Care.

Yes, this is a harsh point to make. But Reality trumps Theory. I suggest no specific action (at this time) concerning this issue with respect our new and developing system. But I would like to interject that providing care is only a single aspect of the problem. There are individuals who are capable of making 'good decisions', yet simply CHOOSE NOT TO. And the implementation of a bureaucracy which imposes (i.e. FORCES) 'Good Habits' on everyone (because a few refuse to use their brains) is a dangerous and slippery slope, to be sure.

Food for thought, nothing more.

- Steve

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