Group items tagged

The fundamental fix for health care reform is likely to be achieved only through trial and error and incremental gains.\n

The researchers found that in areas where end-of-life care costs were normally high, having an advance directive significantly lowered the cost of care. On average, end-of-life care spending was $5,585 less per person in the high-spending regions when someone had an advance directive. > Having an advance directive didn't necessarily limit the initiation of aggressive treatments, but seemed to lead to their earlier withdrawal. Author said this finding was particularly important because some people make the argument that having an advance directive might limit all of the care you receive at the end of your life. But, this finding shows that while treatments are often started, for "patients with an advance directive, there's an earlier recognition of when treatments aren't working and when it's time to go to hospice."

'...the Cochrane Collaboration reported last year that patients who used tools to guide their decisions had a better grasp of their choices and risks. They were also more likely to select less intense or invasive treatment when considering major elective surgery, though results were mixed for other decisions. The influence of decision aids on adherence to medication or overall costs was "inconclusive," according to the report. 'But that uncertainty does not reduce the ethical obligation to better inform patients, or lessen the promise of tools that help patients understand their options and identify their values, some doctors say. "It is the right thing to do," said Dr. Victor Montori, associate director of the Health Care Delivery Research Program at the Mayo Clinic Center for the Science of Health Care Delivery....'

Bob Doherty is the main Washington lobbyist of the ACP - after the AMA, the largest organization of US doctors (representing internal medicine physicians, whether primary care or subspecialist). He's had some very interesting posts since the Massachusetts Senate upset. His blog is a finalist in the sixth annual Medical Weblog Awards for the Best Health Policies/Ethics Weblog. Doherty articulates the ACP's case for supporting the current Senate&House Health Care Reform legislation (whose failure he & many others will end up leading eventually to more draconian limits on doctors & patients, in order to control the currently unsustainable growth in US health care costs (now approaching 20% of GDP).

Need to still address MD SGR (perhaps gradual intro with gradual decr in reimbursement for some docs)

Agrees with Obama's 7/22/09 analysis of need to overhaul health care system - compassion coincides with need for cost constraint.

Harvard econ prof David Cutler says the Obama plan will cut costs-$600 billion over the next decade-and that those in Washington should not walk away from it.

Readers largely support measures to allow death in dignified environment with palliative approach, as opposed to repeated aggressive interventions that are rarely successful when the prognosis is poor.

Serious effect on medical cost curve

Problems with Private Insurance (by financier)

Pho is a fairly conservative primary care doctor in New Hampshire, but believes that defeat of the current Senate/House legislation will eventually lead to more draconian restrictions on doctors and patients, since the cost of medical care will otherwise become untenable in the U.S.

Startup cost & shortage of palliative MDs.

over-spending on very old, too little on young

'A few drugs - such as beta-blockers, statins and glycogen control medications - have proved very effective at managing hypertension, heart disease, diabetes and strokes. Most insurance plans charge something for them. Why not make drugs like these free? Not for everyone, but just the groups for whom they are provably effective. In traditional economics, such a policy creates waste. The basic principle is moral hazard: consumers overuse goods that are subsidized. But people don't always follow a cost-benefit logic. The problem is basic human psychology. Heart disease is silent, with few noticeable symptoms. You feel fine most of the time, so it's all too easy to justify skipping the statin. The problem here is the exact opposite of moral hazard. People are not overusing ineffective drugs; they are underusing highly effective ones. This is a quandary that ... call "behavioral hazard." We've found that co-payments do not resolve behavioral hazard. They make it worse. They reduce the use of a drug that is already underused. My proposal is targeted: Take drugs that are shown to be of very high benefit to some people, and make those drugs free for them. All co-pays should depend on measured medical value; high co-pays should be reserved for drugs and medical services that have little proven value. Why not focus instead on the behaviors - eating unhealthy foods or shunning exercise - that created the conditions we must now treat with drugs? [This]has some merit. But [it] fails the "perfect as the enemy of the good" test.

Conservative criticism of Republican scare tactics about Medicare limiting futile care at EOL

Med resource overuse