NPR's U.S. Healthcare Truths

[Whomp]

About a year and a half ago Chicago Public Radio in partnership with National Public Radio (NPR) received a fair amount of praise and awards for their coverage of the mortgage crisis with their show "The Giant Pool of Money" (May of 2008 and highly recommended listening). It was such a success NPR continues to podcast on the topic with "Planet Money".

About a month ago, the same Chicago crew put together another big piece on "This American Life" on the subject of health care. Though many would expect a certain amount of "American leftishness" from NPR (and even more from Chicago Public Radio) their conclusions will likely be dismissed by those that lean "left of American Center".

As in their coverage of the mortgage crisis in May of '08, the reporting was clear and even-handed. The reporters sought out industry professionals, economists, and patients. Fortunately, they ignored politicians since who needs more grandstanding from this pile of idiots?

They surveyed the history of the American health-care system and drew some conclusions about why it has so many problems. Here are the health care truths uncovered by the new vast right wing conspiracy theorists at NPR and Chicago Public Radio...

• Medical-malpractice lawsuits drive up the cost of health care.
• Insurance companies are not evil.
• Our reliance on third-party payers is at the heart of the problem.
• Obamacare won’t fix it.

Since I've done all the above work for you it's not necessary to listen to both episodes and I'm sympathetic to many of your "tl;dr deficit disorders".

However, if you'd like a real education on U.S. health care hit these links and the spoilers give you what each episode discussed.

http://www.thisamericanlife.org/Radi...spx?sched=1320

Spoiler:

391: More Is Less

An hour explaining the American health care system, specifically, why it is that costs keep rising. One story looks at the doctors, one at the patients and one at the insurance industry.

This show was a co-production with NPR News, and was one of two shows we did on health care: the other is Someone Else's Money. We also have more health care resources here.


Prologue.

Former Bush Administration official David Frum explains a very surprising fact about Bush's economic failure, as it relates to health care. Frum is a regular contributor to the radio show Marketplace. (5 minutes)

Act One. Dartmouth Atlas Shrugged.

Are doctors to blame for the rising costs? NPR Science Correspondent Alix Spiegel reports on the shocking results of studies about varied health care spending. Hear more health care stories this week from Alix at npr.org. (18 minutes)

Act Two. Every CAT Scan has Nine Lives.

Or is the problem the patients? Producer Lisa Pollak reports. (12 1/2 minutes)

Act Three. Who Would Win in a Fight Between a Polar Bear and an Insurance Company?

Or maybe the insurance companies are to blame? Producer Sarah Koenig reports. (12 1/2 minutes )

Act Four. Now What?

Host Ira Glass talks with Susan Dentzer, editor of the journal Health Affairs, about what current health reform proposals do to fix the rising costs of healthcare...And points at a surprising, kind of heartening phenomenon happening within the current debate. (6 minutes)

Song: "Doctor My Eyes," The Jackson Five

http://www.thisamericanlife.org/Radi...spx?sched=1321

Spoiler:

392: Someone Else's Money

This week, we bring you a deeper look inside the health insurance industry. The dark side of prescription drug coupons. A story about Pet Health Insurance, which is in its infancy, and how it is changing human behaviors—for example, if you have the pet health insurance, you bring your pet to the vet more often, and the vet makes more money and...well, you can see the parallels. And insurance company jargon, frighteningly decoded.

This show was a co-production with NPR News, and was one of two shows we did on health care: the other is More Is Less. We also have more health care resources here.


Prologue.

Host Ira Glass talks to Rob Lamberts, a doctor and blogger in Georgia, who describes the crazy world of medical billing, where armies of coders use several contradictory different systems of codes...and none of it makes us healthier. (5 minutes)

Act One. One Pill Two Pill, Red Pill Blue Pill.

Planet Money's Chana Joffe-Walt explains why prescription drug coupons could actually be increasing how much we pay, and prevent us from even telling how much drugs cost. (13 1/2 minutes)

Act Two. Let's Take Your Medical History.

Alex Blumberg and Adam Davidson recount how four accidental steps led to enacting the very questionable system of employers paying for health care. (11 1/2 minutes)

Act Three. Insurance? Ruh Roh!

Planet Money correspondent David Kestenbaum investigates the growing popularity of pet insurance, and what it reveals about insurance for people. (14 minutes )

Act Four. Sorry Johnny... It's Only Business.

This American Life producer Sarah Koenig reports on a very surprising reason why insurance companies dump members, and how this reasoning contradicts President Obama's argument for what will lower health care costs. (11 1/2 minutes)

Song: "Give Me the Cure," Fugazi

[Earthling]

Originally Posted by Whomp

Medical-malpractice lawsuits drive up the cost of health care.

Yes, not 100% but some significant fraction, that's well known. Patent laws and related factors on importation/cost of drugs also have huge impacts, particularly for medical costs for seniors.

Insurance companies are not evil.

As far as this says anything, no, they're not the same as the Joker.

Our reliance on third-party payers is at the heart of the problem.

Yeah, which is why so many wanted a single-payer system

Obamacare won’t fix it.

Again, a lot of people are disappointed in how reform will currently go through, since it wasn't enough.

[amadeus]

Originally Posted by Earthling

Yeah, which is why so many wanted a single-payer system

Which will not reduce the problem of people going in for treatment when it is not needed.

[.Shane.]

Whomp, can you elaborate on this:

"Our reliance on third-party payers is at the heart of the problem."

[Whomp]

Originally Posted by Earthling

Yes, not 100% but some significant fraction, that's well known. Patent laws and related factors on importation/cost of drugs also have huge impacts, particularly for medical costs for seniors.

Drugs are prevention but charging a ob-gyn $350k/year to work on emergency deliveries of pre-me's and crack babies isn't such a great gig.

Originally Posted by Earthling

As far as this says anything, no, they're not the same as the Joker.

Eh, what does that mean?

Originally Posted by Earthling

Yeah, which is why so many wanted a single-payer system

See comment to Shane.

Originally Posted by Earthling

Again, a lot of people are disappointed in how reform will currently go through, since it wasn't enough.

Agreed, all the plan that Harry Reid is having signed tomorrow will do is permanently cement us into a horrific plan. Funny, ever wonder why they decided to do this over this weekend instead of during the week? While everyone else works 3-4 days this week they want the whole week off.

Originally Posted by .Shane.

Whomp, can you elaborate on this:

"Our reliance on third-party payers is at the heart of the problem."

You don’t get the bill for your medical care. Ever thought about that? Someone else gets the bill so it screws up the incentives for payers, providers, and consumers.

In the piece one of the guys explained that, as consumers of health care, we're totally separated from the cost of what we consume. We gets tests and procedures we don't need because well, why not? I can vouch that my mother is a perfect example and her medicare costs don't bother her a bit but it bothers me how much unnecessary care she gets and I can vouch it's considerable.

We're not paying for it a la carte since either our employer or government is paying for it through tax incentives. They go on to explain when the system changed from pre WWII to post WW II. Because of wage and price controls, during the war, companies attracted employees by giving them non company taxed benefits which was put in place at the same time as wage and price controls. These two items had a profound impact on how our system is today.

[Bei1052]

Originally Posted by Whomp

[*]Medical-malpractice lawsuits drive up the cost of health care.

How is this not common knowledge?

[Whomp]

Originally Posted by Bei1052

How is this not common knowledge?

I've seen it posted around here quite a bit how it bears little meaning in health care reform.

[I'm Cleo!]

I haven't listened to the audio (I don't know if I'll have time), but I've read a bit from other people who make central the issue of third-party payers. I always feel unsettled, because it seems like if you approach the problem from that perspective, i.e., people knowing the monetary costs of what they're having done, you're going in the direction of rationing healthcare even more on the basis of wealth. It's just a hunch right now, though.

And do they have any data for the assertions about tort reform? There's a CBO report from 2004 that says the savings would be pretty negligible.

Cleo

[Aegis]

Originally Posted by Earthling

Again, a lot of people are disappointed in how reform will currently go through, since it wasn't enough.

QFT

The Rebublicans have done their absolute best to make sure that it's going to fail, which is sad.

[Labtec600]

Originally Posted by Aegis

QFT

The Rebublicans have done their absolute best to make sure that it's going to fail, which is sad.

[I'm Cleo!]

Originally Posted by Aegis

QFT

The Rebublicans have done their absolute best to make sure that it's going to fail, which is sad.

With all due respect, I think this one's on the Democrats, specifically the "moderates." Republicans have impotent minorities in both houses of Congress -- it's the conservative Democrats who screwed up the bill. (Which, in my opinion, is still better than nothing, and may prove to be very good.)

Cleo

[Aegis]

Originally Posted by Labtec600

Oh, I'm obviously wrong, am I? That must be why not a single Republican is in favor of a public option, they've gone on a smear campaign of disinformation these past ten months and they coughed up the weakest excuse of a reform bill, yet. Don't feign surprise. The two political parties do this to one another all the time. Each party does it's damnedest to undermine the efforts of the other party in an effort to make them look bad. This is nothing new.

[Labtec600]

Originally Posted by Aegis

Oh, I'm obviously wrong, am I? That must be why not a single Republican is in favor of a public option, they've gone on a smear campaign of disinformation these past ten months and they coughed up the weakest excuse of a reform bill, yet. Don't feign surprise. The two political parties do this to one another all the time. Each party does it's damnedest to undermine the efforts of the other party in an effort to make them look bad. This is nothing new.

Nah, it's just funny that you think the Democrats bill was so great and didnt have issues. This is why we have two sides - so that when one side throws out their stupid ideas the other side can knock it down with their stupid ideas and we end up with something in the middle.

[JollyRoger]

To paraphrase Chief Justice Roberts:

The way to end medical practice costs is to stop committing medical malpractice.

[Ayatollah So]

Originally Posted by Whomp

• Medical-malpractice lawsuits drive up the cost of health care.
• Insurance companies are not evil.
• Our reliance on third-party payers is at the heart of the problem.
• Obamacare won’t fix it.

1. Similarly, police departments drive up the cost of government. But not by much, and it's definitely not clear that we'd be better off with less of them.
2. But they're part of the problem nonetheless.
3. Insurance - the very concept - has its downside - to some extent that's just tough.
4. Duh.
5. Numbered lists are better, 'cause then readers don't have to work as hard to match things up.

[Whomp]

Originally Posted by I'm Cleo!

I haven't listened to the audio (I don't know if I'll have time), but I've read a bit from other people who make central the issue of third-party payers. I always feel unsettled, because it seems like if you approach the problem from that perspective, i.e., people knowing the monetary costs of what they're having done, you're going in the direction of rationing healthcare even more on the basis of wealth. It's just a hunch right now, though.

And do they have any data for the assertions about tort reform? There's a CBO report from 2004 that says the savings would be pretty negligible.

Cleo

But let's face it if a doctor is incentived to do more procedures then he'll do more procedures because no one cares about the cost. You bill more hours, you make more money. Same deal.

In the show they explain how studies show 1/3 of all procedures are not necessary and often lead to further complications. Unnecessary CAT scans could lead to thyroid cancer...

The scheme is screwed up and one of the thing that should be mentioned from this show is insurance companies profit margins are less than medical facilities. So why do we always back up what our doc says when the insurance company actually is fighting for lower prices? They give a great example, Shane would be interested in hearing, about how Blue Cross battled Sutter in San Francisco but when it comes down to lowering cost by negotiating price with Sutter or changing a doc people don't want to choose the latter. So much for controlling cost.

Medical coding is another area that's completely screwed up. There's no code for a sore arm but there is one for injuries that involve space craft? Bad deal for everyone on that one.

Originally Posted by JollyRoger

To paraphrase Chief Justice Roberts:

The way to end medical practice costs is to stop committing medical malpractice.

Or just do the PSA test even with it's high incidence of false positives because if another doc automatically tests and the test shows prostate cancer you're sued whether the patient would've died or not.

[JollyRoger]

Originally Posted by Whomp

Or just do the PSA test even with it's high incidence of false positives because if another doc automatically tests and the test shows prostate cancer you're sued whether the patient would've died or not.

I think that defensive practice costs are a problem that should be addressed - although a competent defense attorney should be able to easliy handle a case where a PSA wasn't done when there was no factor at the time of the doctor visit indicating that one should have been done. I face the same issue in my law practice - how to do my job efficiently & correctly without some malpractice attorney getting a good case against me in the future. Instead of doing legal work that I feel is not worth the additional fees, I take less drastic protective steps - generally in the form of disclosures and the client signing off on scope limits. While not a perfect body of armor, I feel confident that I can defend myself from crap litigation - defending myself from actual malpractice would and should be an entirely different matter.

Unfortunately most tort reform uses a hatchet instead of a scapel and cases with merit get dismissed or damage limited when they shouldn't. If we could create some safe harbors that would cut back on the defensive practice of medicine, I feel that would be the better approach than the typical solution of attacking the entire litigation process which sets up three rings of hoops to jump through and damage caps once a malpractice victim has jumped through the hoops.

[otago]

Originally Posted by amadeus

Which will not reduce the problem of people going in for treatment when it is not needed.

I have a suspicion that making visits to the GP happens too often with some if it is completely free to the patient. Some US doctors do practice defensive medicine because of the fear of being sued.
We have had private hospitals down here turning away American would be patients who pay for their surgery because it is just not needed.

[Whomp]

I'm with you 100% JR. Like most things we use the hatchet when a scapel would be more appropriate.

Btw, the example of the PSA test was in this piece and though the doc was not found guilty, the jury awarded $1,000,000 paid by the hospital.

[warpus]

That is all very interesting.

Originally Posted by Whomp

We gets tests and procedures we don't need because well, why not? I can vouch that my mother is a perfect example and her medicare costs don't bother her a bit but it bothers me how much unnecessary care she gets and I can vouch it's considerable.

Are you saying that this is the main thing that's wrong with U.S. healthcare?

As far as I know this sort of stuff happens here in Canada, and probably in Europe too. Does it just happen a lot more often in the U.S.? Is it less regulated or something? What's the fundamental difference?