Friday, August 21, 2009

Annals of Surgery Abstract on Healthcare Reform

Abstract: The United States has the most expensive and complex healthcare system in the world. Despite the magnitude of funds spent on the system, Americans do not achieve the high standards of health seen in other developed countries.

The current model of health insurance has failed to deliver efficient and effective healthcare. The administrative costs and lack of buying power that arise out of the existing multipayer system are at the root of the problem. The current system also directly contributes to the rising number of uninsured and underinsured Americans.

This lack of insurance leads to poorer health outcomes, and a significant amount of money is lost into the system by paying for these complications. Experience from other countries suggests that tangible improvements can occur with conversion to a single-payer system. However, previous efforts at reform have stalled.

There are many myths commonly held true by both patients and physicians. This inscrutability of the US healthcare system may be the major deterrent to its improvement. A discussion of these myths can lead to increased awareness of the inequality of our healthcare system and the possibilities for improvement.

Sarpel U, Vladeck G, Divina C: Klotman P. Fact and Fiction: Debunking Myths in the US Healthcare System Annals of Surgery: April 2008 - volume 247-Issue 4 - PP 563-569


Spencer Thornton, M.D. said...

There is no question that we need reform of our healthcare system, but to introduce another level of controls in the process of delivering good medical care would be a mistake.
A new technology such as phacoemulsification in cataract removal would be blocked because it was "not proven to be better than other available modalities". If a panel of "government experts" had decided that this technique was not acceptable, it never could have become the most effective procedure it is today.
Progress in medicine can only thrive under the "peer review" system, where scientists, not "government experts" determine the value of new technology.
Guiding principles are fine, but government control means stifling innovation and the controls of peer review.

Ellen Troyer, MT MA said...

Government can also be the major supporter of innovation in medicine. Think of the space program and other areas of science that only survived because of government intervention. And government research grants from NEI and NIH suggest that government does not stifle innovative thinkers like you and Charlie Kellman, the inventor of phacoemulsification.

Ellen Troyer, MT MA said...

One more thought! Have I misunderstood the challanges that innovative thinkers like Dr. Charles Kellman and Dr. Daniele Aron Rosa overcame? I was under the impression that it was mostly their ophthalmology peers, not their governments, that stood in the way of their world-changing inventions for so many years.

Heather P. said...

Have any of you noticed that the "cost controls" most of us are demanding to see included in any healthcare reform are on peoples or groups other than our own?

Does single payer healthcare make the most sense, since it is the only form that allows for much needed economies of scale?

Why is the pharmaceutical industry not being asked to make significant sacrifices in the current round of reform? negotiations?

David P said...

We cannot have a wealthy country without being a healthy country, but health care finance solutions by themselves do not help us care for our health. An insurance card does not guarantee a clean bill of health.

Yes, we do need to reform our health care program but if we want true reform we must move from a state of reactive use (an example would be; multi medical testing’s that have a great cost factor) into a more proactive state of knowledge and education. A major action along with health care reform should take place within our homes where were can teach each other the benefits of nutrition and exercise. Also, how many of us are looking at our family trees (history) genes? With this action we should be able to be more proactive with our own medical outcomes and insurance expenses knowing if our Grandparents and Parents had diseases as cancer and Alzheimer’s.

Nancy Nurse said...

I saw a bumper sticker a few days ago that said, “I used up all my sick days so I called in dead.” I liked it because it was absurd, but also because it seemed so apt to the battle raging right now over reforming health care in America.

What do you do when you’ve used up all your sick days and you’re still too sick to go to work? And what if you’ve reached the cap on your health insurance, need a drug that isn’t covered by your plan, or require a scan that you can’t possibly pay for?

If some kind of reasonable reform doesn’t happen, the most ill among us, and the most unlucky, may just have to start calling in dead.

Doug Farrell said...

I'm not alone in fearing a medical catastrophe and what it might do financially to my family. I hope that President Obama will step up to the plate and do what he promised to do and can get some kind of reform legislation passed that will reduce this risk and worry for me and millions like me.

Len Nichols said...

The White House has not given up on passing the bill. The committee chairs, the leadership, and the stakeholders understand profoundly that our (health care) system is unsustainable and they have to start restructuring incentives (now) because it will take a decade. If we fail and wait a decade, it will be that much harder.

Bill Alkinson said...

According to the CDC, the United States spends $147 billion each year on obesity related diseases.
This is nearly three times more than the amount of monies spent on cancer treatment.

Obesity is preventable!

Although some folks in Congress agree that prevention will reduce health care costs, they still seem to be extremely reluctant to spend money on disease prevention programs.

June Pinkin, RN said...

It's shameful that we let the insurance and pharmaceutical industries dupe us into thinking single payer health care for all can't and shouldn't be done. It will take great courage among our elected officials to do this, but it should be done. Now is the time.

This is as important a step forward in our democracy as Social Security and Medicare. Let's put money into health care rather than warfare and start tending to the needs of we, the people.

Dan Roberts said...

Thanks for posting the Annals of Surgery abstract.

The beauty of our democracy is that We the People can be counted on to eventually push the systems reset button on unregulated policies based on Greed and Fear.

Linda A said...

We must defend our country from the Obamacare scam and socialism/communism. It's the right thing to do.

Judy said...

Both Social Security and Medicare are forms of economic socialism. Interesting that those who hate the idea of healthcare reform are determined to protect both.

Unknown said...

Dr. Thornton,

What makes you think the current system of using insurance companies' medical directors aren't now doing the same thing with "non-approved" procedures? In both circumstances it's a panel of MDs who are/would be making medical decisions- except that the government model wouldn't have cost to the "company" as the sole concern or dictating factor.

Let's face it- what is in place now isn't working. As Andrew Weil, MD stated: "We don't have a healthcare system here in the US; we have disease management".


Ellen Troyer, MT MA said...

I predict our children will look back in shame over how long it took our generation to pass a universal healthcare bill, just as we look back and wonder how it could possibly have taken so long for our democracy and our parents and grandparents to pass a universal education bill.

Gus Halin, MD said...

As a physician, I can only recommend to America that you get rid of the current system that is paying me very well right now. I will survive. I will do fine, but the insurance executives will definitely suffer. If you have doubts when you hear people saying the ground has shifted recently, talk to someone with major medical expenses the last five years. Chances are at least half will tell you how they were initially denied care, then had to write letters and make phone calls to get what they deserved in the first place.

Because that's what they do. They deny everything, and when one out of ten doesn't fight it, they make money and lots of it.

If you trust corporate America and giant insurance companies, by all means, keep what we have. But remember, what we have now and will have for the foreseeable future is not what we had in the 70's, the 80's, or even the 90's. Medicine for profit has reached its peak level of efficiency for generating those profits, and it has failed its people utterly.

David A. said...

Thanks Dr. Halin, Eight months into the Obama administration many of us still retain the 'HOPE' Senator Edward Kennedy spoke about at the convention in Denver. Now we are wondering what happened to the 'AUDACITY' required to move our country in a new direction.

If democrats want to enact health care reform this year, they appear to have little choice but to adopt a go-it-alone, majority-rules strategy.

Matthew W. said...

Obama just wants to soak the rich by raising taxes over 5.4 percent on those making more than $350,000 a year and by making companies with payrolls bigger than $250,000 provide health coverage for employees, or face a hefty fine.

I, for one, am disgusted with this potential financial abuse on those of us who have worked hard for more than 10 years to earn incomes in the top 2 percent.

Ellen Troyer, MT MA said...

Thanks for your comments. We can differ in our opinions and still share many common goals - that's the beauty of a democracy.

The White House has just posted a Health Insurance Reform Reality Check. Please take the time to check it out.

Helen Brown said...

I find it hard to believe that not one young woman has mentioned the fact that she, or her employer, is paying more than 150 percent more to insure her than a same age male under the status quo.

Paul C. said...

It's not doctors who make final decisions about health care for most of us. It's for-profit insurance companies.

Edward G said...

Healthcare reform is necessary but a single-payer system will ultimately result in healthcare rationing and a price tag that will escalate out of control. Individuals would lose the freedom to determine their healthcare providers, would lose the right to pursue prompt care, and treatment options would be determined by some faceless bureaucrat or panel. Access to a waiting list is not access to healthcare. The frail elderly would suffer most since life-sustaining care would be denied to these individuals who will be considered past their productive years. Former Colorado Governor Dick Lamm's statement that seniors "have a duty to die" would become a prevailing societal norm. Ponder that outcome, baby boomers, as you enter your retirement years. Trusting healthcare to a government entity with all the efficiency and compassion of the department of motor vehicles or the post office would be an Orwellian nightmare. The private sector will work if the marketplace was truly competitive. Individuals should be able to competitively seek healthcare plans across state lines and should have the tax incentives now granted to employers. State laws that ban open competition should be repealed. Fix the current system but don't resort to a disastrous Canadian or British healthcare model.

Fed Up said...


When was the last time you spoke to a Canadian about healthcare? Their system is not perfect, but Canadians, including many Canadian doctors, that I have spoken to about healthcare say they would not choose our private system over their public system.

I have two relatives in their mid 90s with advanced Alzheimer's who have been kept alive with antibiotics years past the time nature would have let them pass peacefully on, possibly to a better place.

I sincerely hope 'baby-boomers' that you speak of carefully ponder being kept alive in a fetal position in a nursing home, or tied into a wheel chair not knowing anyone or anything.

There is absolutely no reason that universal healthcare has to be run the same way the DMV and Post Officer are run. We can be far far better if healthcare success becomes a universal goal.

We won't be better if the universal goal is to see public healthcare fail.

Ellen Troyer, MT MA said...

People, people, widen your scope.

Being open to diversity in thought is not just the politically correct thing to do, it's also the intelligent thing to do.

Seeing things from multiple perspectives gives all of us a better view of the whole, which is always more than the sum of its parts.

It's time to turn off FOX and MSNBC news and discuss healthcare reform with open minds.

Nick K. said...

Strange Paradox.

Healthcare may be defeated because we Americans are quick to think that government can't do anything right, yet multiple surveys show that 68 percent of those in Medicare feel that their own interests are the priority, compared with only 48 percent of those enrolled in private insurance.

A Rand Corporation study found that Medicare spends one-sixth as much on administration as private health insurers, although some question this study.

Another Rand study found that Americans treated in veterans hospitals "received consistently better care across the board, including screening, diagnosis, treatment and follow-up" than those treated in private institutions.

Jane said...

Universal healthcare is a moral issue.