Healthcare update

Medical errors may be 10 times more common than previous estimates

Should there be a 'fat tax'?

Giving Doctors Orders

A couple years later, I read reports about how neckties and lab coats worn by doctors and clinical workers were suspected as carriers of deadly germs. Infections kill 100,000 patients in hospitals and other clinics in the U.S. every year.

A 2004 study of New York City doctors and clinicians discovered that their ties were contagious with at least one type of infectious microbe. Four years ago, the British National health system initiated a “bare below the elbow” dress code barring ties, lab coats, jewelry on the hands and wrists, and long fingernails. 

The Centers for Disease Control and Prevention says that health care workers, even doctors and nurses, have a “poor” record of obeying hand-washing rules. 

A report in the April issue of Health Affairs indicated that one out of every three people suffer a mistake during a hospital stay.

How to Save a Trillion Dollars

For the first time in history, lifestyle diseases like diabetes, heart disease, some cancers and others kill more people than communicable ones. Treating these diseases — and futile attempts to “cure” them — costs a fortune, more than one-seventh of our GDP. 

But they’re preventable, and you prevent them the same way you cause them: lifestyle. A sane diet, along with exercise, meditation and intangibles like love prevent and even reverse disease. A sane diet alone would save us hundreds of billions of dollars and maybe more. 

This isn’t just me talking. In a recent issue of the magazine Circulation, the American Heart Association editorial board stated flatly that costs in the U.S. from cardiovascular disease — the leading cause of death here and in much of the rest of the world — will triple by 2030, to more than $800 billion annually. Throw in about $276 billion of what they call “real indirect costs,” like productivity, and you have over a trillion. Enough over, in fact, to make $38 billion in budget cuts seem like a rounding error.

What Planned Parenthood actually does

Most Americans have government-subsidized health care

Atul Gawande’s “Better.”

We’re having the wrong argument on health-care costs

Medicare controls costs better than private insurance in this country, and every other developed country controls costs using government-managed systems and most spend around half what we do, so I’d actually say the government comes out pretty well on this measure. But that’s not really the point I want to make in this post. 

Rather, I think a lot of very smart people — Tyler Cowen, Andrew Sullivan, Megan McArdle, etc. — are making a category error. They’re looking at Ryan’s Medicare reforms and seeing an ideological “bureaucrats vs. consumers” contrast from Democratic plans. There is some of that, though it’s mostly on Ryan’s side: Democrats try out the consumer-driven exchange model for most non-seniors and a mostly bureaucratic model for controlling costs in Medicare and Medicaid, while Ryan only uses a consumer-driven exchange model in his quest for savings. 

But from the perspective of health-care cost control, what matters is the sectoral contrast. The basic theory of Ryan’s plan is that you can control costs by focusing on the insurance system. Seniors become consumers and their decision-making holds down costs. The Affordable Care Act has a lot of the same insurance-system reforms that Ryan does, but the basic theory of that plan is you control costs through the care delivery system. It’s about knowing what treatments work and what treatments don’t, paying for value rather than quantity, cutting down on unnecessary readmissions and errors, doing more to manage chronic diseases, etc.

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I’m a big fan of exchanges. I’d use them systemwide if I could, as the Swiss and the Dutch do. But health-care costs are not all about, or even mostly about, insurance. Indeed, so much as I like exchanges, it’s very possible that you need the government putting pressure on the delivery system to control costs. What we tend to see with private insurers is that they just don’t have enough leverage over hospitals or doctors to get major changes done. Medicare does have that leverage, which is why it makes sense to use Medicare as a tool to reform the health-care system, as opposed to just the health-insurance system.

CHS admitting patients unnecessarily to pad bottom line

Hospitals shrinking as largest part of health spending pie

Health Insurance Exchanges: The Most Important, Undernoticed Part of Health Reform