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Zer0's $50 Billion Exaggeration

Mike

Well-known member
WALL STREET JOURNAL

Last week, President Barack Obama convened a health-care summit in Washington to identify programs that would improve quality and restrain burgeoning costs. He stated that all his policies would be based on rigorous scientific evidence of benefit. The flagship proposal presented by the president at this gathering was the national adoption of electronic medical records -- a computer-based system that would contain every patient's clinical history, laboratory results, and treatments. This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill.

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.



Martin KozlowskiThe basis for the president's proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system. And, as the RAND policy analysts readily admit in their report, there was no compelling evidence at the time to support their theoretical claims. Moreover, in the four years since the report, considerable data have been obtained that undermine their claims. The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking.

To be sure, there are real benefits from electronic medical records. Physicians and nurses can readily access all the information on their patients from a single site. Particularly helpful are alerts in the system that warn of potential dangers in the prescribing of a certain drug for a patient on other therapies that could result in toxicity. But do these benefits translate into $80 billion annually in cost-savings? The cost-savings from avoiding medication errors are relatively small, amounting at most to a few billion dollars yearly, as the RAND consultants admit.

Other potential cost-savings are far from certain. The impact of medication errors on malpractice costs is likely to be minimal, since the vast majority of lawsuits arise not from technical mistakes like incorrect prescriptions but from diagnostic errors, where the physician makes a misdiagnosis and the correct therapy is delayed or never delivered. There is no evidence that electronic medical records lower the chances of diagnostic error.

All of us are conditioned to respect the printed word, particularly when it appears repeatedly on a hospital computer screen, and once a misdiagnosis enters into the electronic record, it is rapidly and virally propagated. A study of orthopedic surgeons, comparing handheld PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer -- 48 compared to seven in the paper-based cohort.

But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient's weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error.

Throughout their report, the RAND researchers essentially ignore downsides to electronic medical records. Rather, they base their cost calculations on 100% compliance with the computer programs "adopted widely and used effectively." The real-world use of electronic medical records is quite different from such an idealized vision.

Where do the RAND policy analysts posit major cost-savings? They imagine that the computer will guide doctors to deliver higher quality care, and that patients will better adhere to quality recommendations embedded in the computer programs. This would apply to both preventive interventions like vaccines and weight reduction, and to therapy of costly chronic maladies like diabetes and congestive heart failure. Over 15 years, the RAND analysts assert, more than $350 billion would be saved on inpatient care and nearly $150 billion on outpatient care. Unfortunately, data to support such an appealing scenario are lacking.

A 2008 study published in Circulation, a premier cardiology journal, assessed the influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that "current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems." Similarly, researchers from the Brigham and Women's Hospital and Harvard Medical School, with colleagues from Stanford University, published an analysis in 2007 of some 1.8 billion ambulatory care visits. These experts concluded, "As implemented, electronic health records were not associated with better quality ambulatory care." And just this past January, a group of Canadian researchers reviewed more than 3,700 published papers on the use of electronic medical records in primary care delivered in seven countries. They found no solid evidence of either benefits or drawbacks accruing to patients. This gap in knowledge, they concluded, "should be of concern to adopters, payers, and jurisdictions."

What is clear is that electronic medical records facilitate documentation of services rendered by physicians and hospitals, which is used to justify billing. Doctors in particular are burdened with checking off scores of boxes on the computer screen to satisfy insurance requirements, so called "pay for performance." But again, there are no compelling data to demonstrate that such voluminous documentation translates into better outcomes for their sick patients.

Even before these new data, there were studies casting doubt on the benefits of electronic medical records. In response, the RAND researchers boldly stated, "We choose to interpret reported evidence of negative or no effect of health information technology as likely being attributable to ineffective or not-yet-effective implementation." This flies in the face of the scientific method, where an initial hypothesis needs to be modified or abandoned in the face of contradictory results. Rather than wrestle with contrary information, the report invokes the successes of computer-based systems in saving money in industries like banking, securities trading, and merchandizing, using ATM machines, online brokerage and bar-coded checkouts. Medical care of human beings -- treatment of acute and chronic illnesses and the even more complex process of effecting lifestyle changes like smoking cessation and weight loss to prevent disease -- is not analogous to buying bar-coded groceries and checking-account balances online.

Some have speculated that the patient data collected by the Obama administration in national electronic health records will be mined for research purposes to assess the cost effectiveness of different treatments. This analysis will then be used to dictate which drugs and devices doctors can provide to their patients in federally funded programs like Medicare. Private insurers often follow the lead of the government in such payments. If this is part of the administration's agenda, then it needs to be frankly stated as such. And Americans should decide whether they want to participate in such a national experiment only after learning about the nature of the analysis of their records and who will apply the results to their health care.

All agree skyrocketing health-care costs are a dangerous weight on the economic welfare of the nation. Much of the growing expense is due to the proliferation of new technology and costly treatments. Significant monies are spent for administrative overhead related to insurance billing and payments. The burden of the uninsured who use emergency rooms as their primary care providers, and extensive utilization of intensive care units at the end of life, further escalate costs.

The president and his health-care team have yet to address these difficult and pressing issues. Our culture adores technology, so it is not surprising that the electronic medical record has been touted as the first important step in curing the ills of our health-care system. But it is an overly simplistic and unsubstantiated part of the solution.

We both voted for President Obama, in part because of his pragmatic approach to problems, belief in empirical data, and openness to changing his mind when those data contradict his initial approach to a problem. We need the president to apply real scientific rigor to fix our health-care system rather than rely on elegant exercises in wishful thinking.

Drs. Groopman and Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.
 
A

Anonymous

Guest
All agree skyrocketing health-care costs are a dangerous weight on the economic welfare of the nation. Much of the growing expense is due to the proliferation of new technology and costly treatments. Significant monies are spent for administrative overhead related to insurance billing and payments. The burden of the uninsured who use emergency rooms as their primary care providers, and extensive utilization of intensive care units at the end of life, further escalate costs.

The president and his health-care team have yet to address these difficult and pressing issues. Our culture adores technology, so it is not surprising that the electronic medical record has been touted as the first important step in curing the ills of our health-care system. But it is an overly simplistic and unsubstantiated part of the solution.

We both voted for President Obama, in part because of his pragmatic approach to problems, belief in empirical data, and openness to changing his mind when those data contradict his initial approach to a problem. We need the president to apply real scientific rigor to fix our health-care system rather than rely on elegant exercises in wishful thinking.

And that appears to be the reason President Obama called for and had the first, of what he said would be many, Health-Care Summits- and asked for ideas and input to better fix the system...As he said during the summit- nothing so far is written in stone- and they want new ideas and new plans brought forward...

But like he said- just obstructionism because of partisan politics or philosophy is not needed- because like Senator Orrin Hatch said- and everyone there (Dem or Repub) agreed on " Doing Nothing Is NOT an Option" anymore.....
 

Mike

Well-known member
Oldtimer said:
All agree skyrocketing health-care costs are a dangerous weight on the economic welfare of the nation. Much of the growing expense is due to the proliferation of new technology and costly treatments. Significant monies are spent for administrative overhead related to insurance billing and payments. The burden of the uninsured who use emergency rooms as their primary care providers, and extensive utilization of intensive care units at the end of life, further escalate costs.

The president and his health-care team have yet to address these difficult and pressing issues. Our culture adores technology, so it is not surprising that the electronic medical record has been touted as the first important step in curing the ills of our health-care system. But it is an overly simplistic and unsubstantiated part of the solution.

We both voted for President Obama, in part because of his pragmatic approach to problems, belief in empirical data, and openness to changing his mind when those data contradict his initial approach to a problem. We need the president to apply real scientific rigor to fix our health-care system rather than rely on elegant exercises in wishful thinking.

And that appears to be the reason President Obama called for and had the first, of what he said would be many, Health-Care Summits- and asked for ideas and input to better fix the system...As he said during the summit- nothing so far is written in stone- and they want new ideas and new plans brought forward...

But like he said- just obstructionism because of partisan politics or philosophy is not needed- because like Senator Orrin Hatch said- and everyone there (Dem or Repub) agreed on " Doing Nothing Is NOT an Option" anymore.....

But, but, but, HE HAD A PLAN during the campaign!!!!!!!!! Or so you thought!!!!!!!! :lol: :lol: :lol:

Specifically address the exaggeration point.......... Or is HE as big a liar as you? :lol: :lol: :lol:
 
A

Anonymous

Guest
Mike said:
Oldtimer said:
All agree skyrocketing health-care costs are a dangerous weight on the economic welfare of the nation. Much of the growing expense is due to the proliferation of new technology and costly treatments. Significant monies are spent for administrative overhead related to insurance billing and payments. The burden of the uninsured who use emergency rooms as their primary care providers, and extensive utilization of intensive care units at the end of life, further escalate costs.

The president and his health-care team have yet to address these difficult and pressing issues. Our culture adores technology, so it is not surprising that the electronic medical record has been touted as the first important step in curing the ills of our health-care system. But it is an overly simplistic and unsubstantiated part of the solution.

We both voted for President Obama, in part because of his pragmatic approach to problems, belief in empirical data, and openness to changing his mind when those data contradict his initial approach to a problem. We need the president to apply real scientific rigor to fix our health-care system rather than rely on elegant exercises in wishful thinking.

And that appears to be the reason President Obama called for and had the first, of what he said would be many, Health-Care Summits- and asked for ideas and input to better fix the system...As he said during the summit- nothing so far is written in stone- and they want new ideas and new plans brought forward...

But like he said- just obstructionism because of partisan politics or philosophy is not needed- because like Senator Orrin Hatch said- and everyone there (Dem or Repub) agreed on " Doing Nothing Is NOT an Option" anymore.....

But, but, but, HE HAD A PLAN during the campaign!!!!!!!!! Or so you thought!!!!!!!! :lol: :lol: :lol:

Specifically address the exaggeration point.......... Or is HE as big a liar as you? :lol: :lol: :lol:

They've laid out a basic plan-with some areas having numerous options- but are now asking for input....
 

Mike

Well-known member
but are now asking for input....

In other words.....they are asking for ideas because they had no plan to start with. :lol: :lol: :lol: :lol: :lol: :lol: :lol:

What about the lie on Medical Records? Why would he lie about that? :lol:

Bad advice from his brilliant advisors? :lol: :lol: :lol: :lol: :lol:
 
A

Anonymous

Guest
Mike said:
but are now asking for input....

In other words.....they are asking for ideas because they had no plan to start with. :lol: :lol: :lol: :lol: :lol: :lol: :lol:

What about the lie on Medical Records? Why would he lie about that? :lol:

Bad advice from his brilliant advisors? :lol: :lol: :lol: :lol: :lol:

Lot of difference between lies and differences of opinions or "experts" guesstimates....Thats kind of the reason intelligent administrators hold summits, bring in differing ideas, and look at the info, and seek input from several directions....
 

Mike

Well-known member
Oldtimer said:
Mike said:
but are now asking for input....

In other words.....they are asking for ideas because they had no plan to start with. :lol: :lol: :lol: :lol: :lol: :lol: :lol:

What about the lie on Medical Records? Why would he lie about that? :lol:

Bad advice from his brilliant advisors? :lol: :lol: :lol: :lol: :lol:

Lot of difference between lies and differences of opinions or "experts" guesstimates....Thats kind of the reason intelligent administrators hold summits, bring in differing ideas, and look at the info, and seek input from several directions....

You sound like a fish swimming in a round water tank................. :lol:

Going round and round but not getting anywhere. :lol: :lol: :lol:

"He Has A Plan" but he's needs advice on it....... :roll: :lol: :lol:
 
A

Anonymous

Guest
Intestingly right now New Zealand and Australian economies are thought to be two of the strongest and thriving in the world- both rank close to the US in the WHO ranking of medical care (and Australia ranks 2nd only to Japan in life expectancy)- but they both have programs of government health care/insurance coverage and their costs are almost half the GDP spent in the US ( which is now at 16.5 of GDP)....

In New Zealand hospitals are public and treat citizens or permanent residents free of charge and are managed by District Health Boards. Under the Labour coalition governments, 1999 - 2008, there were plans to make primary health care available free of charge. At present government subsidies exist in health care. This system is funded by taxes. The New Zealand government agency PHARMAC subsides certain pharmaceuticals depending upon their category. Co-payments exist however these are ignored if the user has a community health services card or high user health card. In 2005, New Zealand spent 8.9% of GDP on health care, or US$2,403 per capita. Of that, approximately 77% was government expenditure.


In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications. In 2005, Australia spent 8.8% of GDP on health care, or US$3,181 per capita. Of that, approximately 67% was government expenditure.
 

Mike

Well-known member
When healthcare is paid for and administered by the government, it can be rationed to fit any GDP percentage the government wants.................

Medicare is partly to blame for escalating medical costs in the U.S.

You want to give them more authority? :roll:
 

aplusmnt

Well-known member
Oldtimer said:
Intestingly right now New Zealand and Australian economies are thought to be two of the strongest and thriving in the world- both rank close to the US in the WHO ranking of medical care (and Australia ranks 2nd only to Japan in life expectancy)- but they both have programs of government health care/insurance coverage and their costs are almost half the GDP spent in the US ( which is now at 16.5 of GDP)....

In New Zealand hospitals are public and treat citizens or permanent residents free of charge and are managed by District Health Boards. Under the Labour coalition governments, 1999 - 2008, there were plans to make primary health care available free of charge. At present government subsidies exist in health care. This system is funded by taxes. The New Zealand government agency PHARMAC subsides certain pharmaceuticals depending upon their category. Co-payments exist however these are ignored if the user has a community health services card or high user health card. In 2005, New Zealand spent 8.9% of GDP on health care, or US$2,403 per capita. Of that, approximately 77% was government expenditure.


In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications. In 2005, Australia spent 8.8% of GDP on health care, or US$3,181 per capita. Of that, approximately 67% was government expenditure.

Can not speak for Australia But I did have a friend that tried to move to New Zealand, but once her visiting time was up they would not grant her a longer stay. They said she had no job skills that they needed. They would not give a work visa or citizen ship (whatever it was she tried to get?) unless she had a skill that was needed, such as doctor, engineer etc.......Maybe a strong line on immigration like this helps them compared to us that we seem to feel compelled to let in the low life's so they can have the American dream even if that is not what they want.
 

TexasBred

Well-known member
Oldtimer said:
Intestingly right now New Zealand and Australian economies are thought to be two of the strongest and thriving in the world- both rank close to the US in the WHO ranking of medical care (and Australia ranks 2nd only to Japan in life expectancy)- but they both have programs of government health care/insurance coverage and their costs are almost half the GDP spent in the US ( which is now at 16.5 of GDP)....

In New Zealand hospitals are public and treat citizens or permanent residents free of charge and are managed by District Health Boards. Under the Labour coalition governments, 1999 - 2008, there were plans to make primary health care available free of charge. At present government subsidies exist in health care. This system is funded by taxes. The New Zealand government agency PHARMAC subsides certain pharmaceuticals depending upon their category. Co-payments exist however these are ignored if the user has a community health services card or high user health card. In 2005, New Zealand spent 8.9% of GDP on health care, or US$2,403 per capita. Of that, approximately 77% was government expenditure.


In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications. In 2005, Australia spent 8.8% of GDP on health care, or US$3,181 per capita. Of that, approximately 67% was government expenditure.

OT..did you even bother to see what criteria WTO uses to determine quality of health care???? Check it out. Find out just how many people are really uninsured and why?? By choice??? Columbia and Chila rated ahead of the US...want your next surgery there?? May have to wait a year or so for it...Why do people come half way around the world from these great bastions of great healthcare to get treatment in the USA???
 
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