I'm sure all of you can think of at least a handful of ways to lower our national healthcare bill. By themselves, each measure might not amount to much, but added together and multiplied across the country, they could total trillions of dollars in savings.
Here are a few of my ideas for healthcare providers, including hospitals:
--Require all healthcare providers to wear surgical gloves and masks when treating patients -- even in the doctor's office. Obviously, these would need to be changed often. Yes, there are costs associated with gloves and masks, but we could save by cutting the spread of contagious diseases and pathogens;
--Design waiting rooms and waiting times to reduce or eliminate the spread of illnesses;
--Require providers to regularly disinfect all areas and to routinely clean their air filtering systems;
--Require imaging techs to disinfect MRIs, mammography equipment, etc., after each use. To maximize the use of this expensive equipment, many facilities do not take the time to disinfect it, creating one of the major sources of healthcare-acquired infections (HAIs);
--Prohibit providers from billing for "never" events -- infections or injuries caused by their negligence. Medicare, Medicaid and many private insurers are refusing to pay for these; individuals should not have to pay for such mistakes either. If they have to pay for their own mistakes, maybe providers won't make so many;
--Allow hospital patients to use their regular medications from home rather than forcing them to pay the inflated-hospital price. For that matter, limit hospital drug prices to what area pharmacies charge;
--Allow hospital patients to use their own gowns, toothbrushes, disposable cups, etc., rather than having to pay inflated prices for the ones the hospital provides;
--Require providers to give patients the total cost of a procedure upfront along with the cost of alternatives. Then require them to honor that price quote;
--Require providers to submit itemized bills in a timely manner. Currently, some hospitals wait months and even years to bill so patients cannot challenge the items on the bill;
--Reform patent laws so pharmaceutical and medical device companies have an incentive to create innovative treatments without having to spend millions in court to protect their patents;
--Encourage competition once patents expire, but discourage generic companies from filing on new patents. Under the current system, generic companies often file years before a patent expires, hoping to get a healthy settlement from the brand company in exchange for delaying the launch of their copycat product. The resulting litigation, which often goes through several appeals, increases the costs of both the brand and the generic drugs; and
--Eliminate frivolous malpractice and injury suits; limit legitimate awards to a reasonable amount.
Feel free to add your ideas.
Tuesday, June 9, 2009
Monday, June 8, 2009
At the Doctor's Office -- Take 2
When the president and Congress are talking trillions of dollars for universal insurance coverage and comparative-effectiveness research -- all the big-dollar items of healthcare reform -- they tend to ignore the small practical steps that really could add up to make a huge dent in our national healthcare dollar.
Take the doctor's office, for instance. If doctors and other healthcare providers followed the lead of veterinarians in offering evening and weekend hours and took other steps to prevent lengthy office waits, we could see some real savings. For example, let's say Sally, an expectant mother, makes $15/hour (the median average wage for women in 2004, according to the U.S. Census Bureau). Over the course of her pregnancy, she will make at least 10 prenatal visits to the doctor. While her HMO will cover most of the cost, she will have to miss an average of three hours of work for each doctor's visit (including the commute), so she will miss a total of 30 hours of work because the doctor's office won't work around her schedule. If she doesn't get sick leave, she will lose $450 in pay. And even if she is covered, her office will lose 30 hours' worth of productivity.
According to the Centers for Disease Control and Prevention, 4,265,555 babies were born in the U.S. last year. For the sake of our example, let's just say that 3 million of the women giving birth to those babies worked and made an average of $15/hr. That would mean that in one year, the nation would lose $1.350 billion in productivity for this prenatal care. Over 10 years, that would total $13.5 billion. If you add to this the cost of time off work for all employees to go to the doctor or take their families to the doctor, the amount would be staggering.
Now, no one is suggesting that people shouldn't go to the doctor. But when people can't afford to take off from work for routine doctor visits, they end up going to the emergency room or waiting until their condition gets critical, both of which addseven more to the national healthcare bill. All of these problems could be addressed if we simply change the hours doctors, physical therapists, etc., practice -- or at least cut the amount of time people waste while waiting in the doctor's office.
But since this is a solution that could save billions of dollars while costing us nothing, it probably won't find its way into any national agenda for healthcare reform any time soon.
Take the doctor's office, for instance. If doctors and other healthcare providers followed the lead of veterinarians in offering evening and weekend hours and took other steps to prevent lengthy office waits, we could see some real savings. For example, let's say Sally, an expectant mother, makes $15/hour (the median average wage for women in 2004, according to the U.S. Census Bureau). Over the course of her pregnancy, she will make at least 10 prenatal visits to the doctor. While her HMO will cover most of the cost, she will have to miss an average of three hours of work for each doctor's visit (including the commute), so she will miss a total of 30 hours of work because the doctor's office won't work around her schedule. If she doesn't get sick leave, she will lose $450 in pay. And even if she is covered, her office will lose 30 hours' worth of productivity.
According to the Centers for Disease Control and Prevention, 4,265,555 babies were born in the U.S. last year. For the sake of our example, let's just say that 3 million of the women giving birth to those babies worked and made an average of $15/hr. That would mean that in one year, the nation would lose $1.350 billion in productivity for this prenatal care. Over 10 years, that would total $13.5 billion. If you add to this the cost of time off work for all employees to go to the doctor or take their families to the doctor, the amount would be staggering.
Now, no one is suggesting that people shouldn't go to the doctor. But when people can't afford to take off from work for routine doctor visits, they end up going to the emergency room or waiting until their condition gets critical, both of which addseven more to the national healthcare bill. All of these problems could be addressed if we simply change the hours doctors, physical therapists, etc., practice -- or at least cut the amount of time people waste while waiting in the doctor's office.
But since this is a solution that could save billions of dollars while costing us nothing, it probably won't find its way into any national agenda for healthcare reform any time soon.
Saturday, June 6, 2009
Joey's Take -- At the Doctor's
Call me crazy, but I like going to the vet's. I enjoy being the center of all that attention.
Even though I'm not covered by their health insurance, Mom and Dad make sure I get all my preventive care. It's always been affordable. The veterinarians are upfront about how much each shot or treatment will cost. And they've never prescribed unnecessary tests.
What amazes me is that we've never had to wait months to get an appointment for me. And Mom and Dad have never had to take off from work to get me to the vet's. All the vets we've gone to offer evening and weekend hours to accommodate working parents.
Except for the one time that I had an emergency visit on a Sunday, I've never had to wait more than a few minutes to get in to see the vet. And on the emergency visit, Mom walked me around outside while we waited so I wouldn't give the other dogs my cooties and I wouldn't get theirs.
Another thing I've noticed is that the results of my lab work generally are back within minutes. The longest they've ever taken is a day or two. And then the vet's office always called Mom and Dad to let them know that everything was OK.
If people doctors operated the way animal doctors do, healthcare costs could be cut drastically. For instance, just consider what their waiting rooms cost in terms of lost productivity and wasted time. Those rooms also are germ incubators. If you're not sick before you go to the doctor, give it a few days. Think about it. How often have you seen anyone truly disinfect the waiting room?
And when's the last time a doctor discussed treatment costs with you -- that is, before you complained about the bill? The last time Mom went to a doctor, he wanted to send her to a different specialist for every ache and pain she mentioned. He figured she had insurance, so it would be no dollar out of her wallet. Had she followed his advice, she would have been out of work for weeks just making the rounds and her insurance company would have shelled out thousands of dollars so all these specialists could tell her, "Hey, you're not so young anymore. Your body is going to ache occasionally."
When it comes to healthcare, people are a lot like Pavlov's dog. They've become too conditioned to the way things are. Healthcare reform shouldn't be about coverage; it should be about the way medicine is practiced in this country. It should be about patients becoming impatient with the status quo.
People doctors could learn a lot from the vet's office.
Even though I'm not covered by their health insurance, Mom and Dad make sure I get all my preventive care. It's always been affordable. The veterinarians are upfront about how much each shot or treatment will cost. And they've never prescribed unnecessary tests.
What amazes me is that we've never had to wait months to get an appointment for me. And Mom and Dad have never had to take off from work to get me to the vet's. All the vets we've gone to offer evening and weekend hours to accommodate working parents.
Except for the one time that I had an emergency visit on a Sunday, I've never had to wait more than a few minutes to get in to see the vet. And on the emergency visit, Mom walked me around outside while we waited so I wouldn't give the other dogs my cooties and I wouldn't get theirs.
Another thing I've noticed is that the results of my lab work generally are back within minutes. The longest they've ever taken is a day or two. And then the vet's office always called Mom and Dad to let them know that everything was OK.
If people doctors operated the way animal doctors do, healthcare costs could be cut drastically. For instance, just consider what their waiting rooms cost in terms of lost productivity and wasted time. Those rooms also are germ incubators. If you're not sick before you go to the doctor, give it a few days. Think about it. How often have you seen anyone truly disinfect the waiting room?
And when's the last time a doctor discussed treatment costs with you -- that is, before you complained about the bill? The last time Mom went to a doctor, he wanted to send her to a different specialist for every ache and pain she mentioned. He figured she had insurance, so it would be no dollar out of her wallet. Had she followed his advice, she would have been out of work for weeks just making the rounds and her insurance company would have shelled out thousands of dollars so all these specialists could tell her, "Hey, you're not so young anymore. Your body is going to ache occasionally."
When it comes to healthcare, people are a lot like Pavlov's dog. They've become too conditioned to the way things are. Healthcare reform shouldn't be about coverage; it should be about the way medicine is practiced in this country. It should be about patients becoming impatient with the status quo.
People doctors could learn a lot from the vet's office.
Thursday, June 4, 2009
Healthcare Reform -- In the Workplace
In what is becoming his trademark style, President Obama sent a letter Wednesday to two Democrat congressmen, informing them that he expects them to have healthcare reform legislation passed by October. And in keeping with how he handled the stimulus, he's leaving the details up to Congress. He does signal that his idea of healthcare reform is basically public insurance.
Worrying about universal health insurance before seriously addressing healthcare itself is like treating a patient before diagnosing the problem. If we rethink how we handle healthcare and cut costs instead of merely slowing the growth (see yesterday's post below), insurance reform will naturally follow.
To truly cut healthcare costs, we must put everything on the table -- sick leave, doctor's office hours, hospital practices, treatment costs, malpractice lawsuits, drug patents, even the training of healthcare providers.
Let's start with the workplace, which is generally overlooked in healthcare discussions. Through sick leave policies -- or lack thereof -- the workplace can be a breeding ground for contagious illnesses and a huge obstacle to preventive care. Think about the problems with common sick leave policies:
--No or limited sick leave. Employees come to work sick, making others sick and reducing productivity. They also may not take the time for preventive appointments and may forgo necessary treatment that is only available during the workday. When they do seek help, their condition is pretty bad -- and costs a lot more to treat.
--Sick leave restricted to the employee only. Workers may not take children, spouses or elderly parents to necessary medical appointments -- until an emergency crops up. Again, the costs skyrocket.
--Family leave restricted to extended periods of time and only after all other leave is used. If workers could take family leave for a week or so without jeopardizing vacation time or their own sick leave, they would be free to care for family members while they're in the hospital or recuperating at home. This could cut down on in-home care and speed recovery time for their loved ones.
Changes in sick leave could be written into labor laws. And employers should be encouraged to promote telecommuting when their workers may be contagious but not too sick to work.
Sanitation is another obvious issue in the workplace. How many employers change their air filters regularly or clean the HVAC system? How many warn sensitive workers of pending pesticide spraying? How many workers do not properly wash their hands? These are simple things, but they all add up.
Feel free to contribute your ideas for changes that can be made in the workplace that would help with our healthcare crisis.
Next, we'll tackle the doctor's office.
Worrying about universal health insurance before seriously addressing healthcare itself is like treating a patient before diagnosing the problem. If we rethink how we handle healthcare and cut costs instead of merely slowing the growth (see yesterday's post below), insurance reform will naturally follow.
To truly cut healthcare costs, we must put everything on the table -- sick leave, doctor's office hours, hospital practices, treatment costs, malpractice lawsuits, drug patents, even the training of healthcare providers.
Let's start with the workplace, which is generally overlooked in healthcare discussions. Through sick leave policies -- or lack thereof -- the workplace can be a breeding ground for contagious illnesses and a huge obstacle to preventive care. Think about the problems with common sick leave policies:
--No or limited sick leave. Employees come to work sick, making others sick and reducing productivity. They also may not take the time for preventive appointments and may forgo necessary treatment that is only available during the workday. When they do seek help, their condition is pretty bad -- and costs a lot more to treat.
--Sick leave restricted to the employee only. Workers may not take children, spouses or elderly parents to necessary medical appointments -- until an emergency crops up. Again, the costs skyrocket.
--Family leave restricted to extended periods of time and only after all other leave is used. If workers could take family leave for a week or so without jeopardizing vacation time or their own sick leave, they would be free to care for family members while they're in the hospital or recuperating at home. This could cut down on in-home care and speed recovery time for their loved ones.
Changes in sick leave could be written into labor laws. And employers should be encouraged to promote telecommuting when their workers may be contagious but not too sick to work.
Sanitation is another obvious issue in the workplace. How many employers change their air filters regularly or clean the HVAC system? How many warn sensitive workers of pending pesticide spraying? How many workers do not properly wash their hands? These are simple things, but they all add up.
Feel free to contribute your ideas for changes that can be made in the workplace that would help with our healthcare crisis.
Next, we'll tackle the doctor's office.
Wednesday, June 3, 2009
Healthcare at a Crossroads – The Problem
The growing cost of healthcare was a national problem back in 1992 when Hillary Clinton failed to come up with a workable solution. It’s an even bigger problem today, costing us 18 percent of the national GDP – a figure that’s expected to nearly double over the next 30 years, according to a report released this week by the president’s Council of Economic Advisers. That means more and more of our paycheck – and a greater share of our tax dollar – will go for healthcare.
President Obama made healthcare reform a centerpiece of his campaign. And he’s told Congress it has to get it done this year or else. Although the president is spotlighting any vague promise of future savings as proof that his campaign speeches were more than rhetoric, a lot of Beltway insiders are admitting that the likelihood we’ll see any true reform is getting slimmer and slimmer.
The president can’t blame this one on the Republicans not playing nicely with the Democrats. The truth is that the Democrats aren’t playing nicely with each other. Some congressional Democrats are holding out for all or nothing – meaning they will settle for nothing but a universal, socialized coverage plan. Others insist on a more moderate approach.
Meanwhile, the president and his economic advisers are touting as real progress a broad promise extracted at a closed “summit” last month from a coalition of healthcare providers and pharmaceutical and medical device industry groups. After the afternoon summit, the president proudly announced, without giving any details, that the coalition had promised to slow the growth of healthcare costs by 1.5 percentage points a year over the next decade for a total savings of $2 trillion.
If that savings were to occur, the typical family of four would have $2,600 more in its pocket in 2020, according to the council’s report.
But since that summit, the members of the coalition have had a chance to crunch some numbers. They released a joint letter this week listing some general steps they could take to slow the growth of healthcare costs. (Note that we aren’t talking about actually cutting costs.) And in that letter, they say they might be able to save as little as half of the $2 trillion Obama is counting on.
Yes, we need healthcare reform. But if we want true reform, we’re going to have to come up with the solution ourselves – and then sell it to Congress and the various stakeholders.
I’ll start the ball rolling tomorrow night with some ideas that could realistically – and almost painlessly – change healthcare as we know it.
President Obama made healthcare reform a centerpiece of his campaign. And he’s told Congress it has to get it done this year or else. Although the president is spotlighting any vague promise of future savings as proof that his campaign speeches were more than rhetoric, a lot of Beltway insiders are admitting that the likelihood we’ll see any true reform is getting slimmer and slimmer.
The president can’t blame this one on the Republicans not playing nicely with the Democrats. The truth is that the Democrats aren’t playing nicely with each other. Some congressional Democrats are holding out for all or nothing – meaning they will settle for nothing but a universal, socialized coverage plan. Others insist on a more moderate approach.
Meanwhile, the president and his economic advisers are touting as real progress a broad promise extracted at a closed “summit” last month from a coalition of healthcare providers and pharmaceutical and medical device industry groups. After the afternoon summit, the president proudly announced, without giving any details, that the coalition had promised to slow the growth of healthcare costs by 1.5 percentage points a year over the next decade for a total savings of $2 trillion.
If that savings were to occur, the typical family of four would have $2,600 more in its pocket in 2020, according to the council’s report.
But since that summit, the members of the coalition have had a chance to crunch some numbers. They released a joint letter this week listing some general steps they could take to slow the growth of healthcare costs. (Note that we aren’t talking about actually cutting costs.) And in that letter, they say they might be able to save as little as half of the $2 trillion Obama is counting on.
Yes, we need healthcare reform. But if we want true reform, we’re going to have to come up with the solution ourselves – and then sell it to Congress and the various stakeholders.
I’ll start the ball rolling tomorrow night with some ideas that could realistically – and almost painlessly – change healthcare as we know it.
Tuesday, June 2, 2009
Lessons From History
I had a graduate history professor who insisted on teaching an undergraduate American history class every semester. "I want them to understand that the world didn't begin when they woke up this morning," he said of the freshmen and sophomores who enrolled in his class.
That's as true of all of us as it is of college freshmen. And the more we know and understand of our nation's history, the more we should expect from our leaders.
The cast of characters who have taken the stage on both the state and national levels throughout our history ranges from the rogue to the truly inspirational. Unfortunately, we hear more about the rogues than the heroes today.
Perhaps we need to consider what made our effective leaders legends in their own time:
--They were not born leaders. Rather, they were ordinary men and women who were willing to step up when no one else would.
--They didn't need polls to tell them what course to take, but they valued the counsel of knowledgeable, experienced advisers. And they knew the power -- and solace -- of prayer.
--They stood on principle, but they were able to admit when they were wrong.
--They didn't make promises they knew they couldn't keep. Their word meant something, and they were not going to cheapen it just to be PC or gain a few votes.
--They understood it was not about them -- it was about getting the job done.
--They didn't waste time comparing themselves to historic leaders. They had work to do.
--They realized leadership was more than making eloquent speeches or trading political barbs. For them, action did speak louder than words.
--They knew they had to set the example and inspire others to follow them. It was not a matter of "do as I say and not as I do."
--At the end of the day, they took all the blame but shared the credit.
--They recognized when it was time to move aside and let someone else take the reins. They understood that they were not the one and only.
--And, finally, they didn't worry about their place in history. That was for future generations to decide. It was enough that they had served.
That's as true of all of us as it is of college freshmen. And the more we know and understand of our nation's history, the more we should expect from our leaders.
The cast of characters who have taken the stage on both the state and national levels throughout our history ranges from the rogue to the truly inspirational. Unfortunately, we hear more about the rogues than the heroes today.
Perhaps we need to consider what made our effective leaders legends in their own time:
--They were not born leaders. Rather, they were ordinary men and women who were willing to step up when no one else would.
--They didn't need polls to tell them what course to take, but they valued the counsel of knowledgeable, experienced advisers. And they knew the power -- and solace -- of prayer.
--They stood on principle, but they were able to admit when they were wrong.
--They didn't make promises they knew they couldn't keep. Their word meant something, and they were not going to cheapen it just to be PC or gain a few votes.
--They understood it was not about them -- it was about getting the job done.
--They didn't waste time comparing themselves to historic leaders. They had work to do.
--They realized leadership was more than making eloquent speeches or trading political barbs. For them, action did speak louder than words.
--They knew they had to set the example and inspire others to follow them. It was not a matter of "do as I say and not as I do."
--At the end of the day, they took all the blame but shared the credit.
--They recognized when it was time to move aside and let someone else take the reins. They understood that they were not the one and only.
--And, finally, they didn't worry about their place in history. That was for future generations to decide. It was enough that they had served.
Monday, June 1, 2009
Stick to the Real Issues
Even though Democrats have controlled Congress for nearly three years and the mortgage crisis can be traced back to policies started under the Clinton administration, 62 percent of Americans blame the current economic mess on Republicans, according to Rasmussen Reports.
The reason? We have allowed the Democrats to define the issues, shape the message and control the dialogue. If we want to reclaim any congressional seats next year, or even take a stab at the presidency in 2012, we must do a better job of telling our side of the story.
We are not going to do it by complaining about the president taking his wife to a Broadway play in New York. Every president is entitled to time off -- and away -- from the Beltway. And, yes, wherever they go, whatever they do, we have to pay for the security detail. It goes with the office.
On the other hand, we should be taking aim at a radio-phone-email campaign the Democratic Congressional Campaign Committee has launched against six House Republicans for their votes against President Obama's $787 billion stimulus package. This campaign, which started today, targets Rep. Brian Bilbray of California's 50th congressional district; Rep. Charlie Dent, Pennsylvania's 15th congressional district; Rep. Peter King, New York's 3rd congressional district; Rep. Thad McCotter, Michigan's 11th congressional district; Rep. Tom Rooney, Florida's 16th congressional district, and Alaska's Rep. Don Young. (Hey, haven't the Dems done enough damage to Alaska?)
The campaign is based on half-truths. For instance, the phone script being used in Michigan says, "Congressman McCotter even voted against the economic recovery plan, which is at work now to create or save over 109,000 Michigan jobs."
Yes, it is true that McCotter voted against the stimulus bill, which was passed in early February. But it is not true that the stimulus is doing anything for Michigan -- even though it was supposed to create jobs immediately. According to Michigan labor statistics, the state lost 38,000 jobs in April alone. If I lived in Michigan, I'd be asking the Democrats for my money back!
These are the facts we need to get out there -- along with real-world solutions. Only then will we be able to get our nation back on track.
The reason? We have allowed the Democrats to define the issues, shape the message and control the dialogue. If we want to reclaim any congressional seats next year, or even take a stab at the presidency in 2012, we must do a better job of telling our side of the story.
We are not going to do it by complaining about the president taking his wife to a Broadway play in New York. Every president is entitled to time off -- and away -- from the Beltway. And, yes, wherever they go, whatever they do, we have to pay for the security detail. It goes with the office.
On the other hand, we should be taking aim at a radio-phone-email campaign the Democratic Congressional Campaign Committee has launched against six House Republicans for their votes against President Obama's $787 billion stimulus package. This campaign, which started today, targets Rep. Brian Bilbray of California's 50th congressional district; Rep. Charlie Dent, Pennsylvania's 15th congressional district; Rep. Peter King, New York's 3rd congressional district; Rep. Thad McCotter, Michigan's 11th congressional district; Rep. Tom Rooney, Florida's 16th congressional district, and Alaska's Rep. Don Young. (Hey, haven't the Dems done enough damage to Alaska?)
The campaign is based on half-truths. For instance, the phone script being used in Michigan says, "Congressman McCotter even voted against the economic recovery plan, which is at work now to create or save over 109,000 Michigan jobs."
Yes, it is true that McCotter voted against the stimulus bill, which was passed in early February. But it is not true that the stimulus is doing anything for Michigan -- even though it was supposed to create jobs immediately. According to Michigan labor statistics, the state lost 38,000 jobs in April alone. If I lived in Michigan, I'd be asking the Democrats for my money back!
These are the facts we need to get out there -- along with real-world solutions. Only then will we be able to get our nation back on track.
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