Coyote Blog

I am coming back from vacation today, but just as a quick note, Bruce McQuain has another good post on the current health care bills and Obama's press conference.  In that post, he links two very good posts that provide more facts and discussion around my claim yesterday that health care savings from "preventative medicine" are mostly a myth.  Those two posts are from a physician and from the Manhattan Institute.

And here is McQuain again on the CBO's testimony on the health care bills.

[Democratic Senator] Conrad: Dr. Elmendorf, I am going to really put you on the spot because we are in the middle of this health care debate, but it is critically important that we get this right. Everyone has said, virtually everyone, that bending the cost curve over time is critically important and one of the key goals of this entire effort. From what you have seen from the products of the committees that have reported, do you see a successful effort being mounted to bend the long-term cost curve?

[CBO director] Elmendorf: No, Mr. Chairman. In the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs.

No, not the one that said everyone who likes their current health plan can keep it, though that clearly is a whopper.  This is the one that fascinates me:

[Obama said] if doctors have incentives to provide the best care, instead of more care, we can help Americans avoid unnecessary hospital stays, treatments and tests that drive up costs.

What he is referring to is the fact that if doctors prescribe more procedures, they make more money.

I spent years as a consultant  working with incentive programs in corporations.  They are very tricky things.  It is much harder to create incentives for the wrong behavior than the right behavior.  But I don't think you need similar experience to dissect this plan.  Because there is absolutely nothing of real substance in this plan, or any HMO has discovered, that will truly create incentives for "the best care."  It just doesn't work with doctors.  I know doctors, and when Obama says "best care" he means saying no to a lot of things.  That is not how doctors would understand the phrase.  I worked with Kaiser-Permanente for about a year as a consultant, and this was a constant source of friction between the Kaiser business people and the Permanente medical staff.

Really, all Congress and Obama are doing is twiddling one knob called "payment model" and the knob only has two settings - either create incentives for the doctor to do a lot for the patient by paying for individual services, or create incentives for the doctor to do as little as possible for the patient and resist every plea for a test or specialist referral.  Basically, Obama's intention is to flip the switch from the former to the latter position, similar to what is being done currently in the Massachusetts health plan with switching to capitated payments from fee for service for doctors, and similar to the strong HMO model that pissed so many people off years ago that many states banned practices Obama is implementing nationally.

Yeah, I know the response, that somehow "preventative medicine" will reach the golden mean.  Forget it.  Preventative medicine is great as a spur to individual well-being, but does little to reduce total system costs**.  Waving around the flag of "preventative medicine" is about as believable as when politicians say they will make up budget gaps with savings and efficiency.  Basically, the next time we see either will be the first time.

** This kind of thing always sounds heartless, but for example it is actually cheaper not to find a cancer until its almost too late.  An expensive operation may be called for, but a quick death is actually cheap for the system.  Finding a cancer early means expensive treatments now, and probably expensive treatements later in a longer life.  I much prefer the latter, but it is more expensive.  You can't get around that.  The big wins in reducing health costs rom preventative medicine are in public health and nutrition, and most of those battles are won.  There may still be some savings in pre-natal care, but even that is iffy.

Via Hit and Run, this is some of the worst science I have seen in a while, and it really makes you wonder about what other schlock gets published (as long as the findings support politically correct principles)

A study in Preventive Medicine
finds that a smoking ban in Bowling Green, Ohio, was followed by a 47
percent drop in hospital admissions for coronary heart disease.
According to the researchers, "The findings of this study suggest that
clean indoor air ordinances lead to a reduction in hospital admissions
for coronary heart disease, thus reducing health care costs"....

A look at the raw hospital-admission numbers for Bowling Green, as reported by Michael Siegel, may help resolve this mystery:

1999: 35
2000: 24
2001: 24
2002: 36
2003: 22
2004: 26

Although
the smoking ban took effect in March 2002, Siegel notes, the
researchers treat that year's admissions as if they all occurred before
the ban

That's hilarious.  What responsible researcher would look at that data set, with a March 2002 start date for the program, and be able to come to a conclusion that a smoking ban had any effect at all.  I'm not sure I even fault the "researchers" -- they are obviously trying to flog their point of view with BS data and must be happy they found a sucker to publish them.  But Preventative Medicine should be ashamed.