QUICK PICKS

Posted on August 22, 2003 by Dave Pollard
nejm
Five things worth a read:

  • Health Care Bloat: A new study in the New England Journal of Medicine shows the administrative overhead costs of the US health system are twice what they would be under a Canadian-style public health system. The argument that the private sector is more efficient than the public sector is, more often than not, bumpkus. The extra overhead due purely to excess bureaucracy is $750 for every man, woman and child in America every year.
  • Afghanistan’s Dying: Our Mothership Salon.com features a well-researched John Sifton story that shows the situation in Afghanistan is quickly deteriorating back to levels under the Taliban. In short, the country is run by US-backed gangsters.
  • The KM Revolt Grows: Professor Jim McGee adds his eloquent voice to those calling for a shift in the focus of Knowledge Management away from content management and towards productivity and connectivity of people.
  • Writing Good Poetry: A book called The Poet’s Companion by two excellent poets, Kim Addonizio and Dorianne Laux, provides exercises to improve your creative writing skills without being preachy or academic. Dorianne provides an overview in this compelling interview. Thanks to Kara at SpaceTramp for the link.
  • Remarkable Memoir: Claire Smith’s personal story in her Salon blog, Life in LA, dates back only to June but already describes a lifetime of tragedy and courage. It’s a must read, very powerfully written.
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4 Responses to QUICK PICKS

  1. Terry Frazier says:
    August 24, 2003 at 09:32

    Dave,I was unable to read this article in full, or the referenced article that appears to call into question some of its assumptions (my own administrative overhead not being very tolerant of the $10/article fee.) However, we should note that the US healthcare system is far from “private”. The US Department of Health and Human Services, through its Centers for Medicare & Medicaid Services (CMS) administers and funds the Medicare program, and the federally mandated but state-funded Medicaid program. In combination these two programs make the Federal Government the largest healthcare provider in the US. The states pick up the bill for the poorest 15%-20% of the population via Medicaid. In addition, it looks like about 1/3 of America’s roughly 6,000 hospitals are publicly funded, government-run institutions (I couldn’t find any “free” statistics to get the hard numbers.) In light of these numbers it seems a mischaracterization to frame the U.S. healthcare argument as private vs. public. Further, the article makes no effort to account for service level or quality of care. I didn’t bother to research statistics on this point, but my own experience through family and friends has given me cause to question the efficacy of the Canadian healthcare system. In my own small circle of relatives and acquaintances there are a handful of doctors who left the Canadian system to come to the US for economic reasons. There are also people who, diagnosed with a serious disease, have come to the US to try and get better treatment in a more reasonable time. This is by no means a scientific or representative sample, but it is certainly enough to prevent me thinking Canada’s socialized healthcare is the answer to our (admittedly serious) problem.As self-employed I personally wrestle with this on a daily basis, trying to find a way to provide healthcare for my family. Our system is profoundly broken, but it is a gross oversimplification to see private enterprise as the sole cause of the problems.– twf

  2. Dave Pollard says:
    August 24, 2003 at 14:25

    Terry: Sorry – the article disappeared behind the archive firewall since I made this post – I can’t access it free anymore either. I’m not saying the Canadian system is perfect (it’s far from that). But the article does say that the US system is significantly less efficient than the US system. One of my fellow bloggers in the US just got stung with a $16,000 bill for removing his wisdom teeth, of which $9,000 was ‘hospital administration’. I find this outrageous. And I’ve been told by others in the US who I trust that (a) the US has a true 2-tier health care system with one class of service for the rich and another for the poor (which is why the infant mortality rate in the US is close to third-world levels) and (b) that as many as 30 million Americans have no medical coverage whatever. So the NEJM article didn’t surprise me. And I confess it’s easy for Canadians to criticize when if they’re rich they can cross the border to jump the queue, and when we have a crisis of medical practitioners when so many go to the US for double the salary.

  3. Christopher Key says:
    August 24, 2003 at 21:34

    The two-tier model is quite accurate. Yes, the government funds Medicare for the elderly and Medicaid for the poor, but both those groups are often denied access because reimbursement levels in some areas are so low that physicians are refusing to take any more patients in those categories. When people have no access to a primary care physician, they wait until they are ill enough to go to the emergency room, which can’t legally turn them away. By that time, their condition has often become much more serious than it would have been had it been treated earlier. This runs up the costs for everyone. We all end up paying for those patients who are denied access at the onset of illness.Then there is the gatekeeper issue. In order to actually interact with a physician in this country, you have to negotiate several levels of bureaucracy. First, you talk to a receptionist who decides (on what basis?) whether or not you need to talk to a nurse. The nurse is rarely available and may or may not return your call in a timely manner. Meantime, you’re still sick. The nurse may then refer you to a physician’s assistant who is also not available immediately and may or may not return your call in a timely manner. Meantime, you’re getting sicker. It’s often possible that a five minute chat with the doctor could have cleared everything up, but instead, you’ve spent hours and possibly days without getting the help you need. Now you’re not only sick, you’re seething with frustration. A lot of people have given up and rely on walk-in clinics for primary care. At least there you actually have some chance of seeing a doctor.I have been writing about this issue for months and could go on and on, but it’s my bedtime.

  4. Dave Pollard says:
    August 25, 2003 at 10:41

    Christopher: Thanks for clarifying this. I also read recently that last year for the first time there were more visits to ‘alternative’ medical practitioners in the US than to ‘mainstream’ ones, despite the fact there is little or no coverage for such treatment. Do you think that’s due to the same inaccessibility issue you describe?

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