National Geographic Exposes Privates

Posted on December 30, 2009 by Joe Loveland

Click and zoom for clear viewing

When I was a boy, I always enjoyed the naked majesty of the images in National Geographic.

Well, they’ve still got the touch. This chart from National Geographic lays bare the weakness of the conservatives’ indictment of “government-run health care.”

When you look around the globe, the naked truth is that government-run health care is much more efficient and effective than our largely private system. As National Geographic summarized:

The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Lack of health insurance is a factor in life span and contributes to an estimated 45,000 deaths a year. Why the high cost? The U.S. has a fee-for-service system—paying medical providers piecemeal for appointments, surgery, and the like. That can lead to unneeded treatment that doesn’t reliably improve a patient’s health. Says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who studies health insurance worldwide, “More care does not necessarily mean better care.”

But true to form, their picture said it much better than their words.

- Loveland
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10 Responses

  1. Dennis Lang, on December 30, 2009 at 1:29 pm said:

    Yes, as shocking–and revealing–as pages of naked Aborigines were to a ten year old.

  2. Newt, on December 30, 2009 at 4:25 pm said:

    We all look forward to an aggrandized VA healthcare system and all the efficiencies, savings and quality that it will bring to our lives. Just look to what government care has done for our vets.

    • Joe Loveland, on December 30, 2009 at 4:47 pm said:

      Yes, “just look what government care has done for our vets”…

      Vets Give VA Top Health Care Rating – Five Years in a Row

      WASHINGTON – Are you satisfied with your health care? If you’re a veteran in the Department of Veterans Affairs health care system, the answer is overwhelmingly, yes! For the fifth year in a row, the independent American Customer Satisfaction Index (ACSI) found veterans are happier than most Americans with the health care they receive.

      …..

      The Secretary’s comments came with the release of a respected independent study that showed veterans gave VA health care a rating of 91 for customer satisfaction on a 100-point scale. The rating system’s creator, the American Customer Satisfaction Index (ACSI), said the results “should be considered a benchmark for (federal) agencies.”

      Veterans also gave VA’s inpatient hospital services a rating of 84 and outpatient services a rating of 83, compared to private-sector patients giving their health care providers ratings of 79 and 81, respectively. VA also rated highly — 92 — in veteran loyalty, meaning that nearly all veterans under VA care intend to continue using VA and speak positively to others about their experiences.

      ….

    • Joe Loveland, on December 30, 2009 at 5:00 pm said:

      Doctors say VA care is a model of efficiency
      Minnesota Public Radio
      August 18, 2009

      Minneapolis — One argument against a public insurance option in the current debate over health care is that government typically isn’t as efficient or proficient as the private sector. But some say that the Department of Veteran Affairs medical care is actually an excellent example of how the government is leading on health care quality and cost.

      …

      In fact, the VA is used to stretching a buck. It has to deliver all the care that its patients need without exceeding its annual budget set by Congress.

      It’s a challenge, but Drucker said the VA has figured out a way to do things economically. Like doctors at the Mayo Clinic, most VA doctors receive a salary, so they have no incentive to order unnecessary tests and procedures to make more money. That saves the VA huge sums of money that can be reinvested in necessary care.

      Also, the VA has an electronic medical record system that’s the envy of many. Drucker said doctors can get detailed information about patients even if they were treated at a VA clinic across the country.

      “Staff do not have to transport records,” he said. “They don’t have to look for them; they’re just available on the computer screen in front of the provider who can use that information immediately to make a medical decision about a patient.”

      The electronic records have allowed them to improve patient quality and eliminate a lot of wasteful spending.

      Compared to the average Medicare patient in the private market, the VA spent substantially less on its patients in 2004. That year, Medicare paid an average of $6,800 dollars per patient, while the VA was able to deliver care for approximately $5,000 per patient. That’s 35 percent less than Medicare, which is the baseline widely used in measuring the cost of health care.

      …

      They even measure access to the VA. Doctors must see 95 percent of their patients within 30 days of that patient’s initial request for an appointment. Mental health patients must be seen within 14 days; and if it’s a crisis, they need to be seen immediately.

      Dr. Greg Filice, an infectious disease expert at the VA, said doctors receive regular reports on their success in meeting these goals.

      …

      “We can change things here; we’re all employees of the VA,” Nichol said. “And if we want to re-organize or tweak things or try something differently, we can do that here.”

      Other hospitals don’t usually hire doctors directly. Instead the doctors will often work for their own group practice and get permission from various hospitals to treat patients there as well.
      …

      Dr. Greg Filice said it’s actually how all of America’s citizens should be treated by the health care system.

      …

      Felice said the VA is a model that lawmakers should consider emulating as they try to overhaul the nation’s health care system.

      (Joe’s Note: As context for the $5,000/VA patient figure quoted in this article, Americans as a whole are paying about $7,300 per person, according to the chart cited in this post.)

  3. Mike Keliher, on December 31, 2009 at 7:22 pm said:

    Arguing about efficiency or lack thereof is missing a/the point. The bigger concern, for me, is creating an insatiable monster with an appetite for everyone’s money.

    From Reason magazine:

    Today’s proposals for a universal national health-care policy typically divide into either a government-run “single-payer” system like Canada’s or a “play or pay” scheme that would require employers to provide health insurance for every worker or pay a payroll tax into a government insurance program. Advocates of such policies claim these programs won’t cost much because significant savings can be had through cost containment and other efficiencies of scale. The experience of 25 years of Medicare says otherwise.

    The two primary lessons of Medicare are the chronic problem of woefully underestimating program costs and the impossibility of genuine cost control. A closer look at Medicare shows why these two problems are certain to plague a government-administered universal health-care plan.

    The cost of Medicare is a good place to begin. At its start, in 1966, Medicare cost $3 billion. The House Ways and Means Committee estimated that Medicare would cost only about $ 12 billion by 1990 (a figure that included an allowance for inflation). This was a supposedly “conservative” estimate. But in 1990 Medicare actually cost $107 billion.

    Does that initial description of “today’s proposals” sound familiar? Certainly, but this article was written in 1993. My, how far we haven’t come.

    • Joe Loveland, on January 1, 2010 at 10:18 am said:

      Private sector payors arguably have much more of an “insatiable appetite” take more of our money than the publicly accountable government. In fact, they’re mandated by their stockholders to make as much as they can, which means charging as much as you can while paying out as little as you can.

      Yes, medical, pharmaceutical and medical device inflation has driven costs higher than expected in the U.S. That’s a phemonenon that neither the private nor the non-government sector payors have been able to overcome,

      Have private payors in the U.S. done better at cost containment than public payors in other countries? The NG chart shows they haven’t. On both an efficiency and effectiveness level, their public payor model performs much better than our private payor model.

      Have U.S. private payors done better at cost containment than the U.S. public payors? The numbers I’ve seen show that since 1970 Medicare costs per beneficiary have risen at an annual rate of 8.8% , while private insurance premiums have risen at an annual rate of 9.9%

      But even if the private and public sectors were roughly equal in terms of cost containment, as some maintain, the patient satisfaction with government-run Medicare and VA care is much higher. In addition the VA numbers I shared, the Medicare experience is similar. In 2007, 56 percent of traditional fee-for-service Medicare rated it a 9 or 10 on a 0-10 scale, compared to only 40 percent of Americans enrolled in private health insurance who gave that rating. Not perfect by any means, but patients get a better experience for their buck with private payors.

      Government-run care in the U.S. costs less, or roughly the same, and delivers a much better experience. And government-run care in other countries blows U.S. private health plans away on all measures.

  4. Mike Kennedy, on January 1, 2010 at 11:02 am said:

    Nevertheless, the Medicare system is beyond financially broke. It’s easy to provide everything to everybody when you continue to spend money you don’t have and underpay for services (see recent Mayo Clinic decision to quit taking Medicare patients at one of its clinics).

    In addition, infant mortality measures are cooked (countries use different measuring criteria) and mortality rates are more a function of lifestyle than medical care.

    Personally, since federal and state government already control about 50 cents of every health care dollar, I’d say faults in the current system might warrant less government involvement — not more.

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