News-Record.com

I wrote in August about the problems and costs associated with drugs and procedures that either don't work at all or don't work as well as simpler or cheaper alternatives. Not only does the widespread use of such treatments render medical care of poorer quality than would otherwise be the case, it also costs as much as $700 billion out of the $2.3 trillion the U.S. spends annually on health care.

The good news is, there's a wealth of research in this area on which to base treatment and policy changes. The bad news, according to this New York Times story that ran on -- yeesh -- Thanksgiving, is that all that research does no good at all if physicians don't use the findings.

The article cites a study that found that in treating high blood pressure, generic diuretics, which sell about as cheaply as prescription drugs can sell, outperform calcium channel blockers, alpha blockers and ACE inhibitors that can cost 50 times what the diuretics cost. That study, which looked at 42,000 patients and cost $130 million, was led in part by Dr. Curt Furberg of Wake Forest, whom I quoted in my August article.

The article goes on to explain why these findings don't result in changes in the way the U.S. practices medicine. And the case illustrates that whatever else happens with health-care reform in this country, we must find a way not only to routinely assess relative and absolute effectiveness of treatments but also to see that best practices become the practices that are actually used. Many lives and a lot of money hang in the balance.

The conservative Heritage Foundation has some advice for the incoming administration on what its policies ought to look like, and as you might expect, changes to the current system of health insurance are a big part of the agenda. As part of its "Change We Believe In: A series of memos to President-elect Obama identifying policy areas where his words line up with our vision" series, the think tank offers its thoughts on "Ensuring Access to Affordable Health Insurance."

U.S. Sen. Max Baucus, who chairs the Finance Committee, has been working on health-care reform since long before Barack Obama was elected president. (Any legilsation on this subject would have to go through his committee.) This week he released a white paper, which he says is not proposed legislation but a "Call to Action." (Executive summary here (scroll down a bit); full text here.)

The highlights: 1) Baucus seems to be threading the needle between the practical issue of how quickly anything could be enacted (he says at least three years) and the urgent need to move as quickly as possible. And 2) he would require everybody to buy health insurance (with a sliding price scale to benefit the less-well-off), balanced by the kind of protection for people with pre-existing conditions that's rare, if not impossible to find, in the free market.

He doesn't say anything about how to pay for the plan, possibly because it's kind of vague.

Maggie Mahar of the Health Beat blog has a 2-part analysis up (Part 1, Part 2). Given Baucus' committee chairmanship, there's a strong possibility that any legislation that does come to pass will look a lot like this "Call to Action."

Robert Laszewski at Health Care Policy and Marketplace Review also analyzes the plan.

The Center for American Progress is a liberal think tank likely to contribute both staff and ideas to President-elect Barack Obama's administration. It has a lengthy report here addressing some of the issues involved in reforming our health-care system to get care to more people who need it.

(hat tip: The Health Care Blog)

In the age of massive bank bailouts, nobody seriously believes that every change called for in President-elect Barack Obama's health-care plan can be implemented. But Robert Laszewski over at the blog Health Care Policy and Marketplace Review points to some things we can do right now,some of which have bipartisan support, to help reduce health-care costs, particularly the waste that may constitute up to a third of our annual $2 trillion-plus health-care bill. It's worth a read.

Via the Health Affairs blog, here are links to two articles relating to major issues of health-insurance reform.

The first addresses five "myths" about health insurance. For example, Myth No. 2: Covering The Uninsured Pays For Itself By Reducing Expensive And Inefficient Emergency Room Care. Not so much, it turns out, except in some cases in which management of chronic conditions is cheaper than treating acute problems in the ER. Diabetes is one example.

The second, by Jonathan Oberlander of UNC-Chapel Hill, discusses the politics of health-care reform. Oberlander spoke March 10 in Greensboro on a similar topic at a forum sponsored by the League of Women Voters.

There's some good stuff to chew on in each article. But they present formidable obstacles to some of the most-discussed possible solutions to America's health care/health insurance crisis and, by implication, call upon experts to look beyond the conventional wisdom for real solutions.

Relatedly, at The Health Care Blog, Jacob Hacker touts a book which he edited and to which he contributed that examines various problems with health care. Among other things, he says that to suggest the government has no money to reform health care

... has it exactly backward. To the extent that we’re worried about the budget and the future of our economy, health care reform is more vital, not less so.

For starters, our long-term deficit problem is really a health care spending problem. If you take health care programs out of the equation, there is literally no other long-term federal budget problem. None. No Social Security crisis. No out-of-control-earmarks catastrophe. No deficits as far the eye can see.

I haven't read the book, so I'm reserving judgment. But his description raises some provocative points, and if he's accurate, then he and his co-authors are pointing to a welcome way out of the current long-term financial stress the government faces.

Via The Wall Street Journal's health blog, here's an analysis in the Journal's personal-finance section on who would benefit from each of the major candidates' health plans.

And if it's Thursday, it must be time for some free full-text articles from The New England Journal of Medicine: Three Inconvenient Truths About Health Care and an article about what we can learn from other countries about slowing the increase of U.S. health-care costs.

I commend these to your attention, particularly as the election approaches (and, no, I'm not advocating any particular approach -- I don't know enough about the analysis to do so).

Because I've been bombarded with thousands of e-mails* seeking more analysis of John McCain and Barack Obama's health-insurance proposals, I'm happy to share critiques (well, if, by "critiques," I mean "eviscerations") of both published online this week by The New England Journal of Medicine.

The critique of McCain's plan, offered by an unpaid advisor to the Obama campaign, says in part, "The McCain proposal violates the bedrock principle that major health policy reforms should first do no harm. It would risk the viability of employer-sponsored insurance and the welfare of chronically ill Americans in pell-mell pursuit of a radical vision of consumer-driven health care."

The critique of the Obama plan, offered by someone who disclosed to the journal no connection to the McCain campaign, says in part that Obama proposes to do, and the claimed benefits therefrom, are "are too audacious to be believed."

Read and enjoy.

*Maybe hundreds. Well, OK, actually zero. Still.

This week's New England Journal of Medicine has pieces by the two major presidential candidates on their plans for health-care reform. Barack Obama's is here. John McCain is here.

The journal also has a roundtable discussion on health care in the next administration. Video is here and a transcript (*.pdf file) is here.

... here's another analysis of presidential candidate Barack Obama's health-care plan, this one by Maggie Mahar of The Health Care Blog, based on a review by the Urban Institute, a nonpartisan economic and social-policy think tank.

Although this may be a purely academic exercise in light of recent events, the New England Journal of Medicine's Web site is chockablock this week with publicly available information related to the two major candidates' health plans.

At a forum Sept. 12, co-sponsored by the Harvard School of Public Health and the New England Journal of Medicine, health advisers to the two major presidential candidates offered their views. Links to video and the transcript are here.

Also available online:

• An examination of the role of campaign contributions and lobbying in U.S. health care.


• Statements from John McCain and Barack Obama on their respective health plans.


• Critical outside examinations of both McCain's and Obama's plans.

There's a lot to chew over, and given recent economic events the temptation is to give up on any sort of health-care reform at all for now. But I suspect whoever wins isn't going to give up, so we might as well get some idea of what the winner will be trying to do starting in January.

Back in August, I wrote about how a lot of drugs and procedures either aren't effective or address symptoms without treating the underlying cause. Such waste constitutes roughly a third of the more than $2.1 trillion we spend annually on health care, and it's almost ten times the highest estimate of what we could save with a national conversion to electronic health records.

The waste isn't just money, either. It's lives. The Institute of Medicine estimates that the number of annual U.S. deaths from preventable medical errors alone is between 44,000 and 98,000.

The biggest reason why the waste is so enormous is, of course, how common such wasteful drugs and procedures are. And how common is that? Via The Health Care Blog comes an article in Miller-McCune magazine that says your odds of getting the best evidence-based health care are roughly 55 percent -- barely better than a coin toss.

The figure differs according to the medical problem, the article says: Breast-cancer patients are likely to get the best evidence-based care about 76 percent of the time, but hip-fracture patients get it only about 23 percent of the time.

More disturbingly, patients receive a type of care they actually shouldn't receive about 20 percent of the time for chronic conditions (diabetes, say) and 30 percent of the time for acute ones (such as heart attack or stroke), a trend likely contributing to the numbers noted by the Institute of Medicine. And socioeconomic factors don't appear to make any difference, so even the wealthy at the best medical centers aren't immune, so to speak.

The article examines how doctors practice medicine as the basis for why the best evidence-based practices aren't followed. And it puts some blame on patients, who may insist on a type of care they don't actually need -- an insistence to which some doctors succumb rather than risk a malpractice suit.

Changing this approach will be an enormous project, but the payoff in lives and dollars makes such change essential.

I don't know whether the administration's proposed $700 billion bailout of Wall Street is a good idea, either straight up or with changes proposed by Democrats. But I can do a little math, and the math tells me that if we taxpayers are spending this kind of money on this initiative (which may end up costing a lot more than $700B), there's going to be roughly zero left over for any kind of major government initiative, whether it's health care, public works, economic stimulus or what-have-you.

UPDATE: There may not be any tax cuts for a while, either, and the sunsetting of the tax cuts of the early Bush 43 administration may now be a foregone conclusion, particularly if the Democrats strengthen their hold on Congress.

Holy cow. If you thirst for more information on how the respective major presidential candidates' health plans might work, thirst no more. Jaan Sidorov at the Disease Management Care Blog posts a huge roundup of links to analyses and opinion pieces. It's got to be at least a day's worth of reading, but then perhaps one day isn't too much to spend looking at the country's health care problems and the various proposals on the table for addressing them.

(Well, I say "on the table," but whether much of anything can get through Congress is a question for another day.)

Via the Health Affairs blog, here are critiques of the health-care reform plans of major presidential candidates Barack Obama and John McCain. Health Affairs also links to an essay by an economist who sees potential areas of compromise in the plans.

Endorsement of the candidates' respective health plans, the critiques and/or the essay is neither expressed nor implied; I'm just passing these on for whatever they might be worth.

UPDATE: The articles will be freely available for only two weeks, so act now.

After more than a decade and tens of billions of dollars, an electronic medical-records system for the Department of Defense called AHLTA is a huge bust.

And it didn't have to be that way. The Veterans Administration for decades has been using its own medical-records system, developed by and for health-care professionals, that's both effective and freely available.

Mother Jones magazine has the story, and it's disturbing reading for anyone interested in the quality of health care our service members receive.

UPDATE: The military publication Stars and Stripes was on this problem more than two years ago.

The Health Care Policy and Marketplace Review blog has a post up with links to detailed analyses of the proposed health plans of the two major candidates for president, along with a comparison.