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Why Is There So Much Less Paperwork In Canadian Health Care?

If you ask internists and their patients what makes them bonkers about the U.S. health care system, paperwork will top the list. Many will point to the federal government as the culprit, citing the many forms, RAC audits, pre-and post-payment reviews, documentation and coding guidelines, HIPAA privacy rules, quality measurement and reporting, Part D drug formularies, and HIT meaningful use requirements imposed by Medicare and other federal programs. (Some put more of the blame on private insurers and pharmacy benefit managers.)

But if paperwork is associated with the degree of government involvement in health care, then Canada–a single payer system–should have more of it than the United States, right? Think again.

A new Health Affairs survey of U.S. physicians and practice administrators found that U.S. physicians spend Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Will The Next Generation Of Physicians Save Healthcare Or Abandon It?

The old joke in medicine goes, ‘don’t get sick on July 1st.’ That’s because it’s the day when new resident physicians, freshly graduated from medical schools across the land, begin their training programs. Although they have spent four years in undergraduate school and four years in medical school, it’s residency where physicians are made from the raw material of knowledge-rich, experience poor high achievers.

However, even in residency physicians are seldom told the entire story of how the practice of medicine, and their lives, will look and feel as their careers evolve and they enter the medical work-force.

Since our profession changes from year to year and administration to administration, it seems a good time to mention some of the things upcoming young physicians will face. Sadly, these are things seldom mentioned by pre-med advisors or academic medical educators.

You see, physicians are struggling. Due to falling reimbursements and the ongoing federal mandate to see non-paying patients on call, it is increasingly difficult for physicians to cover costs like malpractice insurance, licensure, professional memberships and office overhead. (Well, if they want to have a house, family and food, that is.)

Many physicians are Read more »

*This blog post was originally published at*

Why Medicare-For-All Would Not Reduce Costs

[This post was written by Charlie Baker, President and CEO of Harvard Pilgrim Health Care, Inc., one of New England’s leading non-profit health plans.]

I heard this idea promoted at a luncheon I was at last week — that the best way to fix health care in the U.S. would be to move to a “Medicare-For-All” system.  Needless to say, I find this odd — since I think many of the things people hate most about our existing system — too procedure driven, doesn’t support primary care and prevention, favors technology over face-to-face interaction, doesn’t support multi-disciplinary approaches to care delivery, etc. — derive from the rules of the game set up and enforced by…Medicare!!!  Yikes!

But aside from that, the two things I always hear about why it’s a good idea are — Medicare has lower Administrative costs than private health plans and they’re a ”better” payer than the private plans.  Hmmm…Let’s take the first one.  What I’ve heard before is that Medicare only spends 4% of its money on a per beneficiary basis on administration, while the plans spend 14% per member on administration — a big difference.  This is interesting, but misleading.

Medicare beneficiaries are over the age of 65.  They spend almost three times as much money on health care as a typical private plan member — most of whom are under the age of 65.  If the Medicare member typically spends $800 per month on health care, and 4% of that is spent on administration, that’s $32  a month on administration.  If the private health plan member typically spends $300 per month on health care, and 14% of that is spent on administration, that’s $42 a month — a much smaller difference.  But we’re not done yet.  Medicare is part of the federal government, so its capital costs (buildings, IT, etc.) and benefit costs (health insurance for its employees and retirees (!), pension benefits, etc.) are funded somewhere else in the federal budget, not in the Medicare administrative budget.

Private plans have to pay for these items themselves.  That’s worth about $5-6 per member per month, and needs to come out of the health plan number for a fair comparison.  Now we’re almost even.  And finally, Medicare doesn’t actually process and pay claims for all of its beneficiaries.  It contracts with health plans around the country to do much of this for them.  That’s not in their administrative number, either — and it is, needless to say, in the private health plan number.

People push and pull these numbers all the time, and there may be “some” difference between Medicare and the private health plans on administrative spending as a percent of total spending.  But it’s not huge, if you try to compare apples to apples.

On the payment issue, the numbers I’ve seen suggest that nationwide, private plans — on average — pay somewhere between 120 and 125 percent of what Medicare pays for hospital and physician services.  In other words, private plans pay MORE than Medicare pays, not less!  If people want Medicare For All, they need to be prepared to either dramatically raise Medicare rates and payment — and therefore, Medicare costs — by a lot of money — 20 to 25% by this estimate — or kick the bejeebers out of the physician and hospital communities and make them eat the difference.

Medicare-For-All is not as simple as it seems.

*This blog post was originally featured at the Let’s Talk Healthcare blog.*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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