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Healthcare price transparency – a good common goal

In my last blog post, I unwittingly evoked vehemence on the part of those pro/con a single payer model for healthcare. And so in this post I’d like to offer some more food for thought (while attempting to dodge the high velocity tomatoes):

First of all, Dr. Reece summarizes things nicely, suggesting that this debate is not entirely resolvable:

Incompatible Mindsets

• If your mindset is that government’s moral duty is to redistribute resources to protect the health of all, and that health is directly related to the extent of health system coverage, you think and receive information in a certain way. You generally attribute superior health statistics of other nations to universal coverage, even if these other nations have more homogeneous, smaller populations, and different cultures.

• If your mindset is that private markets provide the best care for most of the people most of the time, provide better access to high technologies, give more health care choices to citizens, distribute resources more efficiently and that the health of the people is more related to cultural behaviors and a nation’s heterogeneous population, you receive information in completely different way.

The Unending Argument

The power and efficiency of government vis-à-vis the power and efficiency of markets is a never-ending argument – an argument unlikely to change mindsets. To progressives, it’s a moral argument: to conservatives, it’s an exercise in reality. You can marshal persuasive arguments on both sides, without convincing either side who is right.

An economics blogger explains why extending Medicare benefits to all would not succeed:

The dirty little secret behind Medicare is that it works only because it does not cover every American. Part of the reason for this is that Medicare’s payment structure is designed to pay doctors and hospitals in such a way as to limit total spending, rather than to ensure they can break even. Clearly, they have to do better than break even to stay in business, and the people running Medicare know that. Medicare depends on the fact that there are lots of non-Medicare patients out there who (through their private insurance) can pay enough to keep the doctors and hospitals in business. This is called “cost shifting.”

Whether pro/con single payer system, I think that we nearly all can agree on one thing: price transparency is morally right. It’s hard to fix a system if you don’t really know where the money is coming from or going to.  I think it would be nice to have people on both sides of the debate work together for that common goal first. Would you agree?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Medical errors may be reduced by redundancy?

One of the great advantages of electronic medical records (EMRs) is that they can reduce unnecessary repeat testing. Without an EMR that is accessible to all physicians taking care of a single patient, there’s no way for them to know what the other one is prescribing. Expensive tests like MRIs are often ordered by two different physicians (a neurosurgeon and a rehabilitation medicine specialist for example) because one didn’t know that the other had already ordered it. Alternatively, they may be affiliated with institutions that don’t share data, so previous MRI images are not available for viewing by the new specialist – so she just orders another one.

However, an interesting question is raised by Dr. Perloe’s post to my last blog entry: what if all specialists taking care of a patient had access to one medical record – and there was a lab error? They would all rely on the same erroneous record, and this could spark a whole host of inappropriate tests and procedures. Even second opinions (based on one single record) would be less helpful – because they would be misled by false results.

So, the irony is that the redundancy in our system has its benefits. We should be mindful of the checks and balances that we are unwittingly removing with EMRs. Occasional lab errors will always be with us – let’s make sure we catch them early, and not commit them to a permanent record relied upon by all.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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