"The money just flows through a machine that is exquisitely designed to reward everything except simple, affordable, accountable care."
That is true as far as it goes, but some of the rewards (endovascular treatment of ischemia, cancer cures unimaginable 10 years ago, simple cataract removal, etc x 20) are both costly and desirable. And yes, of course, with third party payment either RVU based or episode based, there is fluff, profiteering, and bias toward treatment.
What is costly and not at all desirable is the gigantic administrative superstructure that has grown and metastasized in the last ten years. The pool of money provided by governments and employers for the care of the sick is now feeding many hungry stomachs that have nothing to do with the sick, but rather serve to optimize the share of that pool going to nonclinical and nonproductive work.
I think it’s important to explain what “waste” is.
People hear that and they don’t think “healthcare professionals being overpaid and over employed to do things of marginal value.”
When my father died it was something like a $400,000 bill. Had they done nothing he would have died all the same on basically the same timeline. In fact it was that high because they ignored his living will and would have spent more if we hadn’t eventually been able to stop them.
Most of that money didn’t go to “admin”. It went into the pockets of doctors and nurses and other professionals. But it didn’t buy my father any additional “health”. If anything it made his end of life much more unpleasant.
I could give lots of other examples, but the reason we can’t cut healthcare down from 18% is because you would need to layoff a bunch of doctors and nurses to make that happen. You could fire every single administrator and you’re still going to need to cut providers if you want to make a meaningful dent in the cost curve.
Healthcare is one of the last source of “good middle class jobs” and our health system mostly is just about coming up with things for people in that jobs program to do.
"The money just flows through a machine that is exquisitely designed to reward everything except simple, affordable, accountable care."
That is true as far as it goes, but some of the rewards (endovascular treatment of ischemia, cancer cures unimaginable 10 years ago, simple cataract removal, etc x 20) are both costly and desirable. And yes, of course, with third party payment either RVU based or episode based, there is fluff, profiteering, and bias toward treatment.
What is costly and not at all desirable is the gigantic administrative superstructure that has grown and metastasized in the last ten years. The pool of money provided by governments and employers for the care of the sick is now feeding many hungry stomachs that have nothing to do with the sick, but rather serve to optimize the share of that pool going to nonclinical and nonproductive work.
Oh totally agree. It’s all admin bloat and waste while there are islands of life changing miracles being deployed.
I think it’s important to explain what “waste” is.
People hear that and they don’t think “healthcare professionals being overpaid and over employed to do things of marginal value.”
When my father died it was something like a $400,000 bill. Had they done nothing he would have died all the same on basically the same timeline. In fact it was that high because they ignored his living will and would have spent more if we hadn’t eventually been able to stop them.
Most of that money didn’t go to “admin”. It went into the pockets of doctors and nurses and other professionals. But it didn’t buy my father any additional “health”. If anything it made his end of life much more unpleasant.
I could give lots of other examples, but the reason we can’t cut healthcare down from 18% is because you would need to layoff a bunch of doctors and nurses to make that happen. You could fire every single administrator and you’re still going to need to cut providers if you want to make a meaningful dent in the cost curve.
Healthcare is one of the last source of “good middle class jobs” and our health system mostly is just about coming up with things for people in that jobs program to do.
Same for “Education”.
We (Med) really need to have hard and unpleasant discussions about end of life resource utilization. It is sheer insanity what we are doing.