She knew it ages ago. An ounce of prevention is worth a pound of cure. Health care providers and policy wonks are belatedly rediscovering it.
The best way to rein in runaway health care spending is to prevent chronic illness. That’s where we spend 80% of our money so it’s the only target for real cost control. Managing chronic illness can save us billions but preventing it is far better – for individuals, families and for our wallets.
But Bush isn’t listening to Grandma or anyone else with half a brain. He proposes to veto funding for the Women, Infant and Children (WIC) supplemental nutritional program. WIC is one of the most effective federal programs on the book in preventing and avoiding illness. It’s a proven life and money saver. What better program to put on the chopping block?
Let’s assume for a minute that Bush doesn’t care about the health and welfare of infants and mothers – even though that would be immoral. If he’s trying to save money he should increase WIC not cut it. Investing in nutrition and health saves money.
But Bush isn’t the only one who could rethink the nutrition/prevention issue. Massachusetts is renowned for its creative and aggressive use of federally funded health care programs, so much so that Bush targeted it for Medicaid cuts. But someone forgot about Food Stamps. Even though we had over 200,000 families in hunger in 2006, we rank 49th nationally in Food Stamp participation. Less than half of the people eligible for Food Stamps get them.
Everyone’s looking for ways to cut Massachusetts health care costs. A Patrick Administration initiative to help lower income families buy more healthy food might help do the trick. Its a first step toward lowering obesity rates, preventing chronic illness and cutting health care spending.
If Bush really doesn’t care about kids and moms maybe he’ll consider doing it for Grandma.
Barbara Waters Roop, PhD, JD
Health Care for Massachusetts
contact@healthcareformass.org
And in giving you this code search world please research the topic with an open mind. Don’t take it at it’s false face value of “assuring” food quality standards. Take it as assuring food control standards and assuring profits for Monsanto’s GM nutrient deficient foods. Hey, big pharma will then be able to sell you the magic bullet cure knowing the entire disease was created by food not containing essential ingredients.
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p>How is this the purview of the federal government? No seriously, why should the federal government be involved in this? It makes no sense to send money to Washington and then have it come back after the Washington bureaucracy take it’s vig before sending back the money.
And it is the American government? Just guessing.
Pelosi proposes $5.6 billion
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p>Bush proposes $5.4 billion
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p>Ergo, Bush doesn’t care about babies and mothers?
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p>I think a good case can be made for WIC, but the bigger upside is perhaps less in simply 4% more funding and more in examing the link of WIC and breast-feeding.
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For your assertion that “we spend 80% of our money on Chronic illness”?
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p>You mean like, Cancer? And Heart Disease?
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p>How many trillions of health care dollars will it take to make people eat right, and stop smoking?
The distribution of spending by population comes from the Medical Expenditure Panel Survey. It is an annual survey going bach to 1996 of families and individuals, providers and employers designed to track how often Americans access the health care system, what health services they use, who pays and how much. Needless to say it is a treasure trove of information. A playground for all health care policy wonks.
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p>For a reference to the 80% of spending for 20% of the population take a look at the MEPS data brief for an overview
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p>Wonks frequently talk about this “20% rule”. What is less well known is that 1% of the population accounts for nearly 50% of spending.
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p>And its not just old farts. You have to reach down into folks in their lower 40’s before you’d get to 80% of spending.
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p>The top five chronic conditions – mood disorders, diabetes, heart disease, asthma and hypertension accounted for nearly half of spending in 1996. Since then there has been an obesity driven epidemic of diabetes which in turn causes a variety of other chronic conditions including heart disease, hypertension, high cholesterol and on and on and on.
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p>It wouldn’t take trillions of dollars to help people prevent and manage many of these conditions. Massachusetts’ anti-smoking campaigns have been very successful in reducing the number of smokers and lowering the death and disability rates from smoking related diseases.
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p>Obesity is a tough one. But public education around the importance of a healthy diet, help in buying healthier foods (which are more expensive than a Happy Meal), and restructuring the payment system to reimburse primary care providers for helping their patients prevent and manage chronic illness are the key steps.
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p>Will a few ads and some Food Stamps mean the end of XXL sweatshirts? Of course not. People still smoke today after decades of ads and smoking bans in most public places. But information and some financial help gives people a chance to help themselves. Today hundreds of thousands of people in Massachusetts couldn’t eat a healthy diet if they wanted. Millions more don’t really know why they should.
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p>The Millken Foundation recently did a report on the cost of failing to take on the challenge of chronic illness. They project we could save 25% of what we will spend on chronic care in 2023 if we adopt modest prevention and care reforms now.
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p>A truly wonky study by the Dartmouth Atlas found that Medicare could save 30% through the better management of patients with chronic illnesses.
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p>Prevention is by far the best and cheapest way to go. But doing chronic care better is the next best thing. No one is suggesting that the way to “manage” chronic illness is to stop treating it. We do, however, need to stop dealing with chronic illness as though it were a series of acute illnesses. That is the costliest way and the most destructive to individuals and their families.
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p>Thank you for making me look up the cite. It’s something I have taken for granted for so long that it took me a while to find it.
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p>Sorry.
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p>BWR
Gotta go see if I can find it.
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p>Thrust of the article is that they focussed on a Boston MD who is heading to the southwest. Cheaper and more amenable to physicians. There are a few gives and takes but the balance tipped to Texas.
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p>The point of the post is not that however. The point is that the Globe article pointed out that there are over 150 counties in Texas, that are devoid of ANY—Zero–Zilch, OB/GYN, orthopedits, anaesthesiologists, specialty surgeons etc. As I have stated previously —you can mandate all the healthcare you want. There aren’t practioners to provide the service. What is it that you don’t get? We must have well mother clinics etc. Great—who’s gonna provide the service. You are putting the cart before the horse. To exacerbate the matter—you will find few if any WELL Qualified practitioners who have any desire to practice in this climate of increasing workload and diminishing re imbursement. It just isn’t worth it. Think you have a problem now with impaired physicians?
…And BMW isn’t selling cars in Alabama after a US$4million judgement for a bad paint job rendered by a jury there? And McDonalds stopped selling product in New Mexico after the coffee case?
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p>One OB-GYN practitioner hitched up his Conestoga wagon and headed to a Texas that is largely devoid of practitioners. And we’re supposed to consider that a threat to health care in MA?
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p>Don’t be silly.
at a YR national board meeting. I heard Governor Perry speak, and he spoke about just this thing. By capping malpractice, Texas has enticed doctors to go there from here. Doctors can actually make money now instead of seeing it all go towards malpractice insurance. It is a brilliant case of federalism at work. Where states compete against each other.
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p>Governor Perry was quick to point out that this was an access problem as much as a malpractice problem. Because of Texas’ high malpractice rates doctors did not want to practice medicine there. That meant that large swaths of the state for hundreds of miles went without specialists, or in one case even an ob/gyn. That has changed as a result of this law. The Texas model should be studied.
or, fair enough, sell it to me. For how much would I have to pay you to surgically remove your left hand at the wrist and sell it to me? A million? Ten million? Fifty million?
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p>If you wouldn’t sell it to me for that amount of cash, why is it fair for a doctor to make an avoidable, egregious mistake resulting in you losing your left hand and not be reimbursed that much?
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p>If you bring your car to a mechanic and he ruins the engine, the courts will award you the full value of the engine. The MFA doesn’t limit the insurance on it’s artwork to the value or $1,000,000, whichever is less.
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p>Why should body parts — which are far more important to their owners than cars or paintings — not be insured for their full value? Limiting malpractice settlements restricts the owner from getting full value for the damages.
By analogy you must really hate the Municipal Tort Immunity Acts that have passed throughout most of the States, or the Federal Tort Claims Act that provides a limited waiver of the federal government’s sovereign immunity when its employees are negligent within the scope of their employment.
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p>It isn’t any different–and also a matter of public policy–to limit a physician’s liability if on balance the limit on malpractice settlements results in cheaper or more physicians practicing in a particular field.
if my town is negligent about keeping sidewalks reasonably safe and a person falls as a direct result, I’m not sure that limiting liability to $5,000 is fair.
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p>The public policy slant is a fair one, but it seems to me that a public policy that exacerbates harm to those already harmed to benefit the many who weren’t harmed is puzzling. Then again, I wonder if our shortage of qualified doctors isn’t a result of medical school growth not keeping pace with demand and our shortage of qualified nurses isn’t the combination of insufficient pay and lousy working conditions.
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p>How many 21 year olds are deciding not to apply to medical schools due to the high cost of insurance once they become doctors? How many kids in med school are dropping out? How many doctors are simply retiring and moving on to some non-health care related field? From this non-med-knowledgeable person’s perspective, med schools are still competitive, and they’re still churning out doctors at a steady rate.
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p>And since I can see about a half dozen medical centers from my living room window, it’s not obvious to me that there’s a real shortage of health care professionals in my neighborhood. The again, I don’t live in rural Texas, nor do I plan to anytime soon.
it’s not obvious to me that there’s a real shortage of health care professionals in my neighborhood.
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p>…what people like EaGo and others what to persuade you with is the outfloow of people who have been trained in institutions in MA. What they want you to overlook is the inflow of persons who have come into MA for the purpose of being trained, but who intended to return to their previous residence (or elsewhere).
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p>I suppose it might be interesting to see would happen if every trained in MA institutions were to remain in MA, but that is not going to happen. Otherwise, it’s likely that every third person in the state would be a physician or nurse.
There have been numerous articles about doctors leaving Massachusetts due to the high liability costs of practicing here. These are established doctors not people who just finished their residency. One of the largest costs of healthcare in Massachusetts is malpractice.
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p>In fact the Massachusetts Medical Society commissioned a poll to gauge the public’s opinion on this.
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p>Here is a story from the Fall River newspaper:
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p>Got a source for that stat? There are a lot of costs in healthcare — prescription drugs, medical equipment, salaries, training, buildings, energy, administrators, billing, research, and even advertising.
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p>You’re claiming that malpractice costs exceeds a bunch of those other costs? I’m skeptical.
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p>Maybe this is a good thing. Maybe it isn’t. My worry (a valid one, with a Republican sponsored law (Hello? Texas!!)) is that nobody bothered to ask why, in the first place, malpractice awards are (were?) so high? If the goal is to shield insurers and doctors from the high cost of bad doctors, well, it seems a success, no?
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p>From earlier:
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p>I think this is a good start. But I’ve been told, both by doctors and service providers that the unacknowledged (read: unstudied and non-quantified) elephant in the room is chronic mis-diagnoses,lapses and out-and-out mistakes on the part of doctors (much more so than nurses…) mostly because they are well past overwhelmed 24×8. The current state of malpractice damages would, I think, be corroborative of this view. You’d think that this is something that the insurers would want to know about and perhaps get a handle on… And certainly, you’d think that legislatures would want to know why malpractice damages are such an issue. But that doesn’t seem to be the case.
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p>I don’t know if doctors mistakes are really a problem, (though, as I’ve stated, I’ve been told so by people I consider trustworthy) but it seems to both make sense and to give a sense of the opacity currently seen in the healthcare system. This opacity, for me at least, is exhibit A for the creation of a single payer system.
Are notoriously generous, and hand out whopping awards at a rate that is high compared with courts around the country. In our own Worcester County, juries are among the stingiest.
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p>If you watch stories on gigantic jury awards, watch how many of them originate from Beaumont, Texas.
… in true American choler, let’s let the outliers define the response and to hell with the middle of the curve…
in Texas? So what, exactly is the problem with Texas identifying a problem and providing a remedy?
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p>I’ve identified death as a remedy for all that ails you… what’s the problem with that?
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p>All seriousness aside, I was ‘grumbling’ about the methodology used to determine if caps were A) ‘a problem’ and 2)’a remedy’. If the problem is out of control juries, then this is a remedy. If the problem is out of control doctors, then this is piling on…
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p>…I don’t know the statistics about Beaumont TX, but the WSJ reported about 10-20 years ago that juries in the South were particularly generous towards tort plaintiffs, particularly if the tort defendants were furiners–like BMW–or out of staters–like insurance companies, most of which are headquartered in the North (actually, with re-insurance, it’s difficult to determine where they are located).
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p>Now the chickens are coming home to roost. Insurance companies don’t want to write insurance policies in Gulf states that are increasingly being subject to huge storms So, to preserve property values down there, the states are issuing storm insurance. Welfare for the wealthy, since storm insurance is a requisite for getting a mortgage, and that helps “preserve” property values..
No surprise
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p>Caps on malpractice awards limit access to courts for major malpractice injuries. Not for minor ones. The reason is simple. Caps on malpractice awards generally limit, not direct damages, but the damages attributed to what is jokingly referred to as “pain & suffering.” It is the P&S damages that go to pay, not only the lawyers, but also the expert witnesses that are to help (a) not only determine whether a malpractice case exists, but (b) also prove the malpractice case.at trial. Those issues are particularly crucial, especially in a complex case.
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p>By limiting P&S awards, you and your buddy Perry are effectively closing the courthouse door to persons who have been subject to major malpractice injuries. I’m sure that you’re happy about that.
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p>On a related, but slightly off-topic matter: Suckers Wanted: How Car Dealers and Other Businesses are Taking Away Your Right to Sue
The English Rule.
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p>No need for caps, or tort reform. I don’t understand why it isn’t tried.
But what’s the English Rule?
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p>BWR
I thought I had made the word a link to the description of the English Rule. gary describes the concept correctly.
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p>My thinking is this: A good deal of malpractice defense (and, in my experience, the most frustrating for the medical people) are the cases where they feel unjustly accused, but it is expensive to litigate. The incentives therefore skew in favor of settlement, even before the plaintiff side is forced to hire all of those expensive experts.
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p>If the plaintiff’s lawyer pays the expenses if the plaintiff loses, then there is an effective method of filtering out much of the junk in the system: the plaintiff’s lawyer’s desire to pay his own rent.
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p>While not a complete solution to the gigantic verdict problem, the rule, applied to cases in which certain types of tort claims are made, would be an elegant means of reducing the junk inthe system.
…in the UK as well as much of the civilized world there is universal health care coverage, of some form or another and of some payment mechanism or other that is affordable. So there is little or no need for malpractice insurance since those who have been “malpracticed upon” will get at least some ameliative care.
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p>Unlike the US.