30% of all healthcare spending is waste...$750B a year..more than the military budget

[True Earthling]

and more than the nation's K-12 education budget...

The biggest chunk of waste is from unnecessary medical tests, procedures, drugs etc...

Overkill
An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

Could pointless medical care really be that widespread? Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation. But was McAllen an anomaly or did it represent an emerging norm? In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year, which was more than our nation’s entire budget for K-12 education. The report found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. Bigger than any of those, however, was the amount spent on unnecessary health-care services. Now a far more detailed study confirmed that such waste was pervasive.

Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year. Researchers have come to refer to financial as well as physical “toxicities” of inappropriate care—including reduced spending on food, clothing, education, and shelter. Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.

Overtesting has also created a new, unanticipated problem: overdiagnosis. This isn’t misdiagnosis—the erroneous diagnosis of a disease. This is the correct diagnosis of a disease that is never going to bother you in your lifetime. We’ve long assumed that if we screen a healthy population for diseases like cancer or coronary-artery disease, and catch those diseases early, we’ll be able to treat them before they get dangerously advanced, and save lives in large numbers. But it hasn’t turned out that way. For instance, cancer screening with mammography, ultrasound, and blood testing has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. We’re treating hundreds of thousands more people each year for these diseases than we ever have. Yet only a tiny reduction in death, if any, has resulted.

[scscholar]

1. Like the doctors that give antibiotics...

for sore throats without a test! They need to be put in prison. They're making everything worse for all of us by deciding to increase bacterial resistance. I guess it's good for business is why they keep doing it.

[angstlessk]

2. I went to the emergency room when I broke my collar bone

Had I known there is nothing that can be done...I have scarves at home, and aspirin..

BUT they gave me an xray of my shoulder....FINE

But also, they gave me a chest xray and a cat scan!!!!

Final bill $3,000

I asked why the cat scan, and they said in case you hit your head when you fell!!!! I never hit my head, never said I hit my head..it was a hospital bill enhancer!

[moondust]

3. You call it waste.

Venture capitalist Rick Scott's Columbia/HCA calls it a business plan.

[basselope]

4. Slow down there a little bit.

There is a lot that is true and a lot that STILL NEEDS TIME.

Yes, doctors go to antibiotics far too quickly, which causes all types of problems... but many of the scans and tests that do nothing beneficial are often to be extra cautious.

My wife was diagnosed with Hodgkin's Lymphoma in November. Caught VERY early (stage 1A). Why? Because even though her blood test was absolutely clear, our doctor decided to order a fine needle aspiration test on a swollen lymph node in her neck, that he strongly suspected would show nothing. But, it came back "inconclusive". Doctor still suspected it was nothing (because the blood tests were so clean and she had 0 secondary symptoms), BUT he recommended a biopsy to be safe (which was a full surgical procedure). The surgeon said he was 90% sure it was nothing. Well, as you can guess, it wasn't nothing.

Before starting Chemo she had to take several tests.. even the doctor said they were "probably unnecessary, but better to be safe than sorry".. this included a bone marrow biopsy. Given her stage it was incredibly unlikely the disease had made it into the bone marrow, but on the off chance it had, she suggested the test. Luckily, it was negative.

After 2 rounds of ABVD chemo she got a clean CT scan last week. Just finished 1, hopefully, final round of ABVD and they have scheduled another scan. Probably unnecessary since the last one just 2 weeks ago was negative, but they want to be sure before officially stopping treatment.

Now, if her inflamed lymph node had turned out to be what the doctor original expected, just a leftover gift from a bad cold she had a couple of months before... she would be a statistic in the "unnecessary test". The bone marrow biopsy turned out to be unnecessary as the doctor suspected... this next scan is probably unnecessary. But, there is a world in which you are far better to be safe than sorry!

My other issue is that we wouldn't necessarily be seeing major results from just 25 years of better scanning (and it is actually far less than that, as the more advanced scans and tests have only come out in past 5-10 years). These are results we can't measure for decades.

So yes, is there room for improvement? For sure. But, when I hear this stuff I think of Trump saying "waste, fraud and abuse" as his solution for everything.

I've known personally too many cases of doctors being too dismissive of patients and having the worst happen to start looking for ways to force them to cut back on (I believe) they believe is helpful treatments. Better education.. better testing methods, yes. However, as my wife has gone through her chemo she met someone whose mother died after her 5th ABVD treatment, because she developed a cough (which is a common side effect from one of the drugs). The doctor didn't want to prescribe an antibiotic. After the weekend the cough got worse and she went back in and unfortunately, it was now pneumonia and had gone sepsis. She was dead within 12 hours. Had the doctor given her the antibiotic on Friday, she likely would be alive today.

So, yes, there is an issue here, but lets be VERY CAREFUL in how we approach it, because people's lives are literally at stake.

[Recursion]

5. Put doctors on salaries. But then the problem reverses

and doctors have an incentive to do as few treatments as possible.

Or pay by outcomes. But then doctors are incentivized to seek out only rich healthy patients (this is the same problem as teacher incentives based on test scores).

Specifically, I want to point out, single payer does not solve this problem; if anything it makes it worse because any attempt to reduce provider reimbursements gets attacked as "cutting Medicare".

[basselope]

13. Doesn't that depend on why they became doctors?

I had a friend in Australia, where they have that split system.

While we were in the middle of the Obamacare debate, he spoke up to a group of people who were against it and despite the fact that he was what Australia would consider a right wing nut, he shut everyone up really quick.


"Do you know where you go when you're sick? The public clinics, because they are the people who are actually interested in making you feel better, the private people are just gonna run as many tests as possible to get your money".

So.. if you have a doctor who became a doctor for the financial reward alone, then yes, salary doesn't work. However, if they actually want to help people.. it doesn't matter how they get paid. They will do their job because they want to make people better.

[Recursion]

15. That same argument applies right now

So.. if you have a doctor who became a doctor for the financial reward alone, then yes, salary doesn't work. However, if they actually want to help people.. it doesn't matter how they get paid.

Well, true. But you could say that about today: doctors who are interested in helping people aren't going to order unnecessary procedures. But clearly a lot of them are.

[basselope]

16. You'd have to read my post from earlier...

I think this problem is being a bit over exaggerated, in much the same way Trump uses the phrase "waste, abuse and fraud".

Yes, some doctors order unnecessary procedures, but I think some do it to be cautious. It is better to run a scan and have it come back negative than not and later find out you could have caught something early.

The biggest problem with the current system is the middle person.. the doctor can order all he/she wants, but it has to be "approved" by an insurance company before it is done.

[HuckleB]

6. This has been known for years.

The private insurance bureaucracy has led to so much pointless nonsense. This article is missing a big part of the picture.

[Recursion]

7. Nope, you can't blame this one on insurance. It's even worse with Medicare.

This is providers, which is where we should have focused in 2010 rather than financing.

[HuckleB]

8. Yes, I can.

The bureaucracy waste has been documented for decades, and we just let it grow. This article missed that massive part of the story.

[Recursion]

9. Well, sure, you can, if you don't mind ignoring the actual problem

Medicare has a higher unnecessary procedure rate than private insurance (this is one of the good sides of the profit motive everybody hates). The down side of that lower rate with private insurance is there are also more false negatives (people denied care they legitimately need).

[HuckleB]

10. That doesn't change the reality of private health care bureaucracy.

And it likely has more to do with age and ability of patients to communicate, than anything else.

How do you fail to see that?

[Recursion]

11. Because you aren't actually saying anything. There's nothing to "see"

Both private and public insurance have cumbersome bureaucracy; for that matter the coding system the private insurers use was invented by Medicare.

[HuckleB]

12. You keep pretending.

I'm left wondering why you are so defensive on an issue that has been shown to a cost concern for decades.

Have a good night.

[Recursion]

14. It's not. Private insurance overhead is about 2% of health care spending

Sure, it's irritating, but it's ludicrous for you to pretend that's the problem. I have no idea why you're so defensive about that.

[hedda_foil]

17. That's absolutely untrue. Overhead was 30% of insurance cost before Obamacare brought it to ~20%

Doesn't anyone else remember this? It wasn't that long ago.

[Recursion]

18. And?

It's between 2% and 4% of national healthcare spending (depending on how you count it), which is what I said, and what you completely ignored because it doesn't match the narrative.

Getting rid of private insurance overhead completely doesn't make health care any more affordable.