John

I think you have illustrated the basic problem in the healthcare reform process. Is this the classic example of “not thinking outside the box”? It is discouraging that so many of the presumably brightest thinkers have so little regard for (or ignorance of) the free market system. Thanks for the update.

The data is from McGlynn’s study published in 2003. Incidentally, the stats are the identical in the UK (Asch, same RAND group. Asch SM et al. (RAND) Who Is at Greatest Risk for Receiving Poor-Quality Health Care? NEJM. 2006;354 (11):1147-1156). It is not that the pateints don’t get care, all these studies loooked at were reommended processes. The problem is compliance: those who really needed care got it (senile cataracts e.g., ~87% done) or if even seen on any routine basis (~70% compliance). So most of the “poor processes” problem is compliance complicated by many other factors, most of which are probably soiceconomic and cultural status in origin.

Thanks for all your efforts

In my MBA thesis I suggested that in order to be a fully competitive situation we MUST include the International market in health care. We in the US are to insular in our view of the world market. Competition means GLOBAL competition and we MUST apply this to Health Care; after all we spend nearly 20% of our GDP on this one item. We must bring to the consumer the global market in Health Care, we must ensure that our legislators open our options to fully embrace the global market, including the right to spend our health care dollars where ever we find value, obtaining our drugs abroad, our health care oversees with the sanction of our co partners (health insurance companies, the US government etc.) Here the Europeans have us beat, they already sanction such practices. It is time the US learned from others in this regard, realize that many of the best independent health care facilities world wide are staffed by US trained Health Care professionals, we deserve to reap the benefit of encouraging world class training facilities being in our boarders and should be able to seek care from such professionals. On the subject of prescription drugs we, the consumer should be allowed to spend our money where we get the most value for it. Let the suppliers work out how they should price their products to show a profit, but we the US consumer who for so long has paid a disproportionate share of drug development costs should have the RIGHT to buy the products we have supported the development costs of in any market we choose to purchase from. We MUST insist on value for our money and not the arbitrary prices being set by the suppliers in our inefficient market. If we are to buy the products of other countries that are completing with our domestic producers then the same argument holds for goods and services in the reverse direction. Let the competition begin and let it be unbounded.

We insist on open markets and fair competition let us apply this to Health Care, our largest single expense and see how the market corrects for the creation of a level playing field!. It is my contention that our costs will really go down and our quality will really go up!

What do you mean by this? Do you mean $350 in today’s dollars? Or $350 million as $50 million increased over the timespan at the rate medical costs are increasing? If it is the latter, why is that a relevant way to measure the cost of the study?