Sunday, August 02, 2009

Health Care: 80% or eighty percent?

In the midst of all the words about health care reform, you have probably heard a survey quoted that says that "80% of Americans are satisfied with the quality of health care coverage they are receiving." That tidbit of information has been used by literally thousands of opponents of health care reform to bolster their position that reform is not needed, despite the fact that we all know such a position is absurd. In fact, in that same survey, when asked how they felt about the overall cost of health care more than three out of four said it was too high and they were dissatisfied with that part of the health care system. So 80% are satisfied but more than three-quarters are unsatisfied. All of this numerical sound and fury comes from a CNN telephone poll conducted March 11th-15th, before the health care reform legislation even hit congress, a total of 1,019 adults were surveyed.

Now we all know deep in our coronary chambers and right on surface of our cerebellum that surveys and statistics are generally abused and misused by media pundits and other talking heads to bolster there political positions, even when the numbers really don't say what they say they say. Right? So, here are a couple of observations of this virtual 80% of all Americans.

-Did you know that nearly 46 million Americans or 18% of the population under 65 had no health care coverage in 2007, the latest census data available.
-The largest increase in uninsured since 2007 has been in working age adults, who have lost their jobs and their health insurance benefits.

One has to wonder if 18% of the population under 65 has no health insurance, how can 80% of the population be satisfied with their coverage? Perhaps a disproportionate number of those over 65 are home to answer phone surveys. The 18% are out looking for a job. Also notice that the survey only takes answers from adults and does not consider if their lack of or loss of coverage effects any children.

Here are few more statistical "facts" that might inform the health care debate:

-80% of those with health insurance of some kind do not use the health care system in any given year. Might we not assume that many of those "satisfied" with their coverage are simply happy to have any coverage at all and have not actually interacted with the health care system?
-of those who use the health care system, most adults between the ages of 21-45, only see their physician for an annual check-up or a prescription renewal visit.
-"annual" doctor visits for check-ups on average happen about every 21 months.

We have to assume then that of those surveyed to come up with the "80% satisfied" statistic, easily more than half did not use the health care system at all in the past year and those that did may have seen their doctor for less than 7.2 minutes (the average doctor-patient interface in another survey). When was the last time seven minutes was actually satisfying to you?

Finally, some hard facts and other questions about where our health care dollars actually go.

-80% of health expenses go to senior citizens and the chronically ill, which probably means those are the people we should be asking about the quality of health care. Care to guess how "satisfied" they are?
-wouldn't we get more useful survey results if we asked these questions of people leaving a doctor's office or a hospital or better yet survey patients in the hospital?
-no one wants to talk about the huge expense of "end of life" health care. Yet medical professionals who deal with the costs of the system know full well that we spend a huge proportion of medical costs on ineffective treatment in order to show compassion. End of life health care often causes such severe side effects that the treatment diminishes rather than enhances quality of life.

I leave you with no answers but a quote from a physician friend of mine on the issue of end of life health care expenditures:

"Family rather than the patient are often those who demand we 'do everything' for a terminal patient. They want their loved one around as long as possible. Yet our interventions at most extend the life of perhaps one in every twenty patients and very often, too often, that extra time is spent in a fog of confusion and even pain because of the side effects of our medical interventions. We waste money sure, but more importantly we destroy the quality of our patients final days."

1 comment:

Anonymous said...

I'm calling BS on the terminal patients being the big number item.

My recent, minor, shoulder arthroscopic procedure had a primary bill of $11k. They accepted the $1170.00 from the insurance company (Blue Cross/Blue Shield),and I owed $0.

Some questions:

A) Is the high cost of health care that is talked about the billed-high-cost or an actual-cost? -or is it just the high cost of insurance (ah-HA!?). If it's the high cost of insurance then maybe the insurance companies are taking too fat a slice? (Yeah, hard to believe - I mean look at what the people high up in corporate America have been doing the past couple years). If it's the billed-high-cost, well then that's been a bogus number from the get-go, and it's time to grow up and talk apples and apples.

B) And, by the way, where did they get that 11k number in the first place? Procedure did not take that long, and you had two docs involved, 2 nurses in surgery, and 1-2 nurses taking care of multiple patients post. -The fact that they would take so much less tells you a lot. That health care doesn't have to be expensive, and people should stop getting all amped up because we finally have a president willing to who wants to put an end to the BS.

Rant over.