Doctormanagedcare.com

Overview of Presentation• Money

• Unsafe/ineffective tests and treatments

• Under-funded important health care needs

• “Doctor Managed Care”

Projected Health Care Costs for 2009 in Context

• Projected health care costs: $2.7 trillion• Projected gross national product: $15.2 trillion• Dept. of Defense budget for 2008: $623 billion• Health care as percent of GNP in 1993: 13.8%• Health care as percent of GNP in 2009: 17.6%• Health care as percent of GNP in 2015: 20%

Unsustainable Cost of U.S. Healthcare

• $321 billion: shortfall in reserves set aside for post-retirement benefits for employees of U.S. corporations

• $1.1 trillion: shortfall in health care services funds promised to employees of federal, state, and local governments

• $32.4 trillion: the 75-year actuarial projection of Medicare debt

Inefficiency in Medical System• $680 billion for administering

medical care in 2009

• $500 billion at least for redundancy and inefficiency

• $83 billion or more for fraud

Comprehensive Health Care Reform

Requirements• Universal medical insurance

• Affordable cost

• High quality medical treatment

What is Quality Care?

• Compassionate

• Timely

• Evidence-based tests and treatments

• Good health care outcomes

Comparisons of Health Care Quality in 13

Developed Countries• Low birth weight percentages—

USA is 13th (last)

• Infant mortality—USA is 13th

• Over all years of potential life lost—USA is 13th

Evidence-based Medicine Principles

• Demand scientific evidence of safety and effectiveness for any medical intervention.

• Evidence of benefit in one clinical situation may not be relevant to another.

• The lack of evidence that a treatment is effective is not equal to evidence that it is ineffective.

RAND Corporation Quality of Care Report (2003)

• The RAND study premise: all guidelines for medical tests and treatments endorsed by a consensus of government and academic medical scientists are evidence-based and valid

• The finding: Americans receive only 55% of tests and treatments required by official guidelines.

RAND Report (cont)• The implication: Instead of $2.7

trillion (17.6% of GNP) spending on healthcare in 2009, Americans should spend $4.7 trillion (29% of GNP).

• Money Driven Medicine challenges RAND’s premise that medical establishment endorsed tests and treatments all benefit patients.

Centralized Determination of Medical Practice Guidelines =

“Money Driven Medicine”

1. Many medical orthodoxy-endorsed tests and treatments are unproven to work or proven not to work

2. Paid for by public and private medical insurance

3. Risky (kill over 75,000 Americans/year)

4. Expensive (cost > $1 trillion in 2009)

Table 1. Consequences of Tests and Treatments That Don’t Work in 2009

Test or Treatment Deaths (minimum estimate) Cost (minimum estimate $billions)

Interventions not following guidelines ? 271Excess cesareans (Chapter 3) ? 17 Excess prematurity (Chapter 3) ? 14Diet books, programs, and productsfor overweight and obesity (Chapter 4) ? 55 Drugs for obesity (Chapter 4) ? 2.3 Surgery for obesity (Chapter 4) 2,500 17 High cholesterol medications (Chapter 5) 15 27 High blood pressure meds (Chapter 6) ? 16 Tight control in type 2 diabetes (Ch 7) ? 23 Coronary artery bypasses (Chapter 9) 12,400 60Angioplasty and stents (Chapter 9) 10,000 73.6Coronary arteriography (Chapter 9) 1,400 53.8Thrombolysis (clot busters) (Chapter 10) 2,100 0.5 Anticoagulants for leg/lung clots (Ch 11 1,000 15.2Warfarin in atrial fibrillation (Chapter 11) 5,400 2.1Warfarin for other things (Chapter 11) 6,000 2.3Heparins (Chapter 11) 12,000 7.8Antidepressant medications (Ch 12) 170 18.4Screening PSA (Chapter 13) ? 3.9

Table 1. Consequences of Tests and Treatments That Don’t Work in 2009 (cont)

• Test or Treatment Deaths (minimum estimate) Cost (minimum estimate in $billions)

• Prostate cancer surgery (Chapter 13) 180 3.9• Radiation for prostate cancer (Chapter 13) ? 2.8• Screening mammograms (Chapter 14) ? 4.7• Arthroscopic surgery (Chapter 15) ? 2.2• Back pain tests / treatments (Chapter 15) ? 50.6• Futile cancer chemo (Chapter 16) 2,000 46• Futile treatments (Chapter 17) • (besides those in Chapter 16) ? 80• Off-label prescribing of drugs (Chapter 18) ? 46• Hormone replacement therapy (Chapter 19) ? 3.5• Routine medical checkups (Chapter 19) ? 13.7• Alzheimer's disease drugs (Chapter 19) ? 1.7• Pap smears - no cervix (Chapter 19) ? 0.2 • The “war on drugs” (Chapter 19) ? 7.8• Antiviral drugs for hepatitis C (Chapter 19) ? 1 • Unnecessary hysterectomies (Chapter 19) 250 12.4 • Diet supplements (Chapter 20) ? 28.8• Unaffordable insurance (Chapter 21) 20,500 77 • Total 75,411 1,061

Under-funded Areas in American’s Dysfunctional Healthcare System

additional billions $ needed in 2009

• Insurance for the uninsured $111• Preventive medicine / health promotion 5• Mental health care 174• Addiction prevention and treatment 6• Long-term care / home care / hospice 458• HIV-AIDS prevention 10• Compensation for victims of medical errors 1,200• Electronic medical records 20• Researching healthy lifestyle approaches 4• Recruit and retain more nurses 2• Patient “Bill of Rights” (CBO estimate) 16• Total 2,006

Total Cost of Fixing Health Care Without Comprehensive Reform

$ Trillions

• Estimated health care costs for 2009: 2.7

• Additional interventions per guidelines: 2.0

• Paying for under-funded health needs: 2.0 Total 6.7

$6.7 Trillion = 44% of GNP in 2009

Health Care Reform Conundrum

1. Incremental fixes won’t work2. Comprehensive restructuring of our

medical care system is required. 3. Any comprehensive health care

reform plan must address tests and treatments that don’t work.

4. Reform must also increase funding for many under-funded medical interventions

The system is the problem; not the people in the system.

Altruistic, dedicated, and talentedhealth care professionals exist in

all areas related to healing thebody, mind, and spirit. With few exceptions, medical and allied

professionals want to improve the health of people.

Doctor Managed Care• Primary care physicians (PCPs) would become

the managers of health care resources. • Each U.S. resident would choose his / her own

PCP (Medical Doctor, Doctor of Osteopathy, nurse practitioner, physician’s assistant).

• PCPs would have the authority to authorize insurance payment for any health care services

• For desired services not PCP authorized 1. Pay out of pocket

2. Appeal to an oversight committee

3. Change PCP

Doctor Managed Care (2)• Specialists would compete for referrals

from PCPs

• Market forces would determine fair and just compensation

• PCPs would have to authorize payment of pharmacy charges, tests, treatments, hospitalizations, and specialist bills.

• PCPs would compete by funding beneficial services and not tests and treatments that don’t work.

Doctor Managed Care (3)• Each PCP would receive a capitated fee

for each patient to cover all health care services.

• Health services payments would be adjusted for each patient’s age, sex, medical diagnoses, and cost of sickness care in recent years.

• For the average PCP: 1,000 patients x $7,100 per patient = $7.1 million in 2009

Funding Doctor Managed Care• Employer Mandate—Bad Medicine, abandon it• Federal Government funded but not government

run• Possible replacement funding sources for

approximately $1 trillion private insurance in 2009, mostly employment-based 1. Income taxes2. Sales taxes3. Payroll taxes (e.g., as for Medicare), 4. Targeted health care fees:

• Tobacco• Alcohol• Guns• Junk food• Violent media• Fossil fuel

Health Freedom• Honoring consumers’ rights to make their own

personal health care choices 1. Insurance without health care mandates from

centralized guidelines2. Choose health care plan by choosing the PCP3. Faith-based insurance4. Alternative care emphasis insurance5. Health promotion approach insurance

• Balanced with the need to protect the public from truly potentially harmful interventions

• People need real choices—not HMO A versus HMO B versus PPO X…………

Preventive Medicine• $1.6 trillion in 2009 will go for treatment of

chronic diseases that could be prevented• Interventions to reduce lifestyle-related diseases

will cost insurance companies < $10 billion. • The food industry pays about $36 billion per year

to advertise and market its saturated fat and cholesterol-laden food.

• Doctor Managed Care would give PCPs and patients the incentives to fund health promotion.

Doctor Managed Care Summary

• Government funded—doctor managed

• Market oriented—healthy competition

• More health freedom (choose your PCP)

• Revenue neutral ($2.7 trillion in 2009)

• Reduces funds for ineffective interventions

• Increases funds for preventive medicine, long term care and other neglected priorities

Next Steps• Replies/rebuttals from consumers,

medical experts, politicians, health care policymakers

• A second edition that incorporates criticisms and suggestions from diverse health care stakeholders

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