IOM: "America's Health System Wasted $750 Billion In A Year"

America's health care system is inefficient, suffers from data overload, is complex and very costly, a report from the Institute of Medicine (IoM) revealed today. The authors added that too many negative factors are undermining health care quality and affecting the USA's global competitiveness and economic stability. Despite all this, there are knowhow and tools in place to correct the deep faults within the country's health system so that costs may be reduced and the quality of care improved.

The authors of the report (the Committee) estimated that $750 billion was wasted nationwide on administration costs, fraud, pointless services, and some other problems. Apart from the economic toll these deficiencies place, they also result in patients having to suffer needlessly. Some studies have indicated that in 2005, about 75,000 deaths could have been averted if each state had delivered healthcare at the quality and efficiency levels of the best performing state.

The Committee said that aiming for just incremental upgrades and alterations carried out by individual hospitals or health care providers will have little impact on improving the nation's overall health care service.

America's health care needs to transform into a "learning system"

The only way the USA's healthcare system can really improve is to transform it into a learningsystem that continuously improves itself by "systematically capturing and broadly disseminating lessons from every care experience and new research discovery."

Health care authorities will need to embrace and implement new technologies that gather and analyze clinical data at the point of care, encouraging patients and their loved ones to become active contributors, and working towards total transparency and teamwork within health care organizations. Financial and other types of incentives which focus on quality and results should be placed into the system.

Committee chair Mark D. Smith, president and CEO, California HealthCare Foundation, Oakland, said:

"The threats to Americans' health and economic security are clear and compelling, and it's time to get all hands on deck. Our health care system lags in its ability to adapt, affordably meet patients' needs, and consistently achieve better outcomes. But we have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning health care system that will provide higher quality and greater value."

More:  ROMNEY AND RYAN CONTINUE RAMPAGING OBAMA WITH MEDICARE

Keeping up with new treatments and breakthroughs

One of the main problems today is that healthcare providers cannot keep up with the rapid pace of new research discoveries and technological breakthroughs.

In an online communiqué, the IoM wrote "How health care organizations approach care delivery and how providers are paid for their services also often lead to inefficiencies and lower effectiveness and may hinder improvement."

The Committee said for a health system to be able to continuously evolve, excellent use of data is vital. In the USA, approximately 75 million people have two or more chronic conditions - for proper treatment and control, good coordination among multiple specialists and therapies is vital. Otherwise, the risk of misdiagnoses, clashing interventions, and dangerous drug interactions grows.

Doctors and patients often do not have useful and relevant data at the point of care where decisions are made. Currently, for new breakthroughs to become widely accepted and adopted can take several years. Only after 13 years did beta blockers become standard practice for heart attack victims.

Embracing mobile technologies and electronic health records would contribute considerably to a competent capture of health data, as well as disseminating that information. They wrote that "The National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable, the report says. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care."

During the last 40 years, health care costs have increased at a higher rate than inflation or the economy as a whole for 31 of them. The main thrust has been volume rather than quality as far as reimbursements are concerned, instead of paying a flat rate or rewarding providers according to patient outcomes, the authors added.

The report urges insurance providers, professional societies, researchers, and health economists to work together to find ways of measuring quality performance and to design new payment models and incentives that reward quality rather than volume.

So far, not many health care organizations, clinics or medical practices encourage patients and their families to become engaged in care decisions and management of their conditions, even though studies and examples abroad have proven that they lead to better outcomes and value for money.

The Committee wrote:

"To facilitate these interactions, health care organizations should embrace new tools to gather and assess patients' perspectives and use the information to improve delivery of care. Health care product developers should create tools that assist people in managing their health and communicating with their providers.

Increased transparency about the costs and outcomes of care also boosts opportunities to learn and improve and should be a hallmark of institutions' organizational cultures, the committee said. Linking providers' performance to patient outcomes and measuring performance against internal and external benchmarks allows organizations to enhance their quality and become better stewards of limited resources, the report says. In addition, managers should ensure that their institutions foster teamwork, staff empowerment, and open communication."

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Is Obamacare A Government Takeover Of Medicine?

The purpose of this blog is to educate non-policy people on the content of the Affordable Care Act, discuss the practical logistics of how the law will be implemented, and share my perspective on potential “good” and “bad” of the law. The law is far from perfect, but it is the most significant attempt our country has ever made at reforming our costly and inefficient health care system. In case you are a reader who thinks the entire law is “bad,”.

More: What will happen to Medicare?

In addition to speaking gigs, I also do “talk radio” about once a month. The questions I’m asked give some indication of where education on the ACA is lacking.  One refrain I’ve heard over and over is that Obamacare is a “government takeover” of medicine. This post explores that concept.

“Government takeover” fears seem to take on several different variations.

• Medicine will be a government run entity – doctors will be employed by the government and care will be paid for by the government.
• All of the doctors will be employed by the government, but insurance companies will still exist.
• The government will dictate what doctors can and cannot do.
• The government will make it so onerous to practice medicine that everyone will quit.
• If the government has one iota of involvement in any form, it is a government takeover.

So what really happens with the Affordable Care Act?  The “government” currently pays about 43% to 46% of all healthcare costs, mainly through Medicare, Medicaid, and the armed services.  When Obamacare is fully implemented, it is expected this amount will increase to 49.2%. It is a clear increase, but nowhere near a 100% government-paid program.  The private sector will still be responsible for over half of healthcare spending.

More: Romney:"Obama has robbed Medicare".

How about practice systems? How will the government control this? Most countries pick one payer/provider system and stick with it. Right now, our country has four health care systems:

• Government provided/government paid – this is the VA Health System, the armed services, and the Indian Health Service.  Doctors in these systems are employees of the government and will stay that way under health care reform. There are many complaints with these institutions, but there are also many satisfied patients. This will not change under health care reform.
• Privately provided/government paid – this is Medicare and Medicaid. Many patients are okay with Medicare and those on Medicaid are glad they have something. Doctors don’t like these programs so much because the pay isn’t great and the Medicare/Medicaid watchdogs notoriously look for a reason to not pay the doctor’s fee. Doctors can refuse to participate in these programs, so it technically isn’t government control.
• Privately provided/privately paid – this is “regular” insurance. Most people are okay with their regular insurance, but aren’t very happy when it costs a lot of money or when the insurance company denies payment for care they received. Insurance companies in the group market (i.e. employer plans) are required by the government to insure everyone, regardless of health.  If not required, insurers would certainly choose to cover only healthy people in order to make more money.   In the individual market, insurance companies in most states are not required to insure sick people.  Under the ACA, this will change.  Insurers will be required to sell insurance to anyone who can pay for it. This requirement would be new government involvement, but comparable to the group insurance market.
• Self-insured – these are the roughly 40 million or so people who either cannot afford coverage, choose to go without coverage, or have pre-existing conditions which make it impossible to get coverage.  The uninsured are at the mercy of a patchwork volunteer system that is inefficient and expensive to run. Some of the current programs to cover the uninsured are funded by the government (taxpayers) and some through charity (benevolent taxpayers), but the majority of the uninsured are left to fend for themselves.  Requiring that people obtain coverage and assisting the low income uninsured in paying for that coverage is part of the Affordable Care Act.  This is greater government involvement – making people take responsibility, and assisting individuals in fulfilling that responsibility.

One of the failures of the ACA is that we took a very expensive and complex health care system, and made it more complex. This is the reason that overhead for our health care system is about 30% of the cost of health care.  Most countries pay only 5% to 10% overhead because of the efficiencies of one system.  Had our legislators attempted that coup, it would have definitely been a government takeover.

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Ryan Slams Obama For Leading America To 'Debt, Doubt and Decline

Making one last stop in his hometown before flying to Tampa for the official nomination to the Republican ticket, vice presidential pick Paul Ryan slammed the current White House for putting the nation down a road of "debt, doubt and decline."

In an interview with Fox News' Bret Baier, Ryan teed up his speech at the Republican National Convention by stressing that the weather-delayed event will nevertheless provide a critical opportunity to draw a "contrast" with President Obama's policies.

"The contrast between the President Obama plan, which has put us (down the road of) debt, doubt and decline, versus Mitt Romney's vision and solutions for a better future, to get us back to prosperity, couldn't be clearer," Ryan said. "And what we want to do is highlight those contrasts."

As Republican officials announced that the abbreviated convention would be going forward as planned, after a one-day delay, Ryan said safety remains the priority and "we'll have to call ... how we see it."

He went on to defend his tax policies, preparing for what will likely be an onslaught of Democratic attacks when the rival party holds its convention next week.

Ryan rejected the conclusion of a Tax Policy Center study, which calculated that Mitt Romney's proposals to reform the tax code would require a tax hike on lower- and middle-income households. Obama has continually cited the study on the campaign trail.

"It's not an accurate study, it's actually not a study of the actual Romney plan," Ryan said. The Tax Policy Center stated in its analysis that they do not score Romney's plan "directly" since "certain components of his plan are not specified in sufficient detail."

Pressed to specify which loopholes he and Romney are seeking to close, the vice presidential candidate declined to elaborate.

"We want to get rid of the corporate welfare, the crony capitalism stuff in the tax code," Ryan said. "But we want Congress to participate in a transparent debate, in front of the public eye, so we can have a really good debate about how best to broaden the tax base and lower tax rates." 

Ryan also made an appeal to supporters of Ron Paul, whom the vice presidential candidate called a "friend of mine." 

"We see eye to eye on a lot of issues and believe in some ... limited government," Ryan told Fox News. "We believe in academic freedom. We believe in the founding principles. We believe that this is a watershed moment for America, whether or not we're going to reclaim the American idea or we're going to become, you know, a cradle-to-the-grave welfare state, which is where I think the president is taking us." 

Ryan addressed the tension with Paul supporters after the Texas congressman held a counter-convention rally in Tampa Sunday attended by thousands. At the rally, Paul accused the GOP establishment of "failing" the country. 

Ryan, though, noted that he and Paul have served together for years in the House and suggested he wasn't anticipating any problems. 

"So I think, in the final analysis, Ron is clearly going to -- he and his supporters should be very comfortable with us," Ryan said. "At the end of the day, it's a choice between the president's failed leadership, the big government that he's offering, the borrowing that he's offering, the spending and the regulating that he's offering, which will give us a stagnant economy, a lost generation, not just a lost decade, and the Mitt Romney-Paul Ryan plan of reclaiming our founding principles, getting back to economic freedom and liberty and reviving this economy." 

Monday's hometown rally for Ryan was an emotional sendoff for the Janesville native, with 2,000 people gathering in his high school gym to celebrate the biggest political event the city has ever experienced.  

"We're fifth-generation Janesville, Wisconsin, natives," a visibly moved Ryan said to the crowd, which featured the atmosphere of a pep rally profoundly colored by hometown pride. "And it's not a unique story. It's the American story. And the reason our family came here and the reason everybody else's family came here is because of what this country stands for. America's not just a piece of geography. It's an idea."

Baier asked Ryan to reflect on the time he almost quit Congress, quoting an interview he gave Stephen Hayes of the Weekly Standard in which he said: "After we got thumped by Pelosi in '06, I was just sitting in my tree stand right after that election thinking about, you know, Why am I in Congress? What am I doing? Is it really serving a purpose?"

"That tree stand is about six miles in that direction," Ryan responded. "I can get into my tree stand within about 20 minutes of leaving my house."

"I decided back then I'm going to do what I think is right, I'm going to move this debate, so we can get this country fixed, so we don't have the kind of European result that we're clearly heading toward," he continued. "And what I'm really pleased to see is that we're finally having that adult conversation we need to have in this country if we want to fix this country's problems and get us back to prosperity and get people back to work."

Ryan told Fox News he thinks about his father, who died when he was 16, every day.  

"It was one of those moments in a life where you basically have to make a decision whether you sink or swim. You know, when something like that happens to you, it's a real punch in the stomach and you have to decide whether you're going to get yourself up, brush yourself off and dive into life. That's the decision I made when I was 16. And it's made me a stronger person as a result of it. And I'd like to think he'd be proud of not just what we're doing here, but of my entire family and -- and what we're doing."

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Details:'How Romney Turned The Tables On Obama In Recent Poll"

TAMPA — The Republican National Convention opens this week with President Obama and presumptive nominee Mitt Romney running evenly, with voters more focused on Obama’s handling of the nation’s flagging economy than on some issues dominating the political debate in recent weeks.

A new Washington Post-ABC News poll shows Romney at 47 percent among registered voters and Obama at 46 percent — barely changed from the deadlocked contest in early July.

The findings continue a months-long pattern, with neither the incumbent nor the challenger able to sustain clear momentum, despite airing hundreds of millions of dollars in television ads — most of them negative — and exchanging some of the harshest early rhetoric seen in a modern presidential campaign.

Romney’s selection of Rep. Paul Ryan (R-Wis.) as his running mate also did not fundamentally reshape the race, although the GOP’s conservative base has grown more enthusiastic about the ticket — but no more so about the chances of beating Obama in November.

Enthusiasm — or a lack thereof — will be on display as Republicans and Democrats hold their conventions over the next two weeks. The two parties will make their pitches to an electorate stuck in a deeply pessimistic mood. More than eight in 10 give the economy negative marks and nearly seven in 10 see the country as seriously off track — an assessment that has not changed significantly all year.

The Post-ABC survey highlights the dominance of the economy as an issue in the 2012 election. Seventy-two percent of voters say the president’s handling of the economy will be a “major factor” in their vote this November.

Fewer voters place great significance on other issues that have roiled the campaign, including newly minted GOP vice presidential candidate’s plan to restructure Medicare, differences between the parties on women’s issues and Romney’s handling of his tax returns.

The proposed Medicare changes included in Ryan’s budget proposal in the House have been a focus of sharp debate since he was picked by Romney two weeks ago, and the specific changes to the health-care program are viewed negatively by about two to one.

Though more focused on the economy, half of all voters still see the Wisconsin congressman’s plan as a big factor in their vote. That’s the same percentage that sees Democratic and Republican differences on women’s issues as playing a major factor. Women’s issues dominated the campaign over the past week because of the controversy that erupted over Missouri Rep. Todd Akin’s comments about “legitimate rape” and the ability of women to “shut down” their bodies in such circumstances.

Just 20 percent see Romney’s handling of his tax returns as very important to their vote. The issue has attracted considerable attention, largely due to efforts by the Obama campaign and other Democrats to force the Republican candidate to release more than the two years of returns he has promised. On the substance of the issue, public opinion nearly matches the horse race: 47 percent of voters say releasing two years of tax information is sufficient, and 47 percent want more
.

Obama continues to get more negative reviews than positive ones for his handling of the economy, and there is tepid confidence that the economy would get back on track in a second Obama term. Majorities have disapproved of how Obama is dealing with issue No. 1 for more than two years, although his numbers have not further deteriorated, despite a string of weak jobs reports leading into the fall campaign season.

Romney now holds a slim, seven-point edge among registered voters when it comes to handling the economy, even as there is also limited faith that things would quickly get better if he was to win. Obama counters with an equivalent advantage over Romney when it comes to who is seen as having a better understanding the financial problems people are facing.

Obama’s campaign has spent freely to portray Romney as a businessman more interested in profits than creating jobs, and one who enriched himself even as his company, Bain Capital, was closing companies and shedding jobs. In the new poll, nearly six in 10 voters say Romney, as president, would do more to help the wealthy than the middle class. For Obama the numbers are basically reversed, with about six in 10 saying he does more to help the middle class.

The president’s advantage in helping the middle class is key and gives him some push-back when it comes to voters’ views on the size of government. By 54 percent to 36 percent, voters are more apt to say that unfairness in the economic system is a bigger problem than government overregulation of the private sector. By a similar split, voters prefer a smaller government to a larger one and overwhelmingly see Obama as favoring a more robust role for Washington.

On 13 issues and attributes tested in the poll, Obama has double-digit leads among voters on three: social issues, women’s issues and being more friendly and likable. On that last attribute, likability, Obama’s lead is a still-dominant 34 percentage points — 61 percent to 27 percent.

In addition to his narrow edge on the economy, Romney has a clear edge when it comes to dealing with the federal budget deficit. On all the others, the two are about even or one is ahead by an insignificant margin.

Another indicator of why the race for the White House remains so close is the public’s judgment of Obama’s overall performance. In this latest poll, his approval rating is 50 percent positive, 46 percent negative among all Americans. Among registered voters, 47 percent saying they approve and 50 percent say they disapprove.

The near-even appraisal continues to put Obama in a tenuous position for reelection — neither strong enough to virtually ensure victory nor low enough to presage a loss.

Obama’s predecessor, George W. Bush also had a 50 percent approval rating at this time in 2004. And it is Bush who provides a boost to Obama now — more than half of all voters see Bush, not Obama, as the one more responsible for the economic challenges the country faces.

The president has other advantages, too. On the choice of whether to create jobs by cutting taxes or enacting more government spending programs, spending holds a 14-point advantage among voters. Even among those who would prefer a smaller government, more than a third say spending is a better way for the government to try to spur job growth, as opposed to tax cuts.

One advantage that Obama held in previous polls — a big lead on enthusiasm — is no longer evident. In the new poll, 48 percent of Obama’s backers say they are “very enthusiastic” about his candidacy, compared with 42 percent of Romney backers who feel that way about the Republican’s campaign — a difference that is not statistically significant. Obama had a 13-point edge in July in this measure; his lead was 25 points in May.

Newfound enthusiasm for Romney probably stems in part from his selection of Ryan as his running mate. Very conservative voters overwhelmingly approve of his pick and are now more likely to be “definite” GOP voters. For the first time, enthusiasm among conservative voters who back Romney rivals that of liberals for Obama.

The latest poll points to demographic divisions that have defined the Obama-vs.-Romney contest all year. Prominent among them are a gender gap, with 49 percent of female voters backing Obama and 43 percent supporting Romney, while men break 51 percent to 42 percent in favor of Romney. White voters break for Romney by 18 percentage points; non-whites go for Obama by better than three to one.

The telephone poll was conducted Wednesday through Saturday among a random national sample of 1,002 adults, including 857 registered voters. The margin of sampling error for both samples is plus or minus four percentage points.

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The Details Of Romney's Bain Documents Unfolded

WASHINGTON (AP) — The release of more than 900 pages of internal Bain Capital investment documents by a media website Thursday offered new details on holdings owned by GOP presidential candidate Mitt Romney's family trusts, including offshore account locations and underlying assets.

The confidential records made public by Gawker.com provided financial statements and investor information on 18 Bain investment funds and three hedge funds in which Romney, his wife, Ann, and his children have invested. Some of the funds listed underlying assets that included loans to companies ranging from health care firms to the Las Vegas Sands, the casino owned by major GOP donor Sheldon Adelson.

Gawker.com said Thursday that the files "shed a great deal of light" on Bain's funds. A spokesman for Bain told media organizations that the release of the data was an "unauthorized disclosure."

The massive trove of Bain materials adds to the public's knowledge of the inner workings of some of the funds that the Romneys own through family trusts. In several of the funds, the family owns more than $1 million each in holdings. But the documents did not provide any new major revelations about either the Romneys' personal holdings or their tax strategies, and left veteran tax and legal experts speculating on the cache's informational value.

One expert on private equity taxation, University of Colorado law professor Victor Fleischer, said Thursday in a blog posting that the records from one entity, Bain Capital Fund VII LP, a Cayman Islands-based offshore account, showed that the fund's managers appear to have converted their fees from ordinary income to future capital gains. Such a maneuver, Fleischer said, would allow the income to be deferred and taken later at a lower 15 percent capital gains rate.

As of 2011, Ann Romney's blind trust held between $100,000 and $1 million of that fund, according to Romney's 2011 presidential financial disclosure statement.

Also Last month, Mitt Romney's campaign got into a dustup with the Washington Post after the newspaper reported that Bain Capital, the private equity firm the GOP presidential candidate founded, invested in several US companies that outsourced jobs to China and India.

Some of the Bain documents also show lists of underlying assets — which Romney did not provide in any of his disclosure statements in 2007, 2011 or 2012. The Bain Capital Fund VII files disclose that the fund invested in such companies as Bombardier Recreational Products, Burger King and Warner Music — all entities that Bain had publicly invested in over recent years.

Another Bain investment fund, Sankaty High Yield Partners II, based in Delaware, held nearly $3 million in loans to Adelson's Las Vegas Sands. Adelson is the largest public donor in this year's presidential race, giving more than $45 million to super political action committees benefiting Romney and other GOP candidates.

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"Taxes And Cuts May Lead To Recession":CBO

Washington --

The Congressional Budget Office said Wednesday that the economic recovery would continue "at a modest pace" for the rest of 2012, but if Congress took no action to stave off tax increases and automatic budget cuts scheduled for Jan. 1, the economy could fall into a recession.

The nonpartisan analysis predicted that economic output would shrink and the jobless rate would rise in the second half of 2013.As it happens that less jobs have been a big concern to the Obama Team in election campaigns.

In its semiannual report, the budget office said that the economy was somewhat weaker than it projected in January. Fears about tax increases and spending cuts are depressing economic growth, it said.

In January, the office predicted that the economy would grow by one-half of 1 percent in 2013. Now it predicts that the economy will contract by one-half of 1 percent, partly due to the "sudden and sizable fiscal tightening" scheduled to occur under current law.

If Congress cannot break the impasse on tax and fiscal policy and if current law remains in place, the office said, the federal deficit will plunge, to $641 billion in the fiscal year 2013 and to $387 billion in 2014.

The budget office said that the economy would be stronger and the deficit would total $1 trillion under "an alternative fiscal scenario" in which most expiring tax provisions are extended indefinitely, automatic spending cuts do not occur, and Medicare payments to doctors are frozen instead of being reduced Jan. 1 as scheduled.

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