Sunday, May 10, 2015

Obamacare is woking

That's what Atul Gawande thinks. His most recent article in The New Yorker discusses how it is lowering the incidences of excessive services, which are a major factor in our having the highest medical costs in the world.  Some examples: doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). 

"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." 

Each year do we really need to have  around fifteen million nuclear medicine scans, a hundred million CT and MRI scans, and almost ten billion laboratory tests.

Gawande recognizes that simply eliminating unnecessary care is not enough. We need replace it with necessary care. 

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