Krugman concedes main objection: In fact, more care needn’t cost more…
Posted by steven_spear | Under Business Strategy, health care, high velocity organizations, process excellence Friday Jan 30, 2009Paul Krugman (“Health Care Now,” NY Times, January 29, 2009) wrongly concedes the main argument against expanded health care coverage: That it will put a financial burden on the economy. Aside from the easy rebuttal that an overly sick populace is a drain on society, there is the more succinct point: We can provide much better care to many more people than we currently do at less cost and with less strain on providers. This assertion is not hypothetical but based on concrete evidence across the spectrum of preventative, primary, chronic, acute, urgent, and extended care. Â
In Pittsburgh, hospitals cut the rate of central line infections by 70+%, saving lives and cutting the attendant costs of treating avoidable infections that run up to $70,000 per case. The VA eliminated surgical site infections, other hospitals ended patient falls–a huge source of injury and cost.  Patient safety campaigns by the Institute for Healthcare Improvement have avoided in excess of 100,000 deaths due to mismanaged care and countless injuries, and primary care practices have increased their capacity with no additional spending. The number of exemplary organizations is growing: the Pittsburgh pioneers, Virginia Mason Medical Center in Seattle, Cleveland Clinic, ThedaCare in Wisconsin, Mayo, Beth Israel Deaconess in Boston, Ascension Healthcare, and others. Were their efforts to occur on a national basis, the savings would be in the tens if not hundreds of billions of dollars. The impact on decreased suffering and increased well-being would be immeasurable.
The argument that providing greater health care access will cost more is based on the unfounded assumption that care is delivered with such efficiency and efficacy that to get more we have to pay more. This is false. Providers are typically managed in such antiquated fashions that much human effort and financial resources are wasted, and great harm is done to patients.
Professor Krugman is right about the frayed social safety net. The good news is that this is one problem that shouldn’t cost money to fix. Better care for more people with less effort, cost, and risk is possible.Â
Related posts:
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- Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All
- Spend more to get more? Not necessarily in health care
- Provider Competition Key to Health Care Reform
- Measuring Value-Added, not Compliance, Key to Health Care Reform
Very true. There is a a very simple and obvious explanation that outcomes can be improved by spending less money in health care. The USA currently spends far more than any other country on health care. And many countries have far better outcomes. And adopting better systems being used elsewhere in combination with improving using IHI, and other ideas, will bring even better results at even lower costs.
Fewer mistakes in patient care will also reduce litigation and large cash settlements, and should reduce the cost malpractice of insurance and legal fees, which have been cited as major drags on the medical system.
You are absolutely right, Steve.
That makes the score
Current MIT prof (Spear) 1
Former MIT prof (Krugman) 0
How do we get the government and the “elites” like Krugman to realize that better quality healthcare will cost less?
Do you have any references you could provide regarding your statement “primary care practices have increased their capacity with no additional spending”? I’m interested in researching this further.
Excellent Steve! I completely agree with your points. And to further Mark’s question in his comment - how can we get, not just the government, but organizations of all types to understand and integrate this skills and behaviors? How do we change the masses?
To answer Mark Granban’s statement, we need to have data that shows hospitals which are starting to use Lean can service more patients, with the same level of service, at a lower total cost. This should be right down Mark’s alley.
Hello Steven,
Thanks for the great post. After listening to Paul Levy, CEO of BIDMC in Boston (at http://MITWorld.mit.edu) and John Sterman http://www.systemdynamics.org/wiki/index.php/Resources#Webcasts) have the strong feeling that a lot can be done in the healthcare area.
Saving money (lots of it!) and on the contrary save lifes make the life of patients easier as well as for doctors and nurses.
Yet the lobby behind the healthcare system, pharmaceutical companies, health insurances, technical equipment producers, is quite strong and powerful to not let the change happen in the open. Even though everywhere around the globe the issue of detoriating fundings are obvious.
Let’s work together to make the transformational change happen that Peter Senge has already declared (see http://www.soloneline.org).
Cheers,
Ralf
[...] Â Though there is HUGE variation in efficacy and efficiency of treatments and providers (see previous post in response to Paul Krugman op ed), it is incredibly difficult for payers and patients to see those differences and make wise choices [...]
[...] my view, the only way to control costs in the short run is the one outlined by MIT’s Steven Spear, a huge and dedicated focus on process improvements that would eliminate the major bolus of costs [...]
[...] my view, the only way to control costs in the short run is the one outlined by MIT’s Steven Spear, a huge and dedicated focus on process improvements that would eliminate the major bolus of costs [...]
[...] my view, the only way to control costs in the short run is the one outlined by MIT’s Steven Spear, a huge and dedicated focus on process improvements that would eliminate the major bolus of costs [...]
[...] my view, the only way to control costs in the short run is the one outlined by MIT’s Steven Spear, a huge and dedicated focus on process improvements that would eliminate the major bolus of costs [...]
[...] my view, the only way to control costs in the short run is the one outlined by MIT’s Steven Spear, a huge and dedicated focus on process improvements that would eliminate the major bolus of costs [...]
[...] my view, the only way to control costs in the short run is the one outlined by MIT’s Steven Spear, a huge and dedicated focus on process improvements that would eliminate the major bolus of costs [...]
Audits and more audits of healthcare delivery systems. Cross-trainig win various depts. Next time you visit a hospital or clinic, observe how many employees are just standing around. Facilities need efficency experts. As a 21 year hospital veteran I can tell you that most facilities are over staffed and no cross training within depts. We buy and use the latest healthcare business technology but there is never a reduction in staff. Paramedics sit around while they want for the next 911 call. Why? Night shifts on acute care units can be seen knitting, reading magazines, or texting. So what else could they do? Process improvements are great but don’t hire more staff to perform these improvements.
[...] A symposium is held each year, with a speaker of national renown in the field. Last year, it was Brent James, from Intermountain Health. This year, we were pleased to welcome MIT’s Steven Spear. [...]
[...] system who have similar beliefs. Finally, they will need to engage in process improvement of the type discussed by Steven Spear to squeeze waste out of the system on the “factory [...]