Higher Fees Paid To US Physicians Drive Higher Spending For Physician Services Compared To Other Countries

By Miriam J. Laugesen and Sherry A. Glied
Health Affairs, September 2011

Abstract

Higher health care prices in the United States are a key reason that the nation’s health spending is so much higher than that of other countries. Our study compared physicians’ fees paid by public and private payers for primary care office visits and hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States. We also compared physicians’ incomes net of practice expenses, differences in financing the cost of medical education, and the relative contribution of payments per physician and of physician supply in the countries’ national spending on physician services. Public and private payers paid somewhat higher fees to US primary care physicians for office visits (27 percent more for public, 70 percent more for private) and much higher fees to orthopedic physicians for hip replacements (70 percent more for public, 120 percent more for private) than public and private payers paid these physicians’ counterparts in other countries. US primary care and orthopedic physicians also earned higher incomes ($186,582 and $442,450, respectively) than their foreign counterparts. We conclude that the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher US spending, particularly in orthopedics.

http://content.healthaffairs.org/content/30/9/1647.abstract

And…

Letter

Alliance of Specialty Medicine
September 26, 2011
To:  Glenn M. Hackbarth, J.D., Chairman
Medicare Payment Advisory Commission

(excerpts)

The Alliance of Specialty Medicine (Alliance) and its member organizations are writing to express our opposition to the Chairman’s recommendations on the Sustainable Growth Rate System (SGR) proposed at the MedPAC meeting of September 15, 2011.

The Alliance recognizes that MedPAC has called for repeal of the SGR repeatedly and we welcome your understanding of the critical need to rationalize physician payment to assure stability of patient access to quality physician care. However, we were dismayed to hear the Chairman’s first recommendation to slash the conversion factor for specialist services by 5.9 percent each year for three years to be followed by a freeze for seven years. The cumulative cut to specialty physician payments would be 18 percent over the first three years. The recommendations seek to shield a small percentage of primary care services furnished by primary care specialties by imposing only a 10-year freeze rather than an absolute cut on these services.

Furthermore, while the Alliance understands MedPAC’s desire to support primary care, we have serious objections to the recommended proposal to essentially hold primary care “harmless” while cutting specialty physicians’ reimbursement.

Private Contracting with Physicians Under Medicare

The Alliance strongly supports empowering patients with the ability to obtain medical services from the physician of their choice. To that end, we believe that patients and physicians should be allowed to privately contract for Medicare services without penalty.

Sincerely,

American Academy of Facial Plastic and Reconstructive Surgery
American Association of Neurological Surgeons
American Gastroenterological Association
American Society of Cataract & Refractive Surgery
American Society of Plastic Surgeons
American Urological Association
Coalition of State Rheumatology Organizations
Congress of Neurological Surgeons
Heart Rhythm Society
North American Spine Society
Society for Cardiovascular Angiography and Interventions

http://thehill.com/images/stories/blogs/healthwatch/specialtymedpac.pdf

Today’s message on physician income does not delve into the important topics of fee-for-service, capitation, salary and other such considerations, but rather is intended to provide a perspective on how much money physicians should take home. Having said almost nothing in this first sentence, just opening the topic undoubtedly has already provoked controversy, but we do need to take a look at this.

Before discussing physicians’ net incomes, we should first stipulate that our health care system should be designed to provide all necessary care to everyone. Since health care now is so expensive, that means that we must have some method of pooling funds, and the financing must be progressive. Medicare is an example of pooled funds with progressive financing.

Some of us can remember when Medicare was first established, physicians were allowed to set their own fees. The cost of the program skyrocketed far beyond even the highest cost projections. Medicare was forced into a system (under continual refinement) that controlled fees. Likewise, escalating costs in the private sector forced the insurers into provider contracting as a means of controlling fees. Even the plans that expose patient/consumers to the costs of health care still have limits on how much the physicians can receive.

We need to learn from other nations that have been successful in covering essentially everyone, while spending far less than the United States. The Health Affairs article demonstrates that one important difference between us and those other nations is that we pay physicians more, even with our current private insurance and public program controls on spending.

What is even more alarming is that procedure-oriented specialists are paid much more than primary care physicians. The Health Affairs study cited above looked at orthopedics as a proxy for procedure-oriented specialists. Other studies have shown that very high fees also apply to most other such specialties.

Unfortunately, this is setting up a battle between the primary care and specialty sectors of medicine. The letter to MedPAC (Medical Payment Advisory Commission) sent by the professional organizations representing high-fee specialists states, “we have serious objections to the recommended proposal to essentially hold primary care ‘harmless’ while cutting specialty physicians’ reimbursement.” It’s war.

Worse, the specialists want Medicare rules changed so that they can set their own fees and collect from the patient the full balance beyond the Medicare allowed fees. If you have looked at any Medicare payment statements recently, you know that the amounts that the patient would be responsible for are staggering. Yet this unreasonable demand is from a sector of physicians that are already paid far more than similar specialists in other nations.

How much should physicians be paid? Under our current fragmented system, Medicare is not able to determine the costs of providing care to the beneficiaries since such costs are not segregated, and it is difficult to determine how much of the practice costs should be paid by the private insurers and by cash-paying patients. If Medicare were the only payer (single payer) then pricing could be based on legitimate total practice costs and fair profits (physician net income). This method would provide the greatest value in our health care purchasing – paying enough to be sure that physicians would be there when you need them, but not paying egregiously excessive profits.

Although it would be foolish to try to specify here precise levels of physicians’ incomes for the United States, we can say that adopting an efficient system of financing health care would bring us far closer to getting the levels right. This is partly what we mean by “improved” in an “improved Medicare for all.”

Rising Health Costs Are Not Just a Federal Budget Problem

By Drew Altman, Ph.D.
Kaiser Family Foundation, September 27, 2011

Premiums for employer-provided health insurance, where 150 million Americans get their coverage, jumped 9% in 2011 while workers’ wages grew just 2%, according to our annual employer survey.  The average family policy now costs more than $15,000 per year, more than the cost of a Chevy Aveo or a Ford Fiesta.  Since we began doing this survey thirteen years ago, worker contributions to premiums have increased 168%, wages 50%, and inflation 38%.

The “Supercommittee” created by the recent debt reduction legislation will be looking for more ways to save money in government health programs, but the focus in Washington is almost entirely on cutting government spending, not curbing rising health costs overall.  Employers will be left to their own devices to try to keep health care costs down.  They have never been very successful at this, nor have private health insurance companies.  While the conventional wisdom is that private insurance does a better job of controlling costs, the opposite is true.  The Centers for Medicare and Medicaid Services (CMS) says that Medicare spending per enrollee grew at a much lower rate than private insurance between 1999 and 2009 (4.9% vs. 7.2% for comparable benefits).

In the short term, employers have few new tools to control premium increases.  Employees will continue to see more high-deductible health plans, with and without tax-preferred savings accounts, and deductibles will get even larger.  These plans have lower premiums because the big upfront deductible that people must pay before their insurance kicks in causes them to use fewer health services. The trend here is very clear, especially in firms with fewer than 200 employees where the percentage of workers in a plan with a deductible of $1,000 or more for single coverage has grown from 16% in 2006 to 50% today.  Conservatives rail about Obamacare, but they may be winning more than they are losing; it is their vision of insurance with more “skin in the game” that is gradually taking over the marketplace because employers have no other way to control costs.

Health care groups are maneuvering with defense lobbyists and health provider groups are jockeying with beneficiary advocates about who will take the brunt of the hit from the Supercommittee.  But one thing that should be clear is that reducing federal health spending is not the same thing as controlling health care costs; just ask the 150 million Americans and their employers who will be paying $15,000 when they buy a family policy this year.

http://www.kff.org/pullingittogether/rising_health_costs_federal.cfm

Summary of findings (8 pages):
http://ehbs.kff.org/pdf/8226.pdf

When the Affordable Care Act was drafted every effort was made to leave intact the largest source of health care coverage in America – employer-sponsored health plans. Most working families will have no other choices than the plans offered by their employers. How well are they working?

The average premium for an employer-sponsored family plan is now over $15,000, paid for by employee premium contributions and foregone wage increases. As if that weren’t bad enough, more of the direct costs of health care are being shifted to employees and their families, especially through larger deductibles.

The conservatives won the health care reform battle. Health care coverage for workers was left in the more expensive private market, and consumers are being empowered with the right to decline the health care that they need but can no longer afford because of the high out-of-pocket expenses.

Yesterday’s qotd message was on framing, demonstrating how the right has taken control of our cognitive processes by superimposing the moral worldview of individual responsibility, while bypassing logic. As proof, much of the bashing of single payer advocates is coming from the left. Even though liberals understand fully the logic of single payer, they are absorbed in the process of making the Affordable Care Act work. We’ve shown that it cannot ever accomplish the goals of universal coverage and affordability, yet they insist that this right-wing consumer/market approach will get us there through incremental steps, though incrementalism hasn’t achieved our ultimate goals in over a half century of trying.

Today I received an email message that went out to another list, sent by one of the most intelligent, dedicated, progressive individuals in the health care reform movement. The title of the message was, “Don McCanne is wrong Re: [hc4ac] US Last In Mortality Amenable to Health Care.” She wrote, “The vote on the ACA has occurred; opposing it on a daily basis does not get us closer to universal coverage or price controls or to single payer; nor does intoning single payer on a daily basis.”

So abandoning single payer and tweaking a model designed by the conservative Heritage Foundation will get us there? We certainly screwed up the framing on this one!

By Theodore R. Marmor and Jerry L. Mashaw
The New York Times, September 23, 2011

In the face of nothing but bad economic news, Americans often take heart in remembering that we have been here before — during the Great Depression, when conditions were far worse than they are today — and we survived.

But there is a crucial difference between then and now: the words that our political leaders use to talk about our problems have changed. Where politicians once drew on a morally resonant language of people, family and shared social concern, they now deploy the cold technical idiom of budgetary accounting.

This is more than a superficial difference in rhetoric. It threatens to deprive us of the intellectual resources needed to address today’s problems.

In 1934, the government was us. We had shared circumstances, shared risks and shared obligations. Today the government is the other — not an institution for the achievement of our common goals, but an alien presence that stands between us and the realization of individual ambitions. Programs of social insurance have become “entitlements,” a word apparently meant to signify not a collectively provided and cherished basis for family-income security, but a sinister threat to our national well-being.

Over the last 50 years we seem to have lost the words — and with them the ideas — to frame our situation appropriately.

Can we talk about this? Maybe not.

(Theodore R. Marmor is a professor emeritus of public policy, and Jerry L. Mashaw is a professor of law, both at Yale.)

http://www.nytimes.com/2011/09/24/opinion/how-do-you-say-economic-security.html

And…

The Use of 9/11 to Consolidate Conservative Power: Intimidation via Framing

By George Lakoff
Huff Post Politics, September 10, 2011

From 9/11 on, the American people have been subject to conservative intimidation by framing. I’ve now written five books explaining how framing works in the brain and what citizens could do about it — Moral Politics, Don’t Think of an Elephant, Whose Freedom?, Thinking Points, and The Political Mind. The books were based on results from the cognitive and brain sciences on how reason about social and political issues really works — primarily in terms of morally-based frames, metaphors, and narratives, and only secondarily, if at all, in terms of policy, facts, and logic.

But since the 2008 election, conservative intimidation of the electorate via framing has come back big time, with no adequate Democratic defense against it. With a Democratic president in office, Democrats, both citizens and office-holders, turned their attention to policy and logical, fact-based arguments for the policies. In response to the president’s health care policies, conservatives attacked on the moral front, choosing two moral values from their value system: freedom (“government takeover”) and life (“death panels”). Knowing well that morality trumps lists of policy details, lists of facts, and logic, conservatives won that framing encounter, and have kept winning. Why? Because people, using their real reason, normally think unconsciously in terms of morally based systems of frames, metaphors, and narratives.

Since the 2008 election, America has returned to post-9/11 conservative intimidation by framing. The intimidation does not use violence. It uses media. When conservatives, using their moral system, are able to frame the main values that define public discourse, the media follows suit, because that is how “mainstream” public discourse has been defined. The media, encountering more conservative language, picks up on that language and uses it. Since conservative language evokes conservative frames and values, which are carried with it, the media (liberal or not) winds up helping conservatives. Even arguing against conservatives, liberal pundits in the media first quote what they say. Liberals in the media help the conservatives by quoting their language, even to argue against it.

In the post-2008 return to 9/11 style intimidation by framing, conservatives have been winning. They have protected banks from financial regulation, health insurance companies from government insurance, and corporations from serious environmental regulation. They have successfully attacked the very idea of the public — public education, employees, unions, parks, housing, and safety nets.

Here’s how public intimidation by framing works.

The mechanism of intimidation is framing, not just the use of words or slogans, but rather the changing of what voters take as right as a matter of principle. Framing is much more than mere language or messaging. A frame is a conceptual structure used to think with. Frames come in hierarchies. At the top of the hierarchies are moral frames. All politics is moral. Politicians support policies because they are right, not wrong. The problem is that there is more than one conception of what is moral. Moreover, voters tend to vote their morality, since it is what defines their identity. Poor conservatives vote against their material interests, but for their moral identity.

All language activates frames in the brain. Conservative language activates conservative frames, which activate conservative moral worldviews in the brains of those who hear the language. The more those frames are activated, the stronger the conservative moral views get in people’s brains.

When Democrats are intimidated into using conservative language, they help conservatives, even if they are arguing against them. Here’s why. The main voters you want to affect are the bi-conceptuals, those who are conservative on some issues and progressive on others; that is, those who have both conservative and progressive moral worldviews, but on different issues. They are sometimes misnamed as “the center,” “independents,” or “moderates.” But they do not have any single overriding worldview. Instead they have two. Given the way brains work, the activation of one worldview will inhibit the other worldview. The more one is activated, the stronger it gets and the weaker the opposite one gets. The worldview that is most activated by the public discourse they hear will most likely govern how they will vote. What activates one worldview versus another? Framing. Conservative language activates conservative frames, which activate conservative worldviews. If Democrats use conservative language, even to argue against it, they are just helping conservatives.

To a large extent, Democrats don’t understand this. They think that language is neutral and that reason works by logic. If you just tell people the facts and reason logically, everyone should be convinced. But they aren’t, because language works by framing and by brain mechanisms. Framing is just the normal way people think and talk. Conservatives tend to understand this. They avoid using liberal language. They frame issues very carefully to fit their goals. Democrats need to do the same — avoid using conservative frames and instead frame the issues with their own values.

The conservative consolidation of power violates this most basic of democratic principles. It replaces social and personal responsibility with personal responsibility alone. It approves of the government over our lives by corporations for their own profit, and hence sees government by, of and for the people as immoral and to be eliminated.

The good news is that it doesn’t have to be that way. It is possible for Democrats to learn how frames, narratives, and brains really work. It is possible to take moral stands, with all policies backed up by a single moral vision. It is possible to awaken and strengthen the progressive worldview already present in swing voters who are partly progressive a
s partly conservative (called “independents,” “moderates,” and “the center”). It is possible for Democrats to say what they believe and win, without giving in to intimidation tactics.

http://www.huffingtonpost.com/george-lakoff/the-use-of-911-to-consoli_b_955954.html

Comment:

By Don McCanne, MD

Words. Language. Framing. Egalitarianism? How do you frame that? Is that an American concept? Is that a defining value of democracy? Do our citizens believe that we should strive to ensure that all people have equal rights and opportunities? Or is this a left-wing conspiracy that deprives people of the realization of their individual ambitions? Is it then really just about freedom?

Whatever label you use, the right has gained control of the framing, and framing controls cognitive function. Cognition does not require logic. Those who have been watching the Republican debates have been able to witness cognitive activity that is almost totally devoid of logic, yet the candidates have been well versed on framing. It is the moral worldview of freedom from government that prevails, while dismissing the logic of the great benefits that we receive as a people joining together to establish and operate our own government. This worldview allows them to dismiss the obvious logic of an improved Medicare program that would cover everyone.

We do need to recapture the framing from the conservative ideologues who would destroy as much government functioning as they can. Why they would is beyond the capacity of many of us to understand, but then we are looking for logic where it may not exist.

Do we need to reframe the problems and their potential solutions from a liberal, progressive, Democratic, politically polarized position? Or can we use framing with which the great majority of us can identify? Would framing supporting economic security for everyone work? That’s a moral worldview that is also logical.

Can we talk about this?

How Do You Say ‘Economic Security’?

By Theodore R. Marmor and Jerry L. Mashaw
The New York Times, September 23, 2011

In the face of nothing but bad economic news, Americans often take heart in remembering that we have been here before — during the Great Depression, when conditions were far worse than they are today — and we survived.

But there is a crucial difference between then and now: the words that our political leaders use to talk about our problems have changed. Where politicians once drew on a morally resonant language of people, family and shared social concern, they now deploy the cold technical idiom of budgetary accounting.

This is more than a superficial difference in rhetoric. It threatens to deprive us of the intellectual resources needed to address today’s problems.

In 1934, the government was us. We had shared circumstances, shared risks and shared obligations. Today the government is the other — not an institution for the achievement of our common goals, but an alien presence that stands between us and the realization of individual ambitions. Programs of social insurance have become “entitlements,” a word apparently meant to signify not a collectively provided and cherished basis for family-income security, but a sinister threat to our national well-being.

Over the last 50 years we seem to have lost the words — and with them the ideas — to frame our situation appropriately.

Can we talk about this? Maybe not.

(Theodore R. Marmor is a professor emeritus of public policy, and Jerry L. Mashaw is a professor of law, both at Yale.)

http://www.nytimes.com/2011/09/24/opinion/how-do-you-say-economic-security.html

And…

The Use of 9/11 to Consolidate Conservative Power: Intimidation via Framing

By George Lakoff
Huff Post Politics, September 10, 2011

From 9/11 on, the American people have been subject to conservative intimidation by framing. I’ve now written five books explaining how framing works in the brain and what citizens could do about it — Moral Politics, Don’t Think of an Elephant, Whose Freedom?, Thinking Points, and The Political Mind. The books were based on results from the cognitive and brain sciences on how reason about social and political issues really works — primarily in terms of morally-based frames, metaphors, and narratives, and only secondarily, if at all, in terms of policy, facts, and logic.

But since the 2008 election, conservative intimidation of the electorate via framing has come back big time, with no adequate Democratic defense against it. With a Democratic president in office, Democrats, both citizens and office-holders, turned their attention to policy and logical, fact-based arguments for the policies. In response to the president’s health care policies, conservatives attacked on the moral front, choosing two moral values from their value system: freedom (“government takeover”) and life (“death panels”). Knowing well that morality trumps lists of policy details, lists of facts, and logic, conservatives won that framing encounter, and have kept winning. Why? Because people, using their real reason, normally think unconsciously in terms of morally based systems of frames, metaphors, and narratives.

Since the 2008 election, America has returned to post-9/11 conservative intimidation by framing. The intimidation does not use violence. It uses media. When conservatives, using their moral system, are able to frame the main values that define public discourse, the media follows suit, because that is how “mainstream” public discourse has been defined. The media, encountering more conservative language, picks up on that language and uses it. Since conservative language evokes conservative frames and values, which are carried with it, the media (liberal or not) winds up helping conservatives. Even arguing against conservatives, liberal pundits in the media first quote what they say. Liberals in the media help the conservatives by quoting their language, even to argue against it.

In the post-2008 return to 9/11 style intimidation by framing, conservatives have been winning. They have protected banks from financial regulation, health insurance companies from government insurance, and corporations from serious environmental regulation. They have successfully attacked the very idea of the public — public education, employees, unions, parks, housing, and safety nets.

Here’s how public intimidation by framing works.

The mechanism of intimidation is framing, not just the use of words or slogans, but rather the changing of what voters take as right as a matter of principle. Framing is much more than mere language or messaging. A frame is a conceptual structure used to think with. Frames come in hierarchies. At the top of the hierarchies are moral frames. All politics is moral. Politicians support policies because they are right, not wrong. The problem is that there is more than one conception of what is moral. Moreover, voters tend to vote their morality, since it is what defines their identity. Poor conservatives vote against their material interests, but for their moral identity.

All language activates frames in the brain. Conservative language activates conservative frames, which activate conservative moral worldviews in the brains of those who hear the language. The more those frames are activated, the stronger the conservative moral views get in people’s brains.

When Democrats are intimidated into using conservative language, they help conservatives, even if they are arguing against them. Here’s why. The main voters you want to affect are the bi-conceptuals, those who are conservative on some issues and progressive on others; that is, those who have both conservative and progressive moral worldviews, but on different issues. They are sometimes misnamed as “the center,” “independents,” or “moderates.” But they do not have any single overriding worldview. Instead they have two. Given the way brains work, the activation of one worldview will inhibit the other worldview. The more one is activated, the stronger it gets and the weaker the opposite one gets. The worldview that is most activated by the public discourse they hear will most likely govern how they will vote. What activates one worldview versus another? Framing. Conservative language activates conservative frames, which activate conservative worldviews. If Democrats use conservative language, even to argue against it, they are just helping conservatives.

To a large extent, Democrats don’t understand this. They think that language is neutral and that reason works by logic. If you just tell people the facts and reason logically, everyone should be convinced. But they aren’t, because language works by framing and by brain mechanisms. Framing is just the normal way people think and talk. Conservatives tend to understand this. They avoid using liberal language. They frame issues very carefully to fit their goals. Democrats need to do the same — avoid using conservative frames and instead frame the issues with their own values.

The conservative consolidation of power violates this most basic of democratic principles. It replaces social and personal responsibility with personal responsibility alone. It approves of the government over our lives by corporations for their own profit, and hence sees government by, of and for the people as immoral and to be eliminated.

The good news is that it doesn’t have to be that way. It is possible for Democrats to learn how frames, narratives, and brains really work. It is possible to take moral stands, with all policies backed up by a single moral vision. It is possible to awaken and strengthen the progressive worldview already present in swing voters who are partly progressive as partly conservative (called “independents,” “moderates,” and “the center”). It is possible for Democrats to say what they believe and win, without giving in to intimidation tactics.

http://www.huffingtonpost.com/george-lakoff/the-use-of-911-to-consoli_b_955954.html

Words. Language. Framing. Egalitarianism? How do you frame that? Is that an American concept? Is that a defining value of democracy? Do our citizens believe that we should strive to ensure that all people have equal rights and opportunities? Or is this a left-wing conspiracy that deprives people of the realization of their individual ambitions? Is it then really just about freedom?

Whatever label you use, the right has gained control of the framing, and framing controls cognitive function. Cognition does not require logic. Those who have been watching the Republican debates have been able to witness cognitive activity that is almost totally devoid of logic, yet the candidates have been well versed on framing. It is the moral worldview of freedom from government that prevails, while dismissing the logic of the great benefits that we receive as a people joining together to establish and operate our own government. This worldview allows them to dismiss the obvious logic of an improved Medicare program that would cover everyone.

We do need to recapture the framing from the conservative ideologues who would destroy as much government functioning as they can. Why they would is beyond the capacity of many of us to understand, but then we are looking for logic where it may not exist.

Do we need to reframe the problems and their potential solutions from a liberal, progressive, Democratic, politically polarized position? Or can we use framing with which the great majority of us can identify? Would framing supporting economic security for everyone work? That’s a moral worldview that is also logical.

Can we talk about this?

Variations in Amenable Mortality — Trends in 16 High-Income Nations

By Ellen Nolte, Ph.D., and Martin McKee, M.D., D.Sc.
The Commonwealth Fund, September 23, 2011

Synopsis

The rate of “mortality amenable to health care” — that is, deaths that are considered preventable with timely and effective health care — declined for people under age 75 across 16 high-income nations between 1997–1998 and 2006–2007. While all countries showed improvement, the United States improved the least.

Key Findings

In 2006–2007, amenable mortality accounted for 24 percent of deaths under age 75 in the 16 countries studied.

The highest levels were in the United States, with 95.5 deaths per 100,000 people.

Addressing the Problem

Although amenable mortality fell consistently in all countries, the scale and pace of improvement varied. The United States’s poor performance and relatively slow improvement compared with other nations may be attributable to “the lack of universal coverage and high costs of care,” the authors conclude.

http://www.commonwealthfund.org/Publications/In-the-Literature/2011/Sep/Variations-in-Amenable-Mortality.aspx?omnicid=20

Comment: 

By Don McCanne, MD

So, the United States has “the best health care system in the world,” except for all the others. Our amenable mortality – deaths that are preventable with timely and effective health care – is the worst amongst the 16 high-income nations studied.

The authors suggest that our poor result may be attributable to the lack of universal coverage and the high costs of care. Unfortunately the Affordable Care Act (ACA) will provide neither universal coverage nor adequate measures to control health care spending.

The policy community certainly understands that we could cover everyone and control excessive spending by enacting a single payer national health program – an improved Medicare for all. So why have they disappeared behind closed doors to work on ACA – a model that won’t get us there?

Please, policy wonks, come out of the closet!

Variations in Amenable Mortality — Trends in 16 High-Income Nations

By Ellen Nolte, Ph.D., and Martin McKee, M.D., D.Sc.
The Commonwealth Fund, September 23, 2011

Synopsis

The rate of “mortality amenable to health care” — that is, deaths that are considered preventable with timely and effective health care — declined for people under age 75 across 16 high-income nations between 1997–1998 and 2006–2007. While all countries showed improvement, the United States improved the least.

Key Findings

In 2006–2007, amenable mortality accounted for 24 percent of deaths under age 75 in the 16 countries studied.

The highest levels were in the United States, with 95.5 deaths per 100,000 people.

Addressing the Problem

Although amenable mortality fell consistently in all countries, the scale and pace of improvement varied. The United States’s poor performance and relatively slow improvement compared with other nations may be attributable to “the lack of universal coverage and high costs of care,” the authors conclude.

http://www.commonwealthfund.org/Publications/In-the-Literature/2011/Sep/Variations-in-Amenable-Mortality.aspx?omnicid=20

So, the United States has “the best health care system in the world,” except for all the others. Our amenable mortality – deaths that are preventable with timely and effective health care – is the worst amongst the 16 high-income nations studied.

The authors suggest that our poor result may be attributable to the lack of universal coverage and the high costs of care. Unfortunately the Affordable Care Act (ACA) will provide neither universal coverage nor adequate measures to control health care spending.

The policy community certainly understands that we could cover everyone and control excessive spending by enacting a single payer national health program – an improved Medicare for all. So why have they disappeared behind closed doors to work on ACA – a model that won’t get us there?

Please, policy wonks, come out of the closet!