@JLeslie I just read an article in the New Yorker about ways of targeting the sickest of the sick (mostly on Medicaid, but it could happen anywhere), and different models for providing them services. This model allowed folks to cut health expenditures for these sickest of the sick by 56%, while making them much healthier.
If people are much healthier, there’s less for doctors to do. In fact, some “patient poaching” behavior on the part of some doctors was seen as they lost their cash cow sick patients and wanted them back. Apparently, the techniques they are using were installed in Denmark twenty years ago. Back then, there were more than 150 hospitals for 5 million people. Now there are 71 and in a few years they expect there will be only 40. And all with no loss in health for the people.
It’s about the system, not medical advances. It’s about paying doctors to work with patients over e-mail and in off hours. They use nurse-managers for complex care. They hire health “coaches” to work with people in their homes to encourage them to eat healthy, do exercise, quit smoking, and other health promotion activities. They took one 500 lb man who was in the hospital half the year for three years. They gave him a social worker to help with many of his life problems and other supports, and were able to help him lose 220 lbs, and he has fewer hospital visits for shorter periods of time.
As for manufacturing costs, I really don’t care how you do it. The point is that you are making more using less. What happens to the productive resources that are freed? Or what happens to the “multiplier effect.” I.e., when you invest in something, those dollars are spend several times over in the community. Spending with a higher multiplier effect is more valuable than spending with less of an effect. Military spending has the lowest multiplier effect, fwiw. A dollar spent on just about anything has more effect on the economy than a dollar spent on a tank.
My question is about whether health care spending is more like military spending or more like, say, education spending or road building spending in terms of it’s ability to goose the economy.