A recent op-ed column on improving health care value was written by investment bankers (“The Medical Marketplace Is Changing Fast in Push for Value,” April 10). That tells volumes about U.S. health care costs.
Value in health care means health outcomes achieved per dollar spent. Our numerous for-profit insurers and duplicated public health programs cost twice that of most modern nations. We still leave 28 million Americans uninsured.
Health outcomes and metrics in access, efficiency, coordination and patient health and satisfaction, rank us dead last in performance among developed nations. Waste from unneeded administration and pricing failures are major causes of this poor value.
Administration designed to maximize profit wastes billions yearly. Hospitals and practices contend with multitudes of billings, approval sets and drug formularies, which is equally costly, and misuse or overuse of care for unneeded, ineffective tests and procedures persists.
Incentives to computerize medical records never mandated communication among them, so doctors repeat tests done elsewhere while waiting for the fax. Fragmentation and inefficient care delivery, like routine diabetes care in an ER, creates more waste.
The explosive and opaque costs of medications, diagnostics and procedures is known as “pricing failure.” A spine MRI in New Hampshire can cost four times more than in France. Such disparities reflect closed-door negotiations between insurers and provider-hospital groups, which increasingly resemble monopolies.
Opaque transactions leverage insurer membership size for bulk discounts from providers and vendors. Hospitals subsidize non-reimbursed services with inflated charges to those without negotiated contracts. Out-of-pocket costs skyrocket.
Buyers seek products with prices reflecting production costs and reasonable profit. But consumers can’t be expected to guess elements of complex procedures. Most capitalist nations realized long ago that competitive market models don’t apply well to health care.
Health care and medication costs remain at the top of Americans’ financial worries. This is not the way it needs to be. We can add value in health care by supporting a graduated model of Improved Medicare for All.
Dr. Kenneth Dolkart
Grantham
This week is National Healthcare Volunteer Week, a time to recognize and celebrate the thousands of men and women who volunteer in communities across the country. As the hospice volunteer coordinator at Visiting Nurse and Hospice for Vermont and New Hampshire, I salute all those who give of their time and talents — particularly to people at the end of life’s journey.
Many people are unaware that volunteers provide more than 19 million hours of service through our nation’s hospices. That’s more than 430,000 people giving selflessly to support and care for patients and families. More than 1.6 million people received compassionate care from hospice last year and hospice volunteers are an integral part of the care team.
I decided to become involved in hospice work after experiencing the wonderful care my father received before he died. As a hospice volunteer coordinator, I’m not only giving back to the community by providing dedicated volunteers, I’m also honoring my father’s memory.
There are people who mistakenly think hospice is about giving up — that couldn’t be further from the truth. Hospice is about living as fully as possible, even at the end of life. At the center of hospice is the belief that each person has the right to die free of pain and with dignity, and that our families will receive the necessary support to allow us to do so.
I encourage others to learn more about hospice by contacting VNH at 888-300-8853 or visiting vnhcare.org. We anticipate offering a training session in late spring.
Cindy Wiegand
Visiting Nurse and Hospice for Vt. and N.H.
The Northern Pass proposal to run an electric power line through New Hampshire to bring hydropower from Canada to Massachusetts has been rejected by the state’s Site Evaluation Committee, and this development encourages us as residents of the Upper Valley and New England to examine what we want as energy sources as we approach the post-carbon era in the decades to come.
The New Hampshire Upper Valley Democrats are assembling a panel of experts to discuss the environmental ethics of a range of energy systems for our region, including nuclear, solar, natural gas, hydroelectric and conservation.
Environmental ethics is at the nexus of science, politics and policy, and it is a tool to build a clearer sense of what we value in the realm of energy systems that are essential to our communities. Environmental ethics links what we value with actions we may take in the marketplace, our personal lives and as members of natural ecosystems. It also is central to how and what we say and write to elected officials, and to our neighbors, family and friends in our civic and political lives.
The panel discussion is scheduled for Monday, from 6-8 p.m., at the Lebanon Senior Center at 10 Campbell St. As moderator, I invite you to attend and to bring your interests, values and ideas to share.
Bruce R. James
Lebanon