The Healing American Healthcare Podcast
The Healing American Healthcare Podcast

Episode 6 · 2 years ago

Nordic Countries Excel & Why American Healthcare's So Expensive


John Dalton, Editor of Three Minute Read, talks with Ed Eichhorn about the Nordic response to COVID-19 as well as the state and future of American healthcare and how it's become so complicated and costly.

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Welcome to the first three minute read podcast. I'm John Dollon, editor of the three minute read, the twice monthly newsletter of the healing American healthcare coalition. Joining me today is at Eichhorn, the coalition's cofounder and also CO author of healing American healthcare, a plan to provide quality care to all while saving a trillion dollars a year. Together and and I have nearly a century of healthcare experience and we're still trying to figure it out. You can find our background and contact information at the end of the podcast and feel free to contact us with questions or issues that you'd like to see in the dressed. One year ago, America confirmed his first case of the novel coronavirus that has swept through the world as the worst pandemic in more than a century. Knowing the stress it would produce for busy physicians and clinicians who are trying to deal with coping with the crisis, and I launched the three minute read last March to summarize some of the greatical issues affected them. This is our twenty two issue to date. We summarize a hundred five articles from fifty different sources on eight topics, including physician practices and Shures, coverage drug course and of course, the all consuming vandemic. So let's dig into the current issue. Of three minute read. The first article movie summarize was entitled Crisis Showcases Corner of Europe derided by trump advisors. The is ritings generally level issue. What they pointed out was that in two thousand and eighteen report, quote, the Opportunity Course of socialism, quote, President Trump's advisors trashed the Nordic economic models, saying it reduced living standers and the Nordic countries, as you can see on the map here, far the south as Denmark, Finland, Sweden, Norway that have talked about, all the Scandinavia. Throw in Iceland, the smallest of the least populous of the five countries. We're going to deal with these four in the article. But the World Economic Forum disagreed with the trump administration's findings. They stated that, with low levels of debt as a percentage of gross domestic product, Denmark, Finland, Norway and Sweden have far more leeway to spend their way out of the coronavirus recession than to many of their peer countries. For example, Denmark and nory forty to fifty percent of GDP. I think Swedenes around seventy percent. The European Union as a holes or at ninety percent of GDP in terms of debt, and the US is well over a hundred percent at this point in time. Well desmit thirty one, two thousand and twenty three of the country's rank in the top ten among the Organization of Economic Cooperation Development countries in terms of protecting their residents from covid nineteen. Norway was fifth, not including in the article, was sixth, Finland seventh, Denmark ninth, and then Sweden, which began with a failed attempt at hurt immunity, rank twenty four out of the thirty seven O ECD countries. US, unfortunately, was thirty one out of thirty seven, getting close to the bottom of the barrel. Let's take a brief look at each of the four countries. What they have in common? Things like universal health care, of robust social services, safety that, but they're all that socialist economies. They are export driven free market systems that have done quite well throughout the pandemic in terms of protecting their residence. Denmark, further south populations is about five point eight willion, roughly the same as Colorado, although not mauntness at all. The marks fight as a pinkke capital is Copenhagen. Denlok has the fourth highest percentage of college degree holders in the world and a health system that has strong primary and preventive care. The major corporations include Nobo, nordisc, the pharmaceutical company, and if you ever been to the port of Elizabeth and seeing those container ships of the Mayish Line is Danish. There's an annual world happiness report...

...that comes out and in the last four years the dames, the melancholy dames, a rank number one worldwide in happiness. Finland, virtually landlog is bordered to the east by Russia and Russians have a very heavy influence on Finnish people. Finland is the northernmost of the four countries, population five point six million. It's about the same as Minnesota, with the cold climate of probably even colder in Finland, and one of the shortest growing seasons in the world. The capital is Hell Sinky, and the major corporation that you can entify with Finland is Nokia, a mobile phone manufacturer. Sweden is the largest in terms of land nests of the four countries and also most highly populated, with ten point two William inhabitants, roughly the same as Michigan or North Carolina in terms of population. Stockholm is the capital, and major corporations, you think, quite clearly a Volvo, the automobile manufacturer Electrolux and the iconic Ikea. No way is the westernmost of the three countries, also the huge North Atlantic coast. NORRI's economy is resource driven. The North Sea oil strike in the S was a major driving to their economy. The capital was Oslow, also hosts of the Nobel Prize awards each year. No way has the sixth highest GDP per capita in the world, so it is a very wealthy country and tourist destination with all the fewers along the Atlantic coast. One of the trivial fact of that Norway, the northernmost city in the world, is Norwegian. It's Spitsburg in this smoril guard Archipela. Though it's located halfway between the Yarctic circle and the north pope, it's not on my book and list. These of the four Nordic countries not socialist of strong free market economies. The bank, HSBC, says that the superiority of the Nordic response is largely due to generous social safeteness and high desertization, very well educated population. So we look at the four countries combined. The population of two thousand and seven a half millions of bad equivalent to that of Texas. Texas about twenty nine million. So let's see how some of these compared for the last six months of two thousand and twenty. Let's face it, when the pandemic hit at the beginning of the year, some countries jumped right odds, others stumbled and fumbled, but by June thirty we all knew what we were facing and we'll repnesss with covid nineteen. So what we monitored at the coalition is how the thirty seven O ECD member countries did for the last six months of the year. There was how well do they manage controlling the curve and keeping the fatality rate down? So the table here shows each of the four countries combined to Texas and then the United States as a whole. Population the fatality rate at Midyear. No Way. For examples, at four point six six per hundred thousand population. The US was at thirty eight point six. Sweden, which stumbled at the start, was at fifty two point one, fatality rate of thousand. We moved to the end of the year and we see what the fatality rate moved up to. Let's focus on this column, which is the difference. So in Norway, for example, the fatality rate increase by less than four of a hundred thousand. So they have continued to keep the pandemic under strong control, as has Finland with the four, one eight, Denmark twelve. That's a every good performance. Also, Sweden continued to stumble a bit. Their fatality rate increase by thirty three four. North of the countries as a whole got seventeen for hundred thousand. Compare that. First of the US, as fifty six advise, sixty six by sixteen, you're talking about being four times deadly in terms of the increase in fatality rate. Here Texas Maybe Five Times...

Dad. So conclusion is that the Nordic countries as a whole, for a variety of reasons, then quite well in protecting their residence from the pandemic. In fact, in our prior issue of the three men of read we had an article by Dr Tom Freeden, who had up centers from disease control and Prevention in two thousand and ninety two thousand and seventeen, he has selected countries in several different categories in terms of how well they dealt with the pandemic during two thousand and twenty. He overlooked one, so we added that to the equation. We looked at Europe as a whole and clearly Norway did the best job in Europe of protecting US residence. It was fifth in the OECD the year and fatality rate of eight point one two for a hundred thousand. The countries that exceeded no way and particular the residents all on the CIOGRAM Australia, New Zealand, Japan and South Prolia. so that's Nordic country. Like to take a moment here, John, and talk a little bit about Texas, if we could. Sure, and the reason for that is when you look at the chart that day you've provided, is the performance in the United States certainly is substantially worse over those six months than the Nordic countries, but a performance in Texas is even worse than the average for the United States. So what happened in Texas well. As the pandemic grew in the United States and in Texas, we sort of lock down the country for a while, and that's certainly worked, because you could see the death rate in Texas was only about eight per a hundred thousand. But as we got into the middle of May, Governor Abbot of Texas thought it was time to open up the state and he opened all of the restaurants and all of the bars, and he happened to do that just two weeks before the Memorial Day weekend and as a result of allowing people to, you know, not have to stay at home and not mitigate, there was a lot of joy in the population about going out to restaurants again, doing the things they like to do in times where normal. And unfortunately, as the governor later admitted, they broke their confinement of personal quarantine too soon. In addition to that, the governor never required everyone to wear him and asked they didn't require mitigation once they begin to reopen their economy and as a result, they had a very large infection rate through this summer and that continued through the end of the year, and it just underscores the real importance of using the mitigation strategies that the CDC has recommended from the very beginning of this crisis. So you don't mess with Texas, people die, unfortunately, in this case. Three years ago and an ask was made that shook the healthcare establishment. Two of the world's wealthiest men, Jeff Beso's and Lauren Buffett, and our most prominent banker, Jamie diamond, announced forming haven healthcare to quote, create simpler, high quality healthcare at lower costs. And if you look at the equation you say, well, here, here's Amazon, brush your half the way, and JP Morton Chase, three huge corporations tackling healthcare. It to shake the establishment. They then went out and hired Dr Until Goande, the PROMON surgeon and best selling the author, as CEO. For anyone who's works in healthcare, if you haven't read the checklist manifest though, it should be on your must read list. It's probably one of the best books I've ever read. But, of course, said and I both mentor extreme an engineers, so checklist and the like are not the alien to us. So why did the group, with a good mind, one point two million employees, which requests the probably three millions of the lives spread all around the country. Why did it fail? A couple of reasons. Haven had a mission create simpler, high quality healthcare at lower cost but never developed a real strategy. Another problem was that the divergence of interest among the three companies didn't help. These are three very different organizations, the major bank, Amazon in logistics and distribution, and then burst, You hath... w holding company with owning places like Guy Coo of the Quirky Auto Insurance Company. So the geographic diversity also worked against them terms of creating a very challenging in this first group around the country concern. So, as Dr Corne so aptly pointed out in this checklist manifesto, the volume and complexity of knowledge exceeds our ability as individuals to probably deliver it the people consistently, correctly and safely. Sub State is simply healthcare is really complicated. Next to a lot of the deal with more of these payer side of the equation. First one is one that appeared in healthcare died in January's first time pubus something from that source. Quote. Not Enough time, not enough clary hairs push back on cms prior authorization rule and was authored by Rebecca feiffer and I can clearly recall that as the HMO wave swept through American in the S, United Healthcare devised the way to lower its cost. It began retiring physicians to obtain quote, prior authorization and, of course, the procedures such as MRI's, cat scans and the like non emergency patients. In mid December the partment to health and Human Services provide it proposed streamlining the prior authorization process and they were building off the interoperability regulations or finalizes. Last March we covered that in an early issue of three minute read. You look at the icon down here. So factually, head aches. My least favorite headache is prior orthanization required literally have the insurance carriers second guessing medical judgment of the competent physicians. As basically any physician who's involved in this process that's like. It's probably the most frustrating part of their job. So where are we? As expected, the pushback from America's health insurance plans was immediate and intense. They contend that it is, quote, distracting from the crucial fight against the pandemic. As we enter a key phase in defeating covid nineteen, as if they really have anything to do with it other than process and claims. Conversely, the American Hospital Association Express disappointment that the proposal rule was not include Medicare advantage plans, and as that and I both know from our NA plans, there are procedures where we have to get prior ortization before having them carried out, which often results in delaying treatment and sometimes patients just don't bother. So where are we now? We as a an organization, really we support anything they can do the streamline the pays use to prior ortanizations. Just think of it. You've got a physician having to ask for permission to have a procedure won't perform innovation that he's diagnosed and wants to treat. On the other side of the equation you've got any commission, initially was commer care physicians, and now any many instances it's a nurse, advanced practice nurse, who's on the other side of the coal the deciding whether or not to approve the procedure. The approval rage typically run in the very high ninety percents. We would go even further. We eliminate the procedure all together. And instead, as many other countries do, rely on Post Treatment Review. Offer it out for what an abuse. We're never going to eliminate for it entirely, but if it's one, two, three percent of the procedures, letus look at it afterwards and go after the bandits and let's not delay or denied treatment to patients who need it. And just yesterday ce MS finalized the rules. So they didn't pay attention to the push back from the insurance plans to lobby for the invaders. So just to give you some idea of the streamline, complexity and seems an announcements of this will enable providers to electronically locate prior authorization requirements for each specific payer from within the providers workflow. Will facilitate sending prior orthanization re course and receiving responses electronically within their existing...

...workflow, while maintaining the integrity of the hippo privacy standards. It will include a specific reason for denial when denying and prior authorization request and will send prioritization decisions both through Pasapi, whatever that is, and otherwise requirement by existing requirements within sendings. Who are ours urgent and con calendar days for standard request. That's streamline. So to us to continue using this tactic to delay defer than I care second guesses medical judgment and adds cost very little or no benefit. Let's tell the PROMIS to cause yours. Yes, okay, the cost issue is very significant and really not covered in the CMS ruling. When we wrote our book healing American Health Care, through our research we learned that on average, physicians individually spend three hours a week in contact with insurance companies for seeking approval for the things that they need to do. Sometimes it's a pre authorization issue and here are many other issues. Sometimes it requires them to actually write letters and we compared to bureaucracy staffing requirements between the United States and Canadian practices and we found that, for example, in a practice in Washington state there were for physicians in the practice and they had four staff members working in the practice. Three of the staff members worked on insurance issues, billing, collection and preapproval. Conversely, if you looked at a practice in Canada, we looked at one that had twelve physicians in the practice and they had a manager for the practice who spent half of her time doing billing there was no staff to get pre authorization. There was just half of one staff member for twelve physicians. So that's why in our country we spend as much as fourteen percent of the cost of healthcare on bureaucracy. Broken down another way, that means we spend a thousand dollars a year for a family of for just for hospital and physician bureaucracy in dealing with insurance providers, and we need to reduce those costs and reduce the time. Physicians shouldn't have to spend almost half a day a week talking to insurance companies to get the services for the patients that they are treating. And it leads to another factor that I'll just mention very briefly, and that's physician burnout. Physician burnout in the United States has as high as forty seven percent in surveys that have been done asking patients to physicians rather if they've ever experienced burnout. That is the highest percentage of burnout reported in any profession in the United States. So the issue of pre authorization and they cms move that John just reported are very important and they have very real consequences on the practice of medicine. They ought to be addressed in a more efficient and thorough away and that your dressed a lot of those issues in the book dealing American healthcare. Unfortunately, the debate in the United States got the little bit disorder with the Medicare for all movement. which kind of people now would quite medicare for all with the universal health care. That's just one way to live. A universal healthcare as we've seen in many other countries. America, for better or for worse, is an employer based system that they speck in the S and s and short of our revolution, there's no other way to proceed except to continue building upon it, and some of the countries like France and Germany have done so, where their universal healthcare systems are based on access, with employees providing assurance. So that I know you've got your your thoughts on the next article. The next article in the three minute read we would like to discuss is entitled Lavish Bonuses Luxury Trip Health benefits. Brokers will have... disclose what they receive from the insurance industry, by Marshall Allen for Pro Publica on January sixth. Employers sponsored health plans cover about a hundred fifty million Americans and most employers use insurance brokers to figure out what plans they want to cover their employees. This is generally the largest group of the insured Americans in the United States are through employer sponsored plans, and we learned through this article that a broker's base commission can range from three to six percent of the total premiums for the services that they provide to the employers. The coronavirus relief package included a requirement that health benefit brokers disclosed to employers how much they actually make from the insurance carriers. And what we learned is that through the pro public of two thousand and nineteen report, we learned that insurance industry influences consultants behind the scenes with cash in gifts from six figure bonuses to expensive island vacations. The National Alliance of Healthcare and purchaser coalitions that represents employers called this new disclosure a step in the right direction. You need for employers to use brokers adds to America's highest cost among the OECD healthcare costs for those thirty seven nations. I'm surprised that this act actually passed. The relief backs now requiring this disclosure. That's healthy when you think about it. To start with, the burghers getting a commission for helping to select the plan or plans that employee we used to govern their our plays. Since amission is a strange percentage, there's no really incentive there for the groper to provide the most cost effective solution for the employer or over on the other side of it you get certain of the insurance providers providing some ing for the appropriate selection. So let's mean that's an inherent ethical conflict and it's something that needs to be around me. But disclosures are very good step in the first direction, as the coalition of purchases has pointed out. The final article in bringing a read talks about what life may look like for us after we all get vaccinating and tackle it. Sure. The title of this article is once you and your friends are vaccinated, can you quit social distancing? There are three steps to this effort that we're describing this article, and Dr Mary, a Boston University Epidemiologists, suggests that the best way to set our expectations around this was to focus on these three strategies. Now it's important for us all to understand that once we get the vaccinations, assuming we use a visor or the moderner sources that require two vaccinations. We all think as individuals that once we get the second vaccination everything is fine, but that's really not the strategies that Dr Mary suggests in this article. Stage one is what you can safely do once you and your close friends and your family are all vaccinated. You need, of course, to wait about a week after the last vaccination has been administered, but you can freely meet with each other in your homes or in a close situation and not wear masks and act relatively normally. The exception to that, of course, is if you live with someone who did not get the vaccination and you know could suffer from the virus because of age or complicated healthcare conditions. So that's the first stage, that you can meet with your friends and your family in close situations and not have to worry about masking. The reason you have to worry about masking... that even though you've gone through that protocol, you can still have the virus within you because you can inhale it, because it's airborne, and you can exhale it and people around you would still get infected with that virus. So that's why you have to be a little bit safer and wear masks once we get the ejection and you move around in our normal activities. The second stage is, you know, it's important to understand that we won't all reach herd immunity at the same time. Your city or your state could reach immunity where a neighboring regions or cities and not quite gotten there yet, and for that reason you would still have to wear a mask. Stage three is the idea of getting completely normal a round the entire world, and that's going to take probably well into two thousand and twenty two because we don't have a lot of daity yet about the access to vaccines in other countries around the world. So according to Dr Murray, she said it's really going to come down to what we learned over the next few months and how well the vaccine prevents the infection and transmission for US really to get back to normal. So unfortunately, if your number one nightem on the bucket list is that it isn't the Tazma Hall or the Great Wall of China, that's not likely to happen until two thousand and twenty two, and even within the US. Travel will continue to be regional in terms of which areas reached her community first. Right now, the stats that and I looked at, it's John Denver's favorite state, West Virginia, that is leading the country in terms of getting its people vaccinated. They will be more on that in the next issue of three minute read. Meanwhile, we at the healing American healthcare coalition are very much interested in hearing your thoughts about the future American healthcare. So, as a brief survey at that link. Take two to three minutes to fill it out and get it back to us and we will share feedback with our listeners on the issues, including the united health care versus Medicare for all. As I mentioned before. There's some confusion out there for people think Medicare for all these universal care. It's not. It's a single payer government run healthcare system. There are other ways of providing universal health care and some of our major Western democracies do a very good job of it, like France and Germany. And what's talk about the icon and Hutchinson all care plan, which is what was laid out in the book dealing American healthcare. It bears some reason wants to what the President Biden is calling Biden Care, building on positive in the affordable care act. For example, one of the great accomplishments of the affordable care act to me was the definition of ten essential health benefits, which simplifies plan selection. Want more. We suffer like that with other insurance packages, so will be discussing those. If there's a pigular interests that you'd like to see covered, feel free to contact us. The protect information is at the end of the presentation. Finally, at also post blogs periodically in support of the coalitions guiding principles and okay, I like to discuss this is plug briefly. The title of the blog is strue teach, a compromise, a pathway to universal health care. Our blogs try to discuss the issues that are relevant to our view of healthcare that we described in our hook killing American health care, and we believe that healthcare in America should be a right and not a privilege for those who can afford it. However, the legislative path and process for healthcare reform is complex and challenging. If you choose to read President Obama's book the Promised Land, he goes into great detail about the challenges associated with bringing forward healthcare legislation that they faced as they brought a bombit care forward. So I believe that lawmakers need to have a compromise that works, and I've chosen to call it...

...a strategic compromise, one that allows both sides to have a win. The ICORN Hunchinson all care plan provides a basis for a strategic compromise of this type. With our plan, Democrats get universal healthcare for all Americans, while Republicans get a reduced federal and stayed budget spending of about two hundred and fifty billion each year, and we think a compromise of that type might bring people together to push this bill through Congress and deal with reconciliation that must occurred both the House and the Senate, which we're not going to discuss this article. However, you need to understand that to get healthcare through the Senate could require sixty senators to vote for the bill. So if that's truly the case, and both sides really need to have an opportunity to win, and our plan would provide such a compromise. Anyway, when thank you for listening to us today. We'd love to hear from you and, of course, you can read the blog at our website. If you'd like to join our mailing UST, please text heal healthcare to two, two, eight, to eight. You get started. We love to have you join our mailing list, as see your next podcast.

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