They note that “The dominant form of assistance today is fee-for-service (FFS), which gives providers a clear path to revenue: the more services you render, the more you get paid. … Studies concluding that up to half of all medical services performed in the United States are medically unnecessary pin much of the blame on the financial incentives embedded in fee-for-service” (page 227). We need models that pay providers for keeping people well, rather than when they get sick. Such models are working today at Kaiser Permanente, the Mayo Clinic, and similar institutions.

An example of the difference disruptive innovation could make: Each year, Christensen and a colleague demonstrate, to the satisfaction of medical-school deans, that — using principles developed at Toyota — they could turn out better doctors in three years than they now turn out in four (pages 345-347). This would help all graduates, especially those who want to go into family practice.

Despite the obstacles, new business models are already disrupting established providers and reimbursement systems. The book recommends specific regulatory changes to help the benefits reach patients years sooner.

The proposals in Congress that I’ve heard about don’t correct the perverse incentives of the fee-for-service regime. Christensen offers a way to use market forces and smart regulation to permanently lower the cost curve, while enhancing quality and access — with little or no need for government assistance.

The doc said to me “it’s much easier for them than it is for us.” Exactly so, and at that moment I decided I am going to do all in my power to be sure that I can go as near to the way Anson did as possible.

I’m almost 60 and have had a very healthy and happy life. I feel it would be selfish in the extreme for me to demand life-saving treatment at public expense costing hundreds of thousands of dollars at my age. And, with each additional year I live, it will become even more indefensible. I would not want to spend my own money on it, let alone that of my fellow citizens. Instead let the money be spent helping someone like the young mother mentioned by Anne above to be with her children for a few years more.

In the meantime, I live each day with the kind of appreciation it would deserve if it were my last, because it might be. Nobody’s life has infinite value including mine and our country, rich as it is, doesn’t have infinite funds.

Native-Americans had the practice of the old falling behind when they could not keep up any longer. This is the best I can do to follow in that tradition. Perhaps I can get a medi-bracelet that simply says “Let it be” but would my wish be obeyed?

The first proton therapy center in Western Europe has been in operation at the Paul Scherrer Institute (PSI) in Villigen, Switzerland, since 1984.

From TRIUMF
The Mr. & Mrs. P.A. Woodward’s Foundation provided funds to construct the patient treatment chair and the proton beam line equipment.
Until now, Canadian patients had to go abroad to receive proton treatment. Now they can receive it here in Canada, and at a much lower cost

On 21 August 1995, Mr. Lorne Scott of Campbell River, BC, became the first person to have his cancer treated in Canada with a proton beam. The cancer treatment centre at TRIUMF results from a collaboration between the BC Cancer Agency, UBC’s Eye Care Centre and TRIUMF.

Looks like proton therapy is a medical innovation that started at TRIUMF the sub-particle nuclear physics research institute at the University of British Columbia.

So it means proton therapy (but only for eye cancer) is covered by the health premiums we pay. ($108 per month for a family of three or more in British Columbia)

So Americans can’t claim they have the lock on medical innovation. (But maybe a lock on pricing.)

In Canada, by law, reasonable health care cannot be denied based on income. (In other words, it was an attempt to enshrine, in statute, that access to medical care is not class-based.)

I have heard of public “fights” in Canada over patients being denied access to innovative drugs and procedures that can be very costly. But not specifically on “proton therapy.”

Here is a story that speaks truly about the best of universal health care in Canada. Further down the page, the writer talks about the care his ten year old sister received after she was diagnosed with brain cancer.

http://www.pnhp.org/news/2009/march/a_canadian_comments_.php

However, I would love to know, Tippy, if Melissa would have had this experimental treatment covered in Canada.

Regardless, in both England (single payer, government health care) and the US (private health care program), she needed to pay cash for the experimental treatment.

And frankly, Tippy, the outcome/prognosis is absolutely an issue. I think that viable treatments are always worth the money.

But I absolutely do not want to open the door to funding virtually anyone who promises the possibility of a potential cure – if the patient hands over lots of dough. We all know too well how the profit motive persuades people to promise all sorts of things that have no chance of ever happening.

“For three decades, the governing philosophy of the United States and Britain was defined by the faith that markets are the primary instrument for achieving the public good. The financial crisis has put this faith in question. The era of market triumphalism has come to an end. But we have yet to find our way to a new governing philosophy. Even President Obama has yet to articulate one.

“One obstacle to a new public philosophy is a persisting assumption from the age of market faith. It’s what I’d like to call — market mimicking governance. — It’s the idea that the primary purpose of government is to correct what economists call ‘market failure’.

“As a governing philosophy, however, the task of correcting market failures is too humble and too narrow. Democratic governance is radically devalued if reduced to the role of handmaiden to the market economy. Democracy is about more than fixing and tweaking and nudging incentives to make markets work better.
__________

See: A New Politics of the Common Good
http://www.bbc.co.uk/programmes/b00kt7rg

Melissa is a British school teacher in her 20s. Having survived cancer four years ago, she was then diagnosed with terminal brain and spinal cancer. She was denied an innovative treatment (proton therapy) by the NHS. Her family went public and fund raised to pay for the treatment in Boston. The cost $325,000 USD.

If she was American she too would have been denied proton therapy unless (1) her insurance covered the $325,000 cost, or (2) it was paid for by donations.

The stories don’t indicate her prognosis following the proton treatment. But the prognosis is not the issue. From a human perspective money should not be a barrier to credible medical care.

Is a life worth $325,000? Absolutely.

1. Establish in the U.S. a public health insurer who will accept everybody and provide U.S.-based services (hospitals, physicians, tests, imaging, etc.).

2. Allow private insurers to develop business models at least partially relying on medical services outside the U.S. (expansion and codification of the current medical tourism).

The model for this approach is the U.S. employment marketplace where companies hire citizens and (legal) non-citizens alike, move some of their production to foreign countries and outsource. The Federal employment, on the other hand, is limited to U.S. citizens (which is apart from any need for security clearances).

The benefits of this approach are as follows:
- Overall lower insurance costs from private and public insurers alike.
- Globalization (“flat world”) of medical care.
- Leveling of the playing field of the physicians’ compensation; bringing in the “invisible hand” into a current monopoly.

VictoriaF

Melissa’s dad asks: ‘could treatment have been carried out free on the NHS?
Jan 14 2009 Surrey Herald

NHS red-tape scuppered Melissa’s chances of getting her £160,000 transatlantic proton treatment for free, says her dad, Mark.

As funds continued to pour into her fighting fund this week, Mark said there was a chance Melissa could have been referred to Boston, America, for free by the Leeds-based National Commissioning Group Proton Reference Panel. It was set-up last year for sufferers just like Melissa and has so far granted 18 out of 25 applicants free treatment.

But Melissa only became aware of the panel after she had been referred to Boston as a private patient by her Charing Cross Hospital surgeon in November.

The policy of the panel is it will only consider patients for referral if it is approached first.

As a result, Mark believes there is an ‘information lottery’ in the NHS, where access to treatment is dependent on who patients know, not on their clinical need.

Although at pains to lay no blame on NHS doctors, whom he praised for their ‘fantastic’ care, Mark questioned the present policy.

He said: “The reference panel seems to be set up in a way that makes it difficult to obtain a referral. Not all doctors know about it and by the time we found out, it was too late.

“It’s playing with peoples’ lives and it’s wrong. I sent numerous emails to ask what was going on and didn’t hear back and if we hadn’t have taken matters into our own hands I really dread to think what would have happened.

“We could wait no longer and I don’t like to say it, but if we had have done, she might have died.”

Melissa’s fiancé, James Pegram, added: “NHS matters like these are very slow and it can be difficult to find out what’s going on. The system of referral should be more transparent.”

* Generous donors continued to swell the fund this week. Staines firefighters started a month-long moustache growing competition after meeting Melissa at a sponsored run for her last month

Firefighter Jason O’Herlihy said: “She’s such a nice girl and her story touched us all. She’s so young – it just brings it all home and we wanted to do something that could help.

“There’s been a lot of chat here about who will grow the best and worst moustaches. I will probably get the worst because mine just grows in patches.”

On Friday, kids from St Ignatius dressed in pink, lifting the amount of cash raised by the school to an impressive £27,000.

And the following day, 120 people braved sub-zero temperatures to trek 10 kilometres around Bedfont Lake for the fund.

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Healthcare’s biggest problem, IMO, is the third party payer system. Even for routine care, the insurance company pays for the majority of the cost. Why does this even make sense? Why aren’t we debating, for example, how much food we should feed to a person? Because everyone pays for their own food and can eat as much as they want AND as much as they can afford. Wouldn’t it be stupid if I paid only $10 any time I went to the local grocery store regardless of what I bought? And then the grocery store and my “food insurance” company fight over the actual price of what I purchased.

BTW, don’t get me wrong, I am not saying the poor should be screwed. I think a real “insurance” plan that covers possibly everyone in case of a costly injury or illness is absolutely necessary. I don’t even mind if the government provides this — just add to the taxes.

This will sound funny, but I think the problem with healthcare today is it is not expensive enough — not for the people who use the service.