Since World War II it has slowly evolved into not one but at least three wholly separate entities--each with different infrastructures and different sets of perverse incentives for hospitals, doctors, and other providers. This nutty system of finance is the reason that healthcare expenses are swallowing the U.S. economy (and federal and state budgets), and that healthcare is our biggest domestic policy issue. The healthcare profession has always been quite honorable, but the reality is that these professionals—physicians, nurses, hospital administrators alike—aren't immune to financial incentives, and the incentives created by our current system are completely out of whack.
The demand for healthcare is rising faster than the supply of doctors. The problem is most acute in the developing world, though rich countries are not immune. It does not help that healthcare is notoriously inefficient. Whereas America's overall labour productivity has increased by 1.8% annually for the past two decades, the figure for healthcare has declined by 0.6% each year, according to Robert Kocher of the Brookings Institution and Nikhil Sahni, until recently of Harvard University. But it is in poor countries that interest in alternative ways of training doctors and in alternatives to doctors themselves has produced the most innovation.
Universal Health Services Inc., of King of Prussia, is pushing further into behavioral health, announcing Monday that it had agreed to pay $500 million in cash for Ascend Health Corp., which operates eight inpatient psychiatric hospitals and one substance-abuse treatment center. The planned acquisition, which includes facilities in Texas, Arizona, Utah, Oregon, and Washington, builds on Universal Health Services' $3.1 billion purchase of Psychiatric Solutions Inc. in November 2010. That deal made Universal Health Services (UHS) the nation's largest provider of behavioral-health services, according to the company.
Hospitals across the country have been adding programs in palliative care—which focuses on treating pain, minimizing side effects, coordinating care among doctors and ensuring the concerns of patients and their families are addressed—at a feverish pace. The field has expanded so rapidly that a majority of American hospitals now have palliative programs, to the delight of patients who say they've finally found relief and a sympathetic ear. Palliative care has its roots in the 1970s, but was slow to grow. Several pieces of research helped to advance the cause, though, showing widespread untreated pain in hospitals and nursing homes and the positive impact palliative programs had on such patients.
Gov. Deval Patrick wants Massachusetts to "crack the code" on healthcare costs, a punchy slogan he uses when he's promoting nationally the Bay State's cost-containment efforts. But transforming his ambition into policy has produced some messy sausage-making in his state Legislature. Key stakeholders aren't sure whether the springtime rush to craft a state approach to health care costs will create a national model—much the way Massachusetts's 2006 coverage expansion signed by Gov. Mitt Romney helped create a framework for President Barack Obama's 2010 national health law. In fact, some are wondering whether the cost-savings effort will even work in Massachusetts.
A recent NBC/Wall Street Journal poll found that only 36 percent of voters nationwide think the president's health care plan is a good idea. That means a solid majority of the electorate—64 percent—think the plan is either a bad idea (45 percent) or are unsure about it (19 percent). Moreover, nearly half of those polled (49 percent) would like to see the law repealed; 42 percent oppose repeal. Illustrating public frustration with Washington, the poll also showed that a majority of voters (52 percent) expect the Supreme Court's ruling to be primarily based on politics, while less than one-third (32 percent) think it will be decided mostly on the underlying legal issues.