Maggie Mahar Explains Why Healthcare Costs So Much

Maggie Mahar was on NPR's Fresh Air with Terry Gross yesterday. Here's her interview:
The Costs Of Health Care, Political And Financial

A few highlights:

Terry Gross (TG): One of your main concerns is that we need to eliminate unnecessary and ineffective treatments.

Maggie Mahar (MM): That's right. But then, that has to be done very carefully. I mean, this is not fat that's hanging out on the edges of the steak where you can see it. This is fat that's marbled through the meat.

MM: So we need to take a scalpel and very carefully excise that waste. And that's why we need a panel of physicians, health care experts, looking at the evidence. That's what President Obama has proposed: having an independent, bipartisan panel of doctors and other medical experts that is shielded from Congress and lobbyists to a large degree that is simply looking at the medical evidence and making decisions about which are the most effective treatments for patients who fit a particular medical profile, and then issuing guidelines -not rules, but guidelines - that will help doctors and steer them and patients toward the most effective treatments.

Here she discusses a single-payer system:

TG: If you had your way, what kind of system would you create? Would it be a single-payer system?

MM: If I were czarina, this is what I would do. I would create a hybrid system much like the system that the Obama administration is trying to create where you have both public sector insurance and the option of private sector insurance.

MM: Why don't I want a single-payer plan? First of all, it would be enormously difficult to persuade everyone in this country who has employer-based insurance to give it up and go into an unknown government plan.

MM: Secondly, and maybe even more importantly, a government plan, if that was all we had, depending on the politics of the government, could take away things that many of us feel are necessary to health care. It could become very stingy. It could decide only to cover certain people. It could decide to penalize people who were fat or who were - had other, you know, problems - mental-health problems, etcetera. And that's why I would always want escape hatch. I'd always want alternatives to the public sector plan and for Americans to be free to choose which plan they wanted.

Maggie Mahar authored Money-Driven Medicine: The Real Reason Health Care Costs So Much in 2006. From NPR:

"Money-Driven Medicine argues that, over the past century, the history of U.S. health care has been shaped by corporate interests' gradual encroachment on physician autonomy. According to Mahar, this has produced a system of costly and inefficient competition among providers, leaving Americans worse off than citizens of other industrialized nations."

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Here's a video of Ms. Mahar discussing the same points as above. (The actual interview starts at 1:40. I'm not familiar with the venue or hosts.)



About medical tests, she said that while all tests provide risk, not all tests provide benefit. And sometimes tests harm, either through side effects of the test, or returning a false positive and requiring more risk-involving tests.

One test she said physicians could provide is listening and talking to a patient, but that doesn't generate income:

"It's not lucrative to talk to and listen to a patient. Doctors aren't paid to talk to a patient on the phone or to return an email. We pay primary care doctors, palliative care doctors who keep you out of pain when you're dying and offer you options, much less [than specialists]."

Also said: Medicare's administrative costs are 3% compared to industry's 25%. That's some discrepancy.

This woman knows her healthcare.
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