Season 5, Episode 3
In part one (“How Many Doctors Does It Take to Start a Healthcare Revolution?”), we continue conversations from last week’s episode (“How Do We Know What Really Works in Healthcare?”). Anupam Jena, a physician, economist, and professor at Harvard Medical School, told us last week about his study that shows mortality rates improve when cardiologists are away at medical conferences. One possible explanation for his results, Jena says, is that many procedures, although highly effective, aren’t better than doing nothing in certain cases. Read More »
Our latest Freakonomics Radio episode is called “How Many Doctors Does It Take to Start a Healthcare Revolution?” (You can subscribe to the podcast at iTunes or elsewhere, get the RSS feed, or listen via the media player above. You can also read the transcript, which includes credits for the music you’ll hear in the episode.) The gist of the episode: The practice of medicine has been subsumed by the business of medicine. This is great news for healthcare shareholders — and bad news for pretty much everyone else. Read More »
In the first chapter of our new book, Think Like a Freak, we recount an ill-fated interaction that Dubner and I had with David Cameron shortly before he was elected Prime Minister of the U.K. (In a nutshell, we joked with Cameron about applying the same principles he espoused for health care to automobiles; it turns out you don’t joke with Prime Ministers!)
That story has riled up some people, including an economics blogger named Noah Smith, who rails on us and defends the NHS.
I should start by saying I have nothing in particular against the NHS, and I also would be the last one to ever defend the U.S. system. Anyone who has ever heard me talk about Obamacare knows I am no fan of it, and I never have been. Read More »
In New York magazine, Steve Hall lays out the good, bad, and the ugly of cancer-drug economics. Warning: it is mostly bad and ugly.
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The pharmacist e-mailed the numbers, and Saltz stared at the figures on his computer screen. Zaltrap, the drug that was extremely similar to Avastin, cost roughly $11,000 a month. (And because that extra 42 days wouldn’t be possible without taking the drug for, say, seven months before—which was roughly what was happening in clinical trials—the price for that six-week life extension could be as high as $75,000.)
“Wow,” he said to himself, “that’s a deal-changer for me.”
That may not seem like a heretical statement, but the unspoken rule in American health care is that doctors should never consider the cost of a medicine that might be beneficial to patients. When the FDA approves a new cancer drug, it analyzes safety and effectiveness only. Medicare is obliged to reimburse payment for the drug, and private insurers in most states must cover the cost. Any doctor who considers cost—or the value of a costly drug—risks being accused of “rationing” health care.
Writing for the Wall Street Journal, Jeffrey Singer describes a patient who came in for a “simple outpatient surgical procedure” and discovered it was cheaper to just ignore his “low-cost ‘indemnity’ type of health insurance policy.” The patient’s estimated costs had he used his health insurance plan: approximately $20,000 (out of the estimated hospital charge of $23,000). After speaking to the patient, Singer realized that he wasn’t bound by a “preferred provider” contractual arrangement and offered the patient a solution that saved him $17,000:
I explained that just because he had health insurance didn’t mean he had to use it in every situation. After all, when people have a minor fender-bender, they often settle it privately rather than file an insurance claim. Because of the nature of this man’s policy, he could do the same thing for his medical procedure. However, had I been bound by a preferred-provider contract or by Medicare, I wouldn’t have been able to enlighten him….
Most people are unaware that if they don’t use insurance, they can negotiate upfront cash prices with hospitals and providers substantially below the “list” price. Doctors are happy to do this. We get paid promptly, without paying office staff to wade through the insurance-payment morass.
So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a “self-pay” (or uninsured) patient. I quoted him a reasonable upfront cash price, as did the anesthesiologist. We contacted a different hospital and they quoted him a reasonable upfront cash price for the outpatient surgical/nursing services. He underwent his operation the very next day, with a total bill of just a little over $3,000, including doctor and hospital fees. He ended up saving $17,000 by not using insurance.
(HT: Jason Hirschhorn)
1. They said it would never happen: Israel’s ultra-orthodox lose many of their exemptions.
2. Health-care economics: how the American Medical Association prices medical procedures.
3. The most popular page on Wikipedia in 2012: Facebook. (HT: Eric M. Jones)
4. Everyone knows that the French work fewer hours — but judging by their GDP per capita, they are very productive. Read More »
A few weeks ago, before the flu was national news, a reader who works at a hospital in Portland, Or., wrote to say:
“The organization I work for just started this policy, I think it is very interesting and may push those who don’t want to get a flu shot for whatever reason to get a flu shot to avoid the stigma of wearing a mask. The employee comment section has ranged from HIPPA violations to discrimination for those who can’t have a flu shot based on egg allergies.”
Here’s the policy:
Read More »
You may have heard by now: Flu season is ramping up in Oregon, with cases now starting to affect hospitalized patients in greater numbers. For individuals whose immune systems are compromised by other conditions, the flu can be life threatening.
To keep patients safe, a new Influenza Vaccination and Masking policy requires that workforce members do one of two things during flu season: