Variation in Medicare Spending:

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Variation in Medicare
Spending Some Regions Already Spend at Canadian
Level
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Overuse of Cardiac Stents

• 15 of all stent procedures are appropriate - for
  acute heart problems (ACS)
• But, 85 of stents are done for stable heart
  problems, where no better than simple drugs.
• Patients treated only with drugs are 11 more
  likely to eventually need a procedure.
  
• Hence, 62-75 of PCIs are unnecessary, costing
  13- 15 billion/year (of the total 20,000 spent
  on stents).

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Quality of Care Slightly Better in Canada Than
U.S. A Meta-Analysis of Patients Treated for Same
Illnesses (U.S. Studies Included Mostly Insured
Patients)
Source Guyatt et al, Open Medicine, April 19,
2007
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For-Profit Hospitals Death Rates are 2 Higher
Source CMAJ 20021661399
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For-Profit Hospitals Cost 19 More
Source CMAJ 20041701817
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For-Profit Dialysis Clinics Death Rates are 9
Higher
Source JAMA 20022882449
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New Bad Ideas from the Private Insurance Industry

• Consumer-directed care skimpy coverage
• Individual mandates like Massachusetts (force
  the uninsured to buy skimpy coverage)
• Corporate disease management replace primary
  care with firms that manage care for patients
  with diabetes, heart failure, etc.
• Let private insurers compete with Medicare or
  similar program

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Walmarts Plan Attract Young, Healthy Workers
by CDHP Mandatory Physical Exertion
Actual copy of internal memo from VP for Benefits
to Walmarts Board of Diectors, 2005
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Individual Mandates

• MA law
• Proposed in NY and IL
• Component of plans by Edwards, Obama and others

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Crimes and Punishments in Massachusetts
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Corporate Disease Management Programs

• No evidence that any disease management program
  lowers costs.
• Fair evidence that non-profit disease management
  programs led by health professionals improve
  quality.

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Private insurers competing with Medicare

• Edwards and Obama proposal
• Already policy within the Medicare Advantage
  program

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