If you read here often enough you see the word algorithms all the time, as this is what everyone is using to make their decisions today, the formulas or math that is used for projections.  This articles makes sense out of what we are all debating:  when benefits are more generous, fewer people are covered, but when you restrict benefits, more receive limited healthcare.  image

Cost of Healthcare – Nobody Will Get This Right as Technology Throws you a New Left Curve Every Day

Here’s an excerpt from the link above:

“You want to run algorithms and cut and deny care, well that can cut costs in one area, but it creates problems in other areas and pits everyone against each other with meaningless judgment and creates bad will.  Why do you think we all hate the insurance companies, because the pendulum has swung too far with ethics going in the toilet for profit.  There’s a lot of room for improvement and cost savings with technology but there’s no big hatchet that fixes this. 

I have watched this process evolve for years and 2 years ago I said within 1-2 years we would be close to having riots in the US over healthcare, and I think we are pretty much right there.  When you deal with data, coding, aggregation and have some hands on with all of this, it’s not that hard to see and project where things are going and I’m not alone here by any means, there’s others who see this too, but maybe they are not as vocal.

All of this talk tires and bores me at times as we have people making decisions that don’t have the knowledge I quoted above at the helm and thus we have a mess.  Between the 2, one being tech savvy and the other being the folks living in the 70s, the cultures collide.”

Nice to see the New England Journal recognize and publish similar information here, as it is true, the algorithms are creating the rules we live with or live by, and they need to be correctly done, and that includes more than just math, morally correct an perhaps that will happen when we have members of Congress who participate and get a hold of the entire process instead of the belief all of healthcare reform “is for those guys over there”.   BD

“Uncomfortable Arithmetic — Whom to Cover versus What to Cover | Health Care Reform 2009”

Much of the current debate about expanding health insurance coverage avoids addressing an uncomfortable trade-off: with a limited budget, making benefits more generous means being able to cover fewer people. Moreover, designing insurance benefits that are limited to coverage of higher-value care but are extended to more people will generate greater improvements in health than providing unlimited care for fewer people. Policymakers and patient advocates are reluctant to acknowledge that in a world of scarce resources it will not be enough to eliminate waste: we will have to make active choices in our public insurance programs between increasing the number of people covered and increasing the generosity of that coverage.

Unfortunately, the mere recognition of the existence of trade-offs does not tell us how best to make them. There are no easy solutions in which all people receive all care that might potentially benefit their health. There is only 100% of Gross Domestic Product to go around, whereas we could theoretically spend a virtually unlimited amount of money on health care. As medical technology advances, there will continue to be new treatments that will offer incremental improvements in health at increasingly high costs, and we will have to decide how to allocate scarce resources among treatments and among people. To date, there has been little debate in Congress about the generosity of public benefit packages, except for whether such benefits should cover abortion. But eventually, we will have to engage in the difficult discussions required to choose whom and what our public insurance programs should cover. Some might call this rationing, but the reality is that millions of Americans now have no access to lifesaving medical technologies at the same time that public resources are being devoted to covering less-effective therapies for less-serious conditions. We find that sort of rationing hard to justify.

Uncomfortable Arithmetic — Whom to Cover versus What to Cover | Health Care Reform 2009


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