Critique of "Medical Waste Article"

The following is my take on an article on eliminating waste in health care with the hope of reducing costs. It has major flaws:

This list is a bit problematic. It disregards some facts of medical economics and puts far too much onus of cost reduction on the ill making it confrontational, interfering with the doctor-patient relationship. My critique is as follows:

Overtesting: The costs for testing are relatively fixed. It costs no more for a lab to do 1000 tests versus 2000 tests except for the small expense for materials and upkeep of equipment. Personnel is any service's major outlay and changes little because the technology can handle doubled loads without adding to personnel. In fact most hospital's labs are under utilized and seek to have outlying labs or pick up from doctors' offices. If this revenue disappeared the hospital would have to find some new source of income to pay for other services like inpatient care. No savings here.

Processing Claims: This is probably is a true assessment but hints to a better solution. Under a Single Payer Plan there would be double the savings or more as billing departments would be reduced to a fraction of what they are now. This is a biggy.

Ignoring Doctors Orders: Better interviewing techniques on the part of the physician would be a bigger help here. Making the patient the enemy is never a good idea. Educating the doctor is always the preferred route. Also preventive care adds to costs. It does not reduce it. It requires more personnel to care for patients to accomplish this and also people will live longer. Although a goal we desire, old age care is our largest medical outlay. Medicare accounts for 50% of nation's health expenditure. No savings here either.

Ineffective Use of Technology: Medicine is at its best when there is excellent personal care. The technology is suppose to enhance this by removing time consuming tasks. This would allow more nursing care and hence increase the health care budget. Nurses have always fought for smaller patient to doctor ratios. Good attention to infection control calls for single patient rooms, again adding to the expenses for good reason, but again making care more costly. Again, no savings here.

Hospital Readmissions: This depends and is a conclusion reached from being too far away from the ground level. If patients are frailer and sicker they will be admitted and readmitted more often. Further hospitals, because of reimbursement rules, push patients out by cook book guidelines, even if their physician wants them to stay longer. The waste here is the marching orders, forums by hospital management, and the poor use of case managers' time. This once more goes to the fixed cost argument. For a particular insurance company it may reduce cost but overall no savings since the hospital now has extra administrative costs. The claims receivable loss to the hospital will have to made up somewhere. Again no savings to the overall health care bill.

Unnecessary ER Visits: The same economics holds here. The hospital will be out of cash if these patients don't show up. So the cost will have to replaced for the same reasons given under the lab above. The expense for the ER is pretty much fixed within a wide range of services. Sorry no savings.

Hospital Acquired Infection: No strong issue here. This can be a savings in time and expense of medications. However the research to bring this about and the extra time and personnel to accomplish this will offset any real savings. The advantage is in saved human lives.

This piecemeal approach to an inefficient health care system is leading us to Rube Goldberg solutions. It is the payment system that is mostly at fault here. It drives resources to where a buck can be made when the underlying nature of health care is a fairly fixed cost system. It is the addition of personnel and real estate that adds to the bill. This can not all be stopped nor should it be , but a single payer by budgeting hospitals so they do more careful planning for their services and allowing people to visit their doctors in their offices would help greatly. However, by far, the most benefit to the nation is controlling administrative costs. Single payer's biggest strength is just that and it has a proven 44 year record with Medicare with a 3% overhead.