PHILADELPHIA REFLECTIONS
Musings of a Philadelphia Physician who has served the community for six decades

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(1) Obamacare: Spare Parts for a Book
Maybe these should have been included, but it was decided to leave them out.

Data Sources for Health Care

OTHER REVENUE PROVIDERS WITH POTENTIALLY USEFUL MEDICAL DATA, MOSTLY UNUSED

Although some research discoveries are stumbled on by accident, most of the important ones derive from asking the right questions. If you don't ask the right question, you can wander around in a laboratory white coat for a lifetime without discovering much that is worth knowing. We already have huge stores of data, much of it in electronic form, about the health system. It mostly comes from people paying bills:

Health Insurance

Health Savings Accounts

Payroll deductions for Medicare

Medicare premiums

Military Medical Systems

Veterans Administration

Government subsidies to Hospitals

Medicaid (50-70% Federal)

Social Security

Life Insurance

Premium Investment Income

Cash payments (weak source)

Unclassified Remainder

To summarize the data sources already in existence raises questions of privacy and overwhelming government intrusion into the lives of citizens. That might well be a threat in forty or fifty years, but the disaster of the Health Insurance Exchanges trying to use a small particle of this data is reassuring, in a discouraging sort of way. These systems were originally devised to ask questions of no great relevance to national health costs, so they pose no great temptation to a wandering medical snooper. But they almost always have to meet some sort of an annual budget, so the answer to the question we are now asking is mostly available to everybody, on the Internet. It should be comparatively easy to learn, with adequate accuracy, how much is being spent on what kind of person, right now. If the total comes anywhere near 18% of GDP, we have as much detail as we need for this book to defend the conclusions it draws. We can tell the gross amounts, and by dividing by 350 million, get the average per person costs. Apportionment by age is somewhat less precise, but the numbers are so large, age stratification can be fairly accurately estimated. Let's start with a question we think we know the answer to.

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