Posting in Government
The most important fiscal work before America right now is slowing growth in health care costs without impacting patient care. So why are the best reformers being locked-out of government?
The most important fiscal work before America right now is slowing growth in health care costs without impacting patient care.
A key to that is changing medical business models, moving from fee-for-service systems where all the incentives are to spend more toward fee-for-patient models where wellness can turn a profit.
The biggest buyer of healthcare is the U.S. government, and their biggest buyers are Medicare and Medicaid. The Centers for Medicare and Medicaid Services (CMS) need to speed up their usual 3-5 year pilot program process on these business models because we can't wait that long, the Joint Commission argues.
Few doubt there are billions to be saved, not just in chronic conditions but in simple overtreatment, a reliance on tests that lead to expensive interventions.
Researchers at Dartmouth have long argued there are large regional disparities in testing and treatment that don't pay. People don't live longer in Lubbock, Texas than in Waco, they argue. So why do Medicare patients in Lubbock pay twice as much, on average, for care?
The response of those in industry who don't want change is to attack the Dartmouth study, and the same thing is playing out at CMS, where the nomination of Dr. Donald Berwick is being held up by Republicans who claim he supports rationing of care.
(Above is the leading hold-up, Sen. Pat Roberts of Kansas. The link is to his statement on the matter, and the picture is from his Web site.)
The charge is a nonsense. As is the claim Dr. Berwick supports a nationalized system like the British NHS. But if Berwick can be kept out of CMS, he can't accelerate the business model changes needed to make savings happen.
It makes me mad, and it should make you mad, too. It's not just Medicare and Medicaid that need new business models. Private insurance needs them, too. But private industry can't move until the bigger player moves -- their customers would not accept it.
While the politicians fiddle our fiscal house burns. Some of Berwick's opponents are at least honest, calling for an end to Medicare and Medicaid in the name of freedom. Others, like Roberts, are just playing a game of chicken with the public and private purse.
For your costs to fall, wellness must have a profit. We need financial incentives to stay out of the hospital, avoid unnecessary tests, and get sick less.
No one knows more about how to save money without reducing needed care than Dr. Donald Berwick. This is not a partisan point. Previous CMS directors Gail Wilensky (Bush I) and Mark McClellan (Bush II) agree.
As the present system causes costs to rise every year by double digits, more and more middle class people are seeing themselves rationed by economics into early graves.
Keeping the best reformers from trying to make change isn't going to extend grandma's life by one day.
Jun 9, 2010
The government run medical facilities are much worse than civilian facilities. I'm a military retiree and veteran but not recieving anything near satisfaction for what was supposed to be a retirement benefit. Rather, I'm either disregarded or treated like a commodity since the Naval Medical Center, VA facilities, and the supporting bureacratic agencies operate like quasi-government supported entities. Profit and self-interest has replaced service, support, or providing medical treatment in an effective and efficient manner that could help recovery. Don't even ask about dental treatment because it is totally absent unless you can afford the outrageously expensive plan or fees. I can't consider it or even the other medical insurance required to use civilian medical facilities since my pension is much less than a third of that earned during active duty because all the special/hazardous/combat/sea duty pay and allowances are absent but were granted to have a comparable quality of life although required great risk (like possibly sacrificing your life) to be able to get. The government facilities avoid providing a fee structure or any type of statement that associates costs or charges for specific treatment whether or not it was provided. The progress notes in the medical records are rife with errors and fraud. The matter is that those facilities and agencies take advantage of active duty personnel, their families, veterans, and retirees while colluding with the insurance industry. I have submitted formal complaints with evidence illustrating the problems and offenses that I've experienced that include abuse, cronyism, fraud, and other criminal infractions or violations of applicable titles, codes, and regulations as well as blatant disregard for the sections in the patient's bil of rights but nothing has been to address the matter. Since the oversight involves in-house monitoring the lack of objective review is to be expected and mirrors the compromises of protections with staffing regulatory agencies with industry insiders. Even worse is the ineffectiveness and particular disregard by the elected representatives since it appears they are enabling and motivating the activities. It is both absurd and understandable that medical costs across the nation are skyrocketing since the government is leading the way in overcharging and commiting the most egregious offenses while disregarding people with negligence or incompetence. But hey, although they aren't free either, the pharmaceutical corporation deals ensured that drugs are plentiful and prescriptions come easy when the treatment is so negligent and disappointing or otherwise inaccessible. That is the support and thanks that I have received for defending whatever this nation has become. The recent law passed is not a reform measure but worsens the system and provides even more incentive to raising costs while avoiding access, affordability, and quality treatment that provides a remedy to help a person recover from injuries or disease. Mostly, it will minimize and dumb down medicine to the most basic and perfunctory preventative measures while charging exorbitant fees and obtaining egregious subsidies or other government hook-ups to get paid bank for providing services or activities that everybody should have learned while growing up or if they were paying attention during primary education. Don't be surprised if somebody finds a way to get paid several hundred dollars an hour for opening a business that involves simply getting people outside to walk (not p/o physical rehabilitation or therapy but just to remedy a setient lifestyle that is otherwise called laziness). Despite the argument that capitalism or money should never have influenced medicine or gauged the treatment provided to a person in need, money will never be able to ensure that quality or an outcome is guaranteed. I avoid characterizing the insurance and medical mgmt industry as "caring" or associating any part of it as a legitimate social institution when profit is an overarching motive and affordability isn't conducive to their business model when costs are all too often socialized by taxpayers, subsidies, and other unsavory means that restrict opportunity and pervert values. Witholding treatment that causes victims to experience excruciating pain and long-term suffering is not "caring". It's marketing propaganda that made the association and somehow the politicians perpetuate the illusion that medicine managed by corporate-capitalists can only be provided to the highest bidder or afforded by consumers is "caring". It's not at all caring about the health of citizens. Prices for treatment will never become affordable or influence quality, services will never be equitable to whatever is charged, and victims will never obtain deserved compensation when injured or wronged. Since corporate-capitalism has pervaded society and usurped humanistic values as well as replaced the fundamental processes in our Democratic-Republic while influencing representation, impeding opportunity, eliminating protections that would otherwise prevent hazards or threaten the safety and security of people and the environment, and restricting government access so that self-serving institutions take advantage of citizens and privatize their profit (even when purportedly labeled as a public agency or entity since quasi- and pseudo- is more appropriate) yet avoid accountability or responsiblity. Pay attention to the developments as too-big-too-fail (or care) has become adopted by all corporations as an objective to ensure survival advantage and has now been introduced as a way to profit over human life with indifference and without regard for the outcome. So, in order to address financial solvency as well as the health and well-being of ciitizens, Dr Berwick must address the conflict of interest that has existed between the medical mgmt industry, politicians, and the quasi-government sponsored enterprises since they have enabled government-run medical facilities to reduce services while becoming profit-driven as military veterans and retirees are forsaken. All of them should have recused themselves from any involvement with this matter but then there would not have been any possiblity that those mentioned above and the American citizens would have been sold out by this sham that dares to be regarded as legislation. Then again, since elected reps and other bureacrats have altered the law/rules/codes of conduct to obtain and utilize entitled information that allows personal profit from otherwise abuses/advantages of office/appointment and even quais- or pseudo-public agencies and GSEs have lobbyists or staffed with industry insiders that influence legislators for budgetary outlays/earmarks/avoiding oversight and regulations. Sadly and most indicting of the values and moral crisis (along with deep-set apathy and malaise) is that we don't care or unsurprised when even the most blatant breach of ethics or egregious infractions aren't prosecuted, unpunished, and restitution is pithy compared to the damages or crime, while we are barely amazed or surprised at the exceptions when an actual and deliberate investigation is undertaken and prosecution proceeds. Mostly we're surprised that someone was caught, wonder why they couldn't avoid detection, failed to continue evading or influenicing "authorities", or that some people are still around with fundamental ideals and values to care or to dare test the system. Still, no victim is ever adequately compensated or perp deservedly punished especially for the so-called "white-collar" crimes. Go first, go big, and get out.
Dana, You attribute Republican arguments to me and put words in my mouth that I did not utter. I am not a Republican shill or apologist and hold both Democratic and Republican parties in equal disdain. Both parties operating the sausage factory over reach and ignore constitutional limitations on their power. Before prohibition the Constitution was amended to give Uncle Sam the authority. Likewise, before Medicaid, Medicare and Obamacare were established the people and the States should have been given the opportunity to vote on granting new authority. The Federal Government has the authority to tax and single payer is legal in that respect. But providing health care is not an enumerated power, regardless of the general welfare clause. In fact State governments regulate insurance and have constitutional authority to deal with health care matters. But Uncle Sam does not have the authority to mandate citizens purchase a health care policy. Failure to purchase a good or service does not constitute interstate commerce and Americans have never been required to purchase a good or service as a condition of citizenship. If we allow government to instruct us how to spend after tax dollars where will it stop? How would you define disposable income? I propose our lawmakers set a good example and follow existing laws and limitations or follow the amendment process that allows the States and the people to grant or deny new authority. Ask Congress to pass The "Enumerated Powers Act" and cite the Constitutional authority for each law it passes. Part of the Downsize DC Agenda ? http://www.downsizedc.org/etp/campaigns/87
DanaBlankenhorn: http://www.bloomberg.com/apps/news?pid=20601103&sid=az9qxQZNmf0o About 10 percent of the cost of medical services is linked to malpractice lawsuits and more intensive diagnostic testing due to defensive medicine, according to a January 2006 report prepared by PricewaterhouseCoopers LLP for the insurers? group America?s Health Insurance Plans. I guess 10% reduction is not as good as costing $946 billion more over 10 years. http://online.wsj.com/article/SB10001424052748704454304575081264262957600.html President Obama's health plan adds about $75 billion to the 10-year cost of the $871 billion Senate health-overhaul bill, and includes new taxes.
Gee, you argue against the purchase requirement enacted long before this by Gov. Romney of Massachusetts, but then end up claiming it is all a "bailout" of insurers. Yet I know you have also argued against having a public option (which could keep insurers honest) and recoil in horror against single payer, under which other nations get better results for all their people on a fraction of what we pay. The "solutions" you have proposed don't work. You never have considered aligning incentives in favor of wellness. You even have called comparative effectiveness a "death panel." I am not an enormous fan of what passed. Who likes watching a sausage factory at work? But I like having the doughnut hole closed, having my kids covered, and seeing some incentives for wellness in the marketplace. You want to repeal the provisions that keep insurers from cancelling your policy as soon as you get sick, or refusing to insure you because of a "pre-existing condition?" Please, tell us how far your ideology extends. The difference between principle and ideology is that ideology will deny reality to the point of killing people. I see no difference between yours and those of anyone else. A pox on all of them. And please don't give me that crap that I'm an ideologue for supporting the President. The next principle I see him unwilling to toss aside in the face of overwhelming evidence will be the first.
It has been proven that litigation is not the cause of health care inflation, or even of rising malpractice rates. (They're still rising in states which have enacted tort reform to keep plaintiffs out of court.) Yet you keep repeating this lie as though it is truth. Why? Because you don't have anything else?
Obamacare is the health care industry bailout. Unemployment is officially 10% and in reality closer to 20%. Fewer employees and fewer really good policies mean less insurance money to cost shift to pay for the uninsured year after year. And the baby boomers, even in the best of economic times, would result in a smaller population of workers supporting a larger population of retired. But failure to purchase a health care policy is not an act of interstate commerce! Despite the general welfare clause, the enumerated powers do not include providing universal health care! The real question is who gets to determine how insufficient funds are distributed, We the People or federal politicians and special interest lobbies. Insurance is by definition a risk taking business. Premiums are placed at risk in the stock market or other investments. Bad investments result in higher premiums. Health care reform does not guarantee insurers will make good investments. Insurance companies can and do go broke, fail to pay their obligations and close down like any other business. On March 10, 1992 the Courier Journal printed an article by Jane Bryant Quinn of the Washington Post: according to Standard and Poor 121 Life and Health Insurers had gone bankrupt in the last three years. 131 Health Maintenance Organizations (HMO?s) failed in 1986-1990. In some states doctors and hospitals were requiring patients to sign agreements to pay any bills not paid by failing insurance providers. American taxpayers were forced to bailout the nation?s largest banks, because they were considered to be too big to fail. When citizens are forced to purchase health insurance, do ?government approved providers? become too big to fail? Does Obamacare insure health insurance companies will not suffer mortal losses?
One reason people are "over treated" is because of fear of litigation. The rammed down health care bill does make any Republican trust what this administration has done. Obama is playing political chicken with his rampant government spending. Better to stop what is happening and reach a compromise. Grandma will live another day with gridlock in DC.