August 5, 2009

Health Care Reform, Part 4: Noodling Around



So, with Washington on recess for August and our elected representatives home for vacation and hopefully gathering the pulse of their constituents, here’s a few things for them (and us) to noodle on. And you know of course the fun with noodles is trying to figure out where the end is, which end is up, and how to separate them into individual noodles worthy of your attention.

What's the metric for inclusion in my bowl of noodles? Well, whatever strikes my fancy – some of it is opinions, some of it’s facts (and a nickel to those who can tell the difference) and one’s just hysterical. Let's roll:

The Washington Post has a panel of experts who discuss health care reform. Here are some excerpts of their views on the public option.

  • Umpire or Play Ball, Not Both "I work on behalf of small businesses and they need rising costs to decelerate. That means making the private insurance market more competitive and empowering consumers and providers to find ways to restrain costs. Asking the government to be both umpire and player is no way to get that job done."
  • Haven't We Learned Our Lesson? "The logical answer is no, a public option is not necessary. The federal government should be doing only the 20 activities specified by the Constitution -- and health care is not one of them. Today, actually, more that 50 percent of health care is already delivered by the federal government, if one adds together Medicare, Medicaid, the Veteran's Administration, the military, employees of the federal government, etc. And yet all those are fraught with problems (not unlike "civilian health care"). So why would anyone believe a public option would solve problems, control costs and "keep insurers honest"? Haven't we learned our lessons from "managed" care, the postal system and the rail system regarding cost containment by the federal government?"
  • The Only Option "A public health plan is the only option to secure affordable quality care for all Americans. Let's put this in perspective: Canadians and the British have enjoyed universal health care for over 50 years. To say that these plans aren't working after they have met the needs of a generation of people is laughable. There is no contest to facts that indicate that these countries enjoy better health and longer lives."
  • Getting Everyone Covered Efficiently "The public insurance option would be built to lower administrative costs, utilize electronic health records to minimize paperwork, cover all individuals regardless of preexisting conditions, focus on prevention and wellness and generally produce healthier participants. It would allow us to start from scratch and create the ideal insurance program based on proven concepts. It would also inevitably force private insurers to examine their current practices and innovate to remain competitive."

Here’s a great opinion on cost savings, which I think fires on many of the right cylinders:
We Must Threaten the Status Quo " The health-care reform spotlight has shifted from taxes to cost savings. The danger is that Congress will fall back to old habits and make its usual cuts to physician fee schedules, medical education, social programs, etc. The "big ticket" opportunities lie elsewhere". The author goes on to list several of them, including tort reform, drug costs and a need for the government to negotiate discounts, exploding medical technology costs, preventable errors (never events, in the parlance), and payment for the volume of services done, rather than the quality of care, which is a slippery slope. He also touches on end of life care, another contentious part of the discussion on Obamacare.

Speaking of malpractice reform, here's some data on the impact of medical malpractice to health care costs in Massachusetts. There's lots of info in the study but the bottom line is, in some cases more than 25% of services rendered were 'defensive' in nature, meaning the physician performed extra services as protection against possible malpractice suits. Not sure about you, but that doesn't seem like the best way to treat a patient. It's funny how much we hear about untrustworthy, evil health insurance companies, but not so much about those nasty trial lawyers we used to hear about...wonder how that happened? Where is John Edwards these days, anyway?

Back to the public option, which is supposed to include payment for quality care in addition to all of its other benefits: "Joining the resistance against the public option have been providers held up as models by Obama, such as the Mayo Clinic, which argues that rates linked to Medicare would be too low and fail to reward cost-effective care. Reformers say that the Medicare link is needed at the outset to get the new public option off the ground quickly but that the House bill would allow the government to set public option reimbursements in a way that rewards high-quality care instead of on a fee-for-service basis. But Mayo chief executive Denis Cortese said the government should try such payment reforms with Medicare first. "I don't see why they have to create a new public plan to start paying for value," he said. "

Hmm...why is that? If Congress is convinced that it can work, why don't they test it on Medicare first, reap the benefits (assuming there are any) and then go ahead and put it into the broader marketplace? Or, why don't they try it on their own plan first, let us know how it works, and then put it into the broader marketplace?

And here’s a fun comment from Senator John D Rockefeller IV , from the same WP article: "Other Democrats disagree, saying that reform without a strong public option is doomed to fail, with private insurers reaping a bonanza of new customers while costs continue to escalate and premium subsidies fall short. "Health insurance by its very nature is a rapacious industry. [Insurance companies] want to make a lot of money," said Sen. John D. Rockefeller IV (D-W.Va.). "We have to have a strong counterbalance to them." I tell ya, you've got to love a person who inherited more money than God complaining about an industry trying to make money.

But give him credit, at the same time he’s bashing health insurance companies, he’s also focusing some attention on prescription drugs, which account for the largest portion of out-of-pocket health care costs. The problem is the prescription drug industry is helping craft health care reform. Oh wait, that's not a problem. It's only a problem that health insurance companies are trying to have a voice too. I keep forgetting that part.

In summary, if one can actually summarize this debate, now that our representatives are home, here’s what they’re up against – some great poll numbers from the Wall Street Journal. If most of us are happy with our coverage, and most of us think the government will screw things up, and most thing that taxes will go up to pay for it, our leaders have a dilemma.

The article’s author sums it up better than I can: "In political terms, the most important reality will be how the reform affects the 68% who say they have good or excellent health-insurance coverage. If they end up having to change their coverage, pay significantly higher taxes, or encounter some other unpleasant reality, congressional Democrats will look back on this August as a time when they should have listened more closely to the folks back home."

Enjoy your noodling.




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