Health Care Reform: Between the Shouts, Calls for Equanimity
Justin Gardner seeks some common ground, as do four physicians in an op-ed in today’s NYT.
The latter write that, in the debate over reform so far …
We have really discussed only two options: raising taxes or rationing care. The public is understandably alarmed.
There is a far more desirable alternative: to change how care is delivered so that it is both less expensive and more effective. But there is widespread skepticism about whether that is possible.
They go on to suggest it is possible:
To find models of success, we searched among our country’s 306 Hospital Referral Regions, as defined by the Dartmouth Atlas of Health Care, for “positive outliers.” Our criteria were simple: find regions with per capita Medicare costs that are low or markedly declining in rank and where federal measures of quality are above average. In the end, 74 regions passed our test.
So we invited physicians, hospital executives and local leaders from 10 of these regions to a meeting in Washington so they could explain how they do what they do.
[ ... ]
There is a lot of troubling rhetoric being thrown around in the health care debate. But we don’t need to be trapped between charges that reforms will ration care and doing nothing about costs and coverage. We must instead look at the communities that are already redesigning American health care for the better, and pursue ways for the nation to follow their lead.
Both items are worth a full and fair read, if (like me) you’re tired of Republican extremism status-quo-ism, but not ready to accept, hook-line-and-sinker, the solutions pushed by House Democrats.
11 Responses to “Health Care Reform: Between the Shouts, Calls for Equanimity”
Is it extremism or dysfunctionality? The GOP is far from extremist here, as on other issues. (Going along with big government status quo is not the definition of “mainstream,” or “moderate,” after all, and the pre-and-post-1994 Republicans, for example, were not “extremists,” despite Christopher Dodd's and many others' slanderous lies to the contrary — slandering the public as well as the GOP politicians.)
The House GOP has been _suppressed_, while on health care everyone who's involved (including President Obama) uses the House Dems' bill as the assumed legislation whose passage is to be sought (neglecting what Republicans as well as Democrats in the Senate are ready to propose in place of it).
It merits asking _again_ why simple insurance reform couldn't have simply been sought, along perhaps with a rare Obama promise actually met (which to disbelieve is far from “extremist”), Medicare reform, before attempting anything complicated, rushed, destructive, and sloppy, as the Dems have done so far.
There is no common ground in this debate unfortunately. It has been skewed, owned and controlled by MedMob for so long now and polarized to such a degree that we must debate it loudly. And we will. Both sides. We're not laying down now. Kathy I think said it elsewhere that the original public option was a compromise itself. Now naturally they want to “compromise” it right out of the discussion. Nyet, no, nein, not gonna happen.
We will keep up this heated march, this foaming fued until people get the human-right of basic health care guaranteed. We need it. Our industry and small businesses need it to compete globally and our nation as a whole needs it, yes, for fiscal recovery over the long haul. Nobody is deluding themselves that the fix to Cheneyco's trashing of our economy by financial deregulation and costly public-funded attempted corporate takeovers in the Middle East is going to come quickly and with an easy fix. The public option is the fix to the main bleeder that is making our backbone woozy.
MedMob doesn't care. It really doesn't care. Let me say it again that as long as it can string this democracy along long enough and just enough to gut us each and everyone of our personal finances via premiums or costly deductables or discontinuance after paying premiums for years, it will. It cares not one iota for the consumer and especially not for those who aren't able to afford to consume their coverage.
What they have done is they've priced and racketeered themselves right out of the market. They knew there would come a day when their audacity would be exposed. Instead of being smart business people they just kept up the pace without slack…100% 200% 300% 500% profits while fewer and fewer americans received care. Then we got sick of their abuse. If they'd lowered their rates and included more people sooner, the venom against them wouldn't be nearly as bad. But no. Greed won the day. In the immutable laws of Capitalism, those who do not adjust to the markets shall perish. MedMob failed to adjust their practices to the market.
Silhouette
Whereas I agree with your passion, I'm less sanguine as to the process. As it stands now, the health care debate is not between Dems and Repubs, it's between those bought and paid for and those who are not.
The double compromise on the public plan is a case in point. Blue Dogs have called for the elimination of service-cost negotiation. We're fighting dollar democracy, the best that money can buy.
Gawande is the doctor who wrote the article comparing McAllen and Grand Junction. While I think he's on the right track in focusing on over-utilization as a way to control costs, I haven't seen many specifics on how to accomplish it.
Controlling over-utilization means doing something both doctors and patients hate – saying no to things. That means pre-authorizations, reviews, guidelines, algorithms, etc. In some cities the physicians have a culture of controlling themselves, in others they do not. How to get one group to act more like the other is difficult.
Controlling over-utilization means doing something both doctors and patients hate – saying no to things. That means pre-authorizations, reviews, guidelines, practice algorithms, etc.
That's what insurance companies do now.
On a radiation oncology e-mail list that I am on, the discussions have turned to how different facilities are cutting costs. One hospitals has told all of their oncology departments to drop out of research protocols and give up on research so that they can have more capacity for standard of care patients where they will get paid. Another hospital has had across the board pay cuts.
Why should anyone look at healthcare as a career given the changes proposed by Obama Administraiton and the Democrats in Congress?
That's what insurance companies do now.
You're correct. It's an irony that in order for the government to control costs they will need to be more like the entities they currently criticize.
It's an irony that in order for the government to control costs they will need to be more like the entities they currently criticize.
That's worse than an irony, DaGoat, it's duplicity. The govt officials are trying to sell this plan to the public as though it will 'bend the cost curve', while at the same time they claim it will offer consumers a public option choice which will not do all those nasty things the insurance companies do, and will 'keep the insurance companies honest'.
Even people who don't understand the intricacies of the current healthcare insurance reform plan can see that those two goals are in conflict with each other, and that claiming to do both will likely lead to a failure to do either (and quite possibly, bending the curves in the wrong direction.)
It's an irony that in order for the government to control costs they will need to be more like the entities they currently criticize.
Except that that's not quite accurate, because a public option would bar discrimination for preexisting conditions, and medical coverage determinations would be made by medical professionals (aka doctors) rather than government bureaucrats or insurance company executives.
Some level or kind of rationing is impossible to avoid, DaGoat. The issue is whether the criteria for rationing make sense from a health perspective as well as from a cost perspective.
Measuring the Health of Nations: Updating an Earlier Analysis
DQ:
Thanks for inserting some facts and reason “between the shouts.”