Tuesday, May 12, 2009

Future Health

I was impressed at the headline, something to the effect that "Obama and Health Care Industry Promise Two Trillion in Health Care Savings." Heck, even constant curmudgeon Paul Krugman sounds impressed:

"The fact that the medical-industrial complex is trying to shape health care reform rather than block it is a tremendously good omen. It looks as if America may finally get what every other advanced country already has: a system that guarantees essential health care to all its citizens.

And serious cost control would change everything, not just for health care, but for America's fiscal future. As [Budget Director Peter] Orszag has emphasized, rising health care costs are the main reason long-run budget projections look so grim. Slow the rate at which those costs rise, and the future will look far brighter. I still won't count my health care chickens until they're hatched. But this is some of the best policy news I've heard in a long time."
Indeed, if big insurers and other suckers-out of health care dollars are even talking about participating in reform, it can't be a bad thing (although you can be sure the "Swift-boating" is on the way, not to mention the Orwellian double-speak). Alas, the fine print suggests something less encouraging: it seems, in the usual government-speak, "cutting" costs really means "not raising them so much." It refers, evidently, to a 1.5% reduction in the rate of increase.

Well, if Paul's happy, I'm (sort of possibly) happy. Still, it's a long way from the real deal: single-payer (which is not -- I repeat, NOT!! -- the same as nationalized health care), and addressing the real sources of skyrocketing costs: end of life care, for example; inefficient delivery; choosing other than the most effective means to solve a problem (demagogued by the RWS™ as removing choice [what, they're pro-choice???] from the consumer).

I'd guess the fact that insurers are even giving lip service is a sign they're worried about losing their cash cow; it is, perhaps, a result of Obama's seriousness about reform. It's potentially a big deal, so far be it from me to criticize. What we'll need eventually, though, is an actual decrease in the cost of health care (maybe measured as percentage of GDP?), as opposed to a lowering of the rise. For that, there's still a hell of a long way to go.


  1. Sid, I mentioned in another of your posts that my ex-husband's was a rural general practitioner who sharpened his skill during WWII. He warned doctors becoming dependent on medical insurance reimbursement would eventually lose their independence. He saved his biggest rants to warn against "socialised medicine" & dreaded communism.

    I'm not happy with this "deal" at all, but it is a foot in an other-wise closed fraternity door among insurers & Networks. 30% is adminstrative costs that are duplicative expenses, but coding, etc. provide "pettycoat junction" jobs.

    Meanwhile, don't expect the "deal" to actually save much of anything but executive's future salaries & bonuses.

  2. oops... should've previewed first.
    "ex-husband's FATHER" was a rural doc.

  3. As Krugman notes, "I would strongly urge the Obama administration to hang tough in the bargaining ahead."

    Obama and his administration does not exactly have a stellar track record hanging tough in bargaining and negotiations.

  4. Robert Reich notes, "The only troubling thing about the President's statements today concerning health care reform was what he did not say: that he wanted a any health plan that emerges from Congress to include a public insurance option for Americans who do not want to buy private insurance. But without this option, there will be no pressure on private insurers to adopt all the other reforms to control costs or give all Americans access to affordable care."

  5. Also note: The idea of offering Americans "affordable" health care is inept. With, what, we're projecting about 12%? of Americans unemployed and looking for work, and god knows how many Americans underemployed or employed and not looking, we're going to need outright subsidies, not mere affordability, to call (with a straight face) our health care system "universal".

  6. er, ...god knows how many Americans underemployed or unemployed and not looking...

  7. I wonder how the word "essential" will ultimately be defined and by whom?
    Historically Government has reduced its cost of health care by reducing payments to doctors and hospitals. The actual cost of providing the care never declined, just the amount you received for it.
    Sid can you recall a year where the costs of running your practice decreased from the prior year?

  8. No, tom, I can't; nor, in the last decades, a year in which reimbursement didn't go down. I managed to make more every year I was in practice, but only by virtue of working harder and harder, to the point of burnout. I've said in several posts here and on Surgeonsblog that, to date, the only efforts at cost containment have been one form or another of cutting reimbursement to providers. We need to get real. Unfortunately, even if Obama is as serious as I think he is (and occasionally I'm not sure), the politics in Congress will make it close to impossible. Unless voters keep pushing up.

  9. Physicians need to decode the Washington speak to help the average American understand what Washington folks mean when they say reduce cost, provide essential services, improve access etc.

    Exactly how will the Government generate suffficient numbers of physicians, who are geographically disbursed to provide all of this care?

    In my State (Ca) there are ~ 126,000 licensed physicians, ~ 96,000 of which reside in the State and ~66,000 of which provide 20+ clinical hours per week. 58% of these folks live in one of 5counties.

    50% of primary care docs and 66% of the specialty docs will not treat MediCaid patients.

    So if you are covered by MediCaid you have no guarantee of being able to find a physician to care for you.

    Coverage does not equal access don't people get it?

    I would also put in a plug for Americans taking some personal responsiblity for their health..AND remind folks of the key message in John Kennedy's inaugural speech..."ask not what your country can do for you....


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