Thursday, July 5, 2012

That Was Then...

I read, the other day, a telling comment: both candidates have stood for the same health care reform plan. The difference is one has the support of his party, and the other's party is running away from him on it like a rat from a cat (my words). It'll be entertaining to see where the it's a tax - it's not a tax contretemps will end up as November approaches. Poor "tell me what to say and I'll say it" Rominee: his false claim of never raising taxes in Massachusetts vs the false claim that Rs want to make about the ACA.

Knowing Mitt as we now do, let's assume he'll just tell both lies at the same time. It's a lifestyle choice.

[Update: well, I guess we know: it's a tax. Except that he lied about it, as you'd expect. He said the majority of the court said it's a tax, which, as we know, is flat-out wrong. One of nine said it's a tax. Nice try, Mitt, ass-coverer. He went on to add that at the federal level it's a tax, and at the state level, it's a penalty. Even better. Fact is, it is what it is: a conservative idea, first enacted by Romney, and now by Obama. Call it what you want. Evaluate it on its merits. Yeah. That'll happen.]


  1. OK, Your Side won, Mine Lost, I was wrong(by one vote), Obamacare's the Law O' the Land, and it won't be till 2018 when it takes 9 months to see some Khazakistani Quack in a Borat suit for friggin toenail fungus(don't you hate that?)
    Except for me,cause I'm stockin up on everythang I might need for the next 20 years...
    Just the basics, anti-inflamatories, anti-biotics, antifungals, Methaqualone.
    Just kidding, I've never taken an Antibiotic in my life..
    OK, that ONE time I don't use a condom...


  2. This is an interesting adjunct to the BHO care = Romulus care talking point:


  3. Thanks, PT, it's an interesting article. What's also interesting is that Romney still takes credit for Massachusetts, and that Massachusetts' plan is generally seen as a success.

    So I guess he's taking credit for any successes and stands ready to blame any problems on Patrick, huh? It would be typical.

    In my view, any plan that touts "market forces," as the headline of your link does, and as all the Rs do, raises major skepticism on my part. "Market forces" is what we have, what we've always had, and it's never led to cost containment or a way to get coverage for those unable to afford it, or with preexisting conditions, etc.

    "Market forces" are exactly the problem: clearly, it doesn't apply to health care economics. Maybe not in my lifetime, but sometime, assuming the US survives Republican budgetary devastation, there'll be a single payer system available to everyone.

    Being America, likely there'll be private insurance and broader coverage for the wealthy; and I'd assume providers would not be government employees. But until a single payer system is in place there'll never be meaningful cost control or broad coverage, and the US will continue to provide inferior care for the masses, at greater cost than any other country.

    Count on it.

  4. One could argue that medicine lost its market forces due to: 1. FDRs wage freezes leading to more lavish insurance benefits being paid for by employers rather than individuals and
    2. Medicare/CMS creating a completely arbitrary reimbursement system in the 60's.

    How do you figure there are market forces present in a system Where consumers are shielded from prices and all suppliers charge almost identical, arbitrary prices?


  5. It's the Rs that argue for market forces. And I think with that term both they and I are referring to leaving it up to insurance companies; Rs argue that they'll compete for business by offering cheaper products. And why would that be? They haven't yet.

    Your Atlantic article is interesting, too. Did you read what Singapore does? Do you like it?

    Once again, it's my feeling that health savings accounts, premium supports, all the things that Rs claim will fix everything are just -- not unlike the ACA in many ways -- sops to insurance companies, allowing them to continue to suck 30% of the money that would be going to health care out of the system and into the pockets of investors. And, as I'm sure you know, having dozens and dozens of companies drives costs up further at both ends, with the need for countless people to manage the forms and bookkeeping.

    We agree, I think, that market forces don't work in health care, and you outlined a few reasons why. So why would a system based on private insurers creating markets -- ie the present -- fix any of that?

  6. There is some evidence that increasing High Deductible Plans + HSA's can slow the growth of spending. It's what has always worked for my family and a the disincentivaztion of this plantype is key reason why they dislike BHOcare.

    I like Singapore's plan, especially universal catastrophic coverage, from a philosophical standpoint. It has elements that satisfy almost all ideologies. I think it could work well here until our politicians start modifying it in a quest for more votes.


  7. You like the forced withholdings in Singapore? I'm surprised. Not very libertarian. And your article compares very homogeneous societies and, in the case of Singapore, highly regimented ones, with our diverse and chaotic one.

    The problem with the high deductible approach is that it doesn't lower costs of care, it lowers spending on it; ie, as is the case now, people will put off needed care, stuff that would cost them money. Then, when it's too late, they get care which is way more expensive.

    What's needed, beyond getting rid of insurance companies, is effectiveness research, among many other things. But as soon as it showed up in the ACA, it got demagogued as killing grandma and death panels. Really cynical, really damaging.

    When I operated on people I saved insurers thousands of dollars by being more efficient in the OR, managing their postop care carefully (including making rounds at least twice as often as my colleagues.) The things I did are teachable; were they incentivized -- and were the costly ways others did it disincentivized, it'd go a long way toward controlling costs. As would looking at countless similar instances of unnecessary costs and unrecognized (by too many) inefficiencies.

    High deductibles do nothing in that regard. I assume it keeps people from seeing a doc every time they get a headache, and that's good. But it's small potatoes in terms of overall health care costs. So I'd argue, anyway. And, as I already said, it institutionalizes one of our most serious problems: people not getting care because they can't afford it.

  8. P.S., PT: here's a commercial you might find useful, assuming you're not already using... As a physician, I'm here to help.

  9. Oh! Look, the "Invisible Hand of The Market" gestures again...Oh! Look,it's giving us the finger...again!



Comments back, moderated. Preference given for those who stay on topic.

Popular posts