Quote of the Day

Although the government requirement that an individual be required to purchase an unwanted private health plan is being challenged before the Supreme Court, it is reassuring that Medicare is so well established within our laws that an individual over 65 who is receiving Social Security cannot disclaim their legal entitlement to Medicare Part A benefits, even though they can refuse to receive those benefits.

In his article, single payer is dismissed based on lack of political feasibility, a view widely held in the United States. In contrast, Dr, Reinhardt discusses an all-payer system in which prices are standardized and budgeted by associations - a great improvement over our current system (which Dr. Reinhardt discussed in a previous blog). However, he states, "Admittedly, a transition from the current to an all-payer system for all providers of health care in all states would be challenging, both analytically and politically." Politically challenging. Isn't that like questioning political feasibility?

Yesterday we reported that some of the most politically powerful organizations in the nation have joined together in a coalition to try to weaken the package of "essential health benefits" that will be required of health plans under the Affordable Care Act. Excerpts from two new articles covered in the Kaiser Daily Health Policy Report should have us even more concerned.

The policy community, as represented by Ezekiel Emanuel and Jeffrey Liebman, speaks in glowing terms about idealistic, altruistic accountable care organizations (ACOs) in which health care professionals and institutions join together to improve quality and lower costs. Yet the specifics of the Medicare Shared Savings program that would establish ACOs through the Affordable Care Act (ACA), has only a superficial resemblance to these idealistic models.

One of the greatest abuses of the private insurance industry is taking advantage of favorable selection. Through deceptive practices such as selective marketing, they enroll healthier individuals while receiving higher premiums appropriate for a less healthy population.

Under a well designed single payer system, hospitals would be funded through global budgets, much like police and fire departments, libraries and other civic institutions. Single payer eliminates the need to provide complex, itemized billings for each and every patient to any of hundreds of third party payers. The hospitals are simply paid a global fee that covers all of their costs for the year. As Canada and other nations have shown, global budgeting dramatically reduces the high costs of the administrative excesses that U.S. hospitals face.

Instead of commenting on the cruel and inhumane health care financing system we have in the United States, let's remember Sarah by spending a moment with her.

Recognizing the need to slow the increase in health care spending, much hope has been placed on disease management, care coordination, and value-based payments such as pay-for-performance. Medicare has authorized numerous demonstration projects to prove that these programs are effective. They aren't.

Technology that improves patient outcomes and reduces costs is great. Technology that increases costs, produces undesirable side effects, and provides no evidence of extended life expectancy is... well... not so great, except for meeting the financial goals of the entrepreneurial owners of the technology. And when the owners of the technology are the same trusted physicians who are prescribing it, that's reprehensible.