Healthcare, Cost Control, & Hidden Agendas

My favorite economist, Robert Samuelson, is my favorite economist because he confirms what I usually think. He is also bold and direct in a way most pundits aren't. He has this post today:

One of the bewildering ironies of the health care debate is that President Obama claims to be attacking the status quo when he's actually embracing it. Ever since Congress created Medicare and Medicaid in 1965, health politics has followed a simple logic: Expand benefits and talk about controlling costs. That's the status quo, and Obama faithfully adheres to it. While denouncing skyrocketing health spending, he would increase it by extending government health insurance to millions more Americans.

Now this strikes me as historically impeccable and pretty obvious when it comes to the present situation. Medicare is or is about to become insolvent. If the House plan or something like it passes, we will extend Medicare-like coverage to a lot more people. I don't see who that doesn't mean a much great fiscal burden on the system.

But Jonathan Cohn was irritated enough by this that he put aside blogging about Sarah Palin. That's real sacrifice. He thinks that the Obama plan would cut costs, and tells us lots of ways that would happen. One of them is the creation of healthcare "exchanges".

These "exchanges" would likely attract tens of millions of people, mostly those who now don't have insurance or buy it on their own. Once in the exchanges, people would do exactly what Samuelson says he wants: They'd shop for plans, with incentives heavily favoring those plans that offer high quality at low cost.

Hurray! Competition and incentives. Cohn doesn't mention that all insurance would have to be sold in these "exchanges" which would be controlled by the Fed. No new policies could be sold outside the "exchanges." More on that later.

Well, can we really believe that the Obama Administration is really committed to cutting costs and promoting competition in the healthcare industry? No. A pretty good indication of this is fellow short person Robert Reich's scathing column at Salon:

I'm a strong supporter of universal health insurance, and a fan of the Obama administration. But I'm appalled by the deal the White House has made with the pharmaceutical industry's lobbying arm to buy their support.

Last week, after being reported in the Los Angeles Times, the White House confirmed it has promised Big Pharma that any healthcare legislation will bar the government from using its huge purchasing power to negotiate lower drug prices. That's basically the same deal George W. Bush struck in getting the Medicare drug benefit, and it's proven a bonanza for the drug industry. A continuation will be an even larger bonanza, given all the boomers who will be enrolling in Medicare over the next decade.

Reich is no conservative or even moderate. He is a lefty in good standing. When Obama irritates him, something is up.

Now I should issue a disclaimer here. My father, who personally defeated the Japanese in the Second World War (don't let that influence your opinion) spent his working life as a salesman for Merck. So I like the pharmaceutical industry. It paid for my chemistry set and my Firebird. Both of 'em blew up. But maybe neutralizing one of the advantages of a large government hand in healthcare isn't exactly a cost-cutting measure.

Why did the Administration make this deal? You might say because they had to. But if they really wanted healthcare reform because they want to cut costs and save the economy, isn't that self-defeating?

In fact what they really want is socialized medicine, i.e., single-payer, i.e., Canadian style healthcare. I actually think there are some reasons for going in that direction. But I would only advocate such a reform if it was a reasonable means to good ends. I think Obama comes out of a culture in which single-payer is viewed as good in itself. Any deal with any pharmaceutical devil is okay so long as it gets you socialism, at least at the threshold of every clinic.

Michael Barone backs me up on this. If healthcare reform fails, as I suspect it will, then the cause is this: instead of trying to solve the problems America faces, the Administration tried to satisfy its deepest desires.

Comments

[hsr0601]

Let's Respect others and discussion, not shouting and disruption.
'What's in it' ? or 'shouting and disruption', which one is the reason of slow-down ?

Part 1.

The runaway premium similar to the peak fuel price last year and left so many folks in despair insists on staying the course with the attitude 'unchanged', clearly this trend could bankrupt individual, business, and government. Now the government subsequently is tasked with these two main assignments, first, to address premium inflation, second, to expand coverage to all in urgent need.
In order to cover all and not to add to the deficit, the public option can not set the same rates of private market, rather, it needs to have the function to keep it in check in terms of inflation, too. Unfortunately, this 'unavoidable' direction is aggressively being accused by the runaway premium, citing government 'take-over' .
Under the circumstances the energy bill to determine human future and the other major issues are presently piled up, who wants to waste time making enemies ?, which also does not benefit the forthcoming election.
On the other hand, to make things worse, critics say the savings from the proposed public option is not enough to meet the revenue goal. Furthermore, on another hand, some say 'hands off' . Where do these No tax, No saving and the like intend to force this reform to go ? The conclusion by 'just-say-no' is no doubt. Ironically, the Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of question.

Part 2.

Of all choices, the best thing would be savings through efficiency. Considering the wasteful structure, the highest premium in the world (Costing over twice as much as every other county), and the most expensive part of medicare, with the prevention / wellness program in place, an American style innovation, an 'outcome'-based payment founded upon IT system may be enough to save more than 50 billions per year (500 / decade), both 'improving quality' and removing the unnecessary procedures (as pay is dependent on patient's outcome). Young folks and advocates need to explain the notion of a pay for outcome agreement to the elderly misled by the disinformation.

Part 3.

Unlike private market, this public option includes large-scale investments, these large investments still does not get the fair score, instead seem to become a source of acute conflict, even so, this common sense-based program needs to develop further as early detection goes beyond monetary value.

In short, with the heartbreaking tears in mind (Nearly 11 Million Cancer Patients Without Health Insurance), private market also needs change and should join together to complete this reform , as promised, if not, the runaway premium only has itself to blame. Job-based coverage (indirect payment), mandate code, and ample capital might be favorable to the private market. And It can be said that fair competition starts with fair market value.
Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.

Thank You !

[hsr0601]

Part 1.

Problems :

1. No systematic, expansive Prevention & Wellness Program.

According to the scoring of CBO on the prevention & wellness program, all fitness centers around the world should close down immediately and all media have to end
reporting health tips about prevention. Rather, all of the excellent health systems seem to have one feature in common, a expansive, systematic preventative program
requiring immense investments.
I think a prevention system works as a 'levee' built against flood by the government, similarly, it also needs non-profit investments from the government 'on a large scale'.
This might offer us one clue of why all of the free states have public insurance policy in place.

Surprisingly enough, the system today is designed around treating patients once they become sick. As far as I'm concerned, the congress affected by the special interests
has turned down the budget request for prevention program in Medicare & Medicaid, which are the most expensive parts of the health program. Let's imagine the astronomical
costs and invaluable lives following the levee breach.


2. A pay for each service / volume compensation, & No E-Medical Record.

As much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the
recipients, and this 700 billion dollars a year can cover a lot of uninsured people, in return, it could lessen the tragic, prohibitive ER cares.
Medical errors ( No e-Medical Record ) & lawsuits, more profits motive, and indirect payments from employers etc would account for it.

Supposedly, 'a pay for each service / volume' compensation seems to leave the medical institutes unequipped with the essential IT system. To understand its importance, If
we imagine the cost difference between the previous and current system in financial institutes, the magnitude of cost-savings and the mess in health care system can
be easily explained.

3. Premium Inflation.

This last spring, due to the demand decrease, the peak fuel price came down below $40 per barrel, though, the
'Similar' insurance premiums keep on rising, accordingly the inaction could bankrupt family, business, and
government 'BEYOND this recession' , as all across the spectrum agree.

Insurance premiums have nothing to do with the law of demand & supply and the free / fair market concept.
Basically, as demand diminishes, the price tends to reflect it, nonetheless, the insurers that formed a cartel through
consolidation have replenished the loss by exercising inhumane malpractices involving denying, capping, cherry-picking, rationing, rapid
premium increase and the like. And this runaway premium ended up in the collapse of middle
class ranging ' from finance to mental health' , alongside the peak fuel price and fast-growing mortgage rate, as all of
us know. Thereby they could be cited as an objective for anti-trust or anti-corruption. If the public plan sets the same rate of the insurers, it will be another headache.

Ironically, the Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of
question. Therefore, I'd say they have nothing to say about deficit unless they are free from the sponsors.
And the spoiled menu, 'Takeover and Rationing Cliche' is still marching for bankruptcy, as opposed to its motto.


4. 'Work or Break' health system with no brake or safety system.

Just like marriage, economy also undergoes up and down, however, economic downturn is not reflected in the employment-based system.
The rising mental stress or illness & 'keep eating habit' , which are the epicenter of a number of different diseases,might be traced
to this insecure system and exorbitant premiums.



Part 2.

The Public Plan:

1. Thankfully, the health care reform bill currently before Congress makes several key investments including more primary care doctors in preventive care, and those pieces
of the public plan must be maintained .

2. The pay for 'Outcome' pack is most likely to expedite the introduction of Health Care IT SYSTEM, and it will help doctors focus on their patients.

3. The 'innovative' idea of a 'pay for value / outcome' pack will allow for Quality and affordability
. If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to
prescribe the best medicine earlier in the process, let alone skipping the wasteful, unnecessary risk-carrying
procedures.
Young folks and advocates need to explain the notion of a pay for outcome agreement to the elderly misled by the
disinformation.

4. The synergy effect of the combined Health Care IT & a pay for 'outcome' system may allow the clinicians to
'correctly' diagnose and effectively treat a patient earlier in the process so that it can measurably decrease the
crushing lawsuits and deter the excuse for unnecessary cares to make fortunes.

5. The creative idea of 'a pay for outcome' will more likely prompt team approach and decision, as at Myo clinic.
Under the 'pay for outcome' pack, for good reason, best practices as 'recommendations' would simply help them
make a better decision, and the government won't still have to meddle in the final, actual decision-making
process as a non-expert.

6. This New 'Payment Reform' could accelerate the progress in medical science, in return, it will save more cash.
And this idea will be able to bring 'competition' to the private market, as a result, it can contribute to mitigating premium inflation.

7. Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve'
care, that means more than $1trillian over next decade, and virtually needs no other resources including tax on the
wealthiest. Supposedly even the 'conservative' number of such savings might be able to meet the objective of revenue-neutral.
(Please visit http://www.kare11.com/news/news_article.aspx?storyid=820455&catid=391 for detailed infos).

8. Through clinic's network, users of its health-care services can keep up with their health information and information for family members, and receive health guidance and recommendations from clinic that is optimized for each person.
The system also allows patients to upload information from home-health devices such as blood glucose monitors and digital scales. Patients can authorize whether they want to share their health information with doctors or other caregivers, and those caregivers can provide health-care and general wellness recommendations based on the information patients provide.

9. In case the health care reform provides the general public with peace of mind, the rising mental stress, obesity caused by the insecure system and
exorbitant premiums may bend the curve surprisingly.


10. Clearly, the positive impacts involving massive job creation, promising stem cell research, several times more economic effects of 'from bed to work' lie ahead, these will lead to economic recovery.



Part 3.

Conclusion ;

1. The last thing to expect is rallying for premium inflation, JUST SAYING NO.

2. Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.

3. With the Prevention & Wellness Program as a stable levee in place, the promising pay for value/ outcome reimbursement reform based on IT system could clear the way for revenue-neutral. Some say the installation of IT network will take time, but once this new outcome-based payment system is implemented, the hospitals reluctant to adopt it will most likely rush to introduce it.

4. The final hurdle looks like a scoring issue surrounding the savings on Prevention & Wellness Program, but I'd like to say
health clubs and media reports on prevention tips must be maintained.

5. People would be entitled to various services whether you are employed, unemployed or self-employed, homeless or housed, young or old, chronically ill or mentally ill, moving from job to job or from town to town or from state to state.

Thank You !

[carly]

The real problem is that we can not even get to a civil discussion with the distortions and lies being told by the Right. Prime examples are editorials by IBD and emails from Human Events. There is a related post at http://iamsoannoyed.com/?page_id=588

[FascistSocialist]

Ken Blanchard contests that we are not in a health care crisis and there's no urgent need for reform. You will have to convince him of that before even trying to sell him reform.

[Mac]

Carly, but of course...they are full of BS. Haven't you figured that out by now? These kooks never had a problem with illegal immigration when it was benefiting them through the form of cheap labor, but, now that they may have to help fund their healthcare...now they hate immigrants...what else is new in the land of Horse and Bull Sh--t? LOL...frankly, I don't give two cents what KB, PP, or Guy or Sibby think on any of these issues or the kooks that go screaming on a daily basis about these matters they could care less about as long as they are getting taken care of.

[Mac]

To add: I do not for one second believe there is a genuine "grassroots movement" out there. These kooks are small and being funded to keep the debate alive...

[KB]

Mac: that's a good game plan you have there. When people show up a little angry to a town hall meeting, they aren't real people! They're probably holograms produced by Karl Rove in a Medieval castle. I am sure that everyone who dares to question your hero or his angels is a kook.

FS: I do not believe that there is a healthcare crisis because I know what the word crisis means. I do not deny the need for reform, for reasons pointed out in the excellent New Yorker article you have been pushing. I will blog on that next.

Carly: Maybe the real problem with discussion is that every disagreement is viewed as a case of dishonesty by both sides. I don't think that strict accuracy is to be found on either side, but I would never expect that. It isn't how politics works. People who dare to question the President have honest worries about reform. The President and the Congressional majority honestly believe their policies are the right ones for the country. Maybe we should start there.

[FascistSocialist]

You mean...
"an unstable or crucial time or state of affairs in which a decisive change is impending; especially : one with the distinct possibility of a highly undesirable outcome"

Like... tens of millions of people with poor access health care, hundreds of thousands more declaring personal bankruptcy and hundreds of thousands more kicked off insurance rolls monthly...

No, you're right, not a crisis. There's no crucial time imperative to reach decisive change, and if we do nothing there's no "distinct possibility of a highly undesirable outcome".

[FascistSocialist]

Maybe you mean it's not a crisis for you because you have health care. Which of course isn't a privileged position AT ALL.

[KB]

FS: Is a "decisive change" impending? The items you mention, aside from being fabrications, are certainly undesirable. But would they be the result of the impending change, or what happens if no change occurs? If the latter, then they are not the result of any crisis. A "crisis" means a turning point that cannot be avoided, it doesn't mean a situation that one finds undesirable.

Like most Americans, I find my healthcare reasonably good. I am in favor of extending health insurance to all Americans. Not being a blowhard, I don't presume to condemn anyone who disagrees with my concerns about how to do that.

[FascistSocialist]

But each individual who lacks health insurance or adequate health insurance and is in a dire straits because of it, dying or about to go bankrupt, is in a personal crisis.

How many people in this country have to be in crisis before it becomes a societal crisis?

10s of millions of people are indeed without health care at this moment, in this country, with 10s of millions more under-insured.

Hundreds of thousands of people are being laid off monthly starting over a year ago. Most people get their insurance through work, you think those people are keeping their insurance from their former jobs?

Maybe the crisis occurred years ago and we're now experiencing the "highly undesirable outcome".

Either way, the situation is critical and in desperate need of reform. Using the word crisis is just an attempt to express the urgency of the situation. You denying that it's a crisis appears to me to be an attempt to deny that urgency.

[Miranda]

Carly:

I am amazed at the arrogance of those who can't imagine that anyone who wasn't paid off could disagree with them.

Nobody has to pay me to make me upset that many lawmakers are ready to pass a bill they haven't read. Nor does anyone need to pay me to protest against socialized healthcare. I'm sure there are organizers involved in some conservative protests, but many have been started by every day Americans. I'm amazed that the left has become so furious over people protesting. When Bush was in office, it was so cool and right!

[FascistSocialist]

There is no bill on socialized health care in the house or senate, or any committee. No legislator is proposing socialized health care.

I don't think you know what socialized health care means.

[George Mason]

Poor FS; To his ilk everything is a crisis and every crisis must be addressed by more government intrusion into our lives and restrictions on our freedoms. Of course they never consider that the root cause of all these crisies is government interference in the free market. Whether it be banking and finance, automobile manufacturing,healthcare, etc. The more the government meddles the worse the situation becomes, yet FS believes more government will make it better. To quote a great man, "Government is not the solution to the problem, government is the problem."

[FascistSocialist]

hahahahahahahahahahahahaha

[Mac]

Take a chill pill Mr. Blanchard...

[KB]

FS: again, "crisis" implies a tipping point, not just a bad situation. Secession was a crisis. Moreover, your description of the problem is as hyperbolic and unfounded as any absurd remark by any overheated town-haller. More on that in my next post.

[KB]

Mac: I am sorry if I was a bit testy with you. Know that I love you! But the public confidence in the President and Congress on healthcare is genuine, and if more than 40% of the public is opposed to the latter, there are more than enough genuine people at any location to fill a town hall.