Let the patient be damned! (Politics <==> Inertia)

This discussion point is part of a blog-series, "The Short Shrift of Healthcare." See "Reforming Healthcare & Managed Care" on HCPLive.com

There's a concept in healthcare insurance where all risks in a community of interest, a market, are pooled – community rating; and then there's experience rating where the healthy are advantaged in more ways then one and the sick are marginalized, paying disproportionately more into the pool just to have a seat at the table.  The latter is what we mean by 'a medical catastrophe is one step from personal bankruptcy.'  It also explains Paul Krugman's frustration with politics. 

In "Do the Right Thing," he speaks to the hit that healthcare reform took in Massachusetts: The "Republican victory in the Massachusetts special election means that Democrats can’t send a modified health care bill back to the Senate. That’s a shame because the bill that would have emerged from House-Senate negotiations would have been better than the bill the Senate has already passed. But the Senate bill is much, much better than nothing. And all that has to happen to make it law is for the House to pass the same bill, and send it to President Obama’s desk." Voltaire's "Perfect is the enemy of the good," rings true, part of the reason why politics often means inertia.

"Where is your Moses Now?" [Edward G. Robinson]  [Referring to idol worship rather than doing the right thing.]

Jeff Kaplan writes: Personally, I'm getting sick and tired of the finger pointing, the special interests, the lack of insight, progress and the selling out.

Are you going to sit idly by as nothing is done?  That's a sellout and its sentinels are:

1. Sustaining the antitrust protections, i.e., the exemption enjoyed by the healthcare insurance industry.
2. Similarly, by not allowing insurance companies to provide policies across state lines, we squelch competition and support the high costs of care. (I.E., we need an 'exchange' program in the insurance marketplace).
3. By precluding the re-importation of pharmaceuticals and by allowing Big Pharma to pay-off the manufacturers of generic drugs, the high price of drugs is an exclusive U.S. business.
4. Who ever agreed that medical directors, "Utilization Review,' or  'Pharmacy & Therapeutics' committees would dictate how medicine is practice on the front line of medicine? Here's how they get you: multi-tiered pharmaceutical 'benefits,' the exclusion of integral 'supplies,' the denial of coverage of referrals to relatively unique or scarce specialty services or to vital transports to nearby hospitals.  And, I love how the managed care or insurance businesses obfuscate—'we don't deny care; we just won't pay for it.  It's not our problem that your husband was dying in a non-par (non-participating) ER and you wanted him transferred to a specialty hospital.  That possible tumor? What tumor?
5. By shortchanging primary care reimbursement and by allowing specialists to dominate the landscape, the first venue of care is often ridiculously fractionalized and it is certainly too expensive.  Don't you love it when an ENT refuses to evaluate the pneumonia?
6. Managing by exception, that is, not practicing continuous quality improvement is certainly a huge missed opportunity.  In a similar vein, so is paying for process, rather than outcome, and not aligning the incentives, for both doctors and patients.