Reforming Healthcare & Managed Care

Submitted by Dr. JG Kaplan on Tue, 2009-08-25 08:48

Perhaps, the best 'politics vs. substance' summary to date is "Obamacare: The Only Exit Strategy" by Charles Krauthammer, a syndicated columnist, posted Friday, August 28, 2009.

It says, "Obamacare Version 1.0 is dead. The 1,000-page [actually over 2,000 pages] monstrosity that emerged in various editions from Congress was done in by widespread national revulsion not just at its expense and intrusiveness but also at the mendacity with which it is being sold. You don't need a PhD to see that the promise to expand coverage and reduce costs is a crude deception, or that cutting $500 billion from Medicare without affecting care is a fiction."

Krauthammer continues, "But there is an exit strategy. And a politically clever one, if the Democrats are smart enough to seize it."  

He first sets aside the five of the most compelling proposals for change that are being bandied about:

1)   Government-based competition to private "health care" insurers.

2)   Counseling at the end-of-life. (Read: "subtle encouragement to voluntarily refuse treatment.")

3)   Comparative effectiveness research (code words for having an excuse for denying payment for treatments judged "less effective" out of context, i.e., meaning not in front of a living, breathing patient.

4)   Using the healthcare crisis "at a time of a sinking economy and a bankrupt Treasury" as a wedge to catalyze reform.

5)   "Promise nothing but pleasure -- for now. Make health insurance universal and permanently protected. Tear up the existing bills and write a clean one -- Obamacare 2.0 -- promulgating draconian health-insurance regulation that prohibits (a) denying coverage for preexisting conditions, (b) dropping coverage if the client gets sick and (c) capping insurance company reimbursement."

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And what's the catch? This is the "ultimate bait-and-switch"—pleasure now; pain later. "Government-subsidized universal and virtually unlimited coverage will vastly compound already out-of-control government spending on health care" with catastrophic consequences.  "But by then, resistance will be feeble. Why? "Because at that point the only remaining option will be to give up the benefits we will have become accustomed to. Once granted, guaranteed universal health care is not relinquished. Look at Canada. Look at Britain. They got hooked; now they ration. So will we."

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Enter 'Managed Care,' rewritten as socialized medicine that is designed to be rational, reasonably accessible and affordable. 

"Obamacare 2.0," essentially the above presentation, was also posted as part of a blog-series—"Reforming Healthcare & Managed Care"—at MDNG.com's HCPLive Network. Please visit and comment there or here.

Heated Reform Debate- 1

Submitted by Administrator on Sat, 2009-12-05 21:21.

Update: these past months, I've tried to discuss reality - The facts are that we are not doing well compared to other systems of care.  Moreover, we cannot afford to continue what we are doing--it's a veritable shell game.  And then we've even reviewed the various forms of abuse that one has had to contend with in these United States - Feds taking years to respond to an appeal, bureaucratic hurdles set by "insurers" doctors,' immoral over-billing, billing fraud, and 64 other explicit examples of practice exploitation.  What can be done about inefficient and ineffective care?  How can we improve decision making?  Learn what's missing from healthcare reform proposals, but tempus fugit as Paul Krugman warns... .



"If .... health reform fails, think of the message this would convey: It would signal that any effort to deal with the biggest budget problem we face will be successfully played by political opponents as an attack on older Americans. It would be a long time before anyone was willing to take on the challenge again; remember that after the failure of the Clinton effort, it was 16 years before the next try at health reform.

That’s why anyone who is truly concerned about fiscal policy should be anxious to see health reform succeed. If it fails, the demagogues will have won, and we probably won’t deal with our biggest fiscal problem until we’re forced into action by a nasty debt crisis.  So .... If you care about fiscal responsibility, you better be afraid of what will happen if reform fails."


Paul Krugman, PhD (health care economist and op-ed columnist for the NY Times)  "Reform or Else" pub. Dec. 3, 2009


From: Fredrick H (MD, PhD, Esq)

Sent: December 4, 2009 10:10:09 PM EST

I'm not going to slit my wrists if the bill fails.  The original idea has been so ripped apart to satisfy the right-wing, that it's not a very good bill.
 
And I doubt that the huge Medicare funding cuts, accepted by the Dems to appease the right-wing, can really be paid for out of cutting "fraud and abuse". When they can't find enough fat, I'm afraid they'll cut into the muscle. And, having labored and passed Something, I doubt they'll revisit it for a long time.


Look how long the disastrously flawed ERISA has sat unfixed.
 
Perhaps someday, we'll have no wars draining our treasury, and a good economy to give a nice budget surplus, and the Messiah will appear in his Glory, and all the right-wingers will be whisked bodily into heaven, and out of our way, so we can get REAL reform for us poor sinners who are left on Earth! 

 

Fuchs' Bottom Line for 2009

Submitted by Administrator on Thu, 2009-10-08 07:31.

In "Four Health Care Reforms for 2009," Victor R. Fuchs, Ph.D. (Posted by NEJM • October 7th, 2009) discusses our disfunctional healthcare "system" and calls for, at minimum: 

"The creation of insurance exchanges, the elimination or limitation of the tax exemption of employer-sponsored health insurance, the appointment of an expert commission to devise changes to the way Medicare pays providers, and the provision of ensured funding for a quasi-independent institute for technology assessment. Each of these changes alone has a high probability of doing some good. Taken together, they reinforce each other and lay a foundation for further reforms."

He adds that were Congress to do nothing else for healthcare in this year, the following most regressive feature of the federal tax code must go away, pronto!  

"The revelation that top Goldman Sachs executives are given a tax-free $40,000-per-year health insurance policy highlights what is arguably the most regressive feature of the entire federal tax code: the tax exemption of employer contributions to health insurance premiums. This exemption confers huge subsidies on high-income Americans and small or no subsidies on those with low incomes. There are three reasons that the exemption has this effect: first, the higher a person’s marginal tax bracket, the larger the subsidy he or she receives; second, on average, higher-income workers tend to have more generous insurance policies; and third, the proportion of people who receive employer-sponsored insurance rises dramatically with family income, from approximately one in four among those with incomes under $30,000 to more than four in five among those with incomes above $75,000.2 Elimination of the subsidy would not only make the tax system fairer, but it would also provide more than $200 billion of additional federal revenue annually."

Realigning incentives, technology assessment by those without conflict of interest, universal coverage (unlinked to one's employment), insurance exchanges to level that playing field, etc. are all part of this important read.

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