Friday, July 31, 2009

July 31 News and Observer column

is now up.
Again, sorry for not being able to link it here or on the side bar...the proxy server I am having to use to access the blog while in China greatly reduces the functionality of blogspot and I am not such a whiz without the point and click options.

Point of today's column is to put a bit more clarity on the cost issue that everyone says is so important. Two questions are key: can we afford our system? Answer here is a value judgement (I say no). Question 2: do we get our money's worth for what we spend? Decidedly not is my answer.

It seems as though we had a pause which was related to trying to refocus on cost control in reform bills. Some progress has been made in terms of getting closer to a consensus bill in the House and Senate, but all coalitions are a bit wobbly I think. The House Republicans have offered a bill, but a quick glance does not lead me to think that it is a serious proposal. It does contain a more robust malpractice aspect than did the patients' choice act (Senate Republican alernative) with some caps; this is closer to what most Republicans want, I suspect. Malpractice hasn't been talked about so much so far, but I suspect it turns out to be quite important if any deal on a comprhensive bill is to be reached.

Often the August Congressional recess is a sleepy time politically, but not this year.

The next few weeks I am planning to write in more detail about policy options to address different cost areas outlined in today's column. Next week is patient safety and malpractice.


  1. I've searched high and low for anything addressing the issue of economy of scale in this debate, and there's practically nothing. So, I'll add two arguments for it:

    A truly public option is the only possible way to force insurance companies permanently to cooperate with each other to share information and reduce costs, and they know it. That's why they fight it so hard. Of course w.r.t. economy of scale, single payer/employer/records-keeper is best and also the death of private health insurance.

    You can't rely on regulation alone to provide what's necessary: "The Commission … satisfies the popular clamor for a government supervision … while at the same time that supervision is almost entirely nominal." - William Miller (R), US Attorney General, circa 1889, describing the Interstate Commerce Commission, and so it goes.

    Money loops in Congress have killed past attempts: "The less care they give them, the more money they make." - John Ehrlichman, describing Kaiser Permanente to Pres. Nixon, who replied "Fine." - White House tapes, 2/17/71. Kaiser and his family were Nixon supporters. Their ilk today support the Blue Dogs and GOP.

    The nature of corporations in general will always make it so: "The corporation is an externalizing machine (moving its costs to external organizations and people), in the same way that a shark is a killing machine." - Robert Monks (2003) Maine Republican candidate for Senate, and corporate governance adviser in the film "The Corporation."

  2. Did you compare health care outcomes between the USA's INSURED population to the other populations in your article or just lump everyone together? EMTALA requires uniform interventions once one hits the ER, not before. What if you compared the brakes on two different cars but had one car driven by someone who didn't brake at all 1 out of every 6 times while the other vehicle's driver hit the brakes every time? Would you conclude the brakes were faulty?
    Government reform should not and cannot address the manner and intensity with which a given condition is treated (type of provider, technology) without tort reform. How do you propose to pay providers? I think it's very easy to remove the incentive to do more "unnecessary" tests when you don't have to defend yourself against malpractice suits but much harder when you're actually liable for the patient's health. How are you proposing to decide what's unnecessary? Mayo Clinic provides inexpensive, top-notch healthcare at a significantly lower cost. Having been trained there I can also inform you that the rest of the world's patients travel there for care because it's better than what they have at home, including individuals from all the countries listed in your article.
    Why don't you write about our defense spending and inability to obtain value for our defense dollars? I'd say our wars in Iraq and Afghanistan and inability to capture Osama Bin Laden don't represent much less value for our tax dollars than we get in our healthcare system.