1. Wrong Priorities
Submitted by Dr. JG Kaplan on Thu, 2010-01-07 22:27
Witness the outrageous 20-30% administrative overhead of medical insurance companies....
This discussion point is part of a blog-series, "The Short Shrift of Healthcare." See "Reforming Healthcare & Managed Care" on HCPLive.com
That includes a covert and obnoxious 'cost-savings-is-more-important-than-patient-care' reward system. This is even true for non-profits. It's the difference between medical business and the business of medicine—taking care of patients or profit$.
As stated in the Consumer Watchdog, Dec. 24, 2009, health insurers' rate increases among other intolerable, unaccountability must be monitored, if not prior-approved (cross-ref. Calif. Proposition 103).
Submitted by Nirav Patel (verified) on Wed, 2010-01-06 16:14.
Another Perspective: I don't think health insurance companies are 100% EVIL (many of the rules they impose on doctors keeps them from doing crooked things and ordering extra stuff which could hurt the patient) but are so bad right now because they do whatever they want. Break the Anti-Trust exemption and force them to be more transparent and see if they can keep that 20%-30% buffer to play with. We can use the blogs to spread the word about the companies that use the least amount of money on APPROPRIATE care. Even though they spent the money, they can just give it to certain doctors on their payroll to keep the money under their control. Don't put anything past 'em'!
From jgk:
I agree, Dr. Patil. Here's a fundamental of managed care that is in keeping with your ideal of positive support of doctors--"Measure and Manage."
"Health care reform will eventually pit the goal of expanding health insurance coverage against strong pressure to reduce the growth in health care costs. If left to measures in the proposed reform legislation, cost containment will be driven primarily by marketplace incentives, programmatic initiatives, and organizational changes that would partially offset the costs of expanding coverage.[1] These proposed economic policy changes and incentives, however, are not guaranteed to lead either to individual clinical decisions that will be in patients’ best interests or to enhancement of the public’s health. Rather, these forces are relatively blunt instruments that might nudge the health care system toward efficiency, without precise direction."
"Thus, to ensure that the health of the population is enhanced, rather than diminished, by the reforms, these measures must be accompanied by the sharper tools of comparative-effectiveness research (CER). Unless we are willing to allow our health care to be driven solely by financial and regulatory incentives, CER should become an important part of the equation. Rather than being resisted by the clinical and public health communities, it should be embraced."
Mushlin AL, Ghomrawi H. * "Health Care Reform and the Need for Comparative-Effectiveness Research.: Posted by the N Eng J Med, Jan. 6, 2010 [* From the Department of Public Health, Weill Cornell Medical College, New York.]
"Congress is achingly close
"Congress is achingly close to passing legislation that would cover most uninsured Americans and provide much more security for all Americans — guaranteeing that if they lose their jobs they will be able to buy affordable policies and can’t be denied coverage because of pre-existing conditions."
In the wake of reform, the political tension is palpable. I've heard a different side from the political pundits--Mass. voters hate the Mass. law that allows health care premiums to soar while forcing people to pay them. Surely, political compromise may morbidly, if not fatally weaken the final bill, but I am hopeful that in the 11th hour, there will be a desperate push for agreement. As Mr. Obama said in an interview on ABC News after the defeat in the Massachusetts Senate race, "I would advise that we try to move quickly to coalesce around those elements of the package that people agree on,....notably leaving near-universal insurance coverage off his list of core goals."
Here's what can happen:
Finesse The "death of the public option, insisted upon by Lieberman, is likely to strengthen the House's bargaining position on other issues" such as the House wanting seeking to remove the "health insurance industry's exemption from antitrust laws, and a better Medical Loss Ratio (i.e., that portion of premiums collected, actually spent on health care, as opposed to overindulgence in administrative budgets and executive salaries and bonuses).
Unusual Alliances "For example, both the insurance companies and many progressive groups want to hold providers to the public promises they made at the White House last year to cut the increase in annual health care costs by 1.5% a year over the next decade. This would amount to $2 trillion in savings."
Compromise Example: "the insurance companies agreeing to a national insurance exchange and, possibly, antitrust changes if the final bill also includes a legal requirement that the providers live up to their cost-containment promises."
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