this powerful opinion piece points out the flaws in obama's thinking about health care.listening to NPR lately on any health-care related topic is like hearing supposedly smart and genuine people make increasingly outlandish claims.
that we can spend less, put government in charge of monetary allocation and cover more people and receive higher quality of care is possible...please. think about what you just said.
government had its chance to allocate money and dictate health care in the medicare program, and it will be insolvent in 2017. let's not given them all the reins and expect them not to lead the stagecoach right off a cliff.
this particular opinion piece takes an interesting bent. it points out that the doomsday sentiments coming from the obama camp about the sorry state of health care are generally untrue. it then goes on to show that the 'solutions' he proposes to the 'problems' he has created will make matters worse.
obama's take on health care is worrisome at best...
22 comments:
paul.
i find it curious that you describe this op-ed as powerful. i would go more with slanted. or biases. or agenda-driven. maybe even dishonest. in the second and third paragraph, right off the bat the author seems to conflate costs and spending and suggest that the obama administration is suggest we all need to cut back on OUR spending. rather than their real message which is getting costs contained which would in turn lower our spending. the way this author contorts the out-of-context quote, she makes it sound as if the obama administration is asking everyone to cut back on the care they seek. opening on op-ed piece with such blatant dicing and drivel is far from powerful. and then to wrap the whole thing up with fear-mongering and a little euro-bashing is weak and ineffectual.
in your own fourth paragraph, you state that the US gov already had a chance at fixing health care, by way of medicare and then go on to cite its insolvency (a year or two earlier than projections) as a failure. would you go so far as to say that social security is a failed project too because it will also be insolvent a few years earlier than projected?
in regards to your second paragraph argument, i would ask, have you read much of ezekiel emanuel, the head of bioethics at NIH? he has some very rational, radical, and interesting ideas to the currect state of affairs. he is also an adviser to peter orzag and def has the president's ear, given is the more intellectuals of the brothers emanuel (rahm, ari and zeke). i'll attach just one of his op-ed from the chicago tribune here, and let you do some digging on your own. from what i've read of him and about him, if he were to get his way, we truly could spend less, cover more people, and receive higher quality care, even with some government oversight.
finally. you often deride obama's attempt to fix health care. i hear many nays from you. but all along, i still do know what you are for. surely you don't think it doesn't need fixing. what are your solutions? leave it as it? i know you don't like single-payer (and who would). what method of reform do you favor?
here comes my multi-part post...
hello peter :) thank you for jumping into the fray. i've heard you talk about rahm's brother and i've read some articles talking about how smart the two of them are. i appreciate this article he wrote. the reason i like the op-ed piece in the wall street journal is that is states the important idea that the health care system is not as 'broken' as those who want to take greater hold of the reins would have you believe...
some of ezekial's points that are directly addressed in the op-ed.
"With a Republican administration leading the takeover of Freddie Mac, Fannie Mae, American International Group Inc., and the purchase of housing securities, it hardly seems credible to criticize health-reform plans as socialized anything.
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worrisome is his assumption that the bloated bail-out of wall street is reason for throwing large amounts of money at health care to create a larger government role...
"The phenomenal failure of Wall Street dramatically changes the appetite of the country for regulation and for shoring up the safety net. With trillions of dollars evaporating in this crisis, millions of middle-class Americans face the prospect of losing their homes and jobs, and witnessing a dramatic contraction of their retirement savings. In response, the public will desperately want financial security, and health care is a critical element of that."
'desperate for change?' many are happy with their coverage. the wsj article points out that americans are not spending more on health, food and utilities than they did in the 1950's...
"This financial crisis also means Americans may be more willing to forgo gold-plated comprehensive insurance that covers everything with few restrictions. Under the threat of losing everything, Americans may feel content with the guarantee of a plan that covers cost-effective treatments with some restrictions on choice and services to save money. This should enhance the chances for a bipartisan deal on health care."
this goes to the cruxt of the argument. and i appreciate that he doesn't shy away from the bottom line: if you plan to spend less on health care you will get less health care. there's no accounting trick here. as with most other elements of american society. if you spend less on a car, phone, internet, car insurance, homeowners insurance etc. etc. you will receive less. period.
"The huge increase in the federal debt that these bailouts will entail intensifies the pressure to rein in health-care costs."
is this fear mongering peter? the wsj op-ed piece was getting at this point that health care expenditures are similar to what they have always been. so the bail-outs have whetted people's appetite for the government dictating monetary allocations because they were so effective in giving money to GM before they went under..?
Before the financial crisis, the most likely options for controlling government health-care costs involved tinkering around the edges—striking a new deal between Medicare and physicians on their pay, initiating more demonstration projects in paying for performance and efficiency, and assessing comparative effectiveness of new tests and treatments."
this paragraph is particularly worrisome as i have watched the government tinkering and these programs he speaks of sound OK when he writes them, but they haven't worked.
tinkering with physician's pay through medicare: mostly this has just squeezed primary care physician (of which there are already shortages.) these docs have worked more hours to compensate to this point, but i have read in several places that large majorities of primary care docs state that it wouldn't take much for them to jump to other industries, go back to school etc. etc.
pay for performance has been a disaster. think about the 'antibiotics within 4 hours of pneumonia diagnosis'. so many problems with this government mandate. first and foremost. there is no data to show that antibioticss within four hours of diagnosis effect outcomes. certainly it doesn't effect mortality. mostly, this rule has increased antibiotic orders for coughs earlier in their course--often unnecessarily that increase the side effect problems, resistance problems and cost problems associated with overuse of antibiotics...
ezekial suggests the wyden-bennett bill. an important part of this bill is extending the tax benefits to private citizens that employers enjoy. however, there are problems with the bill as well.
from the heritage foundation, "The dependence on standardization as a means to drive down costs completely rejects the fundamental market principle that open competition produces better quality at lower prices. Moreover, such standardization undermines personal choice and market innovation. A better policy would enable insurers to design and develop products that meet the demands of the consumer and compete directly for customers based on the quality and price of those products."
petey: i will give you more of my thoughts on the solution at a later time (amy is all over me to head to the new house and continue the never ending march to unpack all our stuff.) in short though. the last line of the last quote there is the bottom line. allow more transparency in medicine and allow the market to dictate the worth of the services and allow providers to innovate as a result of the competition...
to clarify, there is much to like about the wyden-bennett bill and i think it is probably the most palatable option on the table right now. but as with any change here. the problems will come in the details when the democrats attach their pork and spending daggers onto the bill to benefit whoever gave them campaign cash...
was that last part too cynical?
Paul,
I like to hear your thoughts on health care. There's a couple of physicians I get to chat with and I really like to hear their perspectives. I have been very surprised to see some big time wealthy physicians who think single payer is the solution. I think the Wyden-Bennett proposal is currently the best because it will not increase the defecit and I think that is why you see a fair amount of support for this bill. I currently have the HDHP with HSA and I'm really liking it. I think HSA's for everyone with a sliding scale HDHP depending on income is the best option. The HDHP should be standardized, like a single insurer. This would still allow free market principles to work in our health care system. Either way you look at it, there just aren't any easy answers. It would be interesting to see what your proposal would be. I was a little surprised the wsj suggested that health care expenditures have basically been what they have always been. The percentage of GDP spent on health care continues to grow. I've really seen a lot of stuff that contradicts that claim. According to the WHO, our health is much worse then most socialized nations who spend significantly less on health care. I'm not sure how accurate that data is, or what they are measuring, or whether the WHO is a bunch of Obama fans who want the U.S. to socialize, but I really don't think we are getting the value we deserve for the amount of money we are spending.
where is allan? I would love to hear his thoughts on the latest?
whoops. that last comment was from me.
allan usually comments privately to me on my email. he thinks it's ironic that we have a system where people lose their health care when they lose their jobs (for instance because of disability) just when they need it the most...
ivan: what is HDHP?
i believe the WSJ said that we are spending the same on utilities, food and health care combined. the health care amount has risen while food and utilities have fallen (that's off the top of my head.)
we had the WHO data drilled into our heads in medical school. several problems i see with it is that the homogenous european population doesn't have the immigrant and inner city problems that we do. many countries count as miscarriages the infant mortality that we try to save in the NICU's of our contyries. there are a lot of problems with the stats. we do spend a lot of money on end of life and beginning of life care.
but for every 10 NICU babies that don't make it (alive or mentally intact) you have one who lives a perfectly productive and normal life.
tough questions.
also, europe uses our generic drugs and old imaging technology. without the money americans spend on technology and new drug development...that well will run dry.
another idea thrown into the mix. there is possibly a majority of physicians in palm desert (where i'm staying tonight) who don't take medicare...because they arbitarily cut reimbursement for inexplicable and often counterproductive ways. what will happen when docs continue to stop taking medicare in droves? will the government force them to work for less than what other insurance companies are willing and able to pay?
more transparancy, require everyone purchase insurance and a strong governmental body to police private insurance practices...
senators tout medicare as a triumph, but that is a big if.
HDHP is the high deductible health insurance plan that you have to be enrolled in to qualify for a health savings account. The one our family currently has is a $1500 deductible and $5000 out of pocket maximum. Preventative care is covered at 100%. It is nice to have an account that will continue to increase every year if we don't have to utilize the health system. If we have 3-4yrs with our family being somewhat healthy, we could have a stash of 10-20K sitting in an account for health care expenses. The only big problem I see with this plan is that these plans do not work for someone who is chronically ill. I've heard senator Bennett say that he thinks these types of consumer driven health insurance plans are moving the country in the right direction. I know that the liberal politicians aren't fond of this plan because it basically takes the healthy individuals out of the same insurance pool of those who utilize the health system much more.
I saw Gran Torino last night, great flick.
sounds intriguing ivan. i've been at the mercy of my employers to this point with healht insurance...but i've been basically happy with the coverage...
paul.
what do you think about salaried groups that aren't paid per procedure/test/exams/etc...? they are controlled/managed by a board of patients/doctors. so if their care isn't up to par, they are let go. but the incentives are the best care, not the most billable procedures...
difficult petey.
an example. the movers we hired to help us move in were paid by the hour. their motivation was to take their sweet time to the limit that they knew would still allow for favorable reviews from me.
the elder's quorum however, has the motivation to get done as quickly as possible.
(or if you pay per move, movers are motivated to finish and move on.)
the quality control comes through choice and transparency for the consumer.
ie. doc gets paid per visit procedure etc. he/she comes in quickly and happily because there is reimbursement for the visit. the quality control is that the patient won't come back and will warm others not to come back if the job is not satisfactory.
the other option is a doc works slower and slower because the salary is there regardless. you can work quite a bit slower and see quite a few less patient (ie. longer wait times) before a panel of providers would actually fire you...
it's the sad truth and human nature. i see salaried docs at the hospital i am working at this month (kaiser in cali) who are the admitting doctors. the more sick patients i see and ask them to admit the more grumpy and less motivated they become because they are swamped and not getting paid any more for admitting 2 patients per hour rather than 1 patient per hour...
which doctor would you rather see. the motivated happy doc or the grumpy one...?
it seems that there are huge health care costs from prescription drugs, end of life care, beginning of life care, care for millions of patients in comas that are 'nearly brain dead' from whatever brain injury who are kept alive in care facilities etc. etc. etc. targeting physicians' salary first (which has been steadily falling in comparison to inflation rates over the years) will seemingly make the problem worse in a time when shortages of primary doctors could become a big problem. sky-rocketing waits for non-urgent and semi-urgent visits.
two intriguing developments:
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I like the Co-op idea. I don't think there would be a large drawback to a "public" option managed by a third party that cannot use spending taxes to cover the benefits it is promising. It could use their power to offer coverage to employers. I think we are seeing Obama's moderate tendencies if this moves forward. Any reason either side would oppose this legislation? I can't really think of anything off hand. If the insurance policies reimbursement is too low, providers could refuse this coverage.
yes, obama continues to impress.
peter: here is a great read about salaried physicians. this guy is a left leaning ER attending physician. i think you'll like what he has to say...
and here is another outstanding look at obama's speech to physicians at the AMA conference...
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