Author: cmh

Journal of Clinical Investigation — Critical: What we can do about the health-care crisis

Journal of Clinical Investigation — Critical: What we can do about the health-care crisis:

The section on the proposed federal HEALTH bard, from a review of the Daschle Book, by Joseph White:

“Part Four explains that the Federal Health Board would operate within a reform context similar to proposals made by major Democratic candidates in the 2008 presidential campaign. Medicaid would be expanded; private health insurance would be made more broadly available through a system of subsidies and would be marketed through an open version of the Federal Employees Health Benefits Program (FEHBP); an expanded version of Medicare would be made available to all Americans for purchase through the FEHBP; employers would be required to subsidize their employees’ coverage directly or make a contribution to the FEHBP insurance pool; and individuals would be required to purchase one of the coverage options (unless eligible for Medicaid), and their premium expenses would be subsidized by a refundable tax credit. The complexity of health policy is shown by all other decisions that would be left to the Federal Health Board. Among these would be defining the minimum benefit package (including parity for mental health care); regulating insurance marketing; standardizing medical records across all federal health care programs (including the Veterans Health Administration, Medicare, and Medicaid); and improving value in all federal programs through new quality measures, new methods of “paying for performance” (P4P), and approving or setting prices for new procedures based on cost-effectiveness research. Daschle argues that applying such reforms to the 100 million Americans (at a minimum) covered by the federal programs (including voluntary Medicare) would create “tremendous pressure on everybody else to follow suit”.”

What Doctors Make, and Why – New York Times

What Doctors Make, and Why – New York Times:

“In “Sending Back the Doctor’s Bill” (Week in Review, July 29), you compare the incomes of American physicians with those earned by doctors in other countries and suggest that American doctors seem overpaid. A more relevant benchmark, however, would seem to be the earnings of the American talent pool from which American doctors must be recruited.

Any college graduate bright enough to get into medical school surely would be able to get a high-paying job on Wall Street. The obverse is not necessarily true. Against that benchmark, every American doctor can be said to be sorely underpaid.

Besides, cutting doctors’ take-home pay would not really solve the American cost crisis. The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.

This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.

Physicians are the central decision makers in health care. A superior strategy might be to pay them very well for helping us reduce unwarranted health spending elsewhere.

Uwe E. Reinhardt, Princeton, N.J., July 30, 2007″

Medical Debt Is a Growing Worry, for Those With Insurance and Without – washingtonpost.com

Medical Debt Is a Growing Worry, for Those With Insurance and Without – washingtonpost.com:

“‘People who are underinsured end up facing almost identical problems as the uninsured,’ said Karen L. Pollitz, director of the Health Policy Institute at Georgetown University. ‘The difference is, they paid for the privilege.’

“Medical debt is likely to figure prominently in the looming national debate over reforming health care.

“Jim Eyler, 57, of Westminster, Md., says he needs help. The cement company manager said he spends about 33 percent of his take-home pay on unreimbursed medical bills, many connected with the advanced breast cancer his wife has been battling since 2005. ‘I keep wondering, where’s the money going to come from?’ he asked.”

More anecdotes here, of course, but the larger point is that our current cost structure is unsustainable.

American Health Care Since 1994: The Unacceptable Status Quo

American Health Care Since 1994: The Unacceptable Status Quo:

“Higher medical costs are also taking a toll on America’s fiscal health. As the CBO has warned, ‘the rate at which health care spending grows relative to the economy is the most important determinant of the country’s long-term fiscal balance.’ Federal health care expenditures, including Medicare and Medicaid, have risen to over $800 billion, or $2,650 per person, in 2008, from $300 billion, or $1,600 per person, in 1994 (in constant 2008 dollars). The burden on states has increased as well, to $300 billion in health care costs in 2008, from $190 billion in 1994 (including each state’s share of the Medicaid program). These trends are projected to speed up, with per-person federal expenditure nearing $6,000 by 2017 and state and local expenditures projected to increase to $2,000 per-person (in 2008 dollars) over the same period.

“While some of this increase is attributable to population growth, an aging population, and changes to the policy structures of Medicare and Medicaid (including an expansion of the State Children’s Health Insurance Program), much of it comes from the underlying inefficiencies and excess costs of the American health care system.”

Atlas Wanked: From Fiction to Fraud in 52 Years | Crooks and Liars

Atlas Wanked: From Fiction to Fraud in 52 Years Crooks and Liars:

“But what’s especially amusing is that the economic wreckage we see before us today is in fact the handiwork of the Randian dimwits who’ve become endemic to conservative economics.

“Exhibit A: Longtime Fed Chairman Alan Greenspan, who was a Big Randian from back in the day.

“Of course, Greenspan now admits this approach may not have worked out so well. Especially the bit about letting the true economic geniuses/captains of industry have their unfettered way. In fact, it all turned out to be a big fat fraud, didn’t it?

“Greenspan wasn’t alone, of course. George W. Bush’s entire approach to governance, especially in the economic sector, was fundamentally Randian: Bush never met a tax cut for the wealthy or deregulation scheme he didn’t chase like a fox after a chicken. Even the Democrats who succumbed to the ‘era of profound irresponsibility’ did so because they were harkening to the siren song of the right-wing Randians.

“Watching Randians at work trying to convince themselves of their essential rightness in the face of the global wreckage pile of evidence to the contrary would be funny were the consequences of their historical muckup not so devastating and so far-reaching for so many of the ordinary schlubs for whom the Randians have at best a guarded contempt. It all reminds me of a bit of wisdom my granddaddy passed along to me: ‘Watch out for ideologues. Ideas are more important to them than people.'”

I have this filed under “Contrarian Economics,” and sadly, the Randian, absolutist free market theory backers are still manning the ramparts to maintain the mantle of respectable economic thought. So, in spite of the wreckage around us, Capitalism with a mandate for social justice is still contrarian.

Blue Shield to restore coverage for dropped Californians – Los Angeles Times

Blue Shield to restore coverage for dropped Californians – Los Angeles Times:

“In an attempt to settle investigations prompted by articles in The Times, the insurer agrees to reissue plans to almost 700 Californians and reimburse them for expenses that would have been covered.
By Lisa Girion [January 7, 2009 ]

“Blue Shield has agreed to reissue medical coverage to nearly 700 Californians whose policies were canceled after they got sick and to make changes in the way it handles insurance bought by individuals, officials said Tuesday.

“Blue Shield of California’s Life & Health Insurance Co. also agreed to reimburse consumers whose coverage was canceled for medical expenses they paid out of pocket.”
…
“Most of the state’s health insurers remain mired in litigation over the practice that has led to the cancellation of thousands of policies of sick patients, as well as financial losses for them, physicians and hospitals. In addition, Los Angeles City Atty. Rocky Delgadillo has sued Anthem Blue Cross, Blue Shield and Health Net, accusing all three of improperly dropping customers.”
…
“When the state’s charges were initially filed, Ross called them “grossly unfair.” Blue Shield and other insurers have maintained that state law allows them to review a patient’s old medical records after they get sick and rescind coverage if it finds something the policyholder failed to disclose on his application — whether intentionally or by mistake.

“Consumer advocates and lawyers have accused Blue Shield and other insurers of using purposefully confusing applications designed to trick people into making mistakes that can later be used against them and of failing to properly vet the applications before issuing coverage.”

God bless the American Businessman! Or woman. (Sorry, Loretta!)

OECD Study of Physician Income in 14 Countires

“The Remuneration of General Practitioners and Specialists in 14 OECD Countries: What are the Factors Influencing Variations across Countries?
(Published 22-Dec-2008)”

This link takes you to the full PDF file of the document. It is interesting.

For primary care, most coutries get between $106k to $121K, US is $146K. Interestingly, the dreaded NHS of the UK is the $121, and France is a low outlier at only $84K! But keep looking through the graphs, they are interesting. For example, US PCP’s are payed 3.4 times the average wage of our countrymen, and this is in line with the top half dozen countries or so.

Turns out the Netherlands has physician income for specialists higher than ours, by quite a bit ($290K vs $236K). But the rest of the countries fall off fairly quickly. They do not have the large disparity of specialist vs PCP income that we do.

I don’t have the data (nor the skills!) to do the analysis, but I would be very interested in how wealth accumulation differs among the countries. Considering the large expense of American colleges and Medical Schools, I would make a guess that we are so far behind the eight ball when we finish our educations and training, that we probably don’t catch up with our international peers until we’re in our forties or fifties, except for the highly payed specialties.

So, would it be wiser to do as other countries do and heavily subsidize our educations so there is not so much pent up delayed gratification? And would that also lead to more PCPs and less income disparity among specialties?

Who Will Be at the Table? : CJR

Who Will Be at the Table? : CJR:

“In a presentation to Congress, acting CBO director Robert Sunshine amplified this point: “Significantly reducing the level of growth of health care spending would require substantial changes in the incentives faced by doctors and hospitals to control costs,” he said. Translation: to really reduce medical spending, doctors and hospitals might face cost controls that could lower their incomes. The American Medical Association successfully fought this possibility every time health reform rose on the national agenda, and it’s a good bet they will fight again, while angling for a prominent place at Obama’s table.”

A discussion of physicians’ role in the upcoming debate. Unfortunately, it seems that only the usual suspects are being considered for participation. I hope we can change this.