Category: Public Option

U.S. to Sponsor Health Insurance Plans Nationwide – NYTimes.com

U.S. to Sponsor Health Insurance Plans Nationwide – NYTimes.com

The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.

These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.

The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.

Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide. The personnel agency has earned high marks for its ability to secure good terms for federal workers through negotiation rather than heavy-handed regulation of insurers.

Individual Irresponsibility in the President’s Healthcare Reform Plan

Individual Irresponsibility in the President’s Healthcare Reform Plan

A response to the above titled post from “Health Leaders”

“The result is that nearly everyone will be “covered” whether they’re insured or not. They’ll be treated, and someone else will pay the cost. That’s the way it is now, and that’s the way it will continue to be if these bills pass—just under a different mechanism.”

And with considerably fewer uninsured to require that cost shifting. That’s the whole point, isn’t it? Less uninsured.

Look, a certain percentage of the population will always try to game the system, by paying the penalty rather than buying insurance. But even those people will stop that behavior as soon as someone in their family has an illness requiring more than a couple visits to the doctor. So, yes there are gamers, but most people want to do the right thing, I still believe.

“Premiums from commercial insurers will be sky-high, if commercial plans even continue to exist long-term.”

That’s not what the CBO says.

“What better way to get the deeply unpopular public option back in the mix in a few years?”

Except it isn’t unpopular, except with the Fox News crowd, who still think it is some sort of Sino-Soviet hybrid system.

And, just for the record, the 10 largest physicians organizations support reform with the option.

Posted using ShareThis

This American Life HC Reform Part 2

This American Life:

This week, we bring you a deeper look inside the health insurance industry. The dark side of prescription drug coupons. A story about Pet Health Insurance, which is in its infancy, and how it is changing human behaviors—for example, if you have the pet health insurance, you bring your pet to the vet more often, and the vet makes more money and…well, you can see the parallels. And insurance company jargon, frighteningly decoded.

Prologue. Host Ira Glass describes the crazy world of medical billing, where armies of coders use several contradictory different systems of codes…and none of it makes us healthier. (5 minutes)

Act One. One Pill Two Pill, Red Pill Blue Pill.
Planet Money’s Chana Joffe-Walt explains why prescription drug coupons could actually be increasing how much we pay, and prevent us from even telling how much drugs cost. (13 1/2 minutes)

Act Two. Let’s Take Your Medical History.
Alex Blumberg and Adam Davidson recount how four accidental steps led to enacting the very questionable system of employers paying for health care. (11 1/2 minutes)

Act Three. Insurance? Ruh Roh!
Planet Money correspondent David Kestenbaum investigates the growing popularity of pet
insurance, and what it reveals about insurance for people. (14 minutes )

Act Four. Sorry Johnny… It’s Only Business.
This American Life producer Sarah Koenig reports on a very surprising reason why insurance companies dump members, and how this reasoning contradicts President Obama’s argument for what will lower health care costs. (11 1/2 minutes)

Again, a very interesting program to follow up on last week’s episode.

In Act IV, the interview with Uwe Reinhardt is very thought provoking. Specifically, he talks about the power of suppliers (i.e., hospitals) in the insurer-provider tug of war, and about Maryland’s “All Payer System,” which I will try to learn more about and pass along when I do…

MP3 of Part 2

MP3 of Part 1 is not offered directly at the website. You can subscribe to the podcast and then download yourself here: http://feeds.thisamericanlife.org/talpodcast

Swiss Model for Health Care Is Gaining Admirers – NYTimes.com

Swiss Model for Health Care Is Gaining Admirers – NYTimes.com:

ZURICH — Like every other country in Europe, Switzerland guarantees health care for all its citizens. But the system here does not remotely resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States.

Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance.
That is why many academics who have studied the Swiss health care system have pointed to this Alpine nation of about 7.5 million as a model that delivers much of what Washington is aiming to accomplish — without the contentious option of a government-run health insurance plan.

In Congress, the Senate Finance Committee is dealing with legislation proposed by its chairman, Max Baucus, Democrat of Montana, which would require nearly all Americans to buy health insurance, but stops short of the government-run insurance option that is still strongly supported by liberal Democrats.

Two amendments that would have added a public option to the Baucus bill were voted down on Tuesday. But another Senate bill, like the House versions, calls for a public insurance option.

By many measures, the Swiss are healthier than Americans, and surveys indicate that Swiss people are generally happy with their system. Switzerland, moreover, provides high-quality care at costs well below what the United States spends per person. Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.

And yet, as a potential model for the United States, the Swiss health care system involves some important trade-offs that American consumers, insurers and health care providers might find hard to swallow.

The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.

The Swiss government also provides direct cash subsidies to people if health insurance equals more than 8 percent of personal income, and about 35 to 40 percent of households get some form of subsidy. In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it. (All the health care proposals in Congress would provide a subsidy to moderate-income Americans.)

The German system also does fine without a “public option,” and is my favorite model, but this type of advance will take us a few years, but I think we will get there eventually. Having a successful public plan pulling the private insurers, including the not-for-profit-in-name-only ones, into some sanity will help tremendously. The bold, italicized part above is really the key to real reform and universal access: “Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.”

Another interesting tid-bit:

As in the United States, practitioners typically are paid on a fee-for-service basis, rather than on salary. But they make less than their American counterparts. According to the O.E.C.D., specialists in Switzerland earn three times more than the nation’s average wage, compared with 5.6 times for American specialists. General practitioners in Switzerland make 2.7 times more than the average wage, versus 3.7 in the United States.

So specialists:PCP income here in the US is $1.51: $1
Switzerland is $1.11:$1.00
Interesting…

Altmire on Public Option

This is from Firedoglake

List of Blue Dogs who have expressed support for a public option (with Nate Silver’s estimate of district support/opposition in parenthesis):

1. Jason Altmire: (35-53)

Signed HCAN principles

July 17: Voted ‘no’ as a member of the Health & Labor Committee against 3200 because of wealth surtax.

September 11: ‘I – I’m speaking for myself, I think that the public option may, if it’s done correctly may be a part of the package and could play a role. As Congresswoman Woolsey described, it would have to airtight, completely self-sustaining, not funded through taxpayer subsidies, and have to meet all the same insurance regulations. So, I don’t think that is the sticking point for the Blue Dogs and the moderate members. I think what we are most concerned about is we have to do this in a fiscally responsible way.’

September 22: ‘Altmire’s chief complaint about his own chamber’s bill was the inclusion of a surtax on the wealthy. But he said he didn’t expect that provision to make it through, and he signaled that excluding it would allow him to vote for the final bill.’

It looks like we in Western PA have some work to do in getting Altmire’s district turned around. Those are abysmal numbers of support for the Public Option.

Sounds like a job for Doctors for America.

If you would like a doctor to come speak in Mr. Altmire’s district, please let me know and I will do it or find someone who will!

George Lakoff: The PolicySpeak Disaster for Health Care

George Lakoff: The PolicySpeak Disaster for Health Care:

The narrative is simple:
Insurance company plans have failed to care for our people. They profit from denying care. Americans care about one another. An American plan is both the moral and practical alternative to provide care for our people.

The insurance companies are doing their worst, spreading lies in an attempt to maintain their profits and keep Americans from getting the care they so desperately need. You, our citizens, must be the heroes. Stand up, and speak up, for an American plan.
Language
As for language, the term ‘public option’ is boring. Yes, it is public, and yes, it is an option, but it does not get to the moral and inspiring idea. Call it the American Plan, because that’s what it really is.
The American Plan. Health care is a patriotic issue. It is what your countrymen are engaged in because Americans care about each other. The right wing understands this well. It’s got conservative veterans at Town Hall meeting shouting things like, ‘I fought for this country in Vietnam, and I’m fight for it here.’ Progressives should be stressing the patriotic nature of having our nation guaranteeing care for our people.
A Health Care Emergency. Americans are suffering and dying because of the failure of insurance company health care. 50 million have no insurance at all, and millions of those who do are denied necessary care or lose their insurance. We can’t wait any longer. It’s an emergency. We have to act now to end the suffering and death.
Doctor-Patient care. This is what the public plan is really about. Call it that. You have said it, buried in PolicySpeak. Use the slogan. Repeat it. Have every spokesperson repeat it.
Coverage is not care. You think you’re insured. You very well may not be, because insurance companies make money by denying you care.
Deny you care… Use the words. That’s what all the paperwork and administrative costs of insurance companies are about – denying you care if they can.
Insurance company profit-based plans. The bottom line is the bottom line for insurance companies. Say it.

Private Taxation. Insurance companies have the power to tax and they tax the public mightily. When 20% – 30% of payments do not go to health care, but to denying care and profiting from it, that constitutes a tax on the 96% of voters that
have health care. But the tax does not go to benefit those who are taxed; it
benefits managers and investors. And the people taxed have no representation.
Insurance company health care is a huge example of taxation without representation. And you can’t vote out the people who have taxed you. The American Plan offers an alternative to private taxation.
Is it time for progressive tea parties at insurance company offices?

Doctors care; insurance companies don’t. A public plan aims to put care back into the hands of doctors.
Insurance company bureaucrats. Obama mentions them, but there is no consistent uproar about them. The term needs to come into common parlance.

Insurance companies ration care. Say it and ask the right questions: Have you ever had to wait more than a week for an authorization? Have you ever had an authorization turned down? Have you had to wait months to see a specialist? Does
you primary care physician have to rush you through? Have your out-of-pocket
costs gone up? Ask these questions. You know the answers. It’s because insurance
companies have been rationing care. Say it.
Insurance companies are inefficient and wasteful. A large chunk of your health care dollar is not going for health care when you buy from insurance companies.
Insurance companies govern your lives. They have more power over you than even governments have. They make life and death decisions. And they are accountable only to profit, not to citizens.

The health care failure is an insurance company failure. Why keep a failing system? Augment it. Give an alternative.

Congressional Republican’s Healthcare Reform Questionnaire

I live in the Pittsburgh are, specifically in Republican Congressman Tim Murphys’s district.

Today we received an “Important Survey on Pending Healthcare Legislation” from the Congressman. I was impressed by the straight forwardness of the questions (the subtle subtext was that you must be a complete moron to want our health care system to change) and by the clear headed, willful ignorance of the actual issues involved in reform displayed by the survey writers.

And awaaay we go…

Okay, in fairness, the first six questions weren’t bad: do you have insurance, what kind, how is it, is it getting more expensive, do you believe the system is broken, and what priority should it be for Congress.

7. Do you favor a healthcare system that is run by the private sector or the government? (Private, Govt, combination, unsure)

Let’s see, I want the highest quality system in the world with costs far lower than our current system. Looking around the world I see that France, a government administered single payer system is the best in the world, and Germany, with a government regulated social health insurance system administered by private, not for profit insurers is right behind it. Low cost, high quality, waiting times like ours are now… OK, I choose either Government Run like France or a Hybrid system like Germany’s.

8. Would you be willing to pay higher taxes to guarantee heath insurance for all Americans?

This is why I’m writing this diary, because this question always sets me off. I would be willing to pay higher taxes because, if we do this correctly (see question 7), I will no longer be paying insurance premiums. If we do it really well (see question 7), I will actually end up paying significantly less for my healthcare overall, because we will eventually squeeze out the tremendous waste, overhead, and obscene profit currently embedded in our system.
What really ticks me off about this is the blatant intellectual dishonesty (or it could be simply ignorance, I can be charitable) on display. It does not require a degree in economics to understand that we pay for health care in many ways, but primarily we pay for it through our compensation packages: our insurance premiums come out of our wages! Ask anyone who’s had stagnant wages over the past decade whether or not health care costs come out of their wages.
Have no republicans *ever* looked at a study on comparative international health care? Do they not know that we pay way more than any other country in the world. Per capita, as percentage of GDP, however you want to slice it: we have the most expensive system on the world and the Republicans seem to think the only fix is to add costs?

9. Do you think a private sector healthcare system can be improved to provide coverage to more Americans at a lower cost than a nationalized plan?

I have to confess my initial impulse was a *big NO*, but, thinking of Germany, Switzerland and the many other countries using a hybrid public-private system of Social Health insurance, I will answer a qualified yes.

If we follow the models provided for us around the world and regulate the private insurers (i.e., a 3 or 4 millimeter long leash), it can be done. The discipline that would be required for our Congress to resist the money that would surely be thrown around does make me despair that it is near impossible. But, it has been done the world over, so, I can dream, can’t I?

Germany, again, provides an interesting model because it uses private, but not for profit, insurers (sickness funds) to do the administration. Everywhere in the world but here, not for profit means not for profit and not for profits don’t accumulate billions in “reserve funds” or pay executives millions of dollars a year.

10. What is your main concern with your current health insurance coverage or plan? Not portable/tied to employer, lack of transparency, too many restrictions on providers/rationing, out of pocket expenses, or other.

Props where they are due for this question. I hope his Democratic constituents give him an earful on these! All of the above is the obvious answer for me, but I just have to take up the choice/rationing bit.

Republicans are always focused on choice of insurer or of insurance plans, as if where you go to the hospital or which doctor you go to is an afterthought. Like every major market in the country, Pittsburgh has essentially 2 insurers. We switched plans a couple years ago *within* one of those insurers and we went from having my wife’s skin cancer specialist on one plan to her breast specialist on the other. But at least I could choose my plan!

My prior manifesto on rationing is here.

11. Should the government require that every American have health insurance?

Germany requires everyone in the bottom 4/5ths income to participate in a sickness fund. The upper fifth can opt out: 3/4 don’t, leaving the wealthiest one fifth in the private market. I can live with that.

Single payer countries, you’re just in. Period.

Either works for me.

12. Should the government require that all health insurance companies provide a “Basic Plan” option…so that families could shop around?

Not the ultimate solution, but since something like this will probably find its way into the reform, here is my proposal. it comes from an old Adam Tobias book on the insurance industry called “The Invisible Bankers.”

I’d like a truth in insurance statement, like a truth in lending statement on a loan or, even better, an energy sticker on an appliance. I can imagine lots of information on this sticker, but the really interesting one would be the one I stole from Tobias: *”This policy, on average, will pay out xx cents on every premium dollar paid.”* I’ll leave you to cogitate on that.

13. Should the government create and manage a public health insurance plan that would compete for business alongside private insurance plans?

If you’ve read this far, you know my answer: Well, it’s better than nothing!. But, seriously, considering how un-progressive this legislation is going to ultimately be, we have to draw a line in the sand somewhere, and this should be where we draw it *at an absolute minimum.*

14. Should people on Medicaid have the option of purchasing private health insurance with a voucher to shop around for the best coverage, rather than have only the option of government insurance?

I happen to think Medicaid has lots of problems. Not the least is its very low reimbursement rates in many big states resulting in de facto rationing.

So I am against using Medicaid as the vehicle to expand coverage, but I know others feel differently.

15. Should the government offer tax credits to individuals to help offset the cost of health insurance?

I think the phrase “magic bullet” must have been invented just to cover the Republican love affair with tax cuts. Or that one about having only a hammer as a tool and every thing looking like a nail. One of those.

16. Should the government allow individuals to purchase health insurance from any state and shop nationally for the best price?

Don’t care, won’t help, but I can’t help but notice that on issues of privacy, national security and torture, republicans say “we,” but on social justice issues, it’s “the government.” Just sayin’.

17. Should the government mandate that private insurance companies cannot turn away patients with pre-existing conditions?

I’ll vote yes, but it provides a teaching opportunity. What happens in Germany or Switzerland, you may ask, if a particular insurer gets a disproportionate care of sicker patients who cost them more? Since they can’t charge higher premiums based on this and can’t drop people, what happens? Risk adjustments are made and the companies get adjusted funds from the government. This is being proposed here, as well.

And finally, just to remind the pipples why they hate government and really hate all this “social justice” nonsense that the Pope and Winston Churchill are so hopped up on:

18. Any government assistance will require taxpayer funds to cover the cost. Which of the following proposals would you support to pay for health care reforms, and for the government to cover the uninsured?(nat’l sales tax, higher payroll taxes, marriage penalty, cell phone taxes, sin tax on soda, sin tax on alcohol, tax on charitable donations,raise income taxes, penalize employers for not providing insurance, tax on insurance, tax on health care expense, tax on future health care needs (?), tax on Rx drugs, raise taxes on oil refineries, taxes on power companies, taxes on US companies doing business overseas, taxes on dividend income, raise capital gains taxes, inheritance tax – phrased “tax you family assets on death” LOL.

So, if you weren’t steamed before, I bet you are now. I refer you back to answer 7 for the inanity of this question, but in the best Republican tradition of ginning up resentment among the citizenry, I give you, “the list.”

Cheers,

The painful side effects of Obama’s healthcare reform – Los Angeles Times

The painful side effects of Obama’s healthcare reform – Los Angeles Times:

“Now, I’m well aware that having 47 million people who can’t afford medical care is a genuine social problem — although many of those millions are illegal immigrants, people between jobs and young folks who choose to go insurance-bare. I’m also aware that I can’t necessarily have everything I want, whether it’s a dozen pairs of Prada boots or a pacemaker at age 99. I know that Medicare is on the greased rails to a train wreck, and not just because of spiraling costs but because doctors are fleeing the system because they’re sick of below-cost reimbursements and crushing paperwork. There are ways to solve some of these problems: healthcare tax breaks, malpractice reform that would lower the cost of practicing medicine, efforts to make it easier to get cheap, high-deductible catastrophic coverage, steps to encourage fee-for-service arrangements of the kind that most people have with their dentists.

“In short, as someone who’s not getting any younger, I’d like to be the one who makes the ‘difficult decision’ as to whether I can afford — and thus really want — that hip replacement in my extreme old age. Sorry, President Obama, but I don’t want ‘society’– that is, government mucky-mucks — determining that I’ve got to go sit on an ice floe just because I’m old and kind of ugly, no matter how many fancy degrees in medicine or bioethics they might have.”

Nothing like folksy wisdom for understanding and dealing with the complexities of health care reform and modern bioethics. The usual right wing disinformation and misdirection are especially tiresome. So, to the rebuttal:

First pillar of fear mongering on health care reform: rationing. Be afraid, be very afraid. Ignore the rationing (by income and economic class) that’s already going on. Ignore rationing by private health insurers. Ignore spiraling costs that will soon have all but the top tiers of income earners on shoe-string insurance plans. Forget all that, just worry about the potential for rationing.

The point of Ms. Allen’s piece is that health care will be rationed by using arbitrary clinical parameters to deny care based solely upon costs. Or, she also warns, that some procedures will be denied based upon scientific, non-arbitrary clinical parameters, specifically along the lines of England’s National Institute for Health and Clinical Excellence which publishes guidelines and does medical and economic analyses of medical treatments to determine whether they are worth it to individuals and to society as a whole. I’m sure Ms. Allen finds it infuriating that some all other societies consider how utilization of finite resources affects everyone, not just the well off.

Interesting thing, that concept of “allocating scarce resources.” It is actually one of the centerpieces of medical professionalism developed by the American Board of Internal Medicine, the American College of Physicians and the European Federation of Internal Medicine and adopted by the American Medical Association and many other physician organizations. The Charter states, “The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.”

This brings up fear mongering pillar two, always frame the debate as a choice between our current “system” or, the systems of either Canada or England, two countries that, while providing universal health care, because of their parsimony, have performed in international health care outcomes research almost as badly as does the United States! It seems genuinely ludicrous (but convenient for generating insecurity among the under-informed) to set as the benchmark for improving our health care system two countries who only do a bit better than we do. I have yet to see an opinion piece from a conservative decrying the inferior care and long wait times in France or Germany, the top performing countries in the world. That’s because they provide excellent care to all of their citizens, have no longer waiting times than our own, have much more satisfied physicians and patients and do it all at a sizeable discount to ours.

Another classic tactic is blaming the poor, the unhealthy, the “other.” On one hand, Ms. Allen laments the imposition of the 47 million uninsured onto our system, and forecasts that it will lead to unacceptable waiting times for those of us already “in.” A few paragraphs later she notes her understanding of the seriousness of the issue of the uninsured, but then posits that many of these 47 million don’t really need or deserve health care insurance as they are illegal immigrants or between jobs, etc. My brother was nearly bankrupted by being “between jobs” and having an illness in his family.

Back to our story. Ms. Allen makes a troubling conflation by muddling together limiting the amount we spend on health care in the last months of life with limiting health care to the elderly. There is a HUGE difference.

Ms. Allen cites the example of the hip fracture treatment President Obama’s grandmother received before her death and the pacemaker placed into the 99 year old mother of a town hall audience member as cautionary tales, indicating the “government run” healthcare would allow these patients to simply die because some intellectual, academic physicians in their ivory towers will give the thumbs down sign and demand their euthanasia. How sad that the public’s opinion of physicians and medical professionalism has deteriorated so badly that this is their expectation. Or, if not their expectation, but their cynical gambit that others will think this rings true.

Here’s the difference: Obama’s grandmother was terminally ill with cancer. The questions surrounding her surgery boiled down to whether it would improve her comfort in her last months and whether the surgery would ultimately shorten her life. As it turns out, it appears to have done both, making this a difficult case to slice down the middle as black and white. That’s why decisions like this cause ethical dilemmas: there are pros and cons to the decisions. There are sometimes non-operative decisions involving immobilization, aggressive pain management and other palliative measures that avoid the pain Mr. Obama was rightly concerned about. And sometimes these measures, especially in extremely frail elderly patients, are the right measures, because they avoid the very high mortality associated with surgery and other aggressive measures in this population.

The medical team, had they made the decision not to operate, would not have been bureaucrats determined to painfully end the life of an elderly cancer patient, but a compassionate team of professionals, balancing the patient’s quality of life in her last months (pain, hospitalization, removal from family and home, etc.), with her wishes and goals – perhaps to see her grandson elected President! When we strive to provide excellent end-of-life care, we balance all of these issues and we counsel our patients and their families as best we can because it is the right thing to do, not because it saves money. We would do it if it cost more: that is apparently the decision arrived at in this case. The calculation was made, as it should always be, based on the goals of the patient and family, not on a corporate balance sheet and potential executive bonus.

The second case, of the 99 year old requiring a pacemaker, is actually not much of an ethical problem. I agree with President Obama that these decisions should not be made based on “spirit,” but they certainly can be made based upon clinical guidelines and the individual patient’s health status. Regardless of this woman’s spirit, if she was a frail 99 year old with advanced chronic heart or lung disease, or with advanced dementia and a feeding tube for nourishment, one would be hard pressed to justify placing an expensive pacemaker or defibrillator into her, but a healthy 99 year old is another matter. It is important to note that Medicare did not deny either of these patients care, as a private insurer may have.

The other inappropriate conflation is the issue of limiting the amount we spend with limiting the amount we spend on treatments without proven benefits or with benefits so limited as to make them frivolous in most senses. If we presume that any guideline that determines a treatment not useful to be rationing, we will be in a world of economic hurt. This is actually the point of Comparative Effectiveness Research (CER), to try to figure out what we do that is costly but adds no value to patient care on one extreme, and figuring out what is relatively inexpensive and saves lives on the other.

Her assessment of the inherent inferiority of screening mammograms every three years compared to annually demonstrates precisely the need for CER: The automatic assumption that more testing means better outcomes. This is actually one of the bigger problems with American medicine, the automatic assumption that doing something, and not just something, but the newest latest most expensive something, is always best. Should the 99 year old patient get the latest greatest pacemaker? Maybe, but having some CER to help us make intelligent judgments should be lauded, not reflexively ridiculed by the anti-intelligentsia.

Update: a link to this item on my dailykos diary and a lively discussion.

Health Beat: The AMA Would Make Health Care Unaffordable for Many Americans

Health Beat: The AMA Would Make Health Care Unaffordable for Many Americans:

“The American Medical Association has announced its opposition to a public-sector health plan that would compete with private insurers. Why? Because the AMA fears that Medicare E (for everyone) might not pay some specialists as handsomely as private insurers do now.

“Why do private insurers pay more? Because they can pass the cost along to you and I in the form of higher premiums. Medicare E has no one to pass costs on to—except taxpayers. And taxpayers will already be helping to subsidize those who cannot afford insurance.

“Everyone agrees that primary care physicians are underpaid. Democrats in both the House and the Senate propose raising their fees, as does the Medicare Payment Advisory Commission (MedPac)—the group that might take over setting fees for Medicare. Moreover, the House, the Senate, President Obama and MedPac have made it clear that they do not favor the across-the-board-cuts called for under the sustainable growth rate (SGR) formula. Congress has consistently refused to make those cuts and President Obama did not include them in the 2010 budget that he originally sent to Congress. On that score, the AMA has nothing to worry about.

“Protecting Excessive Fees for Some Specialists’ Services

“So what does the AMA fear? That either MedPac or Medicare will trim fees for certain specialists’ services. Keep in mind that Medicare’s fee schedule has traditionally been set –and adjusted on a regular basis, by the RUC– a committee dominated by specialists.( Private insurers then follow that fee schedule, usually paying somewhat more for each service.) I have described this group in the past: They meet behind closed doors. No minutes are kept of their meetings. They rarely suggest lowering fees—even though as technology advances, some services become easier to perform. MedPac has pointed out that a less biased group should be involved in determining fees—perhaps physicians who work on salary, and are not affected by Medicare’s fee schedule.

“There is good reason to suspect that the RUC has over-rated the value of some services.. MedPac has suggested taking a look at particularly lucrative tests or treatments that are being done in large volume. Often, this may mean that patients who don’t need the service are receiving it; if the procedure isn’t necessary, then, by definition, they are being exposed to risks without benefits. And in fact, experience shows that when high fees are trimmed, volume falls, suggesting that rich fees were, in fact, driving overtreatment.”

There is more here about using medicare to “bend the curve,” or reduce over-utilization, improve use of preventive services, as well as a discussion of how a Public Plan might besubsidezed, etc. well worth reading, particularly about subsidization.

I would only add that the title falls a bit short: The AMA, or rather, conservative physicians, are hardly the only group fighting significant change. The Health Insurance industry, despite conciliatroy noise, will be the big guns or long knives as this goes forward. And behind them will be Pharma, other device and equipment manufacturers, probably home health servicers, ambulatory care centers, and, for purely ideological reasons, all conservatives.