When carpenters frame a new building's walls, the building takes a recognizable shape. Passers-by get a sense of structure, a release of anxiety, the assurance that the process is reasonable and guided by established principles of physics, mechanics, truth and responsibility.
Unfortunately for his investors, Bernard Madoff's framing process provided his investors with a sense of structure, freedom from anxiety, and assurance - echoed by respected financial experts - that his structure was reasonable, in accordance with the principles of the financial industry of which he was an noted executive, responsible and truthful. A Ponzi scheme is an exercise in framing for deceit.
Framing is not restricted to buildings and financial structures: it is also part of our daily political exposure. Arguments are carefully framed and discussed by health care "experts" representing entrenched vested personal and business financial interests in advocating or opposing health care reform. We hear the expert-of-the day on television proclaiming that he or she has a solution or a reason not to solve, our health care problems and we hear our Congresspeople in high dudgeon about the foolishness of some of the proposals.
What does the "frame" look like? How does it compare to the truth?
The Norman Rockwell painting showing a doctor by the bedside, indelibly etched into our psyche, is a good place to start. It is part of the mythology of American medicine: each person should have his or her own honest and competent personal physician who is completely dedicated to him or her, and can marshall all necessary care without any intervention by an outside force. Unfortunately, the physician that one sees when really sick is not likely to be the physician who might know you; the hospitalist may never have met you before admitting you to the hospital and probably will not know you after discharge. The specialists who undertake your care come and go, often unfamiliar faces appearing at odd hours. Medicine has changed from Rockwell's days when the doctor sat by the bedside, waiting for the patient to die because the doctor had no antibiotics, little technology, and scientific knowledge which was woefully deficient. And today's family practice physicians have the impossible task of being knowledgeable in many complex fields requiring their attention today.
Another myth grew from the non-profit operation of early health insurers such as Blue Cross and Blue Shield and non-profit HMOs, the latter established in response to Richard Nixon's actions supporting a new system of care. Insurers and HMOs have perpetuated an image of providing service and valuable expertise to health care, rather than acknowledging that they are essentially system integrators which primarily contract with networks of providers and themselves provide little or no health care, but lots of resource-draining bureaucratic intervention and political contributions.
Another frame issue is the concept that, as scientifically and technologically advanced Americans, we now provide high-quality and efficient health care to all who need it and that health care reform will exponentially increase health care expense. This is a dubious position: overflowing hospital emergency departments (many roadblocked by the uninsured) are many times more expensive than a doctor's office for providing episodic non-critical care. With health reform, why shouldn't we develop money and life-saving efficiency rather than perpetuating the wasteful system that perpetuates income flow to selected self-serving segments of the health care industry and poor quality inefficient care to many Americans?
Tuesday, June 30, 2009
Monday, June 22, 2009
Insurers Revoke Plans To Avoid Paying For Patients With High Costs
While "shame" is not an insurance concept, after reading the brief article cited below, you may conclude that "shameless" may be an insurance industry concept.
The last paragraph of a news release by Kaiser (click title above to get linked-in):
"The committee's investigators found 19,776 rescissions from three large insurers over five years, which led to savings of $300 million. "Several lawmakers at the hearing suggested there were things the companies could do right now: They could vet applications when they receive them, rather than waiting until people get sick; they could consider whether something that was omitted was related to a current health condition before rescinding; and they could be more careful to positively identify fraud before rescinding a policy" (Silberner, 6/22"
The last paragraph of a news release by Kaiser (click title above to get linked-in):
"The committee's investigators found 19,776 rescissions from three large insurers over five years, which led to savings of $300 million. "Several lawmakers at the hearing suggested there were things the companies could do right now: They could vet applications when they receive them, rather than waiting until people get sick; they could consider whether something that was omitted was related to a current health condition before rescinding; and they could be more careful to positively identify fraud before rescinding a policy" (Silberner, 6/22"
Sunday, June 21, 2009
A Specialist - Defined
A specialist is a person who, because of personality, training and experience, is more comfortable dealing with an impossible problem than the generalist who made the referral.
Saturday, June 20, 2009
Underwriting Is Not The Only Way To Get Rid Of Sick Patients
I was not overjoyed to read that insurers have agreed to abandon underwriting any more than I would be happy to read that terrorists have replaced plans to explode dirty nuclear devices in the subways of our major cities with plans to engage in biologic warfare.
There's more than one way to exclude expensively sick people from an insurer's risk pool: here are several. First, limit the drugs on the plan formulary to make drugs, for people with diseases which are expensive to insure, not covered, very expensive or inaccessible because of bureaucratic requirements. Second, have a network of doctors and health care institutions which doesn't include people or institutions with particular expertise in caring for people with expensive diseases. Exclude providers in certain geographic areas with "undesirable risk exposure." For instance, if a particular occupation (i.e., school teachers and educators) is believed to involve increased insurance coverage risk, don't provide facilities (or solicit business) where teachers and educators are significant population component. Fourth, avoid marketing to "high risk" clientele. And fifth, have an 85% "customer satisfaction" rule: if 85% of your customers are content, ignore complaints from the other 15%: they are not worth the administrative overhead to deal with, they demand too much, and they may be the sick expensive ones.
Finally, a "pool" which is available to individuals who can't get insurance any other way will encourage the strategies described in the last paragraph. It's just another reason to cost shift.
There's more than one way to exclude expensively sick people from an insurer's risk pool: here are several. First, limit the drugs on the plan formulary to make drugs, for people with diseases which are expensive to insure, not covered, very expensive or inaccessible because of bureaucratic requirements. Second, have a network of doctors and health care institutions which doesn't include people or institutions with particular expertise in caring for people with expensive diseases. Exclude providers in certain geographic areas with "undesirable risk exposure." For instance, if a particular occupation (i.e., school teachers and educators) is believed to involve increased insurance coverage risk, don't provide facilities (or solicit business) where teachers and educators are significant population component. Fourth, avoid marketing to "high risk" clientele. And fifth, have an 85% "customer satisfaction" rule: if 85% of your customers are content, ignore complaints from the other 15%: they are not worth the administrative overhead to deal with, they demand too much, and they may be the sick expensive ones.
Finally, a "pool" which is available to individuals who can't get insurance any other way will encourage the strategies described in the last paragraph. It's just another reason to cost shift.
Wednesday, June 17, 2009
Priorities. Political Courage and National Leadership
The Iraq war, according to the TV economists, will end up costing $3 trillion: what did we get for that? The collapse of our financial system, according to the TV economists, went through $3 trillion in a month: what did we get for that? Health care reform will cost less than $3 trillion: what could we get for that?
Insurer's Religious Principle: It Is Better To Receive Than To Give
Kaiser reports that insurers decline to stop their practice of canceling some of their "insured" ill patients' policies. Read the article by clicking the title above. May not be suitable for all ages and may cause the sudden onset of extreme nausea.
Monday, June 15, 2009
Introduction to Guidepath - Health Care Reform
Improve 2ndry science education
1. Require teachers of high-school chemistry, biology, mathematics and physics to have majored in college in one of these four subjects, minored in another and had courses in the remaining two. Survey course will not qualify a person to teach sciences.
2. Require students planning to pursue a medical education and students planning a career in science education to take and pass with at least a “B” high-school courses in biology, chemistry, physics and mathematics.
3. Provide an introductory course in the ethics of scientific research and its application.
College Education in science.
1. Require students majoring in a scientific field, or pre-medical studies, to have passing grades in standard (not just courses for “non-scientists”) courses in biology, chemistry, physics and mathematics. State law and medical school requirements will govern the remainder of the required courses.
2. Provide an introductory and intermediate course in the ethics of scientific research and its application.
Medical School
1. Require standard medical curriculum.
2. Provide yearly courses in medical ethics.
3. Provide an orientation to health law.
Medical Education Funding
1. Provide a full scholarship loan for college and medical school tuition expenses, appropriate housing, health care and food to each student who complies with the requirements above. The loan may be paid back in full after completion of medical or postgraduate scientific studies (including internship, residency, fellowship or postgraduate degree), federal and state tax free, only through completion of 2 years of service in a federal health corps for each year of support. If the loan is not paid back through completion of service, it must be repaid within 8 years of completion of the medical and/or scientific education, or if it is not completed, within 8 years of college graduation.
Advanced Medical Education and Postgraduate Studies Leading to an M.D. and/or Ph.D.
See paragraph immediately above.
Establish an Independent Agency - the Uniformed Federal Health Corps to provide public health services as well as staffing for patient services as federal health facilities. Establish federal health clinics (“Federal Health System”) and services in communities throughout the United States staffed by the Federal Health Corps.
Single Payer" Establish a federal system for collecting all revenues for health insurance and payment of all costs relating to patient health services.
Competing Systems
Provide competing programs for health care among insurers and the Federal Health System. One equivalent “premium” structure for all competing entities.
No Favoritism Each state- professionally licensed health care provider may contract with any or all of the competing entities. Quality requirements, evaluations, and corrective actions to be established and monitored by a separate federal agency within DHS with consideration to preservation, maintenance and safeguarding the life and health of all Americans through provision of medically necessary goods and services which meet generally accepted professional standards of care as determined by non-conflicted standards-setters.
Pharmaceuticals and Devices The federal government will negotiate a schedule of drugs and devices, with related services (i.e., dispensing) and rates of payment. Pharmaceuticals and devices not on the approved list for safety and efficacy for the purpose prescribed, will not be paid for under any government payor program, but pharmaceuticals services on the approved list will be covered.
Hospital, Nursing Home and Other Services Which Are Non-Custodial. Principles are those described in the paragraph above.
Financing. Value Added Tax on goods and services.
Who is Covered Every American citizen, permanent legal resident, and in-utero fetuses.
Medicaid. States may continue Medicaid at their own expenses for non-citizens who are not permanent residents.
1. Require teachers of high-school chemistry, biology, mathematics and physics to have majored in college in one of these four subjects, minored in another and had courses in the remaining two. Survey course will not qualify a person to teach sciences.
2. Require students planning to pursue a medical education and students planning a career in science education to take and pass with at least a “B” high-school courses in biology, chemistry, physics and mathematics.
3. Provide an introductory course in the ethics of scientific research and its application.
College Education in science.
1. Require students majoring in a scientific field, or pre-medical studies, to have passing grades in standard (not just courses for “non-scientists”) courses in biology, chemistry, physics and mathematics. State law and medical school requirements will govern the remainder of the required courses.
2. Provide an introductory and intermediate course in the ethics of scientific research and its application.
Medical School
1. Require standard medical curriculum.
2. Provide yearly courses in medical ethics.
3. Provide an orientation to health law.
Medical Education Funding
1. Provide a full scholarship loan for college and medical school tuition expenses, appropriate housing, health care and food to each student who complies with the requirements above. The loan may be paid back in full after completion of medical or postgraduate scientific studies (including internship, residency, fellowship or postgraduate degree), federal and state tax free, only through completion of 2 years of service in a federal health corps for each year of support. If the loan is not paid back through completion of service, it must be repaid within 8 years of completion of the medical and/or scientific education, or if it is not completed, within 8 years of college graduation.
Advanced Medical Education and Postgraduate Studies Leading to an M.D. and/or Ph.D.
See paragraph immediately above.
Establish an Independent Agency - the Uniformed Federal Health Corps to provide public health services as well as staffing for patient services as federal health facilities. Establish federal health clinics (“Federal Health System”) and services in communities throughout the United States staffed by the Federal Health Corps.
Single Payer" Establish a federal system for collecting all revenues for health insurance and payment of all costs relating to patient health services.
Competing Systems
Provide competing programs for health care among insurers and the Federal Health System. One equivalent “premium” structure for all competing entities.
No Favoritism Each state- professionally licensed health care provider may contract with any or all of the competing entities. Quality requirements, evaluations, and corrective actions to be established and monitored by a separate federal agency within DHS with consideration to preservation, maintenance and safeguarding the life and health of all Americans through provision of medically necessary goods and services which meet generally accepted professional standards of care as determined by non-conflicted standards-setters.
Pharmaceuticals and Devices The federal government will negotiate a schedule of drugs and devices, with related services (i.e., dispensing) and rates of payment. Pharmaceuticals and devices not on the approved list for safety and efficacy for the purpose prescribed, will not be paid for under any government payor program, but pharmaceuticals services on the approved list will be covered.
Hospital, Nursing Home and Other Services Which Are Non-Custodial. Principles are those described in the paragraph above.
Financing. Value Added Tax on goods and services.
Who is Covered Every American citizen, permanent legal resident, and in-utero fetuses.
Medicaid. States may continue Medicaid at their own expenses for non-citizens who are not permanent residents.
Sunday, June 14, 2009
Does NY Times Editorial Demonizing Doctors Signal That Health Reform Is In Trouble?
If you haven't seen the NY Times Sunday (6/12/09 p. 7) editorial "Doctors and the Cost of Care," you should check it out. It focuses on a report by Harvard-affiliated Dr. Atul Gawande who concluded, after investigating high Medicare health care costs in McAllan Texas (population-141,000 with 103 physicians per 100,000 which is less than the U.S. average), that doctors' over-treatment of patients was responsible. Citing Dartmouth Research, the editorial echos the opinion that " . . . more costly areas and institutions provide a lot more tests, services and intensive hospital-based care than the lower cost centers . . . . yet their patients fare no better and often fare worse because they suffer from the over-treatment."
Numbers? Where are the numbers? Whose doctor is it that is testing too much and over-treating? Is the indictment applicable to 2 percent of the physician population, 98% of the physician population, or 50 percent of the physician population. Are these doctors practicing outside the standard of practice for their specialties (these days, even family practice is a specialty)? If they are, the solution is medical board investigation and disciplinary action, medical staff investigation and disciplinary action at the local level, and (unfortunately) appropriate lawsuits for poor practice conduct resulting in injury. But if these physicians are practicing within the standard of practice one must ask, what is the problem? Or is there a problem?
Yes, there is a problem. In part, it is in the education system that provides basic medical education and continuing medical education which is often influenced by pharmaceutical and medical device companies (through their detail personnel, hired-hand expert speakers, subsidized medical journal articles). There is also a problem with direct-to-patient advertising which is focused on having the patient demand the sponsor's product on his or her next visit to the doctor's office or even the urgent care clinic or emergency room. Pharmaceutical companies and device manufacturers, and in some cases universities trying to corner the medical market, set a "standard of medical practice" which is profitable for them and implicitly threatens those doctors who don't prescribe their products as "practicing outside the professional standard" which these companies have conned physicians and the public into believing is appropriate.
It also involves the marketing departments at HMOs, which measure health care quality in terms of "patient satisfaction" which is an entirely different concept. Under the marketing perspective, if a patient is disappointed because her doctor doesn't prescribe an antibiotic for influenza, the doctor is not satisfying the patient and is not providing the quality of care that sells HMO reenlistment. If a 20 year-old male is embarassed when the doctor checks for testicular cancer, the HMO marketing department may be unhappy, though the doctor may be saving lives through this 30 second examination.
When the Times labels physician behavior as "profligate" without providing a carefully investigated factual basis for its serious charge, and when the White House is referenced, I have to conclude that health reform is so threatened that political forces have stooped to demonizing physicians. The American public deserves better from the White House and the Times.
Numbers? Where are the numbers? Whose doctor is it that is testing too much and over-treating? Is the indictment applicable to 2 percent of the physician population, 98% of the physician population, or 50 percent of the physician population. Are these doctors practicing outside the standard of practice for their specialties (these days, even family practice is a specialty)? If they are, the solution is medical board investigation and disciplinary action, medical staff investigation and disciplinary action at the local level, and (unfortunately) appropriate lawsuits for poor practice conduct resulting in injury. But if these physicians are practicing within the standard of practice one must ask, what is the problem? Or is there a problem?
Yes, there is a problem. In part, it is in the education system that provides basic medical education and continuing medical education which is often influenced by pharmaceutical and medical device companies (through their detail personnel, hired-hand expert speakers, subsidized medical journal articles). There is also a problem with direct-to-patient advertising which is focused on having the patient demand the sponsor's product on his or her next visit to the doctor's office or even the urgent care clinic or emergency room. Pharmaceutical companies and device manufacturers, and in some cases universities trying to corner the medical market, set a "standard of medical practice" which is profitable for them and implicitly threatens those doctors who don't prescribe their products as "practicing outside the professional standard" which these companies have conned physicians and the public into believing is appropriate.
It also involves the marketing departments at HMOs, which measure health care quality in terms of "patient satisfaction" which is an entirely different concept. Under the marketing perspective, if a patient is disappointed because her doctor doesn't prescribe an antibiotic for influenza, the doctor is not satisfying the patient and is not providing the quality of care that sells HMO reenlistment. If a 20 year-old male is embarassed when the doctor checks for testicular cancer, the HMO marketing department may be unhappy, though the doctor may be saving lives through this 30 second examination.
When the Times labels physician behavior as "profligate" without providing a carefully investigated factual basis for its serious charge, and when the White House is referenced, I have to conclude that health reform is so threatened that political forces have stooped to demonizing physicians. The American public deserves better from the White House and the Times.
Friday, June 12, 2009
Key health care senators have industry ties
For the Yahoo presentation of the Associated Press report by Associated Press Writers, LARRY MARGASAK and SHARON THEIMER (6/11/09), click the title above. The report lists names of Senators (and, where relevant, their family members) who have serious conflicts of interest. I wonder whether the conflicts should require that they recuse themselves from the legislative process affecting health care, though recusal would throw the legislative process into complete and utter turmoil.
We won't have ethics in health care, or appropriate health care legislation, if we don't have ethics in Congress relating to health care legislation. Doctors, engaging in qualitatively similar behavior, might find themselves accused of Federal Stark Law violations, and face fines, litigation and loss of Medicare provider status and licensure.
We won't have ethics in health care, or appropriate health care legislation, if we don't have ethics in Congress relating to health care legislation. Doctors, engaging in qualitatively similar behavior, might find themselves accused of Federal Stark Law violations, and face fines, litigation and loss of Medicare provider status and licensure.
Thursday, June 11, 2009
End The AIG-like Financial Entitlement of Health Insurers
President Obama and his advisers have announced, with great press coverage, that they have found a way to save $300 million a year from health care expenditures for the next 10 years. Simple multiplication shows that this - miraculously - amounts to $3 billion over 10 years for this element of his reform plan, certainly no small amount.
Let's compare the savings announced by Obama with what could be saved by reigning-in insurance company administrative overhead. If we are about to spend about $3 trillion a year on US health care, and Medicare and other government expenses account for half, that leaves another $1.5 trillion for non-government health expenditures. If half a trillion is spent outside traditional health insurance,HMOs, PPOs and others, that leaves about $1 trillion a year passing through the coffers of the insurance company. If (an approximation) 25% of a significant number of insurance company expenditures go to administrative overhead, wiping out that overhead might save much more than $250 million dollars (perhaps as much as $250 billion?) a year (minus a modest amount for true administrative overhead - comparable to Medicare and Kaiser Permanente). And in addition, if there was one central source of payment for all "insured" health services, the cost of physicians' offices submitting bills might be reduced from over $5 per bill to less than $1.00 per bill through increased efficiency. Net savings would dwarf the $300 million per year trumpeted by Obama for his plan. The difference is that this money would have come from the same insurers who have met, in private conference in Senator Kennedy's offices, and with President Obama, who are significant political campaign contributors, and who are running shameless (covert?)advertising on television aimed at frightening Americans away from serious health reform.
The other really big important difference is that this savings could be plowed into buying health care for Americans, instead of perpetuating the AIG-like attitude of insurers that they are entitled to be made profitable by the sweat of small businesspeople and other working Americans.
Let's compare the savings announced by Obama with what could be saved by reigning-in insurance company administrative overhead. If we are about to spend about $3 trillion a year on US health care, and Medicare and other government expenses account for half, that leaves another $1.5 trillion for non-government health expenditures. If half a trillion is spent outside traditional health insurance,HMOs, PPOs and others, that leaves about $1 trillion a year passing through the coffers of the insurance company. If (an approximation) 25% of a significant number of insurance company expenditures go to administrative overhead, wiping out that overhead might save much more than $250 million dollars (perhaps as much as $250 billion?) a year (minus a modest amount for true administrative overhead - comparable to Medicare and Kaiser Permanente). And in addition, if there was one central source of payment for all "insured" health services, the cost of physicians' offices submitting bills might be reduced from over $5 per bill to less than $1.00 per bill through increased efficiency. Net savings would dwarf the $300 million per year trumpeted by Obama for his plan. The difference is that this money would have come from the same insurers who have met, in private conference in Senator Kennedy's offices, and with President Obama, who are significant political campaign contributors, and who are running shameless (covert?)advertising on television aimed at frightening Americans away from serious health reform.
The other really big important difference is that this savings could be plowed into buying health care for Americans, instead of perpetuating the AIG-like attitude of insurers that they are entitled to be made profitable by the sweat of small businesspeople and other working Americans.
Saturday, June 6, 2009
Read Paul Krugman's "Keeping Them Honest."
My rule is not to waste words. Just read "Keeping Them Honest" in The New York Times, Friday June 5, 2009, p. A21. Krugman's short message is: "1) Don't Trust the insurance industry" and " 2) Don't trust the insurance industry.
To which I can only add, as a physician and as a former active attorney who negotiated with insurers and had to deal with their failures to deliver what was promised, Krugman is right.
To which I can only add, as a physician and as a former active attorney who negotiated with insurers and had to deal with their failures to deliver what was promised, Krugman is right.
Thursday, June 4, 2009
Take A Politician To the ER Day
If we want to get serious about health care reform, I suggest that Americans ask their local, state and national politicians to join them in a visit to a local hospital emergency department on Sunday, September 6, 2009. Let's call it "Take A Politician To the ER Day."
How Can A Boiler Explosion Instruct Health Care Reform?
FATAL EXPLOSION IN CLAIFORNIA (sic):
"Three are killed and scores injured when a boiler explodes beneath a drug store and a dress shop in San Jose, California. Customers, counters and merchandise are hurled through a huge hole torn in the floor of the drug store; both shops are completely wrecked."
As we learn from the newsreel description (http://www.buyoutfootage.com/pages/titles/blacktype/pd_nr_titles/pd_newsreels63_003.html) a fatal boiler explosion occurs when the engineers' assumptions underlying the plans used to design the boiler were wrong but in their arrogance, the designers failed to question their calculations' validity, when the implementation was faulty, when the specifications were not precise leaving room for serious error, when the boiler was operated at too high a pressure, when the maintenance crew did not check safety valve operation at frequent intervals, when the operators of the boiler assumed that the safety valve would blow off steam at time of need, and when no person involved in the premises in which the boiler is located conceives of a fatal explosion, and so no reasonable emergency plans are made.
When I read the economic justification for Obama's health reform, I my impression was that the economists' calculations were grounded on uncertain speculation, that the outcome was determined before the analysis was done, that there was a lack of specificity, and that the risks of disaster if the analysis is used as a justification for proceeding, are too high and too dangerous for a great many Americans who have or will develop serious health problems and will be unable to secure appropriate care under the high-pressure Obama reform package.
A "plan" that does not reference serious ethical issues, is not a plan. A "plan" that doesn't discuss hard issues concerning our need to provide high quality care to all, is not a plan. A "plan" that damages the most vulnerable workers in the United States, hourly health care workers, and decimates their ranks in an unrealistic expectation that saving money on their wages and benefits, will provide the springboard for the massive employment growth strangely predicted by the economic analysis suggests not a plan, but a major group-think disorder. A "plan" that does not confront the concrete reality of people being unable to purchase the drugs prescribed for them because they can't afford them (even at Walmart), is wishful thinking.
Watch out for a fatal explosion when high pressure reform, unrealistically generated, lays waste to our health care system and to those who depend on ethical high quality health care in order to live another day. But beware, the economists' gauges are faulty so you may not be warned until it is too late.
"Three are killed and scores injured when a boiler explodes beneath a drug store and a dress shop in San Jose, California. Customers, counters and merchandise are hurled through a huge hole torn in the floor of the drug store; both shops are completely wrecked."
As we learn from the newsreel description (http://www.buyoutfootage.com/pages/titles/blacktype/pd_nr_titles/pd_newsreels63_003.html) a fatal boiler explosion occurs when the engineers' assumptions underlying the plans used to design the boiler were wrong but in their arrogance, the designers failed to question their calculations' validity, when the implementation was faulty, when the specifications were not precise leaving room for serious error, when the boiler was operated at too high a pressure, when the maintenance crew did not check safety valve operation at frequent intervals, when the operators of the boiler assumed that the safety valve would blow off steam at time of need, and when no person involved in the premises in which the boiler is located conceives of a fatal explosion, and so no reasonable emergency plans are made.
When I read the economic justification for Obama's health reform, I my impression was that the economists' calculations were grounded on uncertain speculation, that the outcome was determined before the analysis was done, that there was a lack of specificity, and that the risks of disaster if the analysis is used as a justification for proceeding, are too high and too dangerous for a great many Americans who have or will develop serious health problems and will be unable to secure appropriate care under the high-pressure Obama reform package.
A "plan" that does not reference serious ethical issues, is not a plan. A "plan" that doesn't discuss hard issues concerning our need to provide high quality care to all, is not a plan. A "plan" that damages the most vulnerable workers in the United States, hourly health care workers, and decimates their ranks in an unrealistic expectation that saving money on their wages and benefits, will provide the springboard for the massive employment growth strangely predicted by the economic analysis suggests not a plan, but a major group-think disorder. A "plan" that does not confront the concrete reality of people being unable to purchase the drugs prescribed for them because they can't afford them (even at Walmart), is wishful thinking.
Watch out for a fatal explosion when high pressure reform, unrealistically generated, lays waste to our health care system and to those who depend on ethical high quality health care in order to live another day. But beware, the economists' gauges are faulty so you may not be warned until it is too late.
Tuesday, June 2, 2009
EMBARGOED UNTIL TUESDAY, JUNE 2 THE ECONOMIC CASE FOR HEALTH CARE REFORM EXECUTIVE SUMMARY
The White House has released its argument supporting its version of health care reform (whatever that version might be). For the link to the entire document, click this blog's title above. Below, are the document's assumption and conclusions. Careful reading will help readers to determine whether this is an analysis based on complete and valid assumptions and whether the sketchy "plan" is more than a preliminary specification for rearrangement of the Titanic's deck chairs, lacking the specificity which would bring the lobbyists for disadvantaged irate major players in health care storming into the capitol.
"Assumptions. In this analysis, we assume that all of the savings to the Federal government take the form of deficit reduction. The assumption is a reasonable approximation. In the absence of reform, rising health care costs will cause unsustainable increases in the deficit. Using the savings from reducing the growth of health care costs to prevent these increases is essential to our long-run fiscal health. This section implicitly assumes that the costs of expanding coverage, which we discuss in the next section, would be covered by budgetary savings above and beyond the “curve benders” that are the focus of this analysis and by revenue increases. This is consistent with the President’s budget, which identified particular savings in the Medicare program and proposed specific revenue measures to pay for health care reform. In addition, over an extended period, the costs of expanded coverage are much smaller than the resources freed up by slowing cost growth. For these reasons, even if a small part of the costs of expanding coverage were paid for out of the savings resulting from slowing cost growth, this would have only a minor effect on the analysis we present....
"VII. CONCLUSION
The American health care system is on an unsustainable path. Expenditures as a share of GDP are already substantially higher than in other developed countries, and are projected to grow rapidly in the next three decades. This growth threatens to have a devastating impact on the growth in workers’ take-home pay and the government budget deficit. It is also likely to increase the number of Americans without health insurance from its already very high level and thus undermine the health of our population.
Successful health care reform will slow the growth rate of health care costs, maintain choices of doctors and health plans, and expand coverage. Slowing the growth rate of costs by 1.5 percentage points per year would have a dramatic impact on the trajectory of health care expenditures as a share of GDP over time. Slowing the growth rate of costs by a smaller amount (0.5 or 1.0 percentage point per year) would have smaller, but still important effects.
Our analysis shows that successful health care reform would have major benefits for the U.S. economy. Over time, the slowing of cost growth through increased efficiency would bring about substantial increases in Americans’ standard of living. It will also prevent devastating increases in the budget deficit and raise capital formation. We estimate that slowing health care cost growth by 1.5 percentage points will increase real GDP in 2030 by nearly 8 percent relative to what would happen without reform. We also find that slowing cost growth is likely to lower the unemployment rate consistent with steady inflation by roughly one-quarter of a percentage point for an extended period.
The net welfare effects of expanding coverage to the uninsured are also likely to be very large—probably in the range of $100 billion each year. Genuine reform will also likely increase labor supply, reduce job lock, and aid small businesses. . . .
The kind of reform that will bring about these economic rewards will not be easy. It will require truly game-changing innovations in many areas. But, if we can bring about such changes, there will be substantial benefits to American households, businesses, and the economy as a whole."
"Assumptions. In this analysis, we assume that all of the savings to the Federal government take the form of deficit reduction. The assumption is a reasonable approximation. In the absence of reform, rising health care costs will cause unsustainable increases in the deficit. Using the savings from reducing the growth of health care costs to prevent these increases is essential to our long-run fiscal health. This section implicitly assumes that the costs of expanding coverage, which we discuss in the next section, would be covered by budgetary savings above and beyond the “curve benders” that are the focus of this analysis and by revenue increases. This is consistent with the President’s budget, which identified particular savings in the Medicare program and proposed specific revenue measures to pay for health care reform. In addition, over an extended period, the costs of expanded coverage are much smaller than the resources freed up by slowing cost growth. For these reasons, even if a small part of the costs of expanding coverage were paid for out of the savings resulting from slowing cost growth, this would have only a minor effect on the analysis we present....
"VII. CONCLUSION
The American health care system is on an unsustainable path. Expenditures as a share of GDP are already substantially higher than in other developed countries, and are projected to grow rapidly in the next three decades. This growth threatens to have a devastating impact on the growth in workers’ take-home pay and the government budget deficit. It is also likely to increase the number of Americans without health insurance from its already very high level and thus undermine the health of our population.
Successful health care reform will slow the growth rate of health care costs, maintain choices of doctors and health plans, and expand coverage. Slowing the growth rate of costs by 1.5 percentage points per year would have a dramatic impact on the trajectory of health care expenditures as a share of GDP over time. Slowing the growth rate of costs by a smaller amount (0.5 or 1.0 percentage point per year) would have smaller, but still important effects.
Our analysis shows that successful health care reform would have major benefits for the U.S. economy. Over time, the slowing of cost growth through increased efficiency would bring about substantial increases in Americans’ standard of living. It will also prevent devastating increases in the budget deficit and raise capital formation. We estimate that slowing health care cost growth by 1.5 percentage points will increase real GDP in 2030 by nearly 8 percent relative to what would happen without reform. We also find that slowing cost growth is likely to lower the unemployment rate consistent with steady inflation by roughly one-quarter of a percentage point for an extended period.
The net welfare effects of expanding coverage to the uninsured are also likely to be very large—probably in the range of $100 billion each year. Genuine reform will also likely increase labor supply, reduce job lock, and aid small businesses. . . .
The kind of reform that will bring about these economic rewards will not be easy. It will require truly game-changing innovations in many areas. But, if we can bring about such changes, there will be substantial benefits to American households, businesses, and the economy as a whole."
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