Check this out about single-payer... (0.00 / 0)

There's a very important article on the Venezuelan Single-Payer system that you should read.

Please go to http://cotocrew.wordpress.com and read the article by Caitlin McNulty of VenezuelanAnalysis.com.
The more articles I read like this, the more I realize how advanced countries are with single-payer systems and how the AMA and the Insurance Companies and the Pgharmaceuticals Companies have been able to use MONEY to keep us pinned against the wall.

Make sure to pass this article on.

Under The LobsterScope

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by: btchakir @ Tue Jun 30, 2009 at 19:29:08 PM CDT

Yes and No. (0.00 / 0)

Yes and No.

A strong public plan would give the government more power to change the payment system that currently pays for quantity (procedures), rather than for quality (better health outcomes).

Therefore, changing the financial system by altering incentives will alter the behavior of many providers. This will therefore indirectly reform the health care that many receive from their GPs. While this could lead to rationing (if payments are simply cut), it could also lead to better coordination between providers and more time spent on well visits, communication, etc. if new forms of payment are introduced by a government payer with more purchasing power (such as the yet to be defined accountable care organization, medical home, more pay for performance, capitation under a new name, etc.).

Because of limited resources (just 25 years ago, health care spending was something like 8% of GDP--now it's more than double that), it's simply impossible to provide quality care to everyone without changing how care is paid for. So indirectly, financing has everything to do with actual health care. Private payers generally follow Medicare as is. With an even larger governmental entity at the federal level (Medicaid practices are determined at the state level, with matching federal dollars based on a sliding scale), all the more power to dictate needed changes.

What changes are the best? That's less than exactly clear, as there was plenty of debate at the AcademyHealth Annual Research meeting in Chicago this week. Of course everyone agrees the current fee for service system is perverse and unsustainable, but good luck finding a consensus on the best new approach. Expect more demonstrations.

I guess the main thing that I'm trying to get across is that a public plan alone won't change anything. It has to be a public plan with that is aggressive in changing the way care is paid for in order to change practices at the beside in order to increase access AND improve quality. Therefore, the way health care is financed (not the cumulative dollars), is definitely health care reform. Unlike a public plan, which could happen this year, this change will take much longer. A public plan is a good mechanism to start with....

Demockracy.com

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by: kvandyke @ Tue Jun 30, 2009 at 20:18:40 PM CDT

Excellent Point, But (4.00 / 2)

The size of & concentration of providers should also be a concern.  Just not a major concern that gets confused with health insurance companies.

One reason I say this is that, I've read stories about hospital consolidation resulting in nothing but Catholic hospitals in some places--and the de facto loss of abortion services as a result.  So diversity is important with providers, too.

"Senate passes expanded GI bill despite Bush, McCain opposition"

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by: Paul Rosenberg @ Tue Jun 30, 2009 at 23:36:40 PM CDT

Consolidation is a Problem.... (0.00 / 0)

Good point. However, on the other side of things, there seems to be pretty good evidence out there that there needs to be some sort of scale in order to have the organizational slack needed to devote resources to things like quality improvement and care coordination. Lack of competition is a problem though in some markets, especially where the main player aren't innovative, forward thinking centers of care like Geisinger, Mayo, etc.

Another issue is that competition doesn't necessarily lower costs, as health care costs are still largely non-transparent. Costs seems to be more tied with things such as the provider culture in a particular region, as Eliot Fisher and others have demonstrated in the Dartmouth Atlas.

Diversity of providers is important. Although it doesn't deal with religious issues such as abortion per say, I was encouraged to see the Senate finance white paper included recommendations mandating the collection of robust data on race/ethnicity and the use of this data to identify and eliminating disparities.  

Demockracy.com

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by: kvandyke @ Wed Jul 01, 2009 at 00:30:22 AM CDT

[ Parent ]

off topic (0.00 / 0)

Is there a problem with Quick Hits comments?  Anything I try to post disappears.


New Jersey politics at Blue Jersey.

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by: Hopeful in NJ @ Wed Jul 01, 2009 at 00:04:31 AM CDT

I'm having the same problem... (0.00 / 0)

Wonder if Chris is doing some upgrades...

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!

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by: lord_mike @ Wed Jul 01, 2009 at 00:48:13 AM CDT

[ Parent ]

You're right and you're wrong (4.00 / 1)

Once again there are lies, damned lies and statistics. Health insurer profits may indeed have risen 428% from 2000 to 2007, but their profit MARGINS have not.  Most insurers today are still making the same margin that they did 10 years ago -- 5 percent in a good year.  For comparison's sake, your average restaurant makes 10 percent, your average media company makes 18 percent.

Insurers are merely a pass-through, and when you focus on them, you are taking your eye off the ball.

The reason insurer net earnings have increased so wildly is that medical costs -- the money we pay for procedures, treatments, therapies and drugs -- has grown so wildly.

Simply put, those doctors and hospitals that we feel so warm and fuzzy about are doing more to us and on us, charging more and more for it, and there's increasing evidence that shows a lot of it does us no good, and in some cases actually causes us more harm.

The cost problem lies with health CARE, not health insurance, or medical financing, or whatever you want to call it.

Think of it this way.  If you go get a car loan with a 2% interest rate, you'd think you got a good deal on the financing, right?  But if you could only afford $300 a month payments, and the car you want would cost you $400 a month, where does the problem lie?  Is it those bastards at the bank?  Or are you just plain paying too much for the car?

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by: gas28man @ Wed Jul 01, 2009 at 09:01:54 AM CDT

Interesting point (0.00 / 0)

I never really though about it that way, it's always just been so damn easy to blame the insurance companies. ;)

But at least most people agree that we do have a major problem.  The US spends more per capita on health care than any other country in the world, yet is ranked what like 50th for quality?  That's some damn good ROI! ;)

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San Diego Investment Property

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by: kanewm @ Wed Jul 01, 2009 at 18:46:39 PM CDT

[ Parent ]

Some good points. (0.00 / 0)

I read a comment about how what we were arguing about had little to do with health care and everything to do with financing.

Yes, indeed.  Consider how we've let "the public option" be portrayed as SO expensive.  Compared to WHAT?  What's expensive is the cost of insuring everyone who is not now insured.  The private insurers have NO problem with getting paid by the government to insure these people, but that would be MUCH more expensive than insuring them with the public option, because of economies of scale, forcing drug manufacturers to comptete, etc.  The "cheaper" alternatives don't insure everyone.  We should no longer allow this apples to oranges comparison to be made without pushback.

And yes, Health Care (Doctors, Nurses, Hospitals) are a service, but Health Insurance is NOT!  (It's a way of paying for that service).  It adds no value.  We should make this point OVER and OVER.  (If private Health Insurance provides a service, it provides it to corporations - and that service is to allow the corporation to AVOID paying health care costs for its workers.  This "service" has NEGATIVE value to the consumers of health care.)

Interestingly, the private insurers are now trying to appear more like a service hiring people to "help you manage your health care."  These people will call you up and offer services that are quite useless, but allow the insurers to appear more service-y.  Nobody should trust these.  I find it incredibly feeble.  I don't want the insurers intruding even further between me and my doctor.

Having said all that, I don't entirely disagree with gas28man either.  There are undoubtedly sources of needless and even harmful expense lurking within the warm fuzzy medical establishment too.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.

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by: sTiVo @ Wed Jul 01, 2009 at 10:24:24 AM CDT

Thanks, Natasha (0.00 / 0)

This bugs me every time I hear the two concepts blended together.

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by: JRD--Iowa @ Wed Jul 01, 2009 at 16:27:40 PM CDT