From the Horse’s Mouth
On the Goal of Health Care Reform
Dr. David Blumenthal, a Harvard professor and key health advisor to President Obama: "The more people have, the more of it they tend to spend on healthcare." But as a nation's wealth increases and standards of medical care become higher and more costly, the lowest income groups get priced out. Government controls are needed to push down healthcare costs (and by inference, standard of care) to a level that everyone, including the poor, can afford, or to what government can afford to provide to everyone equally. The goal is not only universal coverage but also a similar healthcare experience for everyone, regardless of ability to pay (New England Journal of Medicine, March 8, 2001).
On the Rhetoric vs. the Reality of Reform
Dr. Ezekiel Emanuel, a health policy advisor in the Office of Management and Budget and brother of Rahm Emanuel, the president's chief of staff: "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records, and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change." (Health Affairs, February 27, 2008.) True change must include reassessing the promise doctors make when they enter the profession. The Hippocratic Oath is partly to blame for the "overuse" of medical care: Physicians take the "Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of the cost or effects on others." (Journal of the American Medical Association, June 18, 2008.)
On Strongarming to Get Support
Dr. Emanuel: "Every favor to a constituency should be linked to support for the health care reform agenda. If the automakers want a bail out, then they and their suppliers have to agree to support and lobby for the administration's health reform effort." (Health Care Watch, November 16, 2008.)
On the Real Reason for Computer-Guided Medical Care
Dr. David Blumenthal, who is formally, National Coordinator of Health Information Technology: The real importance of computers is to deliver "embedded clinical decision support," a euphemism for computers telling doctors what to do. If controls are too tight, physicians may resist the government encroaching on their treatment decisions: "many physicians and hospitals may rebel – petitioning Congress to change the law or just resigning themselves to…..accepting penalties." (New England Journal of Medicine, April 9, 2009.)
On Overproviding to the Healthy and Underproviding to the Sick
Nancy-Ann De Parle, director of the White House Office of Health Reform: "We have to get to a system of keeping people well, rather than treating the sickness."
Dr. Blumenthal: "Government controls on health care spending are associated with longer waits for elective procedures and reduced availability of new and expensive treatments and devices." It is "debatable" whether the timely care Americans now get is worth the higher cost.
Very scary.
The mainstream media has totally missed this story.
Orszag, Emanuel, and now even the president have admitted that preventive medicine, EMRs, evidence-based care, etc., will only put a small dent in health care costs. The only thing that works, in their opinion, is telling doctors how to practice medicine.
I have tried to get from Washington (Sen. Coryn’s office)the annual cost of “administering” the Medicare system at the government level. I suspect you have this data. We have had to match at least that cost in the private sector just to comply. Have you considered this as a key cost (waste) to emphasize to Congress, your subscribers and to the press? Is there any way we can help?
Grateful for what you do.
What you will never hear
“If the changes does not work, we’ll revert back to what we had before.” Why not? Because, this is not a discusion about healthcare. Doctor and only doctors do healthcare.
Everyone else collects premiums, pays bills, provides supporting services or is a politician propogandizing, without a shred of experience about another group’s discipline.
Why?
This discussion is about confiscating premiums collected by private insurers. However, unlike private insurers who must hold funds in escrow, government spends whatever it collects, then borrows against revenue stream as collateral. Until so indebted no country will front them the money.
Michael Willy’s blog is interestng and thought provoking.
Is it possilbe to cut health care cost without cutting the quality of health care provided– no.
Of the total number of “uninsured Americans” we hear about — a percentage of this number is made up of people who CAN afford health insurance, but simply chose not to carry it.
Universal Health Care, Socialized Medicine, or whatever ones wants to call it, does not work and has not proven to provide quality health care for ALL the people. Of course, if the Doctors have “private clinics” as in Canada– a person could go to a “private clinic” and totally pay out of pocket for needed health care, tests and surgery that could save their life. Would this mean only the very wealth, who can paid, would continue to get quality health care? In turn, would this mean the majority of Americans would be left with substandard health care? Would it be true that if “private clinics” (only affordable to the very wealth are established) — the Doctors are making money and, though taxes, the goverment is making money? What about the rest of ALL Americans? Would we be left with substandard healh care?
On Overproviding to the Healthy and Underproviding to the Sick:
In response to Nancy-Ann De Parie’s comment (“..system of keeping people well, rather than treating the sickness”) — there are many children with numerous types of cancers and other forms of illness’s that had noting to do with “how healthy” they were “before” being stricken with a terrible illness.
In response to Dr. Blumenthal comment– this comment is more sensible, much more logical and more sound.
In response to Dr. Blumenthal’s position on putting government control on steroids to push down health care costs. We only have to look to the long term care industry to find decades of federal regulations on steroids full of “best practice” mandates, squeezing provider payments, imprisonment and fines for failure, annual inspections, unannounced inspections, hot lines for abuse, etc. have neither improved the quality of care or costs if prevented medical errors sent off to hospitals for care are added into total costs. And all these patients are in a controlled environment where diet, exercise, preventive care, smoking, etc. are under government manadates. Plus, ever since DRGs, CMS has been “squeezing” provider payments for excellence while rewarding “inefficient and mediocre care” hoping the revenue pain would inspire hospitals to pursue efficiencies. It did not work then and it will not work by intensifying the “squeeze” on providers. Anyone that calls Blumenthal’s comment’s as “sensible,much more logical and more sound” needs a reality check as does the Obama administration.
In response to Dr. Ezekiel Emanuel position to blame physicians for “overuse.” True there are abuses but what would physician behavior be if they were paid for excellence rather than underpaid. In North Carolina Medicaid in 2006 paid all physicians more for excellence and inspired health care professionals saved 11% over 2005 when physicians were underpaid. The American Academy of Family Physicians reported that this pay-now-save-later policy gave physicians the financial resources to better manage and coordinate patient care on an ongoing basis resulting in fewer ER visits and hospitalizations reducing unnecessary medical costs.
If the nation wants physicians to remain true to the Hippocratic Oath, let’s make sure society is paying them fairly to meet their oath and have reasonable means to address when they fail. Right now failure pays and excellence is underpaid and that is the consequence of government “squeezing” provider payments that Dr. Blumenthal is married to.
I AM A RETIRED NURSE, I THOUROUGHLY UNDERSTAND THE NEED FOR ELECTRONIC MEDICAL RECORDS AND THE END OF LIFE PLANNING THAT ALLOWS A PATIENTS TO MAKE INFORMED DECISIONS ABOUT THEIR CARE ACCORDING TO THEIR WISHES, AND THEIR ABILITY TO MAKE CHANGES IN THE TYPE OF CARE THEY WISH TO RECEIVE. I PAID FOR THIS SERVICE ON THE INTERNET, OBAMA’S PLAN ALLOWS FOR REIMBURSEMENT FOR AN OTHERWISE OUT OF POCKET FEE!
YOU ARE DELIVERING MISINFORMATION FROM THE OTHER END OF THE HORSE, WHICH I FIND STUPID IF YOU REALLY HAVE THAT INTERPRETATION, AND DESPICALBE IF YOU ARE INTENTIONALLY UNDERMINING HEALTH CARE REFORM BY LYING!