Tag: "socialized health care"

Two Visions for Health Reform

How can the federal government encourage low-cost, high-quality medical care?

There are basically two approaches: a bottom-up, market-based approach and a top-down command-and-control approach:

  • The former is based on competition, markets and economic incentives; the latter is based on rules, regulations, fines and penalties.
  • The former gets the economic incentives right for all of the individuals in the system, but does not try to dictate or even predict the final outcome; the latter decides in advance what the end result should look like and tries to free people to achieve it, even if it is not in their self interest to do so.
  • The former pleads ignorance about how medicine should be practiced — letting that be determined by competition in the marketplace; the latter decides in advance how medicine should be practiced and tries to impose it from above.
  • The former depends for its success on the intelligence, creativity and innovative ability of thousands of doctors, nurses and hospital personnel; the latter depends for its success on a small group of experts having all the right answers.

In the bottom-up world, 778,000 doctors, 2.6 million registered nurses and thousands of hospital and facilities personnel get up every morning and ask themselves, “How can I make costs lower and quality higher today?” In the top-down world, all of those people get up every morning and ask, “How can I squeeze even another dollar out of the third-party reimbursement formulas?”

Of these two approaches, which do you think the Obama administration is following? I’ll give you a minute to decide, then check your answer below the fold…tick,…tick,…tick, …tick,…

Searching for what works:
“I’ve Been Everywhere”

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Megan McArdle on “Me-Too” Drugs

I’ve never really understood the objections to “me-too” drugs. Somehow, the topic of health care makes otherwise sensible people forget everything they ever knew about economics and start spouting Victorian-era Socialist rhetoric about wasteful competition and superfluous duplication. These same people would think you were crazy if you started ranting about how many societal resources are wasted by having three kinds of unsalted butter available in the supermarket. And yet, this is the same argument.

Nonetheless, it does seem to bother a lot of people that we have more than one SSRI or anti-platelet drug on the market. In their telling, companies barely bother to do research anymore; they mostly just wait until someone else discovers a drug, and then they generate a cheap knockoff, like those guys on the street corner in Chinatown.

Full article by McArdle on “me-too” drugs.

Disordered Spending on Mental Health

Mental health spending is a black box set to bust the state and federal budgets. To see how mental health providers manipulate state and federal spending to the detriment of virtually everyone else, consider how the “Population in Need” project coalition is seeking to extract more money from Colorado taxpayers.

In Colorado, and, it appears, 10 other states, “Population in Need” seeks to shake more taxpayer dollars loose for rent-seeking mental health providers by “inform[ing] policy planning” with indicators of “unmet need” for “low income” people with a serious behavioral health disorder (SBHD).

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We-Have-to-Pass-to-Find-Out-What’s-In-It Unintended Consequence of the Day

Get prepared for doctors to spend less time with patients. Well, at least for low-income patients:

[Under] the recently passed PPACA…nearly 16 million Americans are expected to be newly covered by public health insurance programs… States implementing SCHIP through an expansion of the income limits for their traditional Medicaid program represent the closest approximation of the public insurance expansion under the PPACA…

Physicians in these Medicaid expansion states decreased their time spent on patient care by approximately 3.48 hours — an 8.1 percent reduction…  If these physicians react similarly to pediatricians, and the PPACA Medicaid expansion is proportionately similar to the implementation of SCHIP, this reduction would amount to a decrease in hours spent on patient care of approximately 15,000 full time equivalent physicians… This is particularly concerning given that recent estimates suggest the passage of health care reform will increase the predicted shortage of primary care physicians by 50 percent over the pre-PPACA estimates.

Full working paper by Craig Garthwaite available here.

What Should Medicare Do with Patients Who Have No Possibility of Improvement?

Plaintiffs say almost 78 percent of the 46 million or so Medicare beneficiaries have at least one chronic condition, such as multiple sclerosis or Alzheimer’s. Denying them care if they don’t meet the so-called “Improvement Standard,” the advocates argue, can prevent them from performing routine daily activities or even cause their condition to deteriorate – leading to higher costs down the road….  The agency’s claims are processed by private subcontractors, many of whom require improvements in patient conditions and deny coverage to thousands of people every year as a result…

The suit seeks to require Medicare to cover certain types of rehabilitative care even when it likely won’t lead to an “improvement” in patients’ condition.

Full post on the class action lawsuit at The Hill’s Healthwatch Blog.

Waiting in Canada

Emergency room waits for people with serious conditions sometimes reached 12 hours or more, the report said. That is far greater than the province’s 8-hour wait time target… And for emergency patients who need a hospital bed, they waited on average for about 10 hours but some waited 26 hours or more.

Pointer from Megan McArdle.


That’s What I Expect to Happen Under the Democrats

“The nation would then be left with zombie legislation, a program that lives on but works badly, consisting of poorly funded and understaffed state health exchanges, …. clumsily administered subsidies that lead to needless resentment and confusion, and mandates that are capriciously enforced.”

Henry Aaron, on Republican plans for ObamaCare

How Much Power Does Sebelius Have?

Apparently a lot. Remember the Obama administration claim that limits on health insurance benefits were being removed? That won’t apply to about one million workers because of waivers Secretary Sebelius has granted to 30 companies and groups:

The 30 entities include fast-food retail chains McDonald’s and Jack in the Box, the United Federation of Teachers Welfare Fund and the United Agricultural Benefit Trust. Under the waiver, the companies and groups will not have to raise the minimum annual benefit in low-cost health plans that they offer their workers, particularly part-time or low-wage employees. HHS said it granted the waivers to ensure that those workers would not lose their coverage if the companies decided to stop offering the plans because of the law’s new rules, as McDonald’s warned the Obama administration it would do unless it received the waiver.

But what happens to the additional million or so people with mini-med plans who didn’t get a waiver?

What Froma Harrop Doesn’t Understand About Health Insurance

Ordinarily I don’t respond to a newspaper column. But this piece is touching and powerful. And the conclusions the writer draws from it are wrong.

Here’s the back story: The husband of Providence Journal columnist Froma Harrop died of liver cancer. After the diagnosis, the couple learned that the best place in the country for liver cancer treatment was in Boston. But since the facility was not in United Healthcare’s network, the insurer refused to pay for it. Eventually the insurer relented but not before a long, frustrating bureaucratic battle — the last thing in the world any family would want on the eve of the death of a loved one.

It’s hard not to sympathize. But Harrop uses the incident to argue for a government-run plan. Not because the government plan would have paid for an out-of-network treatment. It probably wouldn’t have. But because a government plan would have required less hassle:

The bureaucrat would have given a simple “yes” or “no” based on official guidelines. He or she would have had no personal stake in denying you care…… a government-run program doesn’t tell you what treatments you may or may not have. It tells you what the taxpayers will subsidize. You are free to go out with your own money and buy whatever you want.

Believe me, “death panels” already exist, and they have nothing to do with the government.

Here’s what Harrop doesn’t understand.

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Taking Another Look at Swiss Health Care

The Swiss health care system [gated, but with abstract] has attracted interest from many conservatives because insurance there is mainly private, long-term, and personal and portable. By some estimates it also is the most egalitarian health system in the world. What is less well understood is that when the Swiss replaced mixed government and private financing of health care with mandatory health insurance in 1994, the resultant cost cutting efforts both damaged quality and introduced a lot of waste into the Swiss system.

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