Comments by Senator Charles Schumer (D-NY) on MSNBC Morning Joe:
Now how do you get the cost down? We know how to do to it. Basically you have to change the system of payment where it's not just fee-for-service… where every service gets a fee. We learned this in the Defense department where it was cost plus. Rather they say, OK the Shumer insurance company, I'm going to get $10,000 to insure the Scarboro family – and I got to figure out the best way to do it. It does not affect Scarboro, you still go to your doctor, you still go to this… but there's gunna be the waste, the fraud, the duplication…
[break, then discussion goes astray briefly before getting back to the discussion pre break]
What you have to do is to change the system of reimbursement from a cost-plus over to a system… it takes about 10 years to completely get this done. But it will not effect the average person's health care. There's not going to be the rationing or anything else. It's just a useless waste to have extra MRI machines… for every hospital to have a heart transplant unit when you only need two or three in a city – in a big city. These are the things that will happen and we can get this done. By the way, the interesting thing about this is this is one place there's agreement between Democrats and Republicans.
Let’s just hope you do not need care that costs more than $10,000. If you do, it sounds like you are going to be out of luck.
So the government is going to save money by increasing my taxes and denying me care I don’t need.
Question: If I’m paying higher taxes to pay for national health insurance, can I save money by stopping poor people from smoking or eating ice cream?
Why don’t we enroll Schumer and his family in an HMO, give them $10,000 an tell the HMO to ration their care.
It’s hard to believe Schumer actually said any of this.
What Schumer is saying is: put everyone in an HMO and force them to ration care.
Understand that Schumer is only talkling about YOUR care, not HIS care.
Since Medicare already has a diagnosis-related prospective payment system (every procedure does not get a fee in the inpatient world) for closely defined episodes of care, Sen. Schumer must be talking about a shift to capitation, which was one of the orginal defining features of the HMO movement. What he fails to mention is that we tried this once (there are no new ideas), anybody care to share the results from the orginal HMO movement? He is simply talking about moving financial risk from the insurer to the provider, thereby incentivizing providers to keep patients healthy, but more applicably, to lower aggregate treatment costs. Which begs the question, who should have to bear this risk? Although capitation does have its advantages, especially in budgeting and forecasting, is it fair to hold providers financially accountable for the overall health (and therefore expenditures) of patients. Sure they have an impact, but at the aggregate it is only about 10%, an individual’s health status is much more dependent on nutrition, exercise, environmental concerns, etc., than it is on professional medical care. Given this theory, doesn’t it make more sense to put the financial risk in the hands of the person who (at the aggregate) can effect the most change in health status, the individual? To do this would mean the abolishment of community rating (including premium bands/ratios) policies. Is Schumer up for that??