Paraphrasing Sen Ron Wyden (D OR) produces the most accurate soundbite description of the House’ health reform bill.
Is this the best we can do?
If the answer is yes, we’re in deeper trouble than even I thought. I’m really disappointed with the Republicans. They are supposed to be the budget hawks, but instead they’ve spent their time railing against abortion funding, illegal immigrants, and death panels, along with scientific research and taxes on device manufacturers. Instead of attempting to govern responsibly, they’ve abandoned all morality in their quest to re-energize the lunatic fringe of their once-dominant party. Now comes news that Maine’s Susan Collins is convening news conferences to rail against the cost of the bill.
With all due respect, Senator, this isn’t exactly new news. Now you’re getting concerned about cost? After nine months of debate, discussion, and appearances on Meet the Press? Not to single out Collins; at least she’s finally saying something rational about cost.
While there’s plenty of blame to pile at the door of the Republicans, it is the Democrats who are to blame for coming up with a huge entitlement program set up to do nothing but grow.
Cost containment as proposed in the bill is in the form of cuts to Medicare totaling about $420 billion, including:
– $155 billion (about) from price cuts to hospitals,
– reductions in Medicare Advantage subsidies,
– increasing drug rebates payable to CMS, and
– requiring CMS to negotiate with pharma for Part D drugs.
Then there’s a potpourri of funding for Accountable Care Organizations, better primary care coordination, research on quality and effectiveness, and other should-have-been-doing-all-along initiatives.
As for real cost containment, methods/techniques/tools that can actually reduce cost over the near term in the public and private sectors? Bupkus. Nada. Zippo.
Sure, at some point in the future this research will result in data we can use to recommend more changes. But by that time we’ll be broke, and China will own everything of substance.
Oh, and when insurance underwriting reform kicks in health plans will have to take all comers, yet at 2.5% of adjusted gross income, the mandate penalty is not tough enough to force compliance. What we’ll get is individuals and families buying coverage when they need it, only to drop it when the condition is fixed/surgery completed/rehab over. And under the terms of the House bill, you could fall off your motorcycle, buy insurance, get treated, and then stop paying premiums when your rehab is over.
I’m no fan of the insurance industry, but that just isn’t fair. And lest you think this isn’t going to happen, talk to Charlie Baker, former CEO of Harvard Pilgrim Health in Mass. It’s happening in Massachusetts today.
Drastic times call for drastic measures. If we aren’t going to seriously consider Wyden-Bennett – and more’s the tragedy if we don’t, then we need cost containment with teeth.
How about starting with normalizing treatment costs for specific conditions? The huge and wildly inappropriate variation in practice patterns and costs associated with conditions such as COPD and back pain and prostate cancer and diabetes and dozens of other conditions have to stop. Medicare should, and could, gradually ratchet down reimbursements across the country till they are match global reimbursement for care delivered by delivery systems that are demonstrably efficient and deliver quality outcomes – Mayo, Lahey, Geisinger, et al.
Or develop an all-payer fee schedule (similar to the one in Japan) allowing all payers access to the Feds negotiating power.
Crazy? Sure. But the current bills will not reduce cost inflation. And therefore, sure as the sun comes up tomorrow, within ten years you will be paying $30,000 for family coverage. And pretty poor coverage at that.
What does this mean for you?
Despair? Disgust?
Nov
10
“Sure, at some point in the future this research will result in data we can use to recommend more changes. But by that time we’ll be broke, and China will own everything of substance.” Joe- the data is there!It’s called the Medicare data base! Why won’t the governtment allow access to the data to truly show what works and what doesn’t? You know, that nasty term only a few of us talk about – outcome based medicine. We really need to mine the data to truly identify value based medicine. That’s what we need to be spending our tax dollars on, not making sure every American has access to a broken medical system. That my friend, is unsustainable.
Joe, Now you write this? Where have you been? The repub have been screaming cost for 9 months but that got no traction, it had to come to abortion and aliens to get people’s attention. I guess as long as they did it your way you are happy. Joe start supporting real reform and not the takeover. 83% of us are happy with our health care.
Brian — good points all, and the Medicare data, especially the data that’s been published by Dartmouth, has been very valuable. We need more research, but given the long time horizon we also need to get started on something meaningful sooner rather than later.
Wingnut – I’ve been here, blogging about cost for years, and especially over the last nine months.
Where have you been? On one of the Koch Industries’ sponsored bus trips? On the steps of the Capitol with your fellow wingnut Michelle Bachman?
The best health care system in the world is government-run – the VA.
This is far from a takeover. It is both a giveaway to and the deathknell for the private health plans.
Paduda
Thanks for keeping focused on the costs. My concern is that insurance companies forced to accept pre-existing conditions and not charge more for them will spread the cost over all the covered members and we’ll have higher premiums. Good point re figuring out how much a procedure costs and setting charges accordingly.
Brian, Amen brother!!!