One Simple Way to Reduce Health Care Costs, And Why It Won't Happen
| Thu Jun. 4, 2009 7:13 AM PDT
Despite the cynicism that life in Washington breeds, I am almost constantly aghast at how many obviously good, non-controversial policy ideas never get made into law. It obviously has something to do with the fact that good, otherwise non-controversial policy ideas often hurt the economic interests of powerful lobbies or constituencies. Of course, if money didn't buy results in Congress, that wouldn't be such a problem. So it goes. (We'll come back to this.)
One of the problems that our health care system faces is the fact that some areas have way too many doctors and specialists, while other areas have too few. Oversupply of doctors, however, doesn't reduce costs in the way you might expect if you know some basic economics. Instead, it increases costs, such that each additional specialist per 100,000 people in a given region increases health care costs per person. That's one reason why Medicare spends so much more per person in New York than it does in, say, Oklahoma. Peter Bach, a doctor and former Medicare adviser, has an idea about how to fix this:
Here is how it would work. Later this year, the agency would set a 2010 target number for each type of specialist in an oversupplied region. Then it would offer to sign up those doctors at a certain payment rate. The starting rate would be, say, $30 per doctor work unit. (Work units are a measurement that Medicare uses to set its rates; each procedure is assigned a specific number of work units.) This is lower than the $36 per work unit that Medicare pays all doctors today. If too few specialists signed up, the rate would go up, and it would keep rising until there were enough doctors for the area.
"Wow, what a good idea," you might be saying. Don't get too excited. This is exactly the kind of idea I was talking about earlier. It sounds all well and good until you realize that it threatens powerful entrenched interests: doctors and hospitals. Both are big political donors. So even though this idea makes intuitive sense, isn't intrinsically "liberal" or "conservative," and would be in the best interests of almost everyone, it will be very hard to make into law. That's your political system, folks.
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Comments
health policy
Submitted by Annie (not verified) on Thu Jun. 4, 2009 8:55 AM PDT.
I appreciate your frustration about sound and pragmatic policy ideas being relegated to the dustbin without due consideration.
It is especially apparent in the continued exclusion of professional nursing fro healthcare reportage, from health policy discussions and from the absence of expert nurses and nursing research representing nursing's and patients' interests.
When patients are cared for by nurses with a minimum of a baccalaureate level nursing education, their mortality and morbidity rates significantly decline. Nurses prepared at this level or above (about one million of the almost three million licensed registered nurses in the US) are prepared to serve as patient case managers, disease and chronic illness case managers, and community, public and home health nursing clinicians, while their associate degree and hospital-based diploma counterparts are not, mainly due to time and curriculum volume constraints. The critical third - BSN+ educated nurses - also serve as the pool for future nursing faculty, advanced practice nurses, nursing administrators and nursing researchers.
Overall, professional nursing is such a small cost in overall US health-related expenditures, that it doesn't even rate a carve out mention in any cost reporting tool.
Nursing is arguably the profession with the highest ROI and lowest cost. It is charged by ethics and statute with safeguarding patients. It enjoys the highest degree of trust by the public in annual surveys of professions and occupations and public perception.
And yet, it remains invisible and impotent in health policy. Instead of driving policy, it instead is still practiced under largely onerous work conditions, and its shortage continues to increase ominously. It is onthe verge of catastrophic failure as a profession, and most likely, it will be allowed to revert to an apprentice-based skill-based occupation under external regulation and control instead of professional autonomy and authority for its own practice and standards.
Yeah - Good Luck
Submitted by rlculpepper (not verified) on Thu Jun. 4, 2009 2:25 PM PDT.
The idea reeks of regulation. Something that the political right opposes and the rich provider lobbies would defeat. Ideas to more evenly distribute health care provisions are needed and are very important in the effort to curb costs. Observations of over saturation of Physicians, specifically specialists were abound during the first attempts at serious reform in the Clinton era. It is a valid problem. One also aided by the fact that health care is the only field where competition does not create efficiencies and lower costs, but the opposite. Urban areas are over saturated by every aspect of provision including testing and treatment facilities. All of those expensive providers, equipment, medicines and supplies have to be paid for, used or not. Then there's the burden of rural areas that are grossly under served adding costs to get people to care located far away, often in areas with higher cost of living standards than home. How do we spread the availability of provisions? Incentives to put providers, high tech services and treatment centers in rural areas fail because there's not enough sick people and with that, revenue. Nursing is certainly one answer that does seem to be working in some areas, but that satisfies the need for diagnosis and treatment of common ailments. Curbing for profit health care is another, but again too much money is at stake to get away with simply making some new rules to lower profits. People ought to practice health care because they want to help others. That all takes a divergence in current social and wealth status attached to physicians in this country. Health care reform needs abetted by a solid campaign of civil reform of the view that one becomes a doctor for status. That said, the ability to become a provider needs to be spread out and more attainable everywhere. Small, less wealthy rural communities should be able to get their kids to college to learn medicine so they can come home and practice it. When people can become health care providers if and when they want to, and aren’t doing it for wealth and status, I'm pretty sure the stakes even out. We can't get there by forcing it on the community, but by a change in social attitudes.
Hard to understand
Submitted by Online Healthcare Degrees (not verified) on Mon Aug. 10, 2009 10:37 AM PDT.
Its hard to understand how the healthcare changes will not be put into effect. There is an uproar in our country and it needs a resolve.
To Simultaneously Reduce Taxes and Health Care Costs
Submitted by George Meredith MD (not verified) on Sat Nov. 28, 2009 9:00 PM PST.
To Simultaneously Reduce Taxes and Health Care Costs
President Obama to a joint session of Congress September 10, 2009: (To our seniors)… “don’t pay attention to those scary stories…. these same folks….just this year, supported a budget that would have essentially turned Medicare into a privatized voucher program. That will never happen on my watch.”
This simple statement belies the Obama/Democrat pay to play health care scam. These people couldn’t care less about the 20 million “uninsured” Americans (who currently are getting their health care for free). Instead, they just want to create another giant bureaucracy from which they and their lawyer pals can skim. Another giant bureaucracy from which they can draw votes and political power.
To simplify the 1500 page health care bill. And to reduce health care costs, simply provide current Medicare and Medicaid recipients with vouchers and let them buy, with these vouchers, whatever health insurance seems to fit their needs. And, simultaneously, end all Blue Cross/Blue Shield tax-exempt status. And issue a federal mandate that allows patients to cross state lines to buy whatever health insurance they wish.
In other words, break up those cozy, lawyer dominated BC/BS (in state) monopolies that drive costs so high. Like the scam that Kathleen Sebelius ran, with her lawyer pals in Kansas, for so many years. Ditto for the Medicare and Medicaid plans and the armies of lawyers and administrators involved therein.
Wake up America! Simpler is better. Just remove the lawyers and the bureaucrats. And open the bidding. And bingo, the health care costs for patients and taxpayers, alike, will plummet. And our economy will recover. But do it the Democrats’ way and our national economic downhill spiral will tragically accelerate.
George Meredith MD
Virginia Beach
