The Worst Health Care Reforms: What Can We Learn?

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Do you wait to reimburse the doctor for your strep throat visit until your antibiotic works and you report back?
Do you wait a year or two to pay the doctor for an angioplasty to see how the patient's heart gets along in the long term?
Do you pay the doctor for telling patients they don't need knee replacements?
Do you stiff the hospitals on any patients who pass away there?
Yeah, I know about paying doctors for smoking cessation and weight loss---something you could just as easily be paying personal trainers for. What else?

Muser of NM 3:10PM July 30, 2009

Is it not obvious what would happen if a "payment for outcomes" system were enforced in a simplistic fashion (and, does anyone believe that a partisan government scheme would be anything but simplistic? well, of course, it could just be simply pernicious). Unless you intend to enslave the medical profession, and its institutions (i.e. force them to treat those the politicians deem unworthy of expensive care, while refusing to pay for such services), you reward those who treat only the healthiest part of the population (where a "better outcome" is all but guaranteed). Isn't this what the loony left now accuses private insurance of doing? All sides in this debate want to get superior results but let "someone else" pay for them. Bah! Grow up.

ed of WI 2:05PM July 27, 2009

The House leaders reached a deal on Medicare payments: A "Pay for Value" reimbursement system that rewards doctors and hospitals that achieve the best outcomes at the lowest cost.
As a result, The House gained a lot of votes, a lot of people who were withholding support.
The federal Medicare program insures some 44 million elderly and disabled Americans at an annual cost of $450 billion, almost one-fifth of total U.S. health care spending.
Supporters of the agreement say it could save the Medicare System more than $100 billion a year and improve care, that means $1trillian over a decade. (Please visit http://www.mayoclinic.org/news2007-rst/3907.html for detailed infos)
No one can disagree with this best outcome / evidence-based system, and private insurance, too, will be greatly influenced by this change with the focus on value over volume.

hsr0601 7:47AM July 25, 2009

I sure do agree with you on reducing licensing requirements (and liability risk, too, for that matter) to get more doctors practicing---especially primary care.
I also would agree with selling insurance across state lines---IF---the plans being sold first met the standards of a rigorously regulated state and were not merely a means to let plans from the least-regulated state circumvent the insurance laws that citizens have passed for themselves at state level everywhere else.
Actually, though, I'd prefer health care divorced from employer groups and insurance policies and instead funded cradle to grave by a single-payer plan that also has everyone paying modest copays on the side for the services rendered.

Muser of NM 12:04PM July 24, 2009

We don't have lots of free market with some government. Government accounts for nearly half of all health care dollars spent. Medicare and Medicaid are huge. Government further distorts the market through the employer health care deduction that promotes and insane linkage with employment. TennCare and the MA universal model are both disasters.
Regarding your last point, while savings in health care would come out of economic activity it would also free up lots of resources that could then be devoted to other forms of economic activity. Reducing prices is always a win.
The best way to achieve health care savings is through increased competition. It works everywhere it is tried. We should loosen licensing requirements to increase the supply of health care staff, allow the purchase of health care across state lines and either scrap the health care tax deduction entirely or give it to individuals instead of businesses. We need to eliminate the insurance-centric model, which promotes bureaucracy and has little incentive for cost control.
http://togetrichisglorious.blogspot.com

Colin of DC 11:50AM July 24, 2009

that we should have lots of government in health care with some free market on the side to "fill the gaps"?
In the USA we have lots of free market with some government plans on the side to cover specific groups (veterans, elderly, poor).
But we spend more than anybody else.
As a note of balance, though, we do have to realize that health care is one of the few growing sectors of the U.S. economy. So if we "save" bundles by spending less on health care, we have to realize that such "savings" comes out of our economic activity as a whole. Right?

Muser of NM 11:06AM July 24, 2009