Considering that reimbursement has been based on volume/fee for service, the question that must be asked of our readers is how easily will it be to transition the system to one that is structured on successful outcomes or value based medicine? To align the the incentives of doctors, nurses, pharmaceutical companies and hospitals through value-based purchasing is easier said than done. So, in the spirit of debate, who is qualified and will establish the standard for a job well done? Who will come up with the criteria to measure outcomes, and how will that measurement take into account those physicians that treat patients that need medical attention but have associated medical problems? What type of metric will there be to evaluate fusion rates when the patient smokes, is an alcoholic, is obese, or is involved in substance abuse? What happens if the patient has been in a high-speed MVA, will the surgeon and hospital be penalized for having to stage the patients modality of treatment? Unfortunately, those that legislate on behalf of their constituents do not understand that sometimes this is rocket science, even if the individual claiming that medicine is not rocket science, is a former surgeon himself.
So how do we reduce cost, whereas we avoid higher taxes? Why is it that the government and the ABA have such a difficulty in enacting tort reform? If we are a people that believe in free-markets, then why can't we cross state lines to buy better or cheaper insurance? How does the industry delivery better technology, better care, and better outcomes at a cheaper cost? If the best that both parties have to offer is placing the onus on providers to prevent and manage illnesses while reducing complications and cost in the hope of providing data to measure patient outcomes shows how little politicians understand the complexities of modern medicine.
Do any of our readers find it disturbing that the focus of the debate and the onus of providing value based medicine is always on the provider and the patient? What about the escalating cost of healthcare insurance, witnessed by what was reported over the weekend from California regarding Anthem Blue Cross' increase of 25-39% for private subscribers? If the insurance industry is a risk-management business, why aren't people rewarded that have never had to use their health-care plans outside of going for an annual physical? For politicians to pontificate about not appointing Kafkaesque committees to measure quality adjusted life years but foster a climate of scientific research and pipelines for new modalities of treatment exhibits how little they understand about the complex cost of medicine.
Before the cost of healthcare is ever contained, the American public, which includes politicians will have to re-align their priorities not only from a personal health perspective but also from a financial perspective. This will mean not being influenced by every lobbyist that roams the hallowed halls of the Capitol Building. If the two most important aspects of this bill will be to reduce cost and provide coverage for more people, let's clean the slate and start with the insurance companies and address how we will pay for those that have no coverage, and who will take care of those that have minimum coverage? Unless the government continues to print money or raises taxes, how will we subsidize the uninsured? If government officials or think- tank gnomes don't believe that we pay attention to the rising cost of healthcare insurance, then they themselves are living in neverland.
The time has come that both parties start acting in the peoples interest, and not in their own interest, and that means placing America first. If the government was willing to bail out the "banksters" or gangsters of Wall Street, why do we Americans find it so difficult to bail out the uninsured? Why do we dump billions of dollars into Middle Eastern countries that could care less about democracy or human rights, while at the same time mortgage our children's future? It's an embarrassment when we call ourselves the richest country in the world, worry about everyone else's problems, yet have an inability to take care of our own challenges. The answer is simple, it's GREED and SELFISHNESS.
So there you have it readers, let's see what your perspective is on this issue. Take the time and think this through because your opinion and most importantly your vote is the only thing that will change healthcare, its time to get the politicians out of office that are not interested in finding a viable solution to an complex problem.
Have you considered that maybe we're the richest nation in the world because we don't subsidize the uninsured but instead rely on personal responsiblity, or at least we used to? It's not job of the government (and ultimately the tax payer) to fund health insurance or most other social programs. The same political party who complains about the crooks on Wall Street is the same party that forced the banks to make loans to those who couldn't repay them. As for your comment regarding "dumping" billions into the Middle East, consider that our national defense is in everyone's best interest. Just as schools, roads, and law-enforcement. Explain to me how taking income from those who have worked hard and earned it and giving it to those who haven't is in the nation's best interest. It's not, it's only in the best interest of those who don't deserve it. This is not "greed" as you describe it. But as Thomas Jefferson once said "You cannot legislate the poor into freedom by legislating the wealthy out of freedom. "
ReplyDeleteOpportunity: a condition favorable for attainment of a goal, chance or prospect as for advancement or success. Do I need to say anymore?
ReplyDeleteThe health care debate is not one about health care quality, or about health care cost; it’s simply a debate about the control of the industry and the consumer. Insurance, of any sort, is shared risk. We all throw money in and when there is a health care claim, we all share in paying for that claim. That’s basic.
ReplyDeleteQuestion: Who is the biggest consumer of health care? Answer: The federal, state and local governments and all the other associated people, like firemen, policemen, teachers, and politicians, etc, etc, etc. Now that there’s no money to pay for all of their salaries, let alone their health care cost, what is to be done? It’s simple; take control of the industry and force doctors, nurses, surgeons, and all health care workers into a government controlled system. Why? To save the system, that’s why! The biggest consumers of health care are the above mentioned groups. What happens to the health care system if they can’t afford to get care? Simple, the whole thing collapses. This is not a partisan issue, it’s a survival issue. The dirty little secret is that the Republicans aren’t saying a whole lot right now, because they know it’s just like all the other industries. The car industry, banks, construction, real-estate, and others industries are struggling right now.
After 27 years in this business I’ve enjoyed the fruits of my labor and look forward to more years to come. However, if we think this industry will go untouched by this depression (and it is exactly that) we are kidding ourselves.
There are solutions to the problems in health care, but they are extreme. Higher HSA’s allowances. Allow for early interventional regenerative medicine; get the FDA in gear in approving adult stem cell technologies. Get insurance companies to see that early interventional regenerative autologous cell based treatments will save countless dollars in the face of the traditional disease management model.
Think about it. We’ve all seen and heard doctors say things like, “Mr. Smith, I know why your knee hurts, but let’s get you on these meds for a while because they will take away the pain.” Then they go on to manage the disease with other products until they finally replace the joint: first with a partial, then with the total. This is health care today, disease management. Just think of the costs associated with each visit, each injection, each surgery, and each revision. And we wonder why health care costs are so high? It’s because we make it that way.
By the way, don’t tell me this is a negative response, simply because you don’t like the sound of it. If I was on the Titanic and somebody yelled at me to get off the boat into a smaller one, I wouldn’t like the sound of it. But given the alternative, I’d gladly step off the sinking ship and get on the smaller boat. Perhaps we all should start thinking about the sinking ship. Health care? No, the economy.
One last thing, if you think the answer is to cut government spending or cutting government staff, think again. Where do workers go once they are laid off? Why, to the government payroll called unemployment insurance, of course. Cutting spending that supports the private sector is equally as bad, those folks will end up in the same place. Paid by you and me!
And the beat goes on!
By the way, I don't think it is a negative response, it is a realistic response. That's why this forum exists, to provide people like yourself the ability to express themselves truthfully. As usual, thanks for your perspective, hopefully, more people will let their voice be heard.
ReplyDeleteWays to provide opportunity = education, counseling, providing safe streets, job training, regulate competitive fairness, small business loans, tax breaks, etc. I wouldn't put free healthcare on that list.
ReplyDeleteProvide these things and people can get jobs that provide healthcare. Additionally, you provide a sense of self satisfaction and desire to do more. To use a medical analogy, is better to treat the symptoms of an infection (fever, etc.) or is it better to use antibiotics to cure the source?
I think it is going to be nearly impossible to contain/reduce costs AND expand coverage.
ReplyDeleteAlso, the two best things we could do is implement tort reform and allow insurance companies to sell across state lines. From my observation of today's summitt, neither are on the table.
Also, the whole framework of the current administrations argument is that healthcare is a right...therefore it should be free. There has to be equal responsibility on the patient side to incur reasonable costs (not outrageous ones) as well as the insurance side to provide fair coverage at fair prices.