Well it looks like it’s mid afternoon in Health Care Reform land. You remember Health Care Reform don’t you? That thing that some of the talking heads were carrying on was a dead thing? Yeah well about that, not so much. People might not completely agree on details, but the one thing that pretty much everyone who’s not a politician or a CEO Can agree on is that we are sick and tired of having to go through our days living in terror of getting sick. The system is broken and we want something done about it. NOW!
But sadly of course it’s never quite that easy. There is still a process to deal with. The current part of that process is a "bipartisan" meeting between President Obama, and Democratic and Republican legislators. An event which I do find fairly shrug worthy. Although I do have to give the Republicans credit for holding Obama’s feet to the fire over the original plan to do it behind closed doors. But then I take that credit right back because once he agreed to have CSPAN cover the talks they started whining about it.
Basically at this point there are two significant pieces of writing regarding Health Care Reform. One comes from an Op-Ed piece in The New York Times. It is co-written by a small handful of Republicans including Newt Gingrich. The other one is presented on the Whitehouse website, and is essentially President Obama’s ideas on what should be added to a finalized bill.
Today I will be taking a look at the Republican Op-Ed, excerpting portions of it and providing my thoughts, and also excerpting some of the ideas from the Whitehouse Health Care section detailing what Republican ideas have already been included in either the House/Senate bills or in Obama’s suggestions.
Our first contributor to the Op Ed is surgeon and former United States senator from Tennessee Bill Frist,
"President Obama, Harry Reid and Nancy Pelosi have failed at health care reform. They have failed because they fundamentally don’t believe in markets, incentives and the power of hundreds of millions of people to make smart choices about their health. It’s just not in the Democratic leaders’ DNA."
Wow. Way to set that Bi Partisan tone we hear is so important to you Republicants Dr. Frist. I’ll tell you the gods honest truth, if I was not reading this for the blog, I’d have stopped right there.
"The most powerful way to reduce costs (and make room to expand coverage) is to shift away from "volume-based" reimbursement (the more you do, the more money you make) to "value-based" reimbursement."
This sounds great on the surface. In fact it almost qualifies as an "All Babies Need Milk" kind of statement. But what has me concerned is that word, "value". What exactly are they wanting it to mean. After all while I don’t imagine there are many who would disagree that needless testing is a bad thing, sometimes it can be a very, very fine line. The simple truth is that sometimes in the absence of a clear line of inquiry to follow testing may be all a doctor has to fall back on. Now common sense tells us that Doctors should reasonably start with the simplest and least expensive tests in such situations. And anything that encourages the use of common sense by medical practitioners is surely a good thing. However I would hate to see a climate created where doctors are not ordering tests that might ultimately help them to discover what is wrong with a patient, because they are constantly second guessing themselves as to whether or not that test will be seen as "Adding Value".
"Medicare and private insurance companies should reimburse providers not for each discrete service they provide but for managing a patient’s condition over an entire episode of care.
The disbursement of that payment would then be made at the local level, where value can be most accurately determined, and waste most likely eliminated."
Now I have to admit that in my laysentients view this doesn’t seem like such a bad idea. It might also help to nip some of the interdepartmental and disciplinary rivalries that can sometimes take place, and help keep the focus on helping people get and stay healthy.
Next we hear from director of the Engelberg Center for Health Care Reform at the Brookings Institution and former Medicare administrator in the George W. Bush administration, Mark McClellan,
"Republicans should also build on proposals to enable health care providers to get higher Medicare payments when they deliver better care at less cost. For example, the Democratic bills would let providers share in Medicare savings if they can show that the way they prevent and manage illnesses reduces complications and costs Medicare less. Republicans should further propose that Medicare strengthen its capacity to provide data and measure patient outcomes—to help providers and to evaluate changes in care quickly.
This is desperately needed to help make Medicare sustainable while improving the quality of care. Currently, doctors lose money when they work with nurse practitioners, pharmacists or wellness programs to help patients avoid costly complications—because Medicare doesn’t pay for this, and it results in fewer billings for the visits, tests and procedures Medicare does pay for.
"Here is another not terrible idea. Basically rewarding care providers for having healthy patients. Now obviously there’d have to be some pretty strong protections in place to make sure that people weren’t getting claimed treated successfully when in truth they weren’t. I also like the part about reworking the system to encourage physicians to work with nurse practitioner, pharmacists, etc. Because right now there is not only no real incentive to do so, but rather a huge disincentive, Nurse Practitioners, especially in rural areas can often be your first best line of defense as I learned during my mother in-laws recent illness.
"All these steps can add up to a health care system that does much more to support patients and health professionals in improving our health and saving money. That’s a bipartisan opportunity we can’t afford to miss—either because Democrats are unwilling to change or because Republicans insist on starting over."
Now this part surprised me considerably. Personally I don’t think it’s the Democrats that have been "Unwilling To Change", but it is nice to see a Republican acknowledging the folly of the "Scrap The Bill And Start Over" meme that some Republicants have been trying to foist off on the American people.
Next we have a very special Angry Hour(TM) section thanks to fellow at the New America Foundation and former domestic policy aide for Presidents Ronald Reagan and George H. W. Bush, James P. Pinkerton.
I would like to start off by warning you that Mr. Pinkerton doesn’t have any ideas to present. I mean that quite literally. His entire portion of the Op Ed amounts to "Obama and Dumocrats Ebil, Republicans good". Then he breaks into a few rounds of "Free Markets! AHHHH! Savior of the Universe. Free Markets! AHHHH! They’ll save every one of us!"(To the tune of the Flash Gordon theme by Queen). Frankly I was on the fence about even wasting my time excerpting any of his nonsense, but I decided that his opening salvo is so odious it cries out for a response.
"When Americans think about health care, they think first of health, not finance. They go to the doctor to get well, not to show off their government-issued insurance card. So President Obama’s health care reform plan was doomed from the moment the American people figured out that his goal was to spend less on health care."
Allow me to misquote Dan Akroyd from his SNL days. James you ignorant slut. First of all I can pretty much guarantee that finance is indeed the first thing most of us think of these days. We have been forced to by this incredibly broken system we suffer under. We think of finance first because if we don’t we run the risk of quickly winding up bankrupted. As for Obama’s health care reform plan being "doomed from the moment the American people figured out that his goal was to spend less on health care."? Well allow me to quite simply say. Fuck you, you brain damaged Right Wing Republicant asshole. I’m curious as to why one, note I said ONE of Obama’s goals is to spend less on health care? Do you know? I bet you do, but I bet you won’t say. It’s because of Republicant assholes like you having a major hissy fit and flapping their hands and carrying on about how they would kill any bill that added so much as one penny to the deficit. Frankly to insinuate that Obama is in the wrong for seeking to reduce costs after you lot all but insisted on it, is a bit like demonizing as a slut, the girl that you talked into sleeping with you.
"While the president’s idea of "bending the curve" on health care means cuts in Medicare, to the American people bending the curve means living better and longer. To the folks on Main Street, it means not appointing Kafkaesque committees to measure "quality-adjusted life years" but fostering a vibrant climate of scientific research and opening a wider pipeline for new medicines."
Wow. I’m impressed. I don’t think I’ve ever seen someone take so many words to say "Death Panels" in my life. You know death panels like the ones that work for insurance companies and decide that ten year old boys should be refused treatment. And as for the "Wider Pipeline For New Medicines" well sure that’s a great idea, because the FDA's approve it and then see if it kills someone methodology has been entirely too stringent.
Personally I have to wonder how Mr. Pinkerton ended up in this group, how did that phone call go, "Hi James, listen we need someone to be a massive asshole, that way it will make Newt Gingrich seem almost cuddly by comparison. Do you think you can do it?" Given the final result I’d say the answer is that he most definitely can.
Alright, now we hear from former domestic policy adviser to President George H. W. Bush and president of the nonpartisan Committee for Economic Development, Charles Kolb,
"Health care reform should have two critical goals: reducing costs and covering more people. To meet them, Democrats and Republicans must abandon simplistic, ideologically driven proposals that animate each party’s base. Liberals cannot insist on Medicare for all, and conservatives cannot insist on markets for all, plus tort reform. Neither approach will work."
Wow. Now as before with Mr. McClellan, I don’t agree entirely with Mr. Kolb's take on the unworkability of Medicare For All. In fact personally I would think MFA would make the most sense, since there is already infrastructure in place. While surely it would need tweaking, I would tend to think that much like renovating a house is usually less expensive than building from scratch the same would be true here. However I have to tip my hat to anyone who is willing to acknowledge that the market "solution" and tort reform is not going to solve these problems. Certainly not all of them, and frankly I doubt many if any of them.
"Our existing employer-sponsored system offers most Americans little, if any, real choice among competing insurance plans."
I can't really disagree with this. Personally I think that a little competition would be a good thing instead of an insurer knowing that they have a monopoly on say Goodburger (Home of the Goodburger) employees, so they could charge pretty much whatever they felt like, they would know that they had competition and so their prices and offerings would have to be competitive so as to be as attractive to employees as possible.
"Congress should not micromanage people’s health care decisions by imposing price controls or setting up more bureaucracy. Rather, it should introduce competition to the insurance market by creating a system of regional exchanges, similar to the one now operated by the federal government for its employees[.]"
Well I don't entirely agree with the first part of the above statement. Here's the way I look at it, set a reasonable ceiling that rates are absolutely not allowed to go above. Then if all of these other innovations work, well that's great and no one will have to worry because no one will get anywhere near the ceiling. But if there is gap in the system and somehow an insurer manages to find a market in which they have no competition and think that means they can charge whatever they like well then the ceiling will already be in place to stop them. It’s kind of like shutting the barn door before the horse gets out instead of after.
"Appropriate risk adjustment—a mechanism by which insurers who cover more sick people are compensated by insurers who cover fewer of them—could reduce the incentive of some insurance companies to sign up only the healthy."
Now this I like. I don’t think it should be suggested in place of legislation making denial of coverage based on pre-existing conditions illegal, but I think it would be a wonderful supplement.
"Congress should also end the current tax exemption for employer-sponsored insurance coverage. This change would encourage people to pay more attention to the price of their health insurance. And it would provide the money that will be needed to help underwrite coverage for the uninsured."
Aw hell. And here we were doing so well, and suddenly you have to veer the car into RWNJ wargarbleville.
Trust me most people are paying plenty of attention to the price of their health insurance. You see the reality is that there are very few in the working class who have their insurance truly "provided" by their employer. Generally the employer kicks in X amount towards insurance and the employee has to pay the rest. So I can pretty much guarendamntee you that those who are liable to pay attention already are. And those who don't? Well I doubt if much of anything will motivate them to.
"Finally, no backroom deals—for pharmaceutical companies, individual members of Congress or anyone else."
Yep. And remember No means No. So none of this Republicant bullshit of "Well it’s okay (somehow) when we do it, but wrong and horrible and immoral and the terrorists win, when Democrats do it."
And finally we have a man that needs no introduction, The lover of Lieberty, The defender of Marriage(s), the author of The Contract On America, Newt (The Hoot) Gingrich!
"If President Obama and Congress are serious about reducing health care costs, then the more than $600 billion a year in unnecessary care should be at the top of the list. Congress must give states the incentive to reform their civil justice systems so that lawyers will think twice before suing doctors for frivolous cases. There is a place for health courts that address only medical malpractice cases, and a need for caps on damages for "pain and suffering" that have nothing to do with lost wages or actual damages. Doctors who incorporate best medical practices should be protected from lawsuits altogether."
Ah it's time for the tort reform song. Okay first of all I would wholeheartedly support pain and suffering award caps so long as the care provider if found guilty could prove to the courts satisfaction the following,
- That the error was not the result of gross or willful neglect. If you showed up drunk and performed surgery? Well then I hope they bankrupt your ass. Seriously.
- That you made an admission of wrong doing to the patient and/or the patients family and that said admission came from you, and was made prior to the wronged party having been contacted by your or the hospitals lawyers. In other words did you have the common decency to admit you made a mistake and apologize (something which many studies have shown is more important in most cases to patients and their families, than receiving a huge payday)?
- That you and the hospital have taken all possible steps to correct the error as quickly as possible, assuming that it is correctable.
If you have done those three things then I do believe that there should be a reasonable ceiling on pain and suffering awards.
Now as to the last sentence in the excerpt from Newt's portion? Well I pretty much call bullshit on that one. No one, at anytime should be "protected" from lawsuits. What they should instead be protected from is ridiculous malpractice insurance premiums, so long as they are able to demonstrate that they are using "best practices." Frankly if you are doing that, if you are a careful and conscientious practitioner then you are not likely to get sued in the first place, and with common sense reforms there would be strong penalties for true nuisance suits. So instead of creating obstacles for those cases where a doctor well and truly screws up, to be rightfully sued, instead reign in the profiteering insurance companies that charge rates that are astronomical even to doctors who have never had so much as a suit threatened against them.
And now for our wrap up I take a quick look at some of the Republican ideas either already in the House/Senate Health Care Reform bills, or in the suggestions made by President Obama.
Frankly after giving that part another looking over there's honestly not much there. Largely there are several ideas that all stem from the same basic idea which has to do with cutting down on Medicare fraud. It’s not that, that’s not important or valuable, but how many times do you essentially have to say the same thing?
Well ultimately this has been a perfect example of why a Republican bill would be a disaster. Democrats are willing to at least consider Republican ideas. Republicans on the other hand are largely unwilling to do so. I personally found it interesting that the most open minded and flexible of the ideas presented belonged to people who had never held an elected office before. Perhaps the kind of mindset needed to do well in politics, makes it harder for one to truly think for oneself outside of the partisan box.
Check back tomorrow for an in depth look at President Obama's proposals. And until then....
Keep The Faith My Brothers And Sisters!
(This article originally appeared at The One about...)