Health Reform: Bending that Curve

Plllllfffffftttt!

It's just another episode in what appears to be another sordid chapter!

Hell, everyone's saying:

"We can't afford it!"

Of course, just what will be the cost of not doing something that works?

I hear nothing but deafening silence...

Fr'm KT in response t' me comment in response t' gunny in another health care reform thread regardin costs -a might bit long, bu' also a big piece o' th' puzzle:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

a legislative ritual that amounts to one of the most effective and lucrative forms of constituent service

Oh well that's a good reason to not change anything then. Heaven forbid we deprive Congresspeople of their graft.

Two o' th' most pertinent sections o' th' New Yorker piece:

"When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country's best electrician on the job (he trained at Harvard, somebody tells you) isn't going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here's how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they'll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen."

..."Dyke is among the few vocal critics of what's happened in McAllen. “We took a wrong turn when doctors stopped being doctors and became businessmen,” he said.

We began talking about the various proposals being touted in Washington to fix the cost problem. I asked him whether expanding public-insurance programs like Medicare and shrinking the role of insurance companies would do the trick in McAllen.

“I don't have a problem with it,” he said. “But it won't make a difference.” In McAllen, government payers already predominate—not many people have jobs with private insurance.

How about doing the opposite and increasing the role of big insurance companies?

“What good would that do?” Dyke asked.

The third class of health-cost proposals, I explained, would push people to use medical savings accounts and hold high-deductible insurance policies: “They'd have more of their own money on the line, and that'd drive them to bargain with you and other surgeons, right?”

He gave me a quizzical look. We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they're supposed to haggle over the price as if he were selling a rug in a souk? “I'll do three vessels for thirty thousand, but if you take four I'll throw in an extra night in the I.C.U.”—that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”

We be needin' t' change t' single-payer, bu' we be needin' to change this model, too!

Arrgh!

KT- congrats..you made a Media Research Center's blog.

http://newsbusters.org/blogs/warner-todd-huston/2009/07/17/time-warns-president-he-could-lose-healthcare-battle

"The Washington Post's Shailagh Murray explained why earlier this week...."
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HA HA HA HA....a right wing hack writer working for a corporate lobbying group. Did corporate force you to link to this tripe, or are you that f@cking clueless.
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Strange that you and your colleagues have become so concerned w/ the cost of health care, I don't recall your concern regarding the trillion a year we've been spending on military since 2003. Military spending makes corporate America smile. Health care reform makes corporate America and baby Jesus cry.

HA HA HA HA..yes..cuz we all know the Washington Post is so right wing and conservative...LOL!!

"The IMAC would issue recommendations as long as their implementation would not result in any increase in the aggregate level of net expenditures under the Medicare program; and either would improve the quality of medical care received by the program's beneficiaries or improve Medicare's efficiency."

Seems like it could be the means to start to implement a primary care/wellness approach to health care against the current disease model, which would be a much more effective means to reduce long-term aggregate cost that simply tweaking reimbursement. Of course, the real long-term savings is to had by dealing with the dietary and lifestyle habits of the young so this would only be the first bite of the wellness apple, that which can be applied to the elderly through the health care system.

Oh, what a tangled web we weave
When first we practice to...

...Reform a tangled web.

Second classical analogy:

Health care delivery today is like the Gordian Knot. It will take the sword of an Alexander to "untie" it.

Obama speaks on health care this afternoon. Perhaps agreeing to delay his August mandate? Or is he about to skewer moderates for "obstructionism"?

http://www.political-buzz.com/

Is there a CBO report saying out these 12 F-22 no one in the defense department wants are going to pay for themselves?

I 'm just asking because all this absolutely ridiculous fretting about how health care is going to pay for its self is completely friggin insane when the fact is we waste more tax dollars or crazy crap like $250 million-a-pop F-22 stealth dogfighter. While senior military leaders all say they have plenty of the planes.

What is wrong with this picture when no one in congress or the media can put stuff like this into perspective. That we waste serious money every year on all sorts of government goods and services that no one needs. We are trying to spend $250 million dollars 12 times for planes that will help NO AMERICANS! Yet every pundit in the nation is fretting the cost of that health care.

How about we come up with some Common f**king Sense reform and then just maybe health care reform will just naturally happen. Because we will be just so f**king awesome.

http://www.wired.com/dangerroom/2009/07/gates-future-jet-supporters-risking-todays-troops/

GOP Rep. Admits That Health Insurance Companies Control The Market And Dictate Medical Decisions »
Today on C-Span's Washington Journal, a caller told a story of how he was forced to see numerous doctors at different hospitals in the area in where he lives, some as far as 100 miles away, to get a diagnosis. The caller then faulted health insurance companies for preventing the practice of having “diagnostic tests done under one roof.” “So in essence,” the caller noted, “the insurance companies are the ones controlling what tests you can get, when you get them, how you get them and if they're accepted or not.”

In a remarkable moment of candor, C-Span's guest — Republican Congressman Tim Murphy (PA) — agreed:

MURPHY: Yeah and that brings up the point here that with regard to one of our big frustrations with insurance companies is they control the market place, they control what's done, a lot of times doctors not making the decisions here. And you recognize the frustration.

http://thinkprogress.org/2009/07/17/gop-rep-health-insurance/

This is interesting:
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http://www.weeklystandard.com/weblogs/TWSFP/2009/07/obama_takes_to_the_mic_and_dem.asp

"What is wrong with this picture when no one in congress or the media can put stuff like this into perspective."

Or the president Gunny. The buck stops there, period. If he chooses to talk about it, to illustrate the asinine contrast, then the MSM horde would dial in. Regardless of Gates' sanity and/or futile quest to take on a few sacred cows (compared to Rummy & co.), the Obama admin's military budget for 2010 is still an increase over the Bush approved '09 budget! See here: Center for Arms Control and Non-Proliferation

And it's not merely the vague nature of his support for health care. Can any of us clearly say exactly what it is that he does support? Other than getting something passed, preferably something with a few GOP votes so he can burnish his street cred with the Broderian centrist cult. Enough with the cajoling and milk and cookies with the GOP or blue dogs. Go to their f'ing districts and publicly challenge and/or shame them if necessary.

So, I get you on the epic fail of our congress and MSM--that's stating the obvious. But we just elected a new president so he could change the debate, the nature of our goals as a society.

But on gays, on detention, on gun rights, on the drug war or real wars, on DC's too cozy rel'ship with the corp parasites, on climate change, and of course re: H-C, I simply fail to see any reason for enthusiasm. Am I relieved that Bush is out and Mac didn't get in, yes, indeed, but Obama seems to be offering us little more than watered down countermeasures to looming catastrophes. If the flooding of New Orleans encapsulates the Bush years, Obama seems to be offering us a levee constructed out of some dodgy materials.

Fellow swampland tetrapods:
I don't particularly like Halperien, but I have to say that this particular piece is pretty darn accurate:
http://thepage.time.com/halperin%E2%80%99s-take-the-ten-biggest-obstacles-to-health-reform-right-now/

oh, isn't that cute, 53_3 makes a reference to the land animals from which we all descended . . . .

It's ok spob. I really was going to include the disclaimer ("...except for spob"), but that's ok.

The outrage! The outrage!

Our only hope is that Karen Tumulty's ill relative is told that due to spending on the F22, his care will have to be scaled back. Then she'll have an epiphany about military spending in relation to spending on health care reform. We just need every member of the corporate media to lose their health care to get some honest reporting on the matter. Or perhaps health care reform will have an affair w/ a hot Argentinian but claim to be hiking the Appalachian trail and the MSM will fall all over itself to provide cover and offer friendly softball interviews. Example:
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"Look, you [health care reform advocates] have a lot of pitches .. I get it and I know this is a tough situation ... Let me just say this is the place to have a wider conversation with some context about not just the personal but also the future for [health care reform] ... This situation only exacerbates the issue of how the [health care] recovers when another [health care reform advocate] suffers a setback like this. So coming on Meet The Press allows you to frame the conversation how you really want to...and then move on. You can see (sic) you have done your interview and then move on. Consider it."
tpmmuckraker.talkingpointsmemo.com/2009/07/nbcs_gregory_to_sanfords_office_meet_the_press_all.php

Karen this might help control costs but can the CBO score this?

The senate finance committee could not come up with the answer so took the day off today. What makes them think if they have more time they will find the answer? They should give up and let the House do the work they do not want to do. I am surprised that they want the House to look like the leaders.

Waxman's committee will finish up his markups by next Wednesday. The President has announced a prime time presser for Wednesday evening. I think this will put pressure on the Senate to do something, or like Jayack wanted the Senate to take up the House bill. This is what happened with the stimulus bill.
The democrats do not need Republican votes, they only need 51.

During the election I was on pins and needles thinking that Obama would lose and every time something came up he ended up on top. I would not count him out on this.

Remember there is always more to every story.

Digby and the wonk room bring up I think something that everyone should consider.

"Whatever happens, people need to understand at least one thing --- the idea behind health care reform was to bring down costs across the entire health care economy, which was not scored by the CBO. This is a very important piece of information that reporters should be imparting along with what seems to me to be their glee at the prospect of health reform failure."

http://digbysblog.blogspot.com/

"Our only hope is that Karen Tumulty's ill relative is told that due to spending on the F22, his care will have to be scaled back."

Sorry, Cincy, but that's just in poor taste. Are you with P-luk now, that KT is "shilling" for insurance co's? I may not be with SZ & others who laud KT for virtually anything she posts, but her work on this issue is at least worth our measured respect.

Is she willing to call b-s as strongly as we might like, no. Can we constructively criticize her for not quite crossing the line towards doing so, yes. But that doesn't make her a shill, and it doesn't make her an appropriate target for such a personally nasty comment.

"Our only hope is that Karen Tumulty's ill relative is told that due to spending on the F22, his care will have to be scaled back."
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But he's not a troll . . . .
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This is an absolutely appalling comment. Worst I've seen here, by far. KT is a journalist, and that requires a fair bit of balanced treatment of an issue. It's not her job to shill for your side or any side.
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It never ceases to amaze me how people who claim that they are so moral and enlightened can sink to such depths.
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Amazing too that I am pilloried in patently offensive personal terms, yet Cincy's post is "in poor taste".

Pirate Wench, if I deserve a "go f yourself" everytime I post, certainly Cincy deserves one as well. Do you agree?

And Rose, if you're out there in the ether somewhere, here's a piece that glances upon the SCO, though it's primary focus is on: Pipelineistan, competition over

http://www.fpif.org/fpiftxt/6266

Figure I'm going to throw as much paint at the wall as I can before I head into the mtns. for the w-end. More from the Roy piece I linked to above, ostensibly concerning India, but after finishing it I was struck by the notion that all politicis are indeed ... universal:

"This theft of language, this technique of usurping words and deploying them like weapons, of using them to mask intent and to mean exactly the opposite of what they have traditionally meant, has been one of the most brilliant strategic victories of the tsars of the new dispensation. It has allowed them to marginalise their detractors, deprive them of a language in which to voice their critique and dismiss them as being 'anti-progress', 'anti-development', 'anti-reform' and of course 'anti-national' – negativists of the worst sort....

To those who believe that a government is duty-bound to provide people with basic education, health care and social security, they say, 'You're against the market.' And who except a cretin could be against a market....

The hoary institutions of Indian democracy – the judiciary, the police, the 'free' press and, of course, elections – far from working as a system of checks and balances, quite often do the opposite. They provide each other cover to promote the larger interests of union and progress. In the process, they generate such confusion, such a cacophony, that voices raised in warning just become part of the noise. And that only helps to enhance the image of the tolerant, lumbering, colourful, somewhat chaotic democracy. The chaos is real. But so is the consensus."