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6/4/2009
The Sound of Silence
A Washington Post headline Monday morning was a “Duh, you think so?” moment. How many times have we talked about health care here – that the solution to health care for everyone in the U.S. is controlling health care costs.
Economic Advisers Extol Benefits of Cutting Health-Care Spending.
Duh. Yeah.
Slowing the growth in health-care spending from 6 percent a year to 4.5 percent would have enormous benefits for the nation's economy, creating as many as 500,000 jobs a year and increasing annual income for the average family of four by $2,600 over the next decade, the president's chief economic advisers said yesterday. Ok. Pretty obvious. Not earthshaking. Then the article goes on to talk about possible solutions.
The kind of reform that will bring about these economic rewards will not be easy. It will require truly game-changing innovations in many areas. Duh. Phenomenal innovations like reducing hospital infections, simplifying administrative processes, more prevention and eliminating medical errors. Again, I say duh.
Here’s more from a NY Times piece Wednesday.
To help control costs, the administration indicated support on Tuesday for a proposal to strengthen a federal panel that recommends how much Medicare should pay doctors, hospitals, nursing homes and other health care providers.
Senator John D. Rockefeller IV, Democrat of West Virginia, recently introduced a bill that would expand the role of the panel, the Medicare Payment Advisory Commission, and give its recommendations the force of law. I’m being so flip about this because the solution is so darn obvious. Yeah, the Medicare Payment Advisory Commission is going to solve our health care cost problem. No way. Where is the private market? Where is the expectation that WE, individuals, thinking people, can make good decisions when informed – and when motivated to purchase high-value health care? Where is ANY emphasis on personal responsibility?
Alan Sager, a professor of health policy at Boston University said it.
This is a compilation of resolutions to do better. It is not a listing of forces or changes in behavior that will save money. So did Howard Forman, professor in the schools of medicine and management at Yale:
…there is no dispute that the industry proposals represent sound public policy, but that the question is why those actions have not taken place already. "We all know there are hundreds of billions of dollars of low-value or no-value health care out there," he said. "The issue is: How do you convert that into real savings?" Indeed. Here’s part of the refreshing answer, though discouraging because what’s coming from the “free-market” crowd – is…. silence.
Free-Market Health Care: The Sound of Silence. Appearing Tuesday (June 1) in CQPolitics, it’s an excellent read.
- The challenge for free-marketers is that even those most opposed to government intervention believe that some policy change is needed in health care.
- “It’s very difficult in this environment to try to break through when the people setting the agenda have very different ideas from your own…”
- While there’s no one plan that Republicans are uniting behind, there’s a common focus on individuals rather than economics.
- “The danger always in health care is that even though there can be consensus, you can have ideas that really could disrupt that consensus very quickly. Some issues can be addressed easily, while others can be “real deal breakers.” [e.g., government-sponsored option]
Of course, Rep. Paul Ryan’s “Roadmap” is mentioned, along with ten or 12 other serious Republican and think tank proposals.
- [T]hey’re focused on many of the same issues as the administration, including access, affordability and quality, and they want to reach out and help shape a bipartisan bill in the House.
- “We also want to make sure these decisions, health care decisions, remain with the doctor and physician, not a bureaucrat.”
- "[M]andates will be difficult if not impossible to administer. Some 15 percent of the population does not comply with filing taxes, despite stiff laws and penalties from the IRS. So how can you push that number up?”
- [D]iscouragement in this community remains palpable.
- [O]ne problem is with the message: Republican senators don’t want to go to the floor and repeat what another has said. “Consequently, when you try to bring people together for a plan, of the 40 of us, you’d be lucky to get 20.” But he also acknowledged what is perhaps the biggest hurdle of all: “We are the minority.”
Jo Egelhoff, FoxPolitics.net
COMMENTS
Where are the people in either party's plans????? Where are the people?????
Paul Ryan says his party is in the minority. And why is that? You listened to the leaders of your party not people in the streets of Wisconsin.
Well, wake up Paul, all government should be in the minority. PEOPLE are the majority and where is our voice truly being heard on this or any issue?
You get our votes and then what? You say people…what people, there are people? As a result we have all government and no people and both parties are complicit.
There should have been extensive outreach in every community through representatives and senators aggressively seeking ongoing input from the citizenry like nobody’s business.
Now mandated participation has reared it’s ugly head and that means it’s pretty much a done deal.
There’s no transparency. Everything in our government is done under the table, behind closed doors and then marketed to the American people cloaked in terms that deceive and mislead.
I suggest to Ryan and all other elected officials, America is sick of your (in the collective sense) gaming.

Patricia McNaughton (Thu Jun 04 06:53:16 2009)
Jo, I can't believe any thoughtful person would consider slowing the growth in spending on health care from 6% of GDP down to 4.5%, as a VICTORY. In my adult lifetime, health care has gone from 3% of GDP to l7%. This is absurd! When is enough, enough? We need fresh new thinking, and it won't come from Washington Bureaucrats.GLS

gl Schilling (Thu Jun 04 13:21:37 2009)
Until we get the government AND employer out of the equation, Americans will continue to have health-care freedoms stripped away.
Further, nothing proposed so far addresses the root cause of the problem: the complete disconnect between the true costs of health care incurred by the consumer and the costs to both insurance and health care providers. As long as consumers don't pay for their own health care or insurance, this problem will never be resolved.
The talk on both sides of the aisle makes little sense to me. They indicate that even so-called republicans are one more step down the road toward nationalized health care...just not as far as the democrats, yet.
Let me suggest something.
No business worth its beans would ever nationally roll-out an untested, unproven and costly new product.
If we are in a so-called crisis and if we continue as politicians, no matter how well intentioned, the crisis will only get worse and more costly and, most important, irreversible.
What if we instead develop and TEST two, three, four different plans. Private/private with no employer or government involvement and public/private in small test markets throughout the country.
For once, let's stop and do this right and get this right. Maybe by first determining what the real problems are the real solutions can be found. Maybe, just maybe, we'd actually lick this problem and put it behind us once and for all.
It's possible we'd find that what we really need is better access to catastrophic or to create a diagnostic-testing health insurance or something else completely unexpected.
We must start thinking and looking OUTSIDE the government box for answers.

Patricia McNaughton (Thu Jun 04 14:56:25 2009)
But how do we resist????
No U.S. or state government owns our private health records or us.
Private citizens who agree must resist government healthcare by refusing to allow government’s unauthorized confiscation of our records.
We must develop a legal document private citizens can use to prevent physicians, insurance companies, etc. from releasing our health records to any government entity without each individual’s express, informed and written consent.
If medical/insurance providers throughout the country receive millions of these documents, they will take note. Sending a copy to federal/state legislators, the president and governors will reinforce this message.
It will take nationwide participation, but it can be done. It might be the only way to stop the release of our private records to the government and put a stop to government healthcare.
Why I believe this is important:
• It makes no sense, in terms of affordability or quality of service provided, to force every citizen into government healthcare when the problem is only some citizens can’t afford it;
• When government and/or employers make financial expenditures on our behalf, we allow them to justify removing our freedoms and dictating our choices; and
• If we must make a huge transition away from the current system, it makes more sense to first test different models, including private-sector models with no government and employer involvement.
This is America. We the people are smarter and more innovative than our government could ever hope to be. The best answers are out there if we look outside the government box.
Is it possible to do something like this, if so, let's get together and figure out how to get it done.

Patricia McNaughton (Thu Jun 04 15:02:59 2009)
The real problem is doctors assuming that M.D. means millions of dollars. Steve Kagen ran for congress, funding his campaigns with wealth accumulated by overcharging patients.Doctors take the Oath of Hippocrates, which beging with "firstof all, do no harm"...then harm people with their greed.

vern (Fri Jun 05 00:53:46 2009)
Vern: The high cost of health care is not due to doctor compensation. If you look at total cost of health care, physician compensation is about 19-21% of the total. A problem that should be addressed is the income varations between specialties. An orthopedic surgeon can make $1-2 million dollars per year, while a primary care physican usually makes between $150,000 - $200,000 per year. In addition, one has to look at malpractice insurance, costs of defensive medicine, regulation costs. There is more to increase in health care costs than physican salaries (which by the way are decreasing)

William (Fri Jun 05 11:57:42 2009)
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