Tuesday, December 04, 2007

"For the Price of a Cane"

This is a great post title. I doubt thr average reader will catch the nuance, so here is the reference:

For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.

It's an old nursery rhyme that has been around for a long time. Wikipedia managed to give the line an article without prominently citing the source, and the phrase has come into common usage by a lot of people who have no idea where it came from.

But as usual, I digress. This post is about price abuses in medical care perpetrated by Medicare. I have been monitoring a health care blog by way of learning what the professionals have to say about health care reform, and this morning a particularly good post came up.

Be warned: this is the tip of a very large iceberg and the average reader will not dig far into it before tossing in the towell and moving on to something else. If you think the complexities of international relations are convoluted, you haven't seen anything yet. The intricacies of the world of medicine, intersecting with insurance, the drug industry, and politics makes international relations look like a walk in the park. There are acronyms and buzzwords to make your head swim, references to professional taxonomies well understood by the pros that may as well be another language for the average reader. Here is an example:

The outing of the RUC (RBRVS Update Committee), the secretive committee that has so much influence over how Medicare reimburses physicians, and hence bears much blame for the decline in US primary care, continues.

If you don't know right off what those abbreviations mean you're out of luck. Health care professionals use initials like that as easily as sports fans talk about player statistics, so the newcomer has a lot of homework to do. And then "outing...continues" implies that something is in the works that even after you learn the abbreviations, you need to remember them as you dig into the background. This is not an easy assignment.

The nub of the article cited points to a NY Times piece about how Medicare often pays too much for medical equipment, such as canes and oxygen. Elsewhere the blogmaster takes the system for task (justifiably, by the way) for undercompensating certain catgegories of physician services at the expense of others. In the end, the situation illustrates how politics can unbalance any system, making it less effective and cost efficient.

The criticisms are well-taken. Unfortunately, those who might bring about meaningful corrections are not armed with the political resources that would make those corrections have teeth, partly because of what the writer refers to as "stealth lobbying," concluding...

We clearly need to push Medicare into a rational, transparent reimbursement system that does not penalize primary care and other cognitive physicians.

This is also a reminder that those who put their faith in establishing a single payer health care system to cover all US citizens may be sorely disappointed. If a single payer system continues the irrationality, opacity, and susceptibility to political influence of our current single payer system, having such a system cover everyone might just make things worse.

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