Wednesday, February 25, 2009

Another Health Care Blog Regards the Coming Train

Left a comment at a blog called Real Health Reform. According to the sidebar archives, this blog started last year in June and has received about three and a half thousand hits. I haven't dug into the stacks, but from what I can tell there are two contributors who are probably in health care or some related line of work. Insurane if I had to guess. I didn't find descriptive information identifying either screen name, jomaxx or obi jo. Most posts consist of two parts, a leading paragraph in either blue or red which is openly editorial, followed by a journalistic style informational paragraph with supporting links supplied for drilling (but not hyperlink active, which probably saves a lot of valuable time). It is clear that they have a love-hate relationship with the government (Medicare and Medicaid are vital to the health care revenue stream. Many creatures drink from that pool.) and are terrified that the coming Health Care Reform Train will cause a big wreck at their whistle stop.

This morning's post is about J. James Rohack, M.D., president-elect of the AMA, and his endorsement of the stimulus bill's appropriation aimed at improving and standardizing HIT . (Health Information Technology by the way. When you start reading about this stuff you better start a cheat sheet to keep up with acronyms. These people just LOVE acronyms, often using the letters without even knowing what they stand for. I ran into the same phenomenon at a gerontology continuing ed course I took a couple of years ago. The people from CMS sometimes seemed to be speaking another language.) The writer knew better than to cross swords with any future president of the AMA but wanted to warn against a Trojan horse in the stimulus bill. "...we must resist at all turns attempts by federal bureaucrats to interject THEIR beliefs about what is proper care and leave that to professionals and patients." Lord knows, too much scrutiny can mess up comfortable arrangements. If the patient wants it and the doctor says okay, then what's wrong with that?

Go read the post for yourself. Here is the comment I left.

I'm less interested in (and less threatened by) what "federal bureaucrats " have to say about proper care and more interested in what works. The medical community used the term "outcomes" as a metric to determine the effectiveness of a procedure or medicine. Outcomes, unlike opinions, are a measurable statistic.

I'm just a layman looking into what I have learned to call "health care inflation," but in the short span of a few weeks reading I have come to realize that both Medicare and private insurance plans are fighting that same demon. It's gotten a little better over the last decade, but health care costs as a whole are still way over what they should be. Compared with other economies the US shows embarrassing "outcomes" in many categories, while our costs per person are higher than others and continuing to climb.

Something is wrong with this picture.

I'm coming to believe that there are two factors figuring into health care inflation costs. Too many drugs that cost too much. And too many medical procedures that are simply not necessary.

Ours is a sales-oriented economy, so selling is what we do best. In the case of drugs and health care, competition among vendors and providers coupled with an insured population with no real clue about costs adds fuel to the fire. Who gets medical care in our system? Those of us covered by company-subsidized group insurance, others who can afford private insurance, Medicare beneficiaries, and those at the bottom (the uninsured whose care is "written off" and Medicaid and welfare recipients who pay nothing). No where on this list really knows (or cares) what their care costs. Like patrons waiting in line for an "all you can eat" buffet, all want to get something for nothing. They (we?) expect to receive no less than "our money's worth" which means individual money's worth, by the way, whatever that may be.

And if there is any question about actual NEED or RESULTS, we will always choose to get it, just to be on the safe side, in the same way that so many people insist their doctor prescribe antibiotics for the common cold, ignoring the fact that viral infections are not treatable by antibiotics and the over-use of antibiotics has detrimental side effects, not only to the individual but in the larger population, resulting in time in antibiotic-resistant strains of infectious organisms.

As consumers we're speeding down the health care highway in a gas hog. It's time to take a look at a more fuel-efficient model, and until we pick one, we need to apply the brakes a little before we come to a sharp curve and crash.

Here is the reply I received.

Thanks for the thoughtful comments. However, you should be concerned about too much government intervention in the provider/patient relationship.

The first issue is access. The President (including the last several) could have addressed in large measure access issues by executive action without the need for protracted, overly expensive, Congressional action, which will likely be outdated before it takes action. How you ask? By demanding that private insurers become insurance companies again, not money mangers in the risk arbitrage business.

For example, eliminating any exclusion for pre-existing conditions would allow many to get private coverage. Also, by removing sub-group rating to allow for expansion of risk over a large pool of subscribers.

There are many other changes in our system which are needed, and this site will be commenting on them across the board. No group is exempt from the need to participate in reform. In fact this site has indeed addressed a number of those items and we invite you to explore other posts.

Thanks for the commentary and hope you keep checking in!

Now I'm more confused than ever. Here is what I had to ask...

By demanding that private insurers become insurance companies again, not money mangers in the risk arbitrage business.

For example, eliminating any exclusion for pre-existing conditions would allow many to get private coverage. Also, by removing sub-group rating to allow for expansion of risk over a large pool of subscribers.

Whoa! Help me out here.
This is language I don't understand. I know all the words, but I'm confused.

What is the difference between "private insurers" and "insurance companies"? I thought they both meant the same thing.

Does "money managers in the arbitrage business" refer to the medigap "alphabet" plans? Or the now "advantage" products? Or TPA's (that's a cool new acronym I learned lately... Third Party Administrators")?

So how do pre-existing conditions puzzle into all this? By disallowing those with pre-existing conditions, that certainly makes the "risk pool;" a lot cheaper to cover per capita, but at the same time it pushes those excluded into another horrendously expensive pool. I thought the mission of insurance was to do just the opposite... making it better for those in trouble by spreading pooled assets over a larger population.

Are you advocating excluding pre-existing conditions from access? And if so, how might costs for their treatment be covered?

As far as I can tell, the main revenue streams paying for health care are insurance premiums (in one form or another, including Part B deductions from SS checks), co-pays and deductibles directly from clients, and government funds (Medicare and Medicaid) from payroll taxes. The costs of treating uninsured people, indigents and others who do not pay for whatever reason are "written off" but that is only an accounting gimmick. The costs do not, in reality, vanish. If providers are not to go bankrupt they have to recover those costs from one or several of the revenue streams listed.

In the end, the health care pie is cut and paid for one way or another.

What am I missing?

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