I'm tossing in the towel on following the debate. Not because I can't figure out where the many problems are but because I see little chance of those problems being resolved any time soon. The players are too strong. The political interests are too entrenched. The money remains with the strong and those most in need of a better system are and will remain helpless pawns at the bottom of the social heap.
I want to be wrong. Bad wrong. But even the most winning smiles and hand-crunching handshake grips of the president look like very long shots to me.
Dr. Reece at Medinovationblog is tepidly optimistic.
What isn’t being said is that Congress is already addressing ways to provide incentives to employers and hospitals to reduce costs.
• Congress is planning tax credits or other subsidies to employers who offer wellness programs. The goals of such programs are to help people control blood pressure, fight obesity, stop smoking, lose weight , eat better diets, exercise intelligently, and manage diabetes and other conditions.
• Congress is considering rewarding hospitals who reduce the number of people being readmitted after discharge. As things now stand, hospitals profit from these readmissions and have little incentives to reduce them. Reducing readmissions cost money, and hospitals feel they should receive financial incentives for readmission reductions.
• The recently enacted stimulus bill- the American Recovery and Reinvestment Act – contains $19 billion to give doctors hospitals and doctors financial incentives starting in 2011 to adopt electronic health records amounting to a one-time bonus of $ 2 million for hospitals plus on add-on for use for every Medicare admission for 4 years and $44, 000 spread over 5 years for doctors who use EMRs.
• Medicare pay for performance projects are underway to offer positive incentives in the form of bonuses or subsidies for medical students who commit to careers in primary care, for primary care doctors who establish medical homes, or doctors in general who meet or exceed quality standards.
More Care, More Money
As admirable as these efforts are, much of them are cosmetic. Let’s face it, the present health system is still rewarded for doing more rather than less. Hospitals profit from more admissions, health plans margins grow with more members, doctors make more money by doing more procedures and tests, device and drug manufacturers gain from more device and drug sales. And frankly, most government efforts focus on the Medicare and Medicaid populations, which represent about 1/3 of the total market and which are not necessarily representative of the whole.
Cost-Reduction Roles of Market Forces
To a large extent, market forces must also play cost-suppressive roles. This is already taking place in the form of worksite clinics, retail clinics, $4 Wal-Mart prescriptions for generic drugs, care outside of 3rd parties where discounted, basic care is being offered. But more could be done – doctor offices could have lists of comparative prices for brand versus generic drugs.
Meantime, a less sanguine post at The Health Care Blog is worth a look.
Is it possible for these stakeholders to find $2 trillion in excess health care costs over the next ten years?
Are there ice cubes in Antarctica?
Best comment (Bob Stone) which will be ignored:
One wonders how much cost could be eliminated from the system if everybody simply stopped advertising.