Congratulations to new Massachusetts Senator Scott Brown. We saw health care concerns drive the election of a Republican in the bluest of states.
Yet, most people want health care to be reformed…its not that we don’t want change…its that the current approach to ObamaCare looks to lock out change and lock in an insurance model that people can neither comprehend nor afford nor trust. As Albert Einstein once remarked, “Insanity is doing the same thing over and over again and expecting different results.”
So what is the right model for health reform? My humble suggestion is that our nation yearns for Health Assurance, not just Health Insurance. What does that mean?
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Have you visited a MinuteClinic or other retail health clinic? This approach to health care is transparent (prices clearly posted and generally cheaper than physician visits), convenient (located in a pharmacy or other retailer), and customer-friendly (walk-in appointments easy to find).
So why are these clinics, which customers love, struggling?
The answer is surprisingly simple: Medicare (and by proxy, other health insurers) have created a payment system that starves innovators because:
- they can’t charge more for providing better service
- there’s no reward for customers who select a cheaper service
- they can’t even bill customers for innovations that achieve better results and reduce the need for further services
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Doctor Availability Declining with Cuts (via Health Care BS)
Are Primary Care Physicians (PCPs) finally willing to say no to the Fee for Service Medicare approach that has destroyed their practices and profession?
The Mayo Clinic in Arrowhead, Arizona fires a shot across the bow, by informing patients that they will no longer accept Medicare for their primary care doctor visits as of Jan 1 (via Dr. Wes and AZcentral.com)
The discrepancy between what Medicare pays and our cost of providing care acutely impacts the sustainability of our primary care practice. Medicare reimbursements do not cover our actual costs of providing care, and therefore we have recently had to make some difficult decisions that will impact the Arrowhead Family Medicine practice.
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Was struck today that I have heard very little about the role of Medigap in the current health insurance debate…despite massive discussion of Medicare, Medicare Advantage, payment reform…etc. In addition, it highlights how difficult it is to sort through the tangled web of money and influence…not sure how much I believe it, but its certainly food for thought.
This thought was triggered by Michelle Milkin’s post on AARP’s dependance on royalties from selling sponsored insurance plans:
A Hill source summed it up for me this way: “AARP has endorsed a huge reduction in funding of Medicare Advantage, which touches over 10 million middle-lower income seniors. If Medicare Advantage funding is reduced, and seniors are forced out of the program, they become potential buyers of the heavily-promoted and very profitable Medicare Supplement program sponsored by AARP (MediGap is 70% of AARP’s annual income). Medicare Supplement is a huge source of revenue to AARP. At a minimum, AARP should be required to disclose this every time they discuss Medicare Advantage.
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Sustainable health reform requires a solid foundation…unfortunately the proposals we’re seeing out of Washington create a more elaborate house of cards, as we continue to create an elaborate health care ponzi scheme. The House that built Medicare has already saddled our country with Trillions in unfunded liabilities. The proposals we see look to continue to reward a medical-industrial complex that creates and manages diseases rather than focusing on optimizing the health of people.
So what are the criteria of a sustainable health system? continue reading »
Interesting turnaround of the “boycott” created by government health reform suppporters…those supportive of Mackey’s stance have now created a “buycott” movement.
Tea Party Buycott in Support of John Mackey and Whole Foods.
Dana Loesch of the St. Louis Tea Party explained that a Tea Party Buycott asks supporters to gather [in this case] at the Whole Foods store to show economic support. “We are asking supporters to do all their week’s grocery shopping that night. Most tea party supporters are not regular customers of Whole Foods, and we want to show our support for Mr. Mackey’s championship of free market health care reforms.”
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Evan Falchuk makes a nice commentary on his blog on the latest facebook health reform memes
“No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day.”
How about just changing it to “no one should die, and no one should go broke”? I’d be in favor of that, too.
We need to take the discussion about health care past the broad platitudes and really ask ourselves what we want from health care and how we’re going to pay for it. To date, the debate has largely been about how I can get what I want and have someone else pay for it– and in the end we’re all paying anyway, which puts a crimp into that approach.
So, what do I want…I want a convenient and responsive everyday delivery system (that works like most retail services) and protection against unpredictable catastrophic events. I’d also like some help getting my weight down and my exercise up in a way that fits a hectic schedule. I’m willing to pay a few hundred dollars a month for this… What is it that you want and how much are you willing to pay?
David Goldhill’s piece highlights a personal journey of disbelief around how health care and hospitals work today in his essay, How American Health Care Killed My Father – The Atlantic (September 2009) .
For those who haven’t seen it, its a terrific read, and highlighted by David Brooks as the first thing he would ask President Obama to do in preparation for his health care speech. An excerpt below:
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I keep hearing about Comparative Effectiveness and how evidence needs to used in medical practice. Then I remember my days in the clinic/hospital, where complex patients presented in ways that didn’t fit textbook definitions and whose multitude of issues offered contradictory readings from the literature.
So how are we to move forward? I’m a strong believer that the best evidence needs to be used in clinical decision-making…the issue is in making this evidence usable in the field in a way that doctors can trust will be relevant to the person in front of them (as opposed to 300 carefully selected and studied patients in Finland).
So what will the new paradigm look like? My sense is the RCT will fade as consumer-focused care comes into play. If the best of science is directed to the patient sitting in front of a doctor, the goal will be to combine the information of others just like them (across multiple segments and disease phases) to predict both the natural course as well as the potential options for improvement (and their predicted results).
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