Naomi's Idea - Health Care Reform

Friday, October 1, 2010

The cost of medical malpractice liability (NY Times)

I'm sorry that I haven't posted anything new in a while, but after Obamacare was signed into law, I lost interest in the topic. Today, however, an Op-Ed piece in the NY Times by Uwe E. Reinhardt caught my eye. Professor Reinhardt estimates that the cost of medical malpractice litigation is $55 billion per year in the US. Although this figure represents only 2.4% of the annual US health care expenditures, it is certainly a non-trivial number, because it can be easily reduced. Let's hope that this or the next US Congress has the good sense to pass a law to reform medical malpractice litigation.

Sunday, February 21, 2010

Academics fiddle while Health Care Reform burns

The New York Times reports on a New England Journal of Medicine article, that criticizes a report that serves as one of the cornerstones of President Obama's health care reform effort. According to the Times:

"Mr. Obama received his information about the hospitals from a widely cited analysis called the Dartmouth Atlas of Health Care, produced by the Dartmouth Institute for Health Policy and Clinical Practice. An article in The New Yorker magazine last year written by Dr. Atul Gawande that used the Dartmouth Atlas as its organizing principle became required reading in the White House last year.

But an analysis written in The New England Journal of Medicine by Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center in Manhattan, suggests that much of the Dartmouth Atlas is flawed and that it should not be used to compare the relative efficiency of hospitals."

You can read Dr. Bach's critique of the Atlas here.

Friday, February 12, 2010

Health insurance companies post big profits

Here's an interesting article, from the Chicago Tribune.

The five biggest insurance companies made $12.2 billion in 2009 (up 56% from 2008), while insuring 2.7 million less people. And now the best part. The report, released Thursday by Health Care for America Now!, also said three of the five insurers cut the proportion of premiums they spent on their customers' medical care, committing relatively more to salaries, administrative expenses and profits.

Wednesday, January 27, 2010

Argo Navis

The second century astronomer Ptolemy designated a constellation Argo Navis, based on the ship that Jason and the Argonauts sailed. Unfortunately, later astronomers declared that the constellation was too big and unwieldy to be of any use, so it was split into Carina (The Keel), Puppis (The Poop Deck) and Vela (The Sails). Thus appears to also be the track for the ill-fated Obamacare. We may hear more tonight from the POTUS, with regard to health care reform, but all indications are, that the Democrats will resort to passing health care reform in a piecemeal fashion. That should be interesting.

Wednesday, January 20, 2010

Now What?

Now that Scott Brown has defeated Martha Coakley in the Massachusetts US Senate race, the Democrats' super-majority in the Senate is a thing of the past. There could be an attempt to have the House pass the Senate version of the health care reform bill. Or, the Senate could try to pass a Conference bill and let the Republicans stop the wheels of Congress with a prolonged filibuster. And, I'm sure there will be attempts by the Senate leadership to cajole Senator Olympia Snow into a "Ben Nelson" kind of play for pay compromise. Stay tuned.

But what is clear is that the American people are unhappy with the content of the proposed health care reform package. It was a major issue in the Massachusetts Senate race. It wasn't the only issue, as Coakley also ran a lousy campaign. The results in Massachusetts also point out that when no candidate in a primary (or for that matter, a general) election gets more than 50% of the vote (Coakley got 47% of the vote in the Democratic primary), there should also be a runoff election between the top two vote-getters. Coakley wasn't properly vetted by the electorate and further, took the general election for granted.

Monday, January 11, 2010

Not a Growth Industry (redux)

Here come the all the people jumping on the bandwagon:

http://bits.blogs.nytimes.com/2010/01/11/venture-capitalists-eye-the-doctors-office/?ref=technology

Somehow, the word "doctors" and the term "venture capitalists" don't sound like they should be in the same sentence.

Sunday, January 10, 2010

Telemedicine

The NY Times has an article on Telemedicine, the process of only consulting a physician via a computer link. This isn't directly related to Health Care Reform, but we will probably be seeing a lot more of this type of thing, in an attempt to cut costs. The NY Times also has a article on the legitimacy of physical therapy, so I suspect we are going to see a lot of media accounts on the validity of specific aspects of US Health Care.

Health care should't be a growth Industry

As an obstetrician-gynecologist practicing in Upstate New York, I’d like to suggest an alternate path for reforming health care in this country. As a hands-on clinician, I practice in Troy along with five other OB-GYNs, two nurse-midwives and a nurse practitioner. We care for a wide range of patients, from those on Medicaid or less, to the elderly served by Medicare, to state employees, who are blessed with outstanding private health insurance. We have delivered thousands of babies at our local hospitals and have tried our best to stay ahead of the ever-increasing patient load, demanding new technologies, declining reimbursements and the ever-lurking trial lawyers.

The main concern in reform issues has been to contain costs while providing better health care for all Americans. The major argument regarding reform is whether some modest variant of the present health insurance system should be instituted or whether a single-payer system should be imposed by the federal government. In May of this year, Senator Charles Schumer, offered a “middle ground.”

Schumer has laid down some good ground rules, saying that any public plan should be voluntary, fairly funded and self-sustaining, as well as administered by separate managers and regulators, but the debate about alternatives has become protracted.

One day, when sitting with my checkbook and looking at my ever-increasing electric utility bill, I got an idea. It wasn’t a grand, elaborate idea, but rather a simple one: Years ago the power industry in the U.S. was heavily regulated. Those days are gone, of course, swept away in a fury of deregulation. But back then, a state like New York was divided into geographic regions and each electric utility had a regional monopoly, such as Niagara-Mohawk upstate, Consolidated Edison in the New York City and LILCO on Long Island.

These companies couldn’t just raise electric rates on a whim. They spent years, justifying to regulators even a modest increase in the rates that they could charge to the consumer. Every aspect of their business model was thoroughly inspected and restricted. They couldn’t build too many power plants or invest in risky or unrelated capital projects. As a result electric rates remained stable for years. In addition, everyone who invested in the stock market always kept some low risk, utility stocks in their portfolio, to cushion the blow when there was a recession. But the utility company CEOs complained loudly to the politicians. In a matter of years, that stable system, designed for the public benefit and run by private entrepreneurs, was dismantled.

Now what does this have to do with health care? It has lot to do with it. The debate over health care reform has degenerated into sloganeering and as Schumer suggested, someone has to propose a middle ground. Lest we continue to only hear that a single payer system is “irresponsible, heavy-handed socialism” and the present system is “rampant, self-serving capitalism.”

I have another proposal.

Under my proposal, private health insurance companies would bid to the federal government on obtaining a regional monopoly for a specific geographic area. Within that area, there would be no other purveyors of health insurance; no Medicare, no Medicaid and no other private insurers. For those patients who are employed, the employer would pay the geographic insurer. For those patients without employment, the federal government would reimburse the insurance company on a capitation basis at the private employee rate. In exchange for their geographic monopoly, the government would heavily regulate health insurers’ profits and limit the annual increase in profit to either some small percentage or the rate of inflation, whichever was greater. It would be up to each “monopolist” to set insurance costs and provider reimbursement rates within its geographic region, within some guidelines established by the federal government.

In addition, these private insurers would pay no federal, state or local income tax. The private insurance company would also bear the burden of paying out any malpractice claims, as both legal liability and malpractice insurance would be eliminated for individual physicians, hospitals and other health care providers. The federal government would monitor various health care metrics within each geographic region, to assure some measure of consistency in the quality of care throughout the country. If no private insurance company wished to bid on a particularly "risky" geographic area, the federal government could step in with a subsidized public insurance entity.

The health care sector is referred to as “a growth industry.” Investment advisers and economists proudly point to its continued vigor during our present recession. The problem is that it shouldn’t be a growth industry. It should be a stable system, designed for the public benefit and run by private entrepreneurs.