POLICY: Durenberger/Stark

Two veteran healthcare experts….

Stark and Durenberger agree that bipartisanship has gone, because there is an effort to dismantle Medicare. “If god had to make Republicans, he should make them all like Dave Durenberger”.

Stark: Hubbard says that well informed consumers will be shopping for the best deal. But in California was it cheaper in Tenet’s Redding hospital? But it killed alot of people. We spend the least on IT usage and the least information. Doctors cant be ranked and rated, and wont do it amongst themselves. Thinks that HSA’s will just shift the cost to poor and an sicker.

What’s the democratic position. Jesse Jackson and Pete have a constitutional mandate to give a right to health care. Only Americans who have that right are prisoners. Stark-“If it’s good enough for Rostenkowski and Martha Stewart, it’s good enough for me!”

Durenberger: the challenge with Hubbard’s position is that the difference between what we need and what we want. May be able to effect the price of what you want. But his secretary had a heart attack, got a bill for $4,500 from her CDHP because her anesthesiologist was out of network. She never knew who the anesthesiologist was , of course!

Stark: If you allowing people to get in the game late because you don’t insist on universal coverage, then we all pay the cost.

Durenberger—the challenge of the HSA/HDHP is that we are disintegrating the coordinated care of Kaiser, Group Health, etc.

Stark—in my county 600K are members of Kaiser Permanente. It’s attracting docs, and that’s the way more are choosing,

Why would it be such a bad idea to move coverage to CMS, where cost to deliver service is 6% over actual costs, rather than 3rd party providers that need to make at least 15-30% margin. if we can control the marginal cost to deliver reimbursement, why would we not want to take these quick dollars out of the system?

That’s not the real problem. the problem is the Berwick/Wennberg data showing that low cost high quality care is in some places, and that sends money to other places with worse value.

Are there any portions of the Bush health agenda that are unlikely to pass this year?

Stark-No substantive parts will pass this year. But we (the Dems) dont even know where the committees meet anymore. The divisions within the Repubs in the house will prevent anything.

Will this be a big issue in the next presidential election?

Durenberger—we have a governor who wants to make this an issue and both Romney and Huckabee (Arkansas) will make that an issue.Stark—but it’s a major issue for Dems too, as people are losing their insurance via their employers. people are scared…

What about  outcomes/quality research?

We do have some research but not definition of what is quality for doctors and consumers.

Not just the price but what you’re getting for it.

How do we really determine the price? 

Durenberger—No one can give accurate pricing as someone is subsidizing something else. Unless we deal with that, which gets us to the point of universal coverage. We’re all Americans, and if we get to universal coverage, then there’ll be lots of incentives to drive efficiencies.

Stark—Cross subsidization goes on all the time in hospitals and probably cant identify it

If we have price transparency without solving the uninsured problem, wont this make that worse

Stark — Yes and transparency it a myth. He’s trying to get a price for a colonoscopy in DC hospitals. He cant even get a price per procedure let alone a cost accounting breakdown as to why this is cheaper in Rochester MN.

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