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POLICY: What Would Dubya Do?

So I’m up at Spot-on asking if you really wanted to get to universal care and reward your base, what type of political moves would you have to make. In other words, What Would Dubya Do?

Comment back here if you like.

In the last week the Democrats must have gotten sick of being told that they are supposed to be moderates. The New York Times tells them that populism should trump ideology, the nut jobs on the right still think that they are the second coming of Lenin,
and the corporate-friendly Emmanuel faction is already starting the
fight with the Dean "net roots". Which is why I’m on the record as
saying that no radical health-care reform will happen in the balance of
this decade.

When you look at domestic issues, of course, health care is by
a mile the most important, and the party’s presumptive 2008
presidential candidate Sen. Hillary Rodham Clinton, has, shall we say, a history in the area.
But realistically all that will happen in the next two years is for
Congress to give the administration the right – but presumably not the
obligation – to directly negotiate with drug companies about Medicare
prescription drug pricing. There’s also the likelihood that Congress
will approve a reduction in the bonus profits currently offered to
private insurance plans by the 2003 Medicare Act. But it’s just as
likely that the drug pricing measure will be vetoed by President Bush,
although the cuts in Medicare private insurer reimbursement will likely
be part of a budget act which the President will probably sign. Continue

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George JaspertMaggie MaharlynnjdPeter Recent comment authors
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George Jaspert
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Here is a website with real solutions to health care and IRA Reform.
The Giant Health Mae IRA HMIRA
Create a non for profit Universal Health Care workforce for the uninsured.
Staff them in hospitals and clinics.
Drop current $5million policies to $50k per year by creating a universal (Part B) that covers you from $50k and up per year.
This makes more sense than insuring the uninsured at a profit.
It also make more sense than trying to make all of the Dr’s and nurses gov employees like the Canadian system. Do you agree?
Check out the proposals on http://www.mypaysaver.com.

Maggie Mahar
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Maggie Mahar

Matthew— Your Spot-On post is great—the best road-map for reform that I’ve seen. I especially like your “divide and conquer” strategy for hospitals and insurers. The only point I’d add is that, although drugs and devices directly account for only 15% of our health care bill, indirectly they account for much more—especially the devices… Every time a device is used, we pay not for the cost of the device, but the cost of the surgeon implanting it and the hospital care that follows the surgery. And in many cases, the surgery is not needed—i.e. all of the recent news about… Read more »

John Fembup
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John Fembup

“You missed the thrust . . . “ No, I noticed all your thrusting, I didn’t miss it. And I have no problem with data, collect all you want. I said this: “To believe withholding ‘futile care’ can work as general social policy – can improve on decisions made within the present doctor-patient relationship – is to place a huge unearned measure of trust in the people who would define ‘futile care’ and, thereafter, in anyone to whom society gives a legal right to make decisions about other people’s ‘futile care’. I am not willing to give that much trust… Read more »

Peter
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Peter

“One good place to start thinking about how to do that is to acknowledge how much of present health care costs are driven by irresponsible behaviors – poor nutrition; obesity; inadequate physical exercise; unsafe sexual activity; inadequate sleep; drug, alcohol, and other substance abuse; tobacco use; violence and crime; auto accidents; air pollution; stress in the workplace; etc etc.” Ah, the American lifestyle, where choice is everything and consequences are for the other person. Posted by: jd “It is remarkable how physicians seem to hold the scientific method in such low esteem, in favor of some kind of intuitive, I… Read more »

Barry Carol
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Barry Carol

In any given year, I wonder how many patients are on feeding tubes and breathing machines. These are standard interventions that can extend life for quite some time, albeit with low quality and at high cost. Once treatment like this is started, it may be difficult or close to impossible to discontinue. Many people who do not have living wills or advance medical directives do not want these interventions. If they had the will or the directive, their wishes would have been respected. In Porter and Teisberg’s new book Redefining Healthcare, they suggest making executing a living will or advance… Read more »

jd
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jd

John, You missed the thrust of my comment and the thrust of many efforts to curb costs of end of life care. My point was that we can get just as much longevity by getting data on which procedures actually tend to improve longevity and add increased misery (the misery of treatment, and perhaps new side effects) and extensive additional costs without prolonging life on the whole. There isn’t magic involved here. It’s just about collecting data. You write: “I’m not so naive to think that care is never withheld by a physician on grounds of futility. But those decisions… Read more »

lynn
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lynn

What would Dubya do? Call his Daddy for Louis Sullivan and Gail Wilensky’s phone number. Hospitals have already figured out what service/product lines are dogs and what are their stars. They have quietly begun to RATION care. The conflict will come when the patients (and the public) finally figure out the giant gap between REALITY and hospitals’ well advertised CENTERS of EXCELLENCE. At some point a very bright lawyer (or team of lawyers) will figure out how to pursue a claim of fraud against the hospitals and physicians for saying one thing and behaving in a different way on purpose.… Read more »

John Fembup
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John Fembup

Just one more thing. I agree with Barry that there is room for improvement in how end of life care is managed in the U.S. But I’m honestly concerned at the implications of trying to deny “futile care” in order to reduce costs, and that is why I’m raising objections. I’m not so naive to think that care is never withheld by a physician on grounds of futility. But those decisions are usually made privately, reached as a matter of the physician’s (or family’s) conscience, rather than as the result of explicit social policy. Aside from saving money, is there… Read more »

John Fembup
Guest
John Fembup

Look, jd, all I’m saying is: before we toss our grandmas under a train somewhere, it makes sense to devote some serious attention toward improving the general public health. In other words, why not try to reduce the cost of health care by reducing demand for it? Maybe then there wouldn’t be so much angst about the cost of caring for the weakest and sickest among us. One good place to start thinking about how to do that is to acknowledge how much of present health care costs are driven by irresponsible behaviors – poor nutrition; obesity; inadequate physical exercise;… Read more »

jd
Guest
jd

John Fembup seems to live in a world in which the data collected by the Dartmouth Group do not exist. Or maybe he just doesn’t believe it. Because if you do, then you believe that in the American context regions and systems with high-cost, high-intensity end of life care do NOT perform better than those with low-cost, low-intensity end of life care. Minnesota outperforms Florida, at a fraction of the cost, even after you control for health status. Heck, their recent study on Medicare even controlled for outcome: everybody died. If every state’s medical practices were more like those in… Read more »

Barry Carol
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Barry Carol

Peter – I think more widespread use of living wills could make a positive difference and reduce the cost of end of life care. A woman I know who has worked as a nurse in Boston for over 20 years, much of it in the ICU, tells me that when there is a living will, it is honored. If there is a healthcare proxy, they will generally go along with what the proxy wants to do. If neither is present and the patient can’t communicate, the bias is to do everything because of the fear of being sued if they… Read more »

Matthew Holt
Guest

Vince–When you say thoughtful I assuem you’re talking about the piece at Spot-on, not the comment about shooting politicians and doctors! My overall goal is to create a universal health care system where innovation that encourages cost-effective advances in care (e.g. Disesase managemengent if it can be shown to work) is encouraged. That’s extraordinarily difficult, but at the moment we have the exact opposite–a non-universal care system which causes incredible hardships to those who lose the insurance lottery PLUS a financing system that encourages innovation in non-cost-effective care. However, if we solve the first problem–which is by far the biggest… Read more »

Peter
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Peter

I’d be interested to know how many of the so called costly end-of-lifers have or have had any health insurance? I’m thinking that not many of them do. I read that the our illustrious prez will also veto any attempt by Dems to allow medicare to negotiate drug prices because (ideology) that would be a first step toward universal coverage. It’s interesting that a guy like Dumbya, who has had a connected and rich daddy to always get him out of scrapes as well as fund him, thinks he knows whats the best way to run a socially responsible healthcare… Read more »

Vince Kuraitis
Guest

Very thoughtful.
When I think about the term “universal coverage”, its often used in the context of both 1) government financial sponsorship of the uninsured, and 2) a government controlled health care system (e.g., Canada, the UK).
Your arguments seems to go much more toward supporting #1. This makes sense to me because there are minimal market incentives to provide coverage to the uninsured.
Even tho I’m a Democrat, #2 makes me shudder.

Matthew Holt
Guest

How about just shooting all the politicians and physicians instead?