I’m up at Spot-On explaining the Ted Kennedy Medicare miracle to the masses and suggesting that there are some real long-term problems that won’t be so easy for the Dems to solve later. As ever come back here to comment.
Well, lookee there: Congressional Democrats actually won one. That’s right. After 14 years of ignoring core liberal principles – including the last 18 months when they actually had a majority – they took on the Republicans and won.
How did this happen? Well, it’s an election year, and by forcing an issue that Congress has been putting off for years — automatic cuts in Medicare physician payments — Democrats seized the chance to score a few points.
Essentially, the Democrats decided that, instead of agreeing to another fudged compromise to put off the decision to cut payments, they’d set the insurers against the doctors. So they found the money to put off those automatic cuts by taking some away from private Medicare insurers. Now, it was a bit of a surprise that so many House Republicans joined them and drop-kicked the insurers with whom they’ve been aligned for so long, although of course they’re all up for re-election. But once there was a veto-proof majority in the House, the Senate Democrats realized that they could force the issue and score a political win.
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Great blog. I appreciate the info on amount of care correlated with outcome.
The discussion around the cost-effectiveness of procedures/drugs is different in the US vs Canada. While there are cost-effective measures taken within Medicare, Medicare payments often subsidize other services, especially hospital charity care. But here universal care is had when hospital ERs give charity care. This charity pay is subsidized by (over) performing profitable services (mostly funded by Medicare) and DSH payments (more of our tax dollars). Government dollars therefore flow into other aspects of care. So Medicare ‘rationing’ within Medicare is much more ineffective as it’s not a closed system. Meanwhile I think Canada’s government financed care works within a tighter system where funds don’t ‘leak out’.
Overall, in the US rationing is based on the ability to pay and not on the need of the care to be given. This is obviously inefficient (read: fiscally irresponsible). Other countries ration on the effectiveness of care to be given. If we’re talking about my tax dollars, I choose the latter.
Matthew,
I am somewhat put off by your comments concerning what I assume to be overutilization of healthcare resources in terminal medical conditions and situations.
Your paragraph in Spot-On:
“The second argument is less well known. The types and amount of treatment all patients receive, including the very, very sick, vary tremendously in different parts of the country. More importantly, perhaps, the data is pretty clear that less care results in better outcomes. So potentially we could provide all the effective medical care that’s needed while providing less actual care.”
This reads as a generalization implying a statistical correlation between the quantity of care and outcomes on ALL levels of health care. The is unequivocably not true.
While I agree that we can clearly deliver much less care without a concomitant decline in overall health, the areas where this concept applies are specific and not general. Consider prenatal care for example. We would never suggest that less care in this area is more “effective.”
If Ted Kennedy wants to have better medical care, and he thinks that a super-specialist at Duke University would be better for him than at his home in Boston, that is his prerogative.
When I got an appointment for my wife (who had a fast-growing brain met) to see a neurosurgeon at my local community hospital, it wasn’t for four weeks. I had to brow-beat a teaching hospital further away to get an appointment and operation ASAP. You gotta do what you gotta do for the love of your life. She had her stitches taken out of her skull on the same day she originally had her initial community hospital appointment.
Having universal insurance coverage is not a criteria for finding a good doctor, it is that everyone in America can have access to health care. Humans are not a commodity. A physician can feel free to become a specialist (because they make more money) in a free-market health care society, but do patients have to suffer because they have a problem with their digestive tract and can’t find a gastroenterologist because the free market doesn’t pay enough for them to do their operations?
Our for-profit healthcare system has major issues. Delays, rationing, and truly skyrocketing costs; the future has arrived. As more and more solutions are implemented, more and more distortions appear, more and more people want a piece of a growing pie, more and more deals are cut, more and more systems are manipulated, and then regulated, and then re-manipulated, then re-regulated, and higher and higher go the costs.