OP-ED

Op-Ed: Reform- Why have our objectives been abandoned?

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In the campaign of 2008 and the first six months of 2009, the call for healthcare reform has been a refreshing and important theme.  It has been widely recognized that

1.    Healthcare costs are out of control.  You cannot have healthcare expenses inflating at 8% in an economy that is growing in the best of times at 4%.  (today, the current inflation rate is negative 1.3%)

2.    47 million Americans need coverage

3.    14,000 Americans lose their insurance everyday

4.    Medicare is in peril, and along with Medicaid, the combination of ever-increasing costs are the main drivers of this government’s budget deficits that threaten our economic future.

Our politicians pledged to deliver comprehensive solutions to address these problems and they promised budget neutrality. The President told us, that health care costs are driving our deficit; that the current trend is unacceptable, unsustainable, and we are going to change it in 2009.

Now we know they did not mean it.

The President and the Congress appear to be functioning as they always do- Job #1 is getting elected. Thinking out of the box, trying to break out of the mold of old and failed ideas requires courage and political will.  All seem to be missing. Instead, we get an approach that expands government. The demand for a public plan to achieve savings is silly. We already have two public plans in Medicare and Medicaid.  Where are the savings from these plans? The increase of taxes, on the top portion of the country’s citizens to pay for insurance for the uninsured, does nothing to save money or control costs.  In addition, there is no mention of the fact  that by adding complexity to a flawed system will only cause the system to fail faster, not reform it.  The CBO quickly came out and said the two current reform bills will not substantially reduce the cost of medical care over the long run.

There are viable solutions on the table, however, that do address the problem. These concrete solutions include:

1.    The Wyden-Bennett “Healthy Americans Act” to make people more accountable for their own health and health insurance.

2.     Proposals that remedy the inefficient and poor quality associated with the treatment of the chronically ill and excessive re-hospitalizations.

3.     Promising approaches in designing Value- Based Benefits that effectively lessen chronicity, improve quality and stimulate compliance and adherence to an individual’s care plan.

Why are we not hearing about and considering these concrete approaches?  Why are our elected officials so intent on a “quick-fix”?  We know that a quick fix is just that.  We must have a systemic overhaul.  Systemic overhauls require expertise and thought, not haste.  Quick fixes are the modus-operandi of politicians with eyes on the next election, not the behavior we expect from trusted public fiduciaries committed to the health of Americans and of our economy.  We have seen enough of that behavior for the past twenty years.

Dr. Albert S. Waxman PhD is a scientist, serial entrepreneur, investor and current CEO of the Psilos Group, a health venture capital firm.  Dr. Waxman is a frequent speaker and recent author of “Change, Innovation, and Investment in the New Healthcare Economy– a 2009 Outlook on Healthcare Venture Capital.”

If you enjoyed reading this piece by Albert Waxman, try reading “Innovation + Economics: Keys to Successful Healthcare Reform”

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23 replies »

  1. I didn’t know you’d be responding, Nate; I’m so glad you did! My comments follow.
    [Nate] On THCB previously I posted a very long and detailed explanation of what terms he [Mr. Potter] doesn’t appear to understand and where he was lying. When time permits I’ll try to find it. I think there are all sorts of abuses that could turn someone off of insurance companies and even lead someone to campaign against them
    [Steve] I would like to see your post. And I’m glad you are not defending the abuses of insurance companies, even though Mr. Potter pointed out some of them are common knowledge to certain people. What would be great is if you would share your knowledge of all the abuses and underhanded actions you’ve observed.
    [Nate] You don’t know what the term free market means. Nothing about our current system is free market or weakly regulated.
    [Steve] As I understand it, many legislators have a free market ideology that focuses on weakening or eliminating certain governmental regulations that were originally created to protect the public. For example, Federal Reserve Board Chairman Ben Bernanke said we need to strengthen regulation of financial markets to stem excessive risk taking (see http://www.voanews.com/english/archive/2009-03/2009-03-10-voa51.cfm?CFID=265727955&CFTOKEN=42500339&jsessionid=0030d688ba20d5b33f9c33346b174b212612). And my reason for saying we have had a pathological mutation of capitalism comes from an interview of John Bogle, who has been named by FORTUNE magazine as one of the four giants of the 20th century in the investment industry, and by TIME magazine as one of the world’s 100 most powerful and influential people (see http://curinghealthcare.blogspot.com/2007/10/path-to-profound-healthcare.html). Anyway, call our current system whatever you want. The point is that those with free market cravings have been conspiring to kill regulations that were preventing our financial meltdown.
    [Nate] I wouldn’t call Medicare and private employer plans sub systems they are to distinct. And this whole point matters because the failures of Medicare and Medicaid are a terrible reason to destroy our successful private insurance system. None of the reform being discussed will improve the private systems, it will reallocate resources to the failed public plans so they can last a few years longer. Far from being semantics it is the underlying reason why all government reform fails to deliver what they promise the public it will.
    [Steve] Still semantics. Sure, sub-systems can be distinct. For example, like the healthcare system, Nature is a complex system composed of interconnected parts (sub-systems) that as a whole exhibit one or more properties not obvious from the properties of the individual parts; that is, it is a system of distinct interacting sub-systems. Same goes for the human body; the digestive and respiratory systems are distinct interacting sub-system of the human biological system.
    As far as Medicare and Medicaid being failed systems and private insurance being successful system, I guess we have to define what is meant by “success.” There are those who say these programs are successful because, with Medicare for example:
    • Its universal coverage nature creates the ability to redistribute benefits to those who are neediest.
    • It pools risk in order to share the burdens of health care among the healthy and the sick.
    • Through Medicare, the government protects the rights of all beneficiaries to essential health care (Reference: F:\MyDocs\Documents\e.g., http:\www.hopkinsmedicine.org\about\Crossroads6_13_03.html).
    • Medicare is more efficient because, in contrast to private insurers, Medicare doesn’t have to spend millions on marketing, advertising, and Washington lobbyists. On top of that, private insurers must generate profits for their shareholders. (Reference: https://thehealthcareblog.com/the_health_care_blog/2006/06/policy_why_medi.html)
    And in an interesting interview, John Stewart summed up his conversation about healthcare reform with conservative pundit Bill Kristol (editor of Weekly Standard): “So what you are suggesting is that the government could run the best health care system for Americans, but it’s a little too costly, so we should have the shitty insurance company health care” (See this link for the interview: http://www.thedailyshow.com/watch/mon-july-27-2009/bill-kristol).
    Nevertheless, others say the Medicare’s efficiency is over-hyped (e.g., see F:\MyDocs\Documents\Medicare’s Efficiency Over-Hyped).
    In any case, private insurance has never been designed to cover everyone, unlike proposals such as “Medicare for All.” While I’m not opposed to any coverage/payment strategy—be it single payer, public together with private insurance plus subsidies, or any other method—just as long that gives everyone access to good care.
    [Nate] I’m saying we should eliminate Medicare because it is a complete failure. It never delivered what the public was promised when it was passed. It’s poorly ran and destroying our entire healthcare system. Medicare is a cancer on American Society.
    [Steve] Just as private insurance has very serious problems (including cold-hearted abusive tactics, which I hope you can elaborate upon), Medicare and Medicaid certainly have their share of problems. Radical reform is the only way to solve these problems. But failure to cover everyone is a deal-breaker as far as most Americans are concerned (e.g., see http://www.theamericanconsumer.org/2009/02/02/who-supports-guarenteed-health-insurance-for-everyone/).
    [Nate] This is not accomplished by expanding governments role. If you really wanted to accomplish any of this you would eliminate government from healthcare as it is the main driver of waste, fraud, and abuse.
    [Steve] Few would argue that we need government reform, just as we need healthcare reform. But I’m hard pressed to conclude that there is less waste, fraud, and abuse by the private insurance industry compared to government. In fact, it seems to be that government and the private insurance industry have been in cahoots since, as reported recently in the Chicago Times: “Health insurers have lavished $41 million in campaign contributions on current members of Congress since 1989, with more than half going to lawmakers on the five House and Senate panels writing this year’s health bills, according to the nonpartisan Center for Responsive Politics. Since the beginning of 2008 alone, they have spent $145 million on lobbying, led by Blue Cross-Blue Shield organizations and the AHIP trade group.”
    This tells me that no matter what is done, we must have independent oversight and strong regulations to minimize waste, fraud, and abuse, as well as the knowledge to know what constitutes cost-effect care.
    [In response to my question—“Do you want private insurance to become more efficient and affordable as well?” – Nate replied] Yes I do and this is achieved by eliminating wasteful and inefficient regulation like COBRA, HIPAA, ADA, and the limiting of self funding. This is not accomplished by a public plan, 1000 page bills no one has read, or insurance exchanges.
    [To which Steve replied] What’s required is a rational plan that is well-read and understood (although I don’t know how many pages it should have), which gives everyone access to good care, and equally important, the plan should:
    • Enable all clinicians to continually learn how to make (and keep) their patients healthiest and happiest for longest, using the most cost-effective methods of treatment and prevention, and encourage/reward them for doing so.
    • Enable all consumers/patients to continually learn how to make (and keep) themselves healthiest and happiest for longest, using the most cost-effective methods of self-care and self-maintenance, and encourage/reward them for doing so.
    These two bullets, sadly, have not been adequately discussed since we’re all consumed with how to pay for care that we aren’t discussing how to make care much more cost-effective. A sustainable solution MUST fully address both these issues.
    [Nate] I didn’t ask how to measure value I said who? It is VERY easy to come up with legitimate methods to measure something. Depending who’s hand you put that in though is what matters. In the absence of a fair, honest, and efficient god to do this judging it needs to reside with the consumer. Government and corporations have both been given this chance and failed completely, neither can be trusted to measure value.
    How does some disinterested third party appointed to this job make those decisions better?
    Self funded Employer plans deliver the highest percent of dollars to legitimate benefits. All employer plans have lower administrative cost, when you include loss due to fraud, then public plans.
    [Steve] Actually, the necessary measures and related research are FAR FROM EASY; anyone believing otherwise is likely unfamiliar with what’s necessary. Anyway, asking who would do the judging is certainly a reasonable question.
    I absolutely DISAGREE with your assertion that consumers should be the judge of whether they received the best possible (i.e., most cost-effective) care. That’s because the typical consumer doesn’t and can’t have a clue as to what generally constitutes cost-effective care; iIn fact, rarely do clinicians, administrator, or anyone else! Why? Because that knowledge doesn’t exist! Why? Because we’ve been overly focused on issues related to insurance/payment and not enough on (a) discovering what works best for each patient and how to provide that care efficiently and (b) how to incentivize the delivery of such cost-effective care. I discuss this misfocus and its consequences at http://curinghealthcare.blogspot.com/2009/08/healthcare-reforms-most-important-issue.html.
    In any case, determining what care high value and what isn’t requires:
    • Independent researchers and other healthcare experts who focus on collaborating world-wide to establish ever-evolving, personalized, evidence-based guidelines that define high value care and how to implement it.
    • A new generation of computerized decision support tools that help clinicians and patients select the most cost-effective care option and provides instructional guidelines for promoting competent self-care and efficient prevention and treatment.
    As such, high-value care would be defined in black and white for everyone to see and discuss. It would be scientifically-based, not politically contrived.
    The other thing we need is a cost and payment system that rewards good self-maintenance and high-value treatments producing good clinical outcomes, and that penalizes inefficiency and ineffectiveness.

  2. I own three TPAs. Besides administering self funded plans with stop-loss, instead of being fully insured, our most popular service now is self funding under fully insured high deductibles. For example they buy a 5K deductible plan, reduce their premium to the carrier 40%+ and we process claims back down to a $500 deductible.
    Both sides of my business entail helping employers offer insurance more efficiently. This is usually at the expense of insurance companies. We attack the fat. We have also been carving out a lot of drug plans because employers can self fund the risk cheaper then paying premium to a carrier. They also get to share in their rebates, and we push back against the pharma companies when it comes to the high cost drugs.
    http://www.obatpa.com
    No one but Mr. Potter knows why he says what he does now. I do know the left is quick to point out he was an ex “insurance industry” executive but fails to mention he is now on the payroll of a pro-reform, anti insurance company advocacy group. On THCB previously I posted a very long and detailed explanation of what terms he doesn’t appear to understand and where he was lying. When time permits I’ll try to find it. I think there are all sorts of abuses that could turn someone off of insurance companies and even lead someone to campaign against them. What this person wouldn’t do is jump on the payroll of someone with an overt political agenda and market themselves as something he is not. His actions cloud his motives not my skepticism. Mr. Potter is by no means a whistle blower, he hasn’t disclosed any abuse or actions that are not common knowledge. He’s a paid shill at best.
    “Are you are insinuating that the right kind of capitalism is the pathologically mutated form of free market capitalism we’ve been living with for many years, with its weak gov regulations,”
    You don’t know what the term free market means. Nothing about our current system is free market or weakly regulated.
    “just take the word of”
    I don’t take the word of anyone. Everyone is trying to sell or direct you. Every time someone tells me anything I process it with that in mind, what is the goal of the person sharing this with me. That being said you can gain more facts from people that know what they are talking about, after removing their bias, then an academic who doesn’t even understand the data he is reporting and also has bias.
    “These sub-systems share various business models, operational processes, and metrics.”
    I wouldn’t call Medicare and private employer plans sub systems they are to distinct. And this whole point matters because the failures of Medicare and Medicaid are a terrible reason to destroy our successful private insurance system. None of the reform being discussed will improve the private systems, it will reallocate resources to the failed public plans so they can last a few years longer. Far from being semantics it is the underlying reason why all government reform fails to deliver what they promise the public it will.
    “Are you implying that we should eliminate Medicare because it has inefficiencies, or are you saying we should work to make it more efficient?”
    I’m saying we should eliminate Medicare because it is a complete failure. It never delivered what the public was promised when it was passed. It’s poorly ran and destroying our entire healthcare system. Medicare is a cancer on American Society.
    “as well as making our entire healthcare system (including all sub-systems) much more efficient by cutting out waste, fraud, abuse, and inefficient operational processes.”
    This is not accomplished by expanding governments role. If you really wanted to accomplish any of this you would eliminate government from healthcare as it is the main driver of waste, fraud, and abuse.
    “Do you want private insurance to become more efficient and affordable as well?”
    Yes I do and this is achieved by eliminating wasteful and inefficient regulation like COBRA, HIPAA, ADA, and the limiting of self funding. This is not accomplished by a public plan, 1000 page bills no one has read, or insurance exchanges.
    I didn’t ask how to measure value I said who? It is VERY easy to come up with legitimate methods to measure something. Depending who’s hand you put that in though is what matters. In the absence of a fair, honest, and efficient god to do this judging it needs to reside with the consumer. Government and corporations have both been given this chance and failed completely, neither can be trusted to measure value.
    “I presented stories from a consumers point of view in which a person (1) has to make difficult treatment decisions when there are no clear-cut answers and (2) decide on a health insurance policy from among dozens of confusing alternatives.”
    How does some disinterested third party appointed to this job make those decisions better?
    Self funded Employer plans deliver the highest percent of dollars to legitimate benefits. All employer plans have lower administrative cost, when you include loss due to fraud, then public plans.

  3. Let’s start with Mr. Potter’s interview.
    I just noticed that the link to the interview I previously posted was incorrect; it’s at http://www.democracynow.org/blog/2009/7/15/health_insurance_whistle_blower_knows_where_the_bodies_are_buried
    In response to my observation that Mr. Potter’s interview was powerful and convincing, you [Nate] said my perception is such because “… he said what you wanted to hear and reinforced what you thought.”
    [Steve] It’s true that Mr. Potter’s scathing critique is aligned with many other things I’ve learned about the health insurance industry and that his comments reinforced those perceptions. Nevertheless, I have an open mind and am definitely interested in debate.

    [Nate] “It does not bother you that factually he was totally off base and even though he was supposedly an insurance executive he misused basic industry jargon?”
    [Steve] What industry jargon did he misuse and how does that prove he lied to Congress and now lies to the public? In search for truth, please quote all statements he made in the interview (and elsewhere of which you are aware) that are false, and explain how they are invalid.

    [Nate] “I get paid to take money away from insurance companies so you can’t trust what I say good about them, Mr. Potter gets paid to critique insurance companies so you can believe what he says? I don’t follow the logic on that.”
    [Steve] First of all, I don’t know exactly what you do, but it sounds like you work for smaller insurance companies (as a broker?) and get paid when an employer switches to one of your clients. For transparency sake, my personal info is freely available on my blog and wiki for public review. Where can I/we find out more about you? Anyway, are you implying that Mr. Potter became a whistle blower IN ORDER to become a paid critic, rather than his claim that his motivation was influenced by insurance company abuses for which he could no longer in good conscious ignore or accept? Did some liberal leftist organization with deep pockets convince him to start lying against the health insurance industry so he could earn even more money as a whistl-blower? I can only assume why you reject the notion that an insurance company PR person such as Mr. Potter can become empathetic and seek to take the “high road,” but I would like hear you explanation.

    [Nate] “When the government owns 50% of the market and controls through regulation the remainder it does not meet the meaning of capitalism. I don’t understand the rational for thinking for one second our current systems are capitalist, by what possible measure?”
    [Steve] I can understand how a single payer system would not be capitalistic, but why do you say that strong gov regulation is a factor in killing capitalism? Are you are insinuating that the right kind of capitalism is the pathologically mutated form of free market capitalism we’ve been living with for many years, with its weak gov regulations, which has been destroying our country while making a few people very wealthy?

    [Nate] “ I didn’t find anything reputable in any of the studies you referenced. In regards to validated research the majority of my opinions and statements reference my personal knowledge. When you work daily in the field being discussed you don’t need to reference the work of others that work in the field. This is the fallacy of studies, they are to far removed from those actually doing the work and have the knowledge. The people you cite are studying what I do, I don’t need a study to cite myself.
    [Steve] Sounds like you’re insinuating: Don’t bother with academic research, just take the word of non-empathic people in the industry who have a vested financial interest in the status quo and avoiding harsh criticism. Not a convincing argument, imo!

    [Nate] “Some points, like the fact we don’t have A system, we have thousands, do you really need me to name the 1000s of systems to prove to you we don’t have just one?”
    [Steve] Semantics. We have ONE healthcare system comprised of many sub-systems. These sub-systems share various business models, operational processes, and metrics. So … What’s your point?

    [Nate] “Medicare being one of it not the most inefficient systems in the world. This is evidenced by the fact it loses ten cents on every dollar.”
    [Steve] Are you implying that we should eliminate Medicare because it has inefficiencies, or are you saying we should work to make it more efficient? Personally, I think ALL of government should be made much more efficient, as well as making our entire healthcare system (including all sub-systems) much more efficient by cutting out waste, fraud, abuse, and inefficient operational processes. This requires a RADICAL OVERHAUL of our entire healthcare system (with all its sub-systems). Do you want private insurance to become more efficient and affordable as well?

    In response to my [Steve’s] belief that by fixing our healthcare system (with all its sub-systems) we’d have the money to give the 12 million non US citizens good care without jeopardizing the care to American citizens, you [Nate] replied, “Why am I forced to give them any care? Why don’t they start collecting empathy from their own people and government instead of breaking into the US and stealing it? Empathy only works in the naïve world where people respect it. What you are failing to admit is American could show all the empathy in the word and the world would suck us dead. The billions congress rushed through for Katrina was full of empathy, and billions where stolen. You can’t show open ended empathy without protection and you have proposed zero protection.”
    [Steve] It sounds you’re saying that understanding what it’s like to be in someone else’s shoes can a bad thing because (a) it isn’t our responsibility to take care of other peoples, (b) people can’t be trusted, and (c) people for whom we have empathy will take from us without end; therefore, we need to be protected. Well, empathy DOESN’T mean you HAVE TO do anything just because you understanding other people’s woes and points of view (which is something to which you agree). But if you want to act on your empathy to help others—which I contend we should for many reasons, even though we are not obliged to—then I agree that it should be done wisely, including safeguards (rules, regulations, and oversight). The same can be said for empathy toward the bailed out financial institutions and auto manufacturers, as well as toward health insurance companies, the elderly, poor, and disabled, and even foreign governments.

    [Nate] “If you really wanted to help those in need you would stop with the handouts and instead give them opportunity…Guaranteed jobs sorting trash or acting as crossing guards helps people…If you really cared about these people you would give them jobs not handouts.”
    [Steve] If the jobs included access to excellent healthcare and a better quality of life, then I agree with you!

    [Nate] “Who do you expect to measure HIGH VALUE, the same people that think me have 1 system instead of 1000s? The government is created and run the most inefficient healthcare systems in the world? I think High Value is best gauged by the consumer and should be rewarded with the consumers money.”
    [Steve] One thing I your statement appears to confirm is that your 1 vs. 1000 systems comment is a clever semantic ploy meant to discredit me by insinuating I didn’t know the difference. Nevertheless, you do bring up a valid question concerning who should measure the value of care. I contend that one appropriate metric of value would be clinical outcomes (e.g., changes in signs, symptoms, and quality of life; readmission rates; and safety) divided by cost (of meds, procedures, hospital charges, etc.) with due consideration of the severity and complexity of each patient’s condition. In other words, value is a measure of cost-effectiveness. This is not an easy thing to do and there are many daunting challenges. To think that a consumer can judge care value validly and reliably is very naïve to say the least (see http://wellness.wikispaces.com/Problem+of+Consumer+Ignorance+when+Selecting+Providers+and+How+to+Solve+It and http://wellness.wikispaces.com/Tactic+-+Improve+Care+Quality+with+Evidence-Based+Practice+Guidelines#ClinicalOutcomes and http://curinghealthcare.blogspot.com/2006/05/pitfalls-of-measuirng-provider.html)

    In response to my [Steve’s] statement that I would also argue that that the disparity between primary care and certain specialists is lop-sided and ought to be corrected, you [Nate] wrote “Know the best way in the world to accomplish this, let the doctor justify his fee to the patient.”
    [Steve] If you mean that we should have pricing and performance transparency, then I agree, although doing it right is a real challenge (see see A Path to Profound Healthcare Transformation at http://curinghealthcare.blogspot.com/2007/10/path-to-profound-healthcare.html). But, similar to what I said above, expecting patients to effectively evaluate the relative validity of justifications by different doctors is naïve. In a four-part post I wrote about the dilemma modern consumers face in this era of “personal responsibility,” I presented stories from a consumers point of view in which a person (1) has to make difficult treatment decisions when there are no clear-cut answers and (2) decide on a health insurance policy from among dozens of confusing alternatives. This series of posts begins at http://curinghealthcare.blogspot.com/2007/04/i-apologize-for-my-absence-these-past.html.

    [Nate] “Employer plans are the most efficient and deliver the highest quality care.”
    [Steve] Please validate this statement and explain what you mean by most efficient and highest quality. Also, discuss if this high efficiency and quality translate into high value to the consumer.

  4. “Nevertheless, his interview was powerful and convincing.”
    Because he said what you wanted to hear and reinforced what you thought. It does not bother you that factually he was totally off base and even though he was supposedly an insurance executive he misused basic industry jargon? What your admitting is you don’t care rather the facts are accurate as long as you agree with the point, not very scientific. Being paid by a left leaning pro reform organization means you should also not comment on Mr. Potter. I get paid to take money away from insurance companies so you can’t trust what I say good about them, Mr. Potter gets paid to critique insurance companies so you can believe what he says? I don’t follow the logic on that.
    “I don’t understand the rationale of your statement that our insurance systems have not been capitalist since Medicare passed 40+ years ago.”
    Capitalism is an economic and social system in which trade, industry and the means of production (also known as capital) are privately controlled (either singly or jointly) and operated for a profit
    When the government owns 50% of the market and controls through regulation the remainder it does not meet the meaning of capitalism. I don’t understand the rational for thinking for one second our current systems are capitalist, by what possible measure?
    “I’ve cited studies from reputable people and organizations;”
    Reputable in the eyes of those who support them and share common goals. I didn’t find anything reputable in any of the studies you referenced. In regards to validated research the majority of my opinions and statements reference my personal knowledge. When you work daily in the field being discussed you don’t need to reference the work of others that work in the field. This is the fallacy of studies, they are to far removed from those actually doing the work and have the knowledge. The people you cite are studying what I do, I don’t need a study to cite myself.
    Some points, like the fact we don’t have A system, we have thousands, do you really need me to name the 1000s of systems to prove to you we don’t have just one?
    “What “inefficient version of care” are you forced to purchase?”
    House bill 3400 or what ever was passed sets up an insurance exchange and over times outlaws any insurance being sold outside of said exchange. Any ERISA plans would need to meet approval outside the exchange. What would be required is not addressed of course.
    Currently I am forced to pay for, and then strong armed into using Medicare. Medicare being one of it not the most inefficient systems in the world. This is evidenced by the fact it loses ten cents on every dollar.
    “I believe we’d have the money to give them good care without jeopardizing the care to American citizens.”
    Why am I forced to give them any care? Why don’t they start collecting empathy from their own people and government instead of breaking into the US and stealing it?
    Empathy only works in the naïve world where people respect it. What you are failing to admit is American could show all the empathy in the word and the world would suck us dead. The billions congress rushed through for Katrina was full of empathy, and billions where stolen. You can’t show open ended empathy without protection and you have proposed zero protection.
    Your initial metaphor is wrong, putting yourself in someone else’s shoes to see their point of view is not the same as offering to buy anyone that wants it free insurance. I understand people’s difficulties and struggles that doesn’t mean I need to open my wallet and give them all my money.
    If you really wanted to help those in need you would stop with the handouts and instead give them opportunity. The old teaching someone to fish versus giving them a fish. Tax credits, welfare checks and food stamps create dependent voting blocks. Guaranteed jobs sorting trash or acting as crossing guards helps people. This is why liberalism is BS and doesn’t work, you pretend it’s empathy for others that you offer welfare programs even though they hardly ever work. In fact you are creating slaves forced to vote for you. If you really cared about these people you would give them jobs not handouts.
    “your blanket statement that all Medicare and Medicaid providers ought to be paid more.”
    Again not at all what I said.
    “My Implication is providers need to be paid considerably more form these plans.”
    I don’t see the word all anywhere.
    Who do you expect to measure HIGH VALUE, the same people that think me have 1 system instead of 1000s? The government is created and run the most inefficient healthcare systems in the world? I think High Value is best gauged by the consumer and should be rewarded with the consumers money.
    “I would also argue that that the disparity between primary care and certain specialists is lop-sided and ought to be corrected.”
    Know the best way in the world to accomplish this, let the doctor justify his fee to the patient. That is why cosmetic and elective procedures decline in price while all other healthcare inscreases.
    “Please support your claim that the vast majority of state, federal, and employer systems are better than anything else in the world.”
    Again not what I said, federal and state Medicaid are the worst. Employer plans are the most efficient and deliver the highest quality care.

  5. Hmmm, Nate…Sounds like you’re downplaying empathy because there may be unintended consequences. It’s like saying, Why put yourself in someone else’s shoes and try to understand things from their point of view since there have been times when half-assed attempts to help those in need have backfired? I would take a completely different approach by asking: How can we use the understanding empathy brings to do things that are effective in helping those in need to help themselves in a sustainable way?
    Let me add that empathy toward healthcare providers is also important. Put yourself in the shoes of a doctor who strives to deliver cost-effective care when our crazy insurance system actually punishes him financially for doing so! That’s why I disagree with your blanket statement that all Medicare and Medicaid providers ought to be paid more. Instead, I contend that providers who deliver HIGH VALUE care should be paid considerably more than those who don’t, be it from Medicare, Medicaid, and private insurance companies. I would also argue that that the disparity between primary care and certain specialists is lop-sided and ought to be corrected.
    Please support your claim that the vast majority of state, federal, and employer systems are better than anything else in the world.
    I cannot comment on your critique of Wendell Potter since, being an insurance guy, you have a vested interest in disparaging him. Nevertheless, his interview was powerful and convincing. He seems to be a person who let empathy “get in the way” of doing his job as an insurance company spokesman.
    I don’t understand the rationale of your statement that our insurance systems have not been capitalist since Medicare passed 40+ years ago.
    I’ve cited studies from reputable people and organizations; and there are many more. You’ve criticized them all, but have not presented any of your own validated research.
    I don’t understand your statement “That is why I have an issue with politicians telling me I must first work 2-3 months a year so those that choose not to work can have access and care and then they further dictate to me I must purchase their inefficient version of care. They have zero constitutional right to force me to participate in a health insurance exchange or to pay for others so they can.” What “inefficient version of care” are you forced to purchase? Where’s the evidence that it must be inefficient? Why is it that only about giving people who “choose not to work” access to care? What about the working poor, etc.?
    “Question to you, why are 12 million non US citizens allowed to confiscate my labor to pay for their care?”
    If our country’s priorities were different, if our broken healthcare system was fixed, if we knew how to and were rewarded for delivering high value care, them I believe we’d have the money to give them good care without jeopardizing the care to American citizens. That would have help improve the image of America in the eyes of the rest of the world by demonstrating empathy. But because the overall healthcare is so screwed up, we can’t even take care of our own citizens. So, our options are to say the hell with them, or to cure American healthcare in a way that enables us to do more to improve the health and wellbeing of other people’s.

  6. Your report is off from the start and is built on the same faulty rationale as most liberal attacks on our healthcare systems. Notice the S on the end of system, we don’t have one homogenous system. We have 50 state, couple federal and thousands of employer systems. The vast majority of those systems are better then anything else in the world. That is the problem with studies, they are done by academics who don’t have any functional understanding of our healthcare system. Any study that lumps all US systems into one is worthless. Why would you scrap a highly efficient large group self funded plan because Medicaid sucks? Then further why would you propose replacing that once efficient and best system in the world with something that more resembles the failed Medicaid plan?
    I never said healthcare professionals care only about money, never implied anything close to that. Our systems are suffering and are in their current unsustainable position because of inadequate reimbursement form Medicare and Medicaid. My Implication is providers need to be paid considerably more form these plans. Please debate what I say not the talking points you wish I had that you have answers for.
    Wendell Potter was not an insurance executive, he was a PR hack who will say what ever he is paid to save. I have previously destroyed any creditability he had, look up any time I have commented on him on this blog to see how clueless he is. All those years as an “insurance executive” and he doesn’t even grasp basic industry terminology. If someone would pay him to sing the praise on insurance companies tomorrow he would change his tune again.
    If you think we have a capitalist healthcare system you need to go back to square one and start HS all over. Capitalist systems don’t have 50% of expenditures coming from government nor operate under the yoke of regulation our systems do. Our insurance systems have not been capitalist since Medicare passed 40+ years ago.
    Not a lobbyist just a small business owner who helps employers offer affordable insurance by reducing what they pay to evil insurance companies. My living is made pissing off the big carriers.
    I would expect someone who has a PhD and specializes in research to know how to do basic research. Everything you have referenced so far makes you appear more like a vacuum of propaganda. You cite poorly designed studies with flawed premises and build opinions on the shrilling of political operatives. I haven’t seen you once reference any solid facts or data.
    “If access to good healthcare is NOT a right (which I assume you contend), then what makes YOU more deserving than millions of others!”
    Who said I deserved anything? I don’t think I am entitled to any access. I do believe I am entitled to the fruits of my labor though. If I wish to exchange that labor for access or healthcare services that is my right. That is why I have an issue with politicians telling me I must first work 2-3 months a year so those that choose not to work can have access and care and then they further dictate to me I must purchase their inefficient version of care. They have zero constitutional right to force me to participate in a health insurance exchange or to pay for others so they can.
    Question to you, why are 12 million non US citizens allowed to confiscate my labor to pay for their care?
    “If our culture (and others) were more focused on promoting greater empathy (and compassion), we’d have a much better world.”
    If you ignore reality and pretend there are no unintended consequences. Your empathy and gentler world argument is the same one Liberals gave when forcing blacks into public housing. Now that they have destroyed 4+ generations of African Americans do you still consider those actions empathetic? By feeding the starving in Africa you are actually dooming millions more and generations to starvation. As long as people that have no means to feed themselves continue having babies they can’t feed they will starve. So while you might feel good about yourself and think your empathetic your actually monsters enabling the suffering of millions more for your own selfish reasons. Sometimes it is better to let one person die so 10 more don’t have to. If you can’t properly feed them all forever then half ass efforts are only helping you.

  7. I wish I was joking, Nate! [Seems like Steve S and you are a tag-team]
    “80% of Americans have the best healthcare in the world”
    Not according to the reports I’ve read, e.g., http://www.facs.org/fellows_info/bulletin/2009/wenger0709.pdf
    “Ask doctors if they want to be reimbursed Medicaid and Medicare rates in a universal system and what happens to support?”
    Of course people don’t want to pay higher taxes, see their incomes lowered, change the way they do things, or to have to work harder to maintain their standard of living. But I disagree with your implication that healthcare professionals care only about money and that their empathy is shallow and brittle. I suppose you believe that the 16,000 physicians, medical students and health professionals who support single-payer national health insurance through the non-profit Physicians for a National Health Program are lying.
    “So the 22 year old that died in England because they refused him a transplant was shown empathy? The ICU baby brought down from Canada was shown empathy?…Those enrolled in our empathetic public plans like Medicaid are those suffering.”
    While I don’t have enough facts to comment on the individual cases you site, there are many horror stories about the way Americans have been treated under our current system, including denying care recommended by providers and dropping coverage when people get sick and need it in order to increase profits. I refer you to a recent interview of insurance exec turned whistleblower Wendell Potter, who spoke out against the underhanded tactics of the health insurance industry at http://www.democracynow.org/2009/7/16/former_insurance_exec_wendell_porter.
    Empathy doesn’t mean reckless spending. The empathy I’m discussing means assuring everyone has access to the kind of high value care I want for myself and my family. As I wrote in a series of blog posts starting at http://curinghealthcare.blogspot.com/2007/10/path-to-profound-healthcare.html, we should be focusing on radical changes that dramatically increase care value to the consumer to overcome the “pathologically mutated” form of capitalism” that has broken our healthcare system and has pressured doctors into delivering more care rather than losing money by rendering care cost-effectively.
    There are actually two areas in which we agree: (1) I doubt that much empathy went into setting Medicaid reimbursement rates and (2) Much more should be done to control Medicare (and Medicaid) fraud.
    “Please Dr., if you really are one …”
    I’ve twice been questioned about my credentials. I’m a licensed clinical psychologist specializing in treatment, research, and health IT. I’d venture a guess that you (and Steve S) are health insurance lobbyists!
    And since Steve S didn’t reply to my question, I ask you: If access to good healthcare is NOT a right (which I assume you contend), then what makes YOU more deserving than millions of others!
    Anyway, my main point is this: If our culture (and others) were more focused on promoting greater empathy (and compassion), we’d have a much better world. The healthcare problem is a reflection of an economic culture that has “lost its way” through excessive/imbalanced focus on “What’s in it for me?” and “How can I have more by manipulating and taking advantage of others.” This is the root cause of our current economic and healthcare crises. I believe President Obama recognizes this fact and sincerely wants to change things; I applaud and support his courage and efforts!

  8. Steve you got to be joking.
    “All nations having publicly-funded health care with universal coverage as the goal show more empathy than ours since the United States is the only wealthy, industrialized nation that does not provide universal health care”
    So the 22 year old that died in England because they refused him a transplant was shown empathy? The ICU baby brought down from Canada was shown empathy? 80% of Americans have the best healthcare in the world. Those enrolled in our empathetic public plans like Medicaid are those suffering. You want to reduce the quality of care and drastically increase the cost for 80% of Americans so our Medicaid population can get a slight increase in quality, and you call that empathy. You can keep your empathy we’ll all be much better off without it.
    “Read Maggie Mahar’s post on THCB a few years back titled ‘Why Medicare is More Efficient Than Private Insurers’ at”
    Quoting a far left factually challenged propagandist proves what? Maggie has no background in healthcare and very little understanding of it. Her opinion on the efficiency of public plans carries about as much weight as well yours. Examples of her deep understanding of the facts;
    “In contrast to private insurers Medicare doesn’t have to spend millions on marketing, advertising, and Washington lobbyists.”
    Actually it does spend hundreds of millions, where do you think the Medicare commercials come from. The annual CMS material on how to enroll in Medicare and options available doesn’t print itself. Search for Medicare blimp advertising, part of a 13 million campaign Bush admin was attacked for.
    “But if you look at cases where healthcare providers like National Medical Enterprises cheat insurers, you’ll find that they are just as likely to bilk private insurers.”
    No one questions Medicare has a fraud rate 5 times that of private insurance. The GAO, CMS, and everyone every year publish reports about how many billions Medicare loses to fraud. Medicare loses more to fraud then private insurance companies make in profit yet is a fraction of their size.
    Maggie’s entire post is lies and BS easily refuted by 20 seconds on any search engine. To quote it is a joke.
    “In March ’08, more than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea US doctors support universal health care according to a Reuters survey”
    When asked a generic question like would you like things to be better most doctors said yes, WOW what cutting edge research. When given any facts about the proposed changes being discussed the support drops off almost completely. Please Dr., if you really are one, tell me why a generic survey void of any facts or controls should be given any thought? Ask doctors if they want to be reimbursed Medicaid and Medicare rates in a universal system and what happens to support? Exactly.

  9. There are so many special interest groups in the healthcare industry that try very hard with 100s of millions of dollars for lobbying to maintain the status quo of healthcare chaos and crisis.
    We absolutely need the Govt to involve in providing at least basic healthcare. The reasons are compelling.
    1) Country’s GDP depends on the health of the people; no country can continue to grow with millions of sick people.
    2) If Govt does not provide care, people end up in Govt care anyway (Medicaid and Medicare) after getting more sick. Why not provide care before they get into Medicaid and Medicare.
    3) Healthcare is in a crisis only in US among developed nations. Why? Only is US, Govt is not (yet) involved in healthcare.
    4) For-profit insurers exist for making profit. If everyone is healthy, they lose money. Ideally, private insurers prefer chaotic situation and more sick people; it means more healthcare dollars and more profit.
    Cost:
    Unlimited healthcare can not be provided to everyone. Today, people do not care about the cost of any care they receive whether they are insured or not. With this attitude, cost can never be controlled. This attitude will change if they are involved in the payment process. It can be done in may different ways.

  10. My replies to Steve S follow:
    He asked: Can you please identify for me a country that is long on ’empathy?’
    My reply: All nations having publicly-funded health care with universal coverage as the goal show more empathy than ours since the United States is the only wealthy, industrialized nation that does not provide universal health care (http://en.wikipedia.org/wiki/Socialized_medicine)
    He asked: Can you please identify for me a model of public sector healthcare efficiency?
    My reply: Read Maggie Mahar’s post on THCB a few years back titled ‘Why Medicare is More Efficient Than Private Insurers’ at https://thehealthcareblog.com/the_health_care_blog/2006/06/policy_why_medi.html
    He asked: Do you even live in the US?
    You obviously haven’t read the links in my original post.
    He wrote: Health care is not a right!
    My reply: So, what makes YOU deserve it!
    he wrote: Cause if you are a MD, then you would not be supporting the Abomanation being devised in D.C.
    My reply: In March ’08, more than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea US doctors support universal health care according to a Reuters survey at http://www.reuters.com/article/latestCrisis/idUSN31432035. Also see the Physicians for a National Health Program web site at http://www.pnhp.org/

  11. … might help if folks stopped quoting the 47 million without insurance as correct. At the very least, knock the 10 million illegal aliens AKA people who broke the law. They should be covered why?

  12. I love all these people that are no more than the rear of a donkey. I’m a CPA. If all the health insurers can make such great profits and bonuses while covering less and charging more, how can the government be any worse. The insurance companies are already between you and your doctors. Give me a break. Also the GAO’s ability to audit all government programs must be greatly increased to sufficiently monitor all the spending that is being done.

  13. Litigation reform? Where is that? How much do we spend on defensive medicine?
    Oh, sorry, didn’t realize President Messiah wouldn’t lift a finger to endanger his trial lawyer pals’ jackpots.

  14. “47 million Americans need coverage”
    Unfortunately around 42 million of them disagree with you or they would have already signed up for the free coverage they are entitled to or bought coverage with their 75K plus incomes. You also have millions of young healthy 20s who refuse to pay anything for insurance because they don’t feel they need it. Around 5 million people “need” insurance and can’t afford it. 5 million is a far different problem then 47 million.
    “14,000 Americans lose their insurance everyday “
    And roughly that number get new coverage every day. Most people are only uninsured for a short period of time. They choose to forgo coverage during that break even though COBRA and HIPAA is usually there to assist.
    Number 4 is what causes number 1. Fix Medicare and Medicaid and stop shifting cost to private plans and we don’t have a crisis at all. If we don’t have a crisis how do politicians hit you up for money? How do they get elected if they aren’t saving us from something? Nothing being discussed as reform will improve our system, like all previous versions of reform before it care will be more expensive, government handouts to donors will be greater, access to care will be less, and more tax payor money gone. Since the Democrats lied to pass Medicare it has never been about making our healthcare systems better.

  15. I don’t see anyone mentioning one of the major problems of how the industry is stalemated. Yes, a system overhaul is necessary but has anyone examined why the system is so toxic? Has anyone ever heard of “zero-sum” competition?
    For one, the insurance companies must be held accountable for their practices of intentionally confusing customers, cost shifting and shrinking coverage for people while raising overall rates.
    What does anyone have to say about that?
    D

  16. Hey “Doctor Steve”
    Can you please identify for me a country that is long on ’empathy?’ Can you please identify for me a model of public sector healthcare efficiency? Do you even live in the US?
    To be sure, I gotta say that you are right on that those of us “haves” – who ‘have’ way less than 18 months ago and losing more every day, DO NOT WANT TO PAY MORE TAXES to subsidize the “have-nots.”
    Health care is not a right!
    BTW…Are you a real medical doctor or just a PHd? Cause if you are a MD, then you would not be supporting the Abomanation being devised in D.C. Or maybe you just wanna be a ‘Have Not?’

  17. You ask “Why?”
    I’ll tell you “Why!” Because Obama, the majority of his administration and most all his “Czars” are so far in over their collective heads that they don’t have a clue.
    Why? Because it’s an Obamanation!
    Party on Big Govies and Socialists!

  18. Bringing high value care to ALL consumers/patients through radical reform focused on improving quality and lower costs is essential for curing the healthcare crisis. In a country short on empathy, however, the “haves” are unlikely to pay more taxes to assure the “have-nots” get good care. I discuss this issue in a post titled “Empathy, Taxes, Personal Responsibility, and Healthcare Reform” at http://curinghealthcare.blogspot.com/2009/07/empathy-taxes-personal-responsibility.html

  19. I’m not a physician, just a health care “consumer” and writer, but I think there are lot of things killing the “industry.” The industry in many ways is killing itself through a lack of accountability in patient safety, value and overall performance, a lack of self-regulation, and resistance to anything that smells like accountability or regulation.
    I agree with this article at least in spirit. I’m not sure about the specific “concrete solutions” but one thing is certain. We need to be more concerned with controlling health care costs and perhaps less concerned with who’s paying. Let’s face it. Regardless of the payors or payment system, we’re all paying in the end. The scary thing is, no matter what we do, it will all probably get worse before it gets better.

  20. Absolutely I trust the Govt more than my insurance company; I am sure it is true with a vast majority of the people, though some will not accept this fact due to various political, idealogical or other reasons.
    Broadly speaking, to control the cost people (patients) must be involved in the payment process and the Govt must force the providers to publish their rates like in any other industry. Currently, people don’t care how much a service costs whether they have insurance or not.
    As long as consumer is allowed to get anything without any consideration of the cost, the healthcare cost can never be controlled.
    Bottom line is, if I am not paying why should I care about the cost? and why should I change my lifestyle (diet & exercise)…exactly, this is the attitude that is killing the industry.

  21. 1. The Wyden-Bennett “Healthy Americans Act” to make people more accountable for their own health and health insurance.
    Everyone now is fully accountable for their health and health insurance and they are failing completely because they cannot afford the insurance or the cost of health care.
    This bill only ensures that more money will go to the insurance companies to perpetuate the existing wasteful system that produces fat paychecks for doctors, hospitals, pharma, medical device makers, insurance executives, etc.
    I trust the government to decide on the best medical care for me much more than I trust any private insurance company where profits dictate what treatment will be provided. We need a government run universal health insurance plan with uniform benefits for everyone (even congress-men and women).
    There are savings to be made in chronic care… also in curbing excessive expensive procedures which are of unproven value. Much more savings to be made by eliminating insurance company overhead and profit.

  22. Politicians(with a few notable exceptions)by definition are change averse especially with current US campaign finance and election laws.
    The US public is WAY ahead of the politicians on this health care reform issue.
    So that calls for grassroots mobilization and pressure which Obama and team are trying to do.
    DESPITE THE PROBLEMS I STILL FORECAST REFORM THIS YEAR- TO BE FURTHER BETTER REFORMED IN THE NEAR FUTURE.
    Dr. Rick Lippin
    Southampton,Pa
    http://medicalcrises.blogspot.com

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