Physicians

Our President is on the Ropes

Stephen Kardos

Recent pictures of President Obama suggest he is battered and on the ropes. Our President can recover if he chooses to change his fighting strategy to improve health instead of budgeting health. There is clearly emerging consensus against yet another health plan sponsored by the federal government.

There is already much oversight at federal and state levels of all insurance programs, yet all of these programs experience unsustainable cost trends. Medicare, Medicaid and the Federal Employee Health Benefit Plans are modeled after private insurance plans and they do not work for our country. In the instances where profit incentives have been removed from government-run programs such as the federal employee health plans, the trends in these plans are not significantly different from private insurance plan trends.

One sustaining aspect of our health system is the belief in the patient/doctor relationship. This bond between patients and their physicians continues to survive insurer, government, and other third party interference. This patient physician bond must be strengthened in any successful strategy for change.

Instead of continuing to list all that is wrong with American Health and coming up with new unproven expensive plans for change, the president should focus on practical ways to improve quality in health care by leveraging our patient physician bonds.

First he has to communicate the message to everyone that on average clear evidence indicates that Americans receive substandard basic health care. This circumstance is driving up our health costs because without basic care we often develop catastrophic expensive illness. Less than 50% of all Americans participate in early cancer detection programs whether or not they have insurance coverage. Similarly for diabetes, many people develop complications of stroke and kidney failure because they do not follow basic treatment recommendations of the American Diabetes Association.

Physicians and their patients, contrary to their perception, do not have useful up to date information when making health care decisions that involve everyday health care.

One powerful source of information to improve health, and strengthen physician and patient bonds has been available for years, yet not shared. Medical claims, laboratory results, and pharmacy data stored in health plan administrators’ computers (Medicare, Medicaid, Private Insurers, and Third Party Administrators) are available and able to support individual and doctors efforts to narrow quality of care gaps. Proper organization of this data can link every diagnosis, test, and prescription for each patient in a way that each doctor and patient are unable to do for themselves. The government can make this happen by regulation.

Our President can no longer avoid sharing available and accurate health information that may be in conflict with some special interest groups that supported his campaign. Those involved in health plan administration must no longer withhold vital information about our health even though it may not be in their financial interest to disclose it.

Only with clearly understood reasons for change will change occur, patient physician bonds strengthened and special interests pushed aside. Changing the discussion to a “Moral Imperative” does not give a practical incentive for change that is ultimately determined by the people of America.  He has already won consensus on the need for change.

If our President does not get off the ropes quickly and change his strategy to improving health by empowering the patient physician relationship he will get knocked out of the health care arena very much like his predecessors and the opportunity for “Change” regarding health care in America will be lost. The President and the nation risk losing much more than the battle for our nation’s health.


Dr. Kardos is Chief Medical Officer Health Insight, Inc. a supplier of infrastructure for newly emerging Value Based Health Plans and Former Chief Medical officer of Blue Cross and Blue Shield of NJ. He is a Pediatrician.

Livongo’s Post Ad Banner 728*90
Spread the love

39 replies »

  1. “Your fears of EEOC, etc action are overblown; a cursory look at data on enforcement activity tells anyone that.”
    You aren’t saying it is ok to ignore EEOC opinions becuase there is minimal enforcement activity?
    “serenely confident that wiser heads will simply direct EEOC to reconsider their foolish position.”
    Here you seem to acknowledge the EEOC does not allow this activity but you suggest going ahead and doing it anyways in the hope the EEOC wises up. My personal experience waiting for government to wise up is measured in lifetimes.

  2. Nate said: “You apparently have never owned or ran a business. When you advise your client to do something illegal, even when there is little to no chance of them getting caught you are asking for lawsuits. Most honest business people try to avoid such activity. Not to mention I prefer not to lose my various licenses and E&O policy. Your obviously a liberal with the mentality of just ignore any laws you don’t like, liek tax laws and Obama cabinet members.”
    Nate, I advocated no illegal activity.
    If you feel I did, post details.
    You’re demonstrating you do not know how to interpret the laws that affect your own business.

  3. the legal structure allows for reduced risk and cheaper administration, small businesses wouldn’t have to copy the rich benefits, I’m certain small employer pools would be smarter about plan design.
    Ideally I would love to see HDHP pools. Small employers join and have 3K-10K deductibles per employee. That risk is pooled then partially ceded off to insurers. Under the employers deductible they would offer employees benefits appropriate for their industry and location.
    The rates for the pool would be based on the experience of the pool stabalizing renewals. The pool would be insulated from the utilization and consumption of paricipants.

  4. “If small employers could pool like Union Taft Hartley plans their cost would drop overnight.”
    Nate, I like your spirit but really disagree with your statement.
    I am very familiar with Taft Harly Plans’ data in which benefits are extraordinarily rich, yet costs are rising at unacceptable rates. The members have complete access and little cost sharing.
    They guarantee their rising costs because they do not follow minimal guidelines for preventive health. They set the stage for being sure they develop lots of avoidable illness which is expensive emotionally, productively, and financially.
    This behavior among doctors and their patients is the guarantor of continued escalating health expense and not unique to Taft hartly Plans.
    No new financial model will change this trend. We need a cultural anthropological solution created by truthful easy to undstand information available for use by everyone.

  5. why small employers don’t offer coverage.
    Democrats, the left doesn’t want to hear this and will claim I lie and distort but it has been 23+ years of political decisions by Democrats that has made insurance unaffordable for small businesses.
    1. They have blocked AHPs for the past 15 years. It’s funny they now propose co-ops for small businesses but they have blocked exactly the same thing to protect unions for the past 15 years. If small employers could pool like Union Taft Hartley plans their cost would drop overnight.
    2. COBRA rushed into law in 1986 by the Democrats killed small group self funding. Small employers, down to 12-15 lives even use to avoid typical insurance companies and self fund their benefits. COBRA was so badly written no one knew how to comply with it. Employers got sued left and right forcing them to either return to insurance companies or drop benefits.
    3. Medicare Secondary Payor, again most businesses self funded their plans and purchased stop-loss to protect against large claims and bad years. Government couldn’t afford the promises they made in regards to Medicare so they looked to shift cost to employers. What they did was go back and look at bills they paid for active workers over 65 who might have other insurance. It is important to remember the employer didn’t do anything wrong the providers billed the wrong insurance. Medicare would still go back after the employer 2-4 years after the bill was paid. This huge delay was after the employers insurance policy already expired. That meant employers where liable with no protection. Most plans say you have 12 months to submit a claim, with the power of law they decalred these provisions don’t apply Medicare is exempt and can come after the employer at any time. Employers can’t manage liability when you have unknown risk sitting out there.
    4. States shifting cost to employers. In Ohio and other states they made it law that employers had to cover dependents up to age 30. This meant disabeled adults which should be cared for by society as a whole are now being paid for by 10-100 employees of a small company that have bad luck.
    There are more reasons but it is clear “reform” is what drove employers away from offering insurance.
    HIPAA passed over 10 years ago means no one is subject to pre-ex as long as they don’t have a gap over 61 days. If you play by the rules there is almost no chance of not getting coverage.
    More of my clients, large and small could offer coverage or better coverage if politicians hadn’t destroyed our systems. Another huge problem is ADA and HIPAA. We can’t force employees to take better care of themselves. The law is so distorited that if you offer coverage the employees then have the right to waste as much of it as they want. Something we use to see a lot of is non complaint diabetics, it is a sad sitution but why should everyone else pay out the nose for someone who doesn’t care about their own health? Everyone having affordable basic coverage should be a priority over people wasting resources.
    The arguments about America not being competitive becuase of Insurance are BS. We aren’t losing jobs to England, France, and Japan. We are losing the competitve fight to China, India, and Mexico, is anyone going to argue we should model our systems after theirs to be competitive?

  6. Which portion of the uninsured is the bigger problem
    Around half of the uninsured are already eligibile for free or heavily subsidized insurance and choose not to enroll. It is assumed the don’t enroll becuase they don’t need it. While it would be nice to have them in the system if they don’t need care that should not be the priority. We already have plans in place to help them. Kaiser has good info such as;
    “Almost two-thirds (65%) of the uninsured are from families with incomes below twice the poverty level (about $40,000 a year in income for a family of four in 2006”
    I don’t believe most Americans want to trash insurance they are happy with for people that choose to not sign up for free or affordable coverage.
    A huge part of this problem is past Liberal reform has driven so many millions out of the system. If your a young person making 30K a year and the Democrats in yoru state passed no underwriting and community rating for those that choose to buy insurance why would you buy a policy? Young healthy people should be allowed to buy cheap catostrophic plans that protect them in case of accident or other unforeseen event. Young people shouldn’t be paying more then $40-$60 per month.
    If we addressed the failure of past reform more individuals and small business could buy insurance that makes sense for them. That would reduce the burden on providers and public plans.

  7. Happy Labor Day Jerry.
    Those making over 50K can afford insurance is based on my general knowledge and no one study I could point to. I don’t beleive I have ever seen a study broad enough to quantify it. I currently spend half my time in Las Vegas, before that I lived in CA. I know for certain and I am sure there are studies to back it up but I don’t have one that people under-report their income. In Vegas the IRS has a program called TIPs where people with hard to verify income pay taxes on a fraction of their income and the IRS turns a bling eye. Landscapers, day care, restraunt employees, etc all make far more then they claim and all are more likely to be uninsured.
    The other piece of personal experience is my years in the insurance business and working with so many brokers. Every day someone driving a hummer, living in a 3000 SqFt house that vacations every year passes on buying insurance becuase they don’t spend that much on medical expenses. It’s an engrained belief in to many people that if the insurance premium isn’t less then what your claims would be there is no reason to buy insurance. The amount of research needed to prove this would be termindous, I haven’t seen it done but fully beleive it to be true.
    found this
    “When taxpayers are split into two groups, above and below $100,000, the net misreporting percentage is much higher for the higher-income taxpayers: 15.2 percent for those with true income above $100,000, and 7.0 percent for those with true income below $100,000, said the report.”

  8. Hi, Stephen.
    Thanks for the clarification, though I disagree with your assessment. I think the ground’s in place for the Senate to pass a bill with a public option via the reconciliation process (i.e., with a simple majority) – but that’s my own seat-of-the-pants assessment ;^)
    Now we have news of the outlines of the bill cobbled together by six members Senate Finance.
    It sounds like a non-starter to me – there’s something in it to annoy everybody.
    Finally, I though you’d be interested in this piece. I think Nate Silver’s overall analyses have been well- borne out, especially when polling is involved.
    Scroll down to the subheader “So, who gets it right?” for this money quote:
    “62 percent of people support the public option in Quinnipiac’s August 5th poll, versus 32 percent opposed.”
    So, the implications of your assessment, if true, is that it runs counter to popular sentiment.
    Thanks, Jerry

  9. Jerry,
    Thank you for your polite reminder. The consensus I referred to is developing opposition to another insurance program run by the Federal governemnt that seems to be emerging in the Senate and the general news comments about the risk of another insurance company not being able to change any trend, only adding liability to an already overburdoned tax base. I do not have any specific statistics.
    Rampant conflicts of interest must be eliminated in order for successful improvement in health care to occur. The president has the opportunity to be up front and honest with the populace about dealing with these special interests or he will probably lose any opportunity for reelection or opportunity to achieve many of the worthy goals he has identified.
    Hospitals benefit from incresaed numbers of sick people as well as some doctors, case managers, disease management companies, pharmaceutical companies, health insurance brokers, lawyers, and insurers. These groups continue to benefit from the increasing amount of GDP paid for health. Even our elected officials are in large part subsidized by they groups.
    Unless as a country we can align the interests of these groups with the people they serve, no insurance mechanism will change the trend in health care and we will continue to bankrupt our economy due to the srtangelhold of a few.
    Obama’s challenge is to bring the facts about the poor quality of medical services we already reaceive and are not aware of it. He must take action in this regard quickly and according to recommendations already put forward. http://bit.ly/1lJk8y

  10. Hi, Stephen:
    You haven’t yet answered my question about your basis for saying “There is clearly emerging consensus against yet another health plan sponsored by the federal government.”
    Are you talking about the republican caucuses in the House and Senate? A few Democratic senators from states with low populations? Other?
    It’s unclear. Can you clarify?
    Thanks, Jerry

  11. Hi, Nate.
    Thanks for the link – that’s a very helpful report.
    I was briefly confused because the page 23 you cited is page 23 of the actual report, though it’s page 31 of the pdf – but I found your citation ;^)
    So, those are the numbers.
    Now, with regard to your contention that “there is no reason most of the 6.6 million making 50K plus can’t buy their own insurance as well.” That’s a very big leap, and I have to believe that it’s based on some assumptions you’ve made, along with some personal bias, and not on actual data or findings.
    Is that the case? If it’s based on data or findings, what are they?
    Similarly, I have questions about your contention that “it is clear people choosing not to buy coverage they can afford is a bigger problem them (sic) people that can’t afford it.”
    The total population you’re describing is about 14-15M. The total population of uninsured is 46.3M, as reported in the table (Table 7) on the same page you cited.
    By my math, 46.3 – 15 = 31, and 31 > 15.
    And while I understand that there are likely people who “choose” to not become insured, in the sense that they say, “Hey, why bother?” I don’t assume that it’s universally a careless decision.
    I think it’s understandable human nature to expect that when a person is faced with a list of immediate expenses like shelter, food, transportation, childcare, and perhaps other items like student loans, that the cost of health insurance falls to the bottom of overall priorities as a practical matter.
    The census data you linked to also raises a number of questions worth pursuing, like changes in the rates at which employers offer health insurance.
    Also, plans offered through employers are not transportable, and people are changing jobs at higher rates than previously; and since coverage can be denied, or exclusions made, on the basis of pre-existing conditions, are some of the factors that I think lays the groundwork for an argument that there are some systemic defects contributing to the problem of uninsured (or under-insured) populations.
    Finally, I see that you’ve often argued from the perspective of a small business owner. What are the burdens to an employer offering health insurance as an employment benefit, including the burden of premium increases? What effects do those burdens have on an employer’s competitive position?
    Thanks, Jerry

  12. Jerry,
    Kaiser has some decent data but if you want to go strait to the hard data;
    http://www.census.gov/prod/2008pubs/p60-235.pdf
    Page 23
    Uninsured rates decreased for
    each consecutive household income
    group to 21.1 percent for households
    with incomes of $25,000 to $49,999,
    14.5 percent for households with
    incomes of $50,000 to $74,999, and
    7.8 percent for households with
    incomes of $75,000 or more.
    Talking about at least 3.6 million. Factor in under reporting of income and deductions and there is no reason most of the 6.6 million making 50K plus can’t buy their own insurance as well. Add to that the 8 million 18-24 year olds that can buy policies for under $100 per month and it is clear people choosing not to buy coverage they can afford is a bigger problem them people that can’t afford it.
    inchoate but earnest,
    You apparently have never owned or ran a business. When you advise your client to do something illegal, even when there is little to no chance of them getting caught you are asking for lawsuits. Most honest business people try to avoid such activity. Not to mention I prefer not to lose my various licenses and E&O policy. Your obviously a liberal with the mentality of just ignore any laws you don’t like, liek tax laws and Obama cabinet members.
    Margalit, force everyone to pay in premiums, period, no liberals deciding who gets to pay and who doesn’t based on what votes they need. Buy your votes with your own money not mine.

  13. Nate,
    However much you desire to assume the mantle of “Voice of the Industry” hereabouts, you’re not the only person with deep group experience. Your fears of EEOC, etc action are overblown; a cursory look at data on enforcement activity tells anyone that.
    Meanwhile, why not ac-cent-uate the positive, & tell everyone how enthused you are about the possibilities presented by Sec 224(c) of H.R. 3200, the America’s Affordable Health Choices Act of 2009. Let’s see what kind of imagination you have concerning possibilities other than boogiemen under your bed.

  14. So let’s fix the communist(?) problem, Nate:
    Force everybody to pay into the system when they can (taxes) and let them draw when they need to (universal coverage).
    Should take care of all the questions you asked.

  15. inchoate but earnest,
    have you ever been on the wrong side of the IRS, DOL, or EEOC? They put you out of business then ask questions. You might win and prove you were right but your still out of business.
    do you have any examples of anyone doing mandatory surveys? We do have examples of EEOC shuting people down that tried.
    Look forward to seeing who you show that is really doing what you say.
    Margalit your denying the very real truth that to many people are not contributing when they can but still trying to draw when they need. And those that do contribute are not contributing enough to cover what they draw. How is that equitable? Take the millions of uninsured making over 75K per year, how are they contributing? But if they need care you would expect the system to treat them. That is why what your saying is communist, a very few people are contributing almost all of the resources while the majority consume.

  16. Hi, Stephen:
    Thanks for your response to my second question. When you say that “much” = “inadequate” and “ineffective,” are you suggesting that we need more and better regulation of health insurers?
    My first question remains: what evidence are you drawing on to support your statement, There is clearly emerging consensus against yet another health plan sponsored by the federal government.?
    Thx, Jerry

  17. Nate, I don’t understand why you are having trouble understanding that people’s health status is not a constant; it changes with time.
    People are born, age and eventually die, thus progressing from status to status along a time axis, from children to young-and-healthy to elderly-and-sick to end-of-life.
    Today’s young-and-healthy were subsidized yesterday by today’s elderly-and-sick and will be subsidized tomorrow by today’s children.
    Everybody should pay into the system during the period of their lives when they can, and draw from the system when they cannot.
    You can call it socialism/communism/welfare state, whatever you wish, but it’s the only equitable option. I would call it socially responsible.

  18. Nate , for a guy who talks tough all the time, your quaking in the face of EEOC’s well-intentioned but wrongheaded edicts is comical.
    You know, surely, that there are employers providing incentives for employees to complete HRAs (tying lower contributions for coverage to completion, rather than particular results), serenely confident that wiser heads will simply direct EEOC to reconsider their foolish position. They aren’t worried about – or hiding behind? – the flimsy threat of EEOC ‘firing squads’, meekly staying on the sidelines; they’re doing sensible things to prompt sensible behavior, and getting accolades from employees for it. Thank heaven they aren’t waiting for keyboard kapitalists like you to design their plans for them.

  19. There is clearly emerging consensus against yet another health plan sponsored by the federal government.
    Stephen, do you have any evidence to support this statement?
    There is already much oversight at federal and state levels of all insurance programs…
    Is “much” the same as “adequate” or “effective?”
    I have other comments, but let’s get this stuff out of the way first.

  20. “Their retirement income limited their ability to pay for the increased cost share required by the health plan so benefits were increased to pay for medicines if members complied with preventive care.”
    Those SOBs, if I do this with my private insurance clients the EEOC lines us up in front of the firing squad. Apparently this horrible version of discrinmination is acceptable as long as it is the federal government doing the discrimination.

  21. “I had the privelege of administering a Federal employee health plan in which the majority of the membership was poor, black and mixed racial background, some causasian and chinese.”
    How much did the Feds subsidize premiums? Enough to consider it a quasi public plan?
    “The issue for Obama to bring forward is access to care, not insurance.”
    Absolutely! As new and complicated financial investements did not get (most of) us rich, new insurance contracts designed by actuaries won’t get us better healthcare at affordable prices.

  22. Nate and Mat
    Having taken care of many indigent and Medicaid patients I can tell you for sure, this socieconomic subset of America is made up of people with the same desires to take care of their families, avoid personal harm, and to fiancially survive and succeed as the rest of America. The uninsured and financially disenfranchised are in fact a reflection of our larger humanity.
    As a subgroup of all America this group respond to support and true advocacy like the rest of America, not paternalism and assumptions that they need someone else to make judgments for them.
    I had the privelege of administering a Federal employee health plan in which the majority of the membership was poor, black and mixed racial background, some causasian and chinese. Their retirement income limited their ability to pay for the increased cost share required by the health plan so benefits were increased to pay for medicines if members complied with preventive care. High quality social service and nursing support advocated for these plan members. The trend dropped from 14% over the previous 5 years to 3% over the next 6 years while health status improved and hospital admissions for hypertension, diabetes, and renal failure dropped by as much as 50%. The essential ingredient in the success of this plan was high quality humanity, availability of accurtae information, and trust that well informed people will act in their own self interest.
    The issue for Obama to bring forward is access to care, not insurance. Medicaid health plan members receive disproportianetely low access. One measure of the issue of access is how much of the medicaid budget is spent for transportaion. Transportation costs are enormously high because medicaid members are funnelled into overcrowded hospital clinics and emergency rooms because other care givers are not reasonably reimbursed.
    Historically, doctors cared for patients in volunteer clinics as part of the requirement for hospital staff provileges, and doctors provided either free care or reduced fees for economically disadvantaged patients they saw either in their office or in the operating room.
    Medicaid and Medicare changed alll of that, eliminated volunteerism and then stimulated a tremendous rise in physician fees.http://bit.ly/na9yc. The government programs are administered like private health plans and can not economically survive in the long run.
    The issue of health status and health care quality must be discussed before meaningful reform can occur. The information is available, just not publicized. Once the information is understood, by everyone at the indidual and subgroup level, change will be successful and immediate. Change will be mandated by the people, not by politicians.

  23. I have an idea. Cancel Social Security and Medicaid. Send those in the hospital receiving money from these programs to the streets! I find it very hypocritical that someone can embrase and use social security and medicaid and fight government health care. All or nothing. Take the 5 Trillion dollars in these accounts and distribute it amoung the tax paying citizens. Forget about the elders, What did they do for us? Fight to defend our freedom, Pave roads and help make this nation what it is today? So what? I am grateful to be able to afford to pay into social security, which I will never receive from. I owe it to those who fought this fight that I might be able to live as I do. I for me and me for me. What a great nation we are. Why is government run insurance socialist and pooled insurance capitalist? Answer: They are both socialist.

  24. lol, wow Matt there is your inner communist rearing its head.
    “which means that costs are not as inequitably spread across the system as they are now–falling massively disproportionately upon those un or underinsured who are also sick.”
    By any risk measure the cost falling on the sick is equitably. In fact the cost hasn’t fallen inequitably on the sick since the 70s. What you want is the exact opposite of equitable distribution, you want the sick to be heavily subsidized, even more then they are today.
    I’m actually ok with that if you do it via insurance where they pay into the system when they are not sick. But you want to subvert equality and allow people to spend their money freely when healthy then stick some nameless wealthy person with the bill when their luck runs out and they get sick. That is not a sustainable system. If you follow the rules you should always be able to purchase affordable pooled insurance. If you take advantage of the system and try to cheat you need to suffer consequences. That is not being inequitable.

  25. Stephen, you’re right that we have a problem in inefficient and ineffective care being delivered. But the problem is that before 2009 no one talked about this on a national level, and we are just not ready for that conversation–if it can be had at all within our current political structure. Despite the fact that Obama has brought it up many times.
    Instead we need to first fix the problem of universal access to insurance, or whatever the equivalent of that is which means that costs are not as inequitably spread across the system as they are now–falling massively disproportionately upon those un or underinsured who are also sick.
    If we don’t fix that first, the system has no incentive to look past cost avoidance to improved effectiveness.

  26. Having a healthy doctor patient relationship is an important piece of the healthcare equation, regardless of the overall structure. Patients who don’t trust their doctors are less likely to follow medical advice and doctors that aren’t attentive to their patients are more likely to miss something important. As we reform the healthcare system, its important to incentivise, and reduce barriers to, development of strong relations. The use of e-mail communications, using free online services such as housdoc.us, as example, would facilitate the flow of information and improve communications between doctors and patients. There are other examples. But the important thing to keep in mind is to ensure that whatever changes are implemented, that they do not degrade the patient doctor relation.

  27. Stephen I agree 100% with you on the need for an in your face intervention to change behavior. As Nate noted HIPAA & ADA complicit with EEOC enforcement has been the primary barrier to engaging at risk members.

  28. Stephen I would love to see how they structure such a plan. Everything we have read says any such penalty would violate HIPAA and ADA and you can only reward participants up to 20% before that is a violation. An example of something basic with no risk of abuse is still illegal;
    “In the situation presented to the EEOC, the county employer required employees to fill out a short health-related questionnaire, take a blood pressure test and give a blood sample for screening as part of the health risk assessment. The results of the test were given directly and exclusively to the employee, with the county only receiving results in the aggregate.”
    “The EEOC noted that ADA requires disability-related questions or medical examinations of employees to be job-related and consistent with business necessity, which the health risk assessment was not.
    “The EEOC noted that ADA requires disability-related questions or medical examinations of employees to be job-related and consistent with business necessity, which the health risk assessment was not.”
    “In its letter, the EEOC distinguished the health risk assessment from a wellness program, which typically does not violate the ADA as long as it is voluntary. In the county’s case, even if the assessment were part of a wellness program, the program would not be voluntary because nonparticipants were penalized for nonparticipation, Sellstrom says.”
    The federal government should not be making it this hard for employers to incentivise healthy choices and try to control cost.

  29. Nate: I appreciate your thoughtful comments. Focusing on your first point I agree that a small percentage of covered people get preventive care or completely follow high quality standards for chronic illness. Thre are a couple of major reasons failure to act proactively in health occurs. First if one feels “well” the assumption is nothing is wrong. Second pepople do not know what proactive steps are required for themselves, when they should be taken, and what the risks are for not taking them. The connections between financial outlay and poor quality fo life or even death needs to be an “in your face connection” in order for behavior to change. Currently the connections do not exist because available trusted actionable information is not efficiently shared. it could easily be made avilable to get phyusicians and their patients on the same page. please see “How Your Health Measures Up” http://bit.ly/2trTHR for a specific prescription for action. The discussion needs to be about value of what we get in health, and until value is defined for all stakeholders, there can be no meanigful discussion about reform.
    Incidentally, you can penalize your employees for not complying to preventive health standards if your health plan is written properly. One recent development gaining momentum in America which successfully aligns physicians, their patients, and their claims administrators is Value Based Health Care. This new benefit design links compliance to health care standards required by each individual plan member to the cost of his contribution for premium. The components of such plans use existing web based personal health records as the vehicle to communicate an individual’s preventive and condition management responsibilities. Aggregate reporting highlights improved population health status as costs decrease. Hospitals and physicians adjust to less demand, and irrational regional expense differences for care are reduced. Physicians and hospitals, who achieve better health status among their patients, can receive better payments.

  30. Doctors in the current fee-for-service payment system don’t have the financial incentive to help their patients. They get slapped by the invisible hand of capitalism when they put their patients needs ahead of generating revenue. Time commitments go up and dollars-in go down.
    In today’s economy managed care is a euphemism for insurance controlled care. Strengthening the doctor patient relationship implies: Stop the health insurers from practicing medicine!
    Doctors need a support system, which gives doctor’s continuous information about patient health. Patients need a system, which: (1) actively supports them in being responsible for their own health, (2) the health care system is always accessible no matter what happens and (3) their doctor is proactive in his approach to patient care.
    In a fee-for-access payment system the patient buys insurance, each doctor receives a retainer for every registered patient. health insurers by annual licenses from big Pharma, which afford them access to their medicines. The patient never has a copay for delivery of health care services, medical supplies or medicines.
    Proactive doctors develop efficient mechanisms to deliver quality care and maintain customer satisfaction. These doctors will actually spend less time with their patients because they know a small amount of time spent on prevention saves a large amount of time spent on cure.
    More satisfied patients translates into more money for the doctor. The invisible hand of capitalism pats him on the back for taking care of his patients.
    Obama can deliver successful reform, when he can legislate a payment transformation from fee-for-service to fee-for-access.

  31. I don’t think the doctor/patient relationship should be put on such a pedastal. There are good doctors and not so good doctors. Substantial health reform can begin by empowering the US health care consumer to preferentially select better MD’s… once THAT relationship is established then that relationship should be supported and encouraged.
    Until the US health care consumer has access to credible information & tools that enable them to differentiate high quality MD’s/hospitals from those of lower quality, they (consumers) will continue to insist upon having the broadest possible choice in network providers. The unempowered health care consumer, in our current health plan paradigm, wants broad choice~ in effect preserving their ability to chose from the bottom 50% of providers. Plans, burdened with the need to offer broad choice, foresake the capacity to negotiate meaningful discounts because they aren’t really moving market share to network providers.
    Ironically, health plans have the data to profile provider quality but they are the last organization that the health care consumer would trust to define quality or to present it.
    Consumerism can plan a role but it begins by enabling the consumer (and the provider) to understand what quality is and how it is measured.

  32. Peter a number with many places to the right of the . but still greater then zero, but barely

  33. Health reform is currently happening within many settings including employers as payers. When Employers focus their plans designs to create the incentives for members to be accountable for their own health through the management of their chronic conditions by removing the access barriers to care they have an opportunity to reduce their over health care and disability trends. At my former employer we were able to bend the trend by improving access to doctors, labs and medications.

  34. “Our President can recover if he chooses to change his fighting strategy to improve health instead of budgeting health. There is clearly emerging consensus against yet another health plan sponsored by the federal government.”
    If we don’t budget health then how do you expect people to afford that patient/doctor relationship?
    “Our President can recover if he chooses to change his fighting strategy to improve health instead of budgeting health. There is clearly emerging consensus against yet another health plan sponsored by the federal government.”
    I’m not sure Republicans and Rant Radio/Fox News will allow him to recover.
    “Emerging consensus” by whom – the people who need it?
    I also don’t understand how the above statement is going to improve the; “Less than 50% of all Americans participate in early cancer detection programs whether or not they have insurance coverage. Similarly for diabetes, many people develop complications of stroke and kidney failure because they do not follow basic treatment recommendations of the American Diabetes Association.” Are you saying that the reasons the uninsured don’t do the above is the same as those who have insurance? Surely a lack of access for financial reasons is different from just plain bad habits.
    Do I detect an anti-Obama tone to your piece Dr. Kardos? Do you still have that BCBS soft spot in your heart? Here in NC BCBS is fighting tooth and nail to derail/kill any health reform that cuts costs, they just want the government to fund more un/under-insured care at the present profit/bonus/utilization rate.
    Nate, what percentage of your people would use their annual preventive care if it was not free?

  35. “on average clear evidence indicates that Americans receive substandard basic health care.”
    I think receive should be changed to seek and this is a major difference. Better care is available but people choose to not avail themselves to it. There is a major difference between making it available and getting people to use it. Most of the plans I work with have annual preventive care paid at 100% but still fewer then 20% of the people use it. Federal law makes it almost impossible for me to force people to have their annual check up. A simple solution would be repealling the federal laws preventing me from penalizing employees that don’t. Instead they are proposing more federal laws making it even harder still.
    “The government can make this happen by regulation.”
    Again I think the accurate term is unregulation, it is cumbersom government regualtion that killed data sharing.
    I think it is very important for people to realize it was government action that created this mess, we don’t need more government to solve it we need them to back off and do what the consitution says they are suppose to, i.e. proecting our borders not our health data.

Leave a Reply

Your email address will not be published. Required fields are marked *