Matthew Holt

The big question for what’s next

By MATTHEW HOLT

It’s the morning after the big night. Soon all melodrama of the past 14 months will be forgotten, particularly the last 6 weeks (for which the current narrative is that Nancy Pelosi brought health care reform back from the ashes with an assist from Angela Braly and Anthem Blue Cross). In the end the current bill is probably better than the version that would have come from a 60 vote Senate win after conference as the abuses of the Cornhusker kickback and more would still be there. Given that the sticking points at the end were more about the irrelevancy of abortion than anything else, the more mainstream Democrats might be wondering whether this wasn’t a better way to do things in the first place, and therefore whether they couldn’t have got a public option through if the 51 vote reconciliation process was adopted earlier in the bill’s life.

But no matter, we’s got what we’s got. For now. And whatever happens I can’t see any way that this gets overturned—especially when people figure out what’s in the bill. More likely the subsidies get sweetened, and the holes in the coverage get filled.

So it’s almost time to turn our attention away from payment reform, to delivery reform. Now every time in the past that we’ve had reform or something approaching it, those organizations who have shaped themselves to operate in an environment that rewards cost-effective innovation have ended up losing their financial shirts. You can go back to Friendly Hills in the 1990s, or look at Intermountain and Virginia Mason more recently. (Which is why I’ve been ranting at Michael Porter & Elizabeth Teisberg for years)

Now as Maggie Mahar has trumpeted, there appear to be some serious provisions for pilots in Medicare payment and eventually changes to overall Medicare reimbursement. Ideas like accountable care organizations and more should start to become reality. But of course, these concepts will need considerable change on the provider side before they become reality.

So the big question for the health care system going forward is, if providers start making the changes that will promote more cost-effective care, will they be rewarded or will they be hung out to dry?

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candy crush soda hackingaltruancePeterLucifer66Fred Recent comment authors
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candy crush soda hacking
Guest

With Candy Chemistry, kids can learn that simple chemistry
principles are applied in everyday life. Instead of purchasing
a harsh cleanser, try to find a soap with gentler ingredients, such as tea tree oil.
Sift flour, baking powder, baking soda and salt into a large bowl.

altruance
Guest

These bills are NOT real health care reform; they are simply a tweaking of the health insurance industry. What has changed is that insurance companies now have some new regulations to contend with. They can no longer drop you when you get sick and they can no longer say NO to your application for whatever little visit to the doctor you may have on your record. Additionally, there is nothing in the passed bill that really attacks the root cause of health insurance premium increases.
Read more: http://www.altruance.com/2010/03/health-insurance-reform-reality-check/

Peter
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Peter

“I’m a 100% disabled vet and I’d rather go to civilian doctors and hospitals.”
ed, who pays for that?

Lucifer66
Guest
Lucifer66

So now it’s “Buy health insurance or face the I.R.S.” what’s next?
Will they mandate that we buy a GM (Government Manufactured) vehicle if we wish to drive in America?
Will we be mandated to only use government owned banks to keep our money in so they can keep track of our money that much easier?
How long before we are mandated to join a union if we wish to work?
How many more times will we see them marching lockstep up those steps to take away our rights?
Better wake up America before we change to The United Socialists States Of America.

Fred
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Fred

I find it ironic that a guy from England promotes how great subsidies and govt run health care are ! ?! Wow, England NHS is such a model of health care. Wow,England is such a model of innovation Wow, england is such a model for working hard and achieving Wow, England is….well i could go on…but let’s just say, a great place for culture, a terrible place for just about anything else. When’s the last time you heard “wow, that company came from England”. you dont, its a social state with a broke system, and a broke hc system to… Read more »

ExhaustedMD
Guest
ExhaustedMD

To Stop Obamacare: pay attention to the loudest zealots taking shots at physicians like you and I, they are not clinicians and per reading their repeated comments, you have to wonder if they are either psychotic or have an agenda that will not be exposed until something forces their hand. As I shared at a prior posting, everyone is a damn doctor until the feces hits the fan, and how convenient these charlatans are the first for the door and leave the patient and doctor to be showered with their filth. It is the timeless rhetoric of those who resent… Read more »

jd
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jd

It will be nice when the yellers who don’t know anything about healthcare go back to NewsMax or wherever they came from.

Kim
Guest
Kim

ed waltz – i think your comment was intended for Mao, and I believe his comments were sarcastic.

rxvette
Guest

applaud President Obama for his effort to get healthcare reform passed. This legislation has many much needed fixes for our current system. However, being the independent voter and healthcare professional I am I do believe that we still fall far short of addressing the core of this nation’s healthcare crisis. And this would be – an unhealthy America. Michelle Obama is the one fighting the bigger more important fight with her campaign to reduce obesity in children. This needs to be expanded to everyone in America. Because if you still have 2/3 of Americans who are overweight and sick you… Read more »

Ken
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Ken

To “Stop Obamacare”, It is clear that, while you may be an accomplished doctor in your field, you don’t have the faintest idea of health economics. That is why arguments of many health care professionals, much as I respect them for doing their noble calling, ring really hollow. Your comparison to the mandatory car insurance is correct and incorrect. You are right in that driving car causes externality (hurting other people) and the tort system alone cannot compensate victims due to judgment-proof problem. Thus the need for mandatory automobile insurance. Yet, living without health insurance also causes externality. When one… Read more »

ed waltz
Guest
ed waltz

Well Kim your full of crap the VA hosp is as good as the public/ I’m a 100% disabled vet and I’d rather go to civilian doctors and hospitals. The VA has made so many cuts its in sorry shape for the vets. Government health care is so great huh. Only get to see you primary health care doctor twice a year. Get real.

Kim
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Kim

The scary thing is that costs are going to go up more, not less, for at least the the short term, and stop blaming those insurers. When one combines mandatory expansions of coverage (e.g., removal of lifetime limits and opening up the risk pool) with increasing provider bargaining power (e.g., Bersenson, et al (http://www.hschange.com/CONTENT/1118/) or the Massachusett AG report (http://www.mass.gov/Cago/docs/healthcare/Investigation_HCCT&CD.pdf)) — well, it does not bode well. Until subsidies and mandates start to kick in there is not much hope of improving the underlying risk pools, and richer coverage/more high cost insureds/higher provider costs will trump “Managed care 2.0,” whatever… Read more »

Mao
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Mao

FUNNY, MATTHEW
” .. So the big question for the health care system going forward is, if providers start making the changes that will promote more cost-effective care, will they be rewarded or will they be hung out to dry?”
How FUNNY!!! Try Comedy Central! And add these —
“I’m from the government, and I’m here to help.”
“NHS works just fine.”
“VA just as good as private providers.”
“Medicare is not bankrupt.”
“Taxes do not deter economic growth.”
“Obama is competent.”

bev M.D.
Guest
bev M.D.

To Stop Obamacare:
The bill is passed. You are dwelling in the past. Time to move on.

Stop Obamacare
Guest
Stop Obamacare

With regards to the Medicare cuts slated to pay for this bill, see below as to how they will affect doctors and ultimately patients. Do we want 32 million more people insured at the cost of the elderly in this nation?
And if this is how our nation’s doctors feel about the health plan run by our gov’t, do we want them to have a hand in the insurance of 32 million more?
https://thehealthcareblog.com/the_health_care_blog/2010/03/dear-mr-president-medicare-stinks.html