Let the buyer beware in a free-market health care system
Posted Sept. 20, 2012, at 1:17 p.m.
For the past 30 years or so, a debate about the proper place for competition vs. regulation in our health care system has raged. That debate has now become a central theme in the 2012 presidential race. Democrats favor a regulated system while Republicans favor a more market-driven system, nationally and in Maine.
Americans have the most market-driven health care system in the world. We are now seeing the results. We have the world’s highest health care costs, the highest rates of un- and underinsurance, some of the poorest health outcomes, and an almost universal belief that our health care system is badly broken.
Having a choice of health care providers is very important, since trust is critical to healing. But full-blown market-based competition doesn’t work. It has been known for years that the more doctors and hospitals there are in a region, the higher the costs — a phenomenon known as “provider-induced demand.” The Institute of Medicine recently reported that our system wastes about $750 billion a year, more than 30 percent of our spending. Much is due to an oversupply of some services and technology.
Usually, I am a great fan of competitive markets — where the seller and the buyer each have the same information about prices, features and availability. When it comes to buying a car, washing machine, TV or computer, I go to Consumer Reports or other websites where I can get current and accurate information about the price, quality, availability, reliability and other characteristics of the product I’m interested in. I can also find the opinions of lots of other customers. Then I can decide, usually at my leisure, which features of those products are important to me, how much I want to spend, and when and whether to make my purchase.
Good information is the one indispensable ingredient of competitive markets.
None of this applies to the strange world of health care. I don’t know when I am going to have an injury or illness, what it will be, or what treatment will be recommended. There is vigorous disagreement among even the best-trained doctors about the most effective course of treatment for many conditions. Tests and procedures that have been standard for years can turn out to be more trouble than they are worth. Mammograms, prostate cancer tests and excessive imaging procedures for many patients are the latest examples.
The pricing of health care services is so complicated and irrational that it is impossible to determine in advance what the costs of treatment will be.
http://bangordailynews.com/2012/09/20/health/let-the-buyer-beware-in-a-free-market-health-care-system/print/
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Is A Competitive Health Care Model All It’s Cracked Up ToBe?
As models, he often cites the health program for federal employees – including members of Congress -- and Medicare’s prescription drug program. "It works with federal employees, it works with the prescription drug benefit, and more to the point, it saves Medicare," Ryan said on "Meet the Press" in April.
Both of those programs get high marks from beneficiaries for the choices they offer. But their track record on cost control is more complicated, raising questions about whether the competitive model is in fact the silver bullet that backers have suggested.
Controversy—The Republican Governors Need to Put Up or Shut Up
Indiana, New Mexico, and Wisconsin are asking the federal government to exempt people making between 100% and 133% of the poverty level from the upcoming Medicaid expansion.
These Republican governors need to put up or shut up.
Ever since the passage of the Affordable Care Act (ACA) Republican governors have been clamoring for block granting Medicaid.
The Supreme Court ruled that a state doesn’t have to accept the new Medicaid expansion money under the ACA.
These Republican governors need to put up or shut up.
Ever since the passage of the Affordable Care Act (ACA) Republican governors have been clamoring for block granting Medicaid.
The Supreme Court ruled that a state doesn’t have to accept the new Medicaid expansion money under the ACA.
Many Republican governors—all of them actually—were saying before the Court ruling that the Medicaid expansion was yet another unfunded federal mandate they could not afford. Now the Court has told them they don’t have to do it.
Be careful what you wish for.
http://healthpolicyandmarket.blogspot.com/2012/09/the-medicaid-controversythe-republican.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29
New York’s Medicaid Reforms
New York State has substantially changed its Medicaid program in the past year and a half in ways likely to improve the health of its poorest residents and rein in the program’s enormous costs.
Now the state is asking the federal government to let it use $10 billion in projected federal savings from its reforms to modernize hospitals and clinics serving the poor and to expand primary and preventive care. If spent wisely, that investment could turn New York into a model on how to cut Medicaid without harming the beneficiaries.
New York’s Medicaid program, the nation’s costliest, spends more than $54 billion a year to cover some five million people, about a quarter of the state’s population. Roughly half the cost is paid by the federal government and the other half by state and local governments.
New York faces the same problem as many other states: its share of the costs of this state-federal insurance program for the poor has been rising steadily, limiting its ability to pay for other urgent needs, like education.
Last year, Gov. Andrew Cuomo, working in collaboration with health care providers and labor leaders, pushed through a budget that seems to be easing the stress. It places a cap on what the state can spend on most Medicaid programs, cuts payments to health care providers and managed care plans and sets up a mechanism to make further cuts to provider payments to stay below the cap, which, so far, has not been breached.
The cap started at $15.3 billion last year and is allowed to rise by only 4 percent a year, bringing it to $15.9 billion for the current 2012-13 budget year. The state’s total budget for Medicaid, including noncapped programs, is $20.8 billion for the current year.
The reforms do not impose higher cost-sharing on beneficiaries or make significant cuts in benefits except in a few programs, like home care visits for housekeeping services or unlimited rehabilitative services.
Romney Adviser’s Firm Says Most States Will Expand Medicaid — If Obama Is Re-Elected
Life Expectancy Shrinks for Less-Educated Whites in U.S.
By SABRINA TAVERNISE
For generations of Americans, it was a given that children would live longer than their parents. But there is now mounting evidence that this enduring trend has reversed itself for the country’s least-educated whites, an increasingly troubled group whose life expectancy has fallen by four years since 1990.
Researchers have long documented that the most educated Americans were making the biggest gains in life expectancy, but now they say mortality data show that life spans for some of the least educated Americans are actually contracting. Four studies in recent years identified modest declines, but a new one that looks separately at Americans lacking a high school diploma found disturbingly sharp drops in life expectancy for whites in this group. Experts not involved in the new research said its findings were persuasive.
The reasons for the decline remain unclear, but researchers offered possible explanations, including a spike in prescription drug overdoses among young whites, higher rates of smoking among less educated white women, rising obesity, and a steady increase in the number of the least educated Americans who lack health insurance.
The steepest declines were for white women without a high school diploma, who lost five years of life between 1990 and 2008, said S. Jay Olshansky, a public health professor at the University of Illinois at Chicago and the lead investigator on the study, published last month in Health Affairs. By 2008, life expectancy for black women without a high school diploma had surpassed that of white women of the same education level, the study found.
White men lacking a high school diploma lost three years of life. Life expectancy for both blacks and Hispanics of the same education level rose, the data showed. But blacks over all do not live as long as whites, while Hispanics live longer than both whites and blacks.
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