HEALTH POLICY
From HMOs to ACOs: The Quest for the Holy Grail in U.S. Health
Policy
Theodore Marmor, PhD1 and Jonathan Oberlander, PhD2,3,4
1School of Management and Department of Political Science (emeritus), Yale University, New Haven, CT, USA; 2Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; 3 Department of Health Policy and Management, University of North Carolina Gillings Global School of Public Health, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; 4Visiting Scholar, Center for Health and Wellbeing, Princeton University, Princeton, NJ, USA.
From HMOs to ACOs: The Quest for the Holy Grail in U.S. Health
Policy
Theodore Marmor, PhD1 and Jonathan Oberlander, PhD2,3,4
1School of Management and Department of Political Science (emeritus), Yale University, New Haven, CT, USA; 2Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; 3 Department of Health Policy and Management, University of North Carolina Gillings Global School of Public Health, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; 4Visiting Scholar, Center for Health and Wellbeing, Princeton University, Princeton, NJ, USA.
The United States has been singularly unsuccessful at controlling health care spending. During the past four decades, American policymakers and analysts have embraced an ever changing array of panaceas to control costs, including managed care, consumer-directed health care, and most recently, delivery system reform and value-based purchasing. Past panaceas have gone through a cycle of excessive hope followed by disappoint- ment at their failure to rein in medical care spending. We argue that accountable care organizations, medical homes, and similar ideas in vogue today could repeat this pattern. We explain why the United States persis- tently pursues health policy fads—despite their poor record—and how the promotion of panaceas obscures critical debate about controlling health care costs. Americans spend too much time on the quest for the “holy grail”—a reform that will decisively curtail spending while simultaneously improving quality of care—and too little time learning from the experiences of others. Reliable cost control does not, contrary to conventional wisdom, require fundamental delivery system reform or an end to fee-for-service payment. It does require the U. S. to emulate the lessons of other nations that have been more successful at limiting spending through budgeting, systemwide fee schedules, and concentrated purchasing.
http://www.springerlink.com/content/m86245k22018507n/fulltext.pdf?MUD=MP
Updated: Today at 10:23 AM
AUGUSTA — Top Democratic state lawmakers sent a letter to the Obama administration Wednesday, opposing Gov. Paul LePage's plan to cut Medicaid benefits for about 27,000 Mainers.
Sen. Dawn Hill, D-Cape Neddick, and Rep. Peggy Rotundo, D-Lewiston, wrote to U.S. Health and Human Services Secretary Kathleen Sebelius disputing LePage's arguments that the cuts are needed because of a state budget crisis. They also argue in the letter that the Affordable Care Act continues to forbid such cuts without a special waiver, despite LePage's argument otherwise.
"It is important to note that there is no budget deficit. In fact, the State ended FY 2012 with a $20 million budget surplus. In April 2012, the Revenue Forecasting Committee re-projected state revenues upward by $50 million," the letter says.
Hill and Rotundo are the ranking Democrats on the state's budget writing Appropriations Committee and say in the letter they speak for all the committee's Democrats.
Comments open through August 8, 2012
http://www.springerlink.com/content/m86245k22018507n/fulltext.pdf?MUD=MP
Some of the comments on the following Collins op-ed are worth checking out -
SPC
Middle-Age Blues
By GAIL COLLINS
Paul Ryan is everywhere! Nobody can talk about anything but the congressman from Wisconsin. We now know he is the intellectual, spiritual and moral center of the House of Representatives, who keeps his body fat below 8 percent and excels at a sport that involves sticking your hand inside a catfish, grabbing it by the tonsils and pulling it out of the water. Also, I believe he may have been the guy who ran the men’s relay race in the Olympics on a broken fibula.
Today, let’s consider what the selection of Ryan as Mitt Romney’s running mate will mean to the American health care system. To start, there’s good news for senior citizens: You can stop worrying! Neither Ryan nor Romney wants to change Medicare coverage for people over 55.
Also, the news media is going to quit calling you senior citizens. You are now Medicare Sensitive Voters.
Any other questions? Let’s start with you over there in the corner — the one jumping up and down and hysterically waving your arms.
I am 54! How come nobody cares about my health care?
As Romney said on “60 Minutes,” the Republican ticket is “looking for young people down the road and saying, ‘We’re going to give you a bigger choice.’ ” So the good news is that: A) you are getting a choice, and B) you are now officially a young person.
No, I’m not! I am totally falling apart! And now you’re telling me that people just one year older than me will get guaranteed government coverage that everybody likes, while I am going to be getting a choice? What if I don’t want a choice?
Freedom is always good.
Freedom’s just another word for nothing left to lose.
Obama vs. Romney on Medicare
Until this week, Republican presidential candidate Mitt Romney had sought to make the election a referendum on just one thing: President Obama's handling of the economy. But by teaming up with Rep. Paul D. Ryan (R-Wis.), the architect of the House GOP's plan for cutting spending, Romney made a campaign issue out of one of the government's biggest programs, Medicare. Sure enough, the attacks on Ryan's proposal to transform Medicare from insurance into premium subsidies began within minutes after Romney announced Ryan as his running mate.
Both Romney and Obama are seeking major changes to Medicare to rein in its runaway costs, which threaten to consume 20% of federal revenues by 2022. So when they promise to "preserve and protect" Medicare, as Romney did in Florida on Monday, they're talking about the idea of Medicare, not the program as it looks today. Significantly, both Obama and Ryan have called for holding Medicare spending to the same rate of growth in future years. The difference — and it's significant — is in how they would meet that target.
The challenge for Medicare is twofold. Thanks to the baby boom and advances in medicine, Medicare beneficiaries are growing in number and longevity. At the same time, medical costs have been rising far faster than inflation. The recession slowed the rate of increase somewhat, but the relief is likely to be temporary.
Dems push back on LePage's proposed Medicaid cuts
Posted: August 15Updated: Today at 10:23 AM
They say not only are the cuts illegal, but Maine finished FY 2012 with a $20 million surplus, so the cuts are unnecessary.
AUGUSTA — Top Democratic state lawmakers sent a letter to the Obama administration Wednesday, opposing Gov. Paul LePage's plan to cut Medicaid benefits for about 27,000 Mainers.
Sen. Dawn Hill, D-Cape Neddick, and Rep. Peggy Rotundo, D-Lewiston, wrote to U.S. Health and Human Services Secretary Kathleen Sebelius disputing LePage's arguments that the cuts are needed because of a state budget crisis. They also argue in the letter that the Affordable Care Act continues to forbid such cuts without a special waiver, despite LePage's argument otherwise.
"It is important to note that there is no budget deficit. In fact, the State ended FY 2012 with a $20 million budget surplus. In April 2012, the Revenue Forecasting Committee re-projected state revenues upward by $50 million," the letter says.
Hill and Rotundo are the ranking Democrats on the state's budget writing Appropriations Committee and say in the letter they speak for all the committee's Democrats.
How Much Can Patients Learn in a 15-Minute Doctor Visit?
By PAULINE W. CHEN, M.D.Built more like a former professional basketball player than an elementary schoolteacher nearing retirement, the patient dropped a bagful of prescription medications on the table in the examining room and fell back into a chair. He couldn't remember what most of them were for.
Several weeks earlier, he had seen a new doctor who'd prescribed several new drugs and spent much of the visit reciting a list of advice - lose weight, exercise more, stop smoking, eat more fruits and vegetables. Before he even arrived home, he realized he couldn't recall any of the details of what the doctor had said.
"I felt like I was in a Charlie Brown cartoon," he said, recounting the visit with a laugh. "All I can remember the doctor saying was, 'Waw, waw-waw, waw-waw.' "
This patient is far from alone in his difficulty absorbing a fire hose of advice. Thanks to some dazzling advances in preventive medicine and public health, doctors in almost every specialty of medicine now have a panoply of proven preventive recommendations to keep their patients from getting sick. And as the number of validated interventions has grown, so has the pressure on doctors to remind their patients of all the now-standard advice in the course of a 15-minute office visit.
Faced with an impossible task, some physicians have thrown up their hands and chosen to focus on only a couple of topics at each visit. Others have resorted to handing out typed lists of the recommendations for patients to read at home. But an increasing number of doctors, under mounting pressures from insurance companies and others to prove that they are delivering quality care, are simply scrambling to cover as many of the wellness recommendations as they can, piling on the dos and don'ts in what a colleague of mine once referred to as "the grand information dump."
Taking health-care reform a step further
By Ruth Marcus,
If turning Medicare into a voucher program isn’t the answer to controlling the program’s growth, what is? This is the essential question about the federal budget.
Already, health care consumes 25 percent of federal spending, of which Medicare accounts for two-thirds. On the current trajectory, health care’s share of the federal budget will rise to 40 percent by 2037. Recent slowdowns in spending are encouraging, but they can’t be counted on to continue.
So what’s a responsible Democrat to do? As it turns out, 23 responsible Democrats — some of the left’s leading thinkers in the health-care field — have just come up with a set of answers.
The group includes ex-government types such as former White House chief of staff John Podesta; former budget director Peter Orszag; former Obama health-care adviser Neera Tanden; Donald Berwick, who oversaw the Medicare and Medicaid programs; and former Senate majority leader Tom Daschle.
The chief author of the proposal, developed under the auspices of the Center for American Progress and published recently in the New England Journal of Medicine, is Ezekiel Emanuel, another key Obama health-care adviser. Former, of course.
These are not necessarily proposals that incumbent presidents or sitting members of Congress leap to embrace.
Another crucial point is that these are some of the people who helped give birth to Obamacare. They acknowledge that the health-care law, while making an important down payment on reducing costs, is just that: a start.
A Systemic Approach to Containing Health Care Spending
August 1, 2012 (10.1056/NEJMsb1205901)
Comments open through August 8, 2012- Article
- In this election year, U.S. national spending on health care will reach $2.8 trillion, or about 18% of total spending on all goods and services. This high level of spending reduces our ability to invest in other important parts of the economy and also adds to our unsustainable national debt. There is wide agreement that we must find ways to bend the health care cost curve. Taking different approaches, the the two Sounding Board articles, by Emanuel et al. andAntos et al., present a range of options, including reducing both the prices and quantity of services for public and private payers, reducing administrative costs, implementing new market-based incentives, and reforming the tax subsidy for employer-sponsored health insurance. It is our hope that these articles will stimulate discussion and debate on the best ways to address the cost problem and to place our health care system on a more sustainable path.
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