POLITICO
Experts debate all-payer setups vs. Medicare for all
Health care prices are too damn high.
That’s the punch line to the provocative Time magazine piece “Bitter Pill” by Steven Brill, who laid out his diagnosis of the problem Wednesday at a Center for American Progress panel.
He cited sky-high hospital executive salaries and operating margins, monopolistic and opaque pricing by providers and a fearsome lobbying force — many times larger than those of the oil and gas or defense industries — that has beaten policymakers into submission.
“The lap-doggery to the health care industry is bipartisan,” he said. The article has sent hospitals and other stakeholders to the wall in defense of the system, and it’s fueling debates in policy circles.
But while many policy experts agree with much of Brill’s diagnosis of factors that are driving up costs, there’s far less consensus on what to do about it.
Brill said the voluminous feedback he’s received since publishing the article breaks down along two lines. Conservatives believe consumers need to have more “skin in the game” — to pay more of health costs so they become more conscientious shoppers and put pressure on providers to more efficiently compete for their business. And liberals see the solution in Medicare-for-all, a single-payer system, amplifying the negotiating might the federal health care program already leverages to keep costs down.
Brill rejected the single-payer possibility as impractical in his article but now says that he is increasingly siding with that camp. “It’s sort of the cleanest way to clean up the system,” he said.
POLITICO
Experts debate all-payer setups vs. Medicare for all | |
| Health care prices are too damn high. That’s the punch line to the provocative Time magazine piece “Bitter Pill” by Steven Brill, who laid out his diagnosis of the problem Wednesday at a Center for American Progress panel. He cited sky-high hospital executive salaries and operating margins, monopolistic and opaque pricing by providers and a fearsome lobbying force — many times larger than those of the oil and gas or defense industries — that has beaten policymakers into submission. “The lap-doggery to the health care industry is bipartisan,” he said. The article has sent hospitals and other stakeholders to the wall in defense of the system, and it’s fueling debates in policy circles. But while many policy experts agree with much of Brill’s diagnosis of factors that are driving up costs, there’s far less consensus on what to do about it. Brill said the voluminous feedback he’s received since publishing the article breaks down along two lines. Conservatives believe consumers need to have more “skin in the game” — to pay more of health costs so they become more conscientious shoppers and put pressure on providers to more efficiently compete for their business. And liberals see the solution in Medicare-for-all, a single-payer system, amplifying the negotiating might the federal health care program already leverages to keep costs down. Brill rejected the single-payer possibility as impractical in his article but now says that he is increasingly siding with that camp. “It’s sort of the cleanest way to clean up the system,” he said. |
Finding a Partner for Children’s Health in Centralized Care
By BECCA AARONSON
It takes a team of medical specialists to care for Anna Barkhuizen, a 9-year-old with epilepsy, cerebral palsy and significant developmental delays. Her mother, Rebecca, recalls waiting for hours in exam rooms and leaving before seeing the doctor, because Anna had grown too impatient.
“I felt like we had all of these dots with all of these specialists, but no one to connect all these dots for us,” Ms. Barkhuizen said. “Now, I feel like I have a partner in raising Anna.”
For the last year, Anna has participated in a pilot program at the Seton Children’s Comprehensive Care clinic at Dell Children’s Medical Center of Central Texas in Austin. The three-year program, now in its second year, coordinates care for medically needy children, providing access to pediatric physicians, medical specialists and behavioral health care, while offering family support services. The program’s founders hope comparative data collected from the pilot program and routine outpatient care will show that centralized coordination improves the quality of care while cutting costs.
“Typically, you put everybody through the same rigid system, and it’s not necessarily efficient or effective,” said Dr. Rahel Berhane, the medical director of the clinic. “The hypothesis is that this is much more cost-effective, so Medicaid would be able to serve more patients.”
Dell Children’s Medical Center hopes to expand the program, which gets $1.5 million annually from its parent, the Seton Healthcare Family. It has applied for $18 million through a federal Medicaid waiver that Texas received in 2011. The waiver allows the state to invest nearly $10 billion in federal and local financing to transform health care delivery across Texas. More than 1,300 projects have been proposed, and federal approval is expected in May. (Seton is a corporate sponsor of The Texas Tribune.)
The program has enrolled 130 children, three-quarters of whom receive Medicaid. Half speak only Spanish.
Preliminary data shows that the program has halved the rate of emergency room visits for these children.
Legislative panel opposes bill to loosen health care expansion requirements
Posted March 14, 2013, at 7:16 p.m.
AUGUSTA, Maine — A legislative committee voted 7-5 along party lines Thursday against an attempt to roll back the state’s Certificate of Need program, which closely regulates the expansion of hospitals and other health care facilities in Maine.
Democrats on the Legislature’s Health and Human Services Committee opposed the measure, sponsored by Rep. Richard Malaby, R-Hancock, while Republicans supported it.
Malaby said his bill, LD 162, would remove a layer of regulation that stifles free-market competition in health care that could ultimately lower costs and ensure Maine residents have access to the latest medical developments.
“The monopoly that we have created, the cost shifting that we endure, that we indeed promote, is driving up costs,” he said. “Until we start competing, we are never going to drive down costs. Until we have openness, we are never going to drive down costs.”
Maine’s per-capita spending on health care was fifth highest in the nation in 2009, according to the Kaiser Family Foundation.
But Democrats on the Legislature’s Health and Human Services Committee said the state’s Certificate of Need program is an essential part of the state’s cost containment strategy for health care. Unraveling the program could open the state up to for-profit health care providers that don’t accept patients insured by MaineCare, the state’s Medicaid program, some Democrats said Thursday.
“We can’t allow our infrastructure to be pulled apart just because we want to expand it and open it up to whatever market might like to just skim off the top and not take MaineCare payments,” said Sen. Margaret Craven, D-Lewiston, chairwoman of the Health and Human Services panel. “That’s my biggest concern with just throwing this to the wind and not caring for our current providers.”
Posted March 13, 2013, at 11:18 a.m.
AUGUSTA, Maine — Rep. Ann Peoples married her husband, Patrick, 35 years ago. They raised children together, worked successful careers in the same field and planned to spend their old age relaxing in their second home up north.
But in January 2012, Patrick suffered a debilitating stroke and everything changed. Growing old together is a common goal for married couples, but not this way.
“It’s just what you do,” said Ann. “You just keep putting one foot in front of the other. I consider myself fortunate because I have a roof over my head, food, work that I love and a companion who I love very much.”
When the Maine House of Representatives is in session, Patrick sits at the rear of the chamber, behind the glass wall that separates lawmakers from the general public. When his wife is listening to hours of testimony in the Transportation Committee, Patrick sits next to her through it all, slumped over in his wheelchair. But there’s no question he’s listening. Later in the State House cafeteria or on the ride home, he and his wife banter about that day’s debate. Patrick’s speech is blurred by his physical condition, but not his mind.
“Those two are the model of what a loving couple should be,” said Maine Sen. Anne Haskell, who like Peoples, is a Democrat from Westbrook.
Ann Peoples said it took her decades to learn what “in sickness and in health” means.
“One of two things is going to happen to you at an advanced age,” she said. “Either you’re going to need long-term care or you’re going to die. There is no alternative.”
There are alternatives available for spouses and other loved ones of people sick enough to need round-the-clock care, according to Brenda Gallant, Maine’s long-term-care ombudsman. They include homemaker care, in which workers go to a person’s home to help with household chores; home-based care, in which medical professionals provide services in a person’s home; and full-time nursing homes. But there are waiting lists for those services, including 1,530 for the homemaker program and about 60 for home-based care. There also are more than 600 people waiting for financial assessments for state funding for home-based care.
“Maine families really are the backbone of the long-term care system” said Gallant. “With respect to home and community-based services, we only supplement what families provide. There’s a tremendous benefit to the person who’s receiving the care as well as the long-term care system in general.”
According to Gallant and others, funding for long-term care programs lags far behind the need, which has the troubling side effect of pushing people into nursing homes ahead of their time. In addition to separating families too early, it costs the state and federal governments millions in Medicaid dollars.
I am re-posting the following article that illustrates the dangers of "competition" in the healthcare delivery "marketplace" conducted in an excessively corporatized healthcare environment. Thanks to Stephen Kimble of Hawaii for reminding me of it.
-SPC
A Hospital War Reflects a Bind for Doctors in the U.S.
By JULIE CRESWELL and REED ABELSON
For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.
But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.
Today, Boise is a medical battleground.
A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.
Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit.
In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.
Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.
In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.
Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition.
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