Wednesday, September 10, 2008

McCain on lowering healthcare costs

So, now, post convention season, what plans do the presidential candidates have to reduce health care costs?
John McCain Believes The Key To Health Care Reform Is To Restore Control To The Patients Themselves. We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need. Health care should be available to all and not limited by where you work or how much you make. Families should be in charge of their health care dollars and have more control over care.
John McCain also discusses tort reform and transparency in information to patients.
TORT REFORM: Passing Medical Liability Reform. We must pass medical liability reform that eliminates lawsuits directed at doctors who follow clinical guidelines and adhere to safety protocols. Every patient should have access to legal remedies in cases of bad medical practice but that should not be an invitation to endless, frivolous lawsuits.
Okay, McCain. Sounds great . . .

* But what about the American Medical Association prohibiting doctors from testifying against another doctor (and for the patient)? Can we stop that?

* And what about Medicare and various commercial health insurance companies refusing to pay for "never events" but then failing to assist patients in suing bad doctors or the doctors being disciplined for "never events"?

* And what about "no fault" malpractice insurance?
TRANSPARENCY: Bringing Transparency To Health Care Costs. We must make public more information on treatment options and doctor records, and require transparency regarding medical outcomes, quality of care, costs and prices. We must also facilitate the development of national standards for measuring and recording treatments and outcomes.
Terrific, McCain!!

And then there is Obama and universal health care. From the outset, I want to be clear how I feel about universal health care. It has been tried and proven to be dopey.

Michael Tanner (from the CATO Institute) remarks:

  • What these politicians and many other Americans fail to understand is that there's a big difference between universal coverage and actual access to medical care
  • Supporters of universal coverage fear that people without health insurance will be denied the health care they need. Of course, all Americans already have access to at least emergency care. Hospitals are legally obligated to provide care regardless of ability to pay, and although physicians do not face the same legal requirements, we do not hear of many who are willing to deny treatment because a patient lacks insurance
  • You may think it is self-evident that the uninsured may forgo preventive care or receive a lower quality of care. And yet, in reviewing all the academic literature on the subject, Helen Levy of the University of Michigan's Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a "causal relationship" between health insurance and better health. Believe it or not, there is "no evidence," Levy and Meltzer wrote, that expanding insurance coverage is a cost-effective way to promote health. Similarly, a study published in the New England Journal of Medicine last year found that, although far too many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."
  • Another common concern is that the young and healthy will go without insurance, leaving a risk pool of older and sicker people. This results in higher insurance premiums for those who are insured. But that's only true if the law forbids insurers from charging their customers according to the cost of covering them. If companies can charge more to cover people who are likely to need more care — smokers, the elderly, etc. — then it won't make any difference who does or doesn't buy insurance.
  • Everyone agrees that far too many Americans lack health insurance. But covering the uninsured comes about as a byproduct of getting other things right. The real danger is that our national obsession with universal coverage will lead us to neglect reforms — such as enacting a standard health insurance deduction, expanding health savings accounts and deregulating insurance markets — that could truly expand coverage, improve quality and make care more affordable.
http://www.latimes.com/news/opinion/la-oe-tanner5apr05,0,2227144.story?coll=la-opinion-rightrail


Although I believe the above referenced article is a terrific discussion of the under-belly of "universal health care," I add a few suggestions:


1. Require that all medical care providers charge the "reasonable, usual and customary" charge for each procedure, visit, consult, etc. regardless of the commercial or government administered health insurance issue.

A policy of honesty and transparency in medical billing would prevent medical facilities from charging premium/high amounts to patients who have no insurance. And, in turn, reduce the extraordinary stress and need for personal bankruptcies.

Indeed, it is standard practice for the medical care providers to charge no-insurance patients a premium dollar amount for each piece of care and treatment. In what reality does that make sense? If the patient has no insurance, he or she is treated by the medical care provider often in emergency situations.


Instead of having an actual price list for services rendered, medical care providers enter into contracts with individual health insurance companies for the price that will be charged for the particular companies' and government plans' insureds. Under these contracts, the medical care providers charge amounts for services that are less than the established "reasonable, usual and customary charge" applied to the uninsured.

So how many "usual and customary" rates for a particular service actually exist? How can there be more than one "usual and customary" rate?p;[----

I am not proposing that the uninsured be charged less for medical care and treatment simply because they are "self pays." I am proposing that there should be one established "reasonable, usual and customary price for a particular procedure (say, for example, an ankle x-ray). And then the patient (whether insured or not) could make the decision based on their economic situation to pay the amount themselves as a "self pay." Perhaps the insured patient has a medical savings account or does not want to file with insurance because the patient knows that the insurance company will argue about necessity of this ankle x-ray.

2. Medicare and insurance companies should rethink the concept of "P4P" or "value based pricing" and focus instead on disciplining bad doctors.

On October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will begin value-based purchasing (VBP), a three-year-plus phased implementation plan under which incentives will be paid to top performers. These incentives will be based on quality measures performance, not just reporting. Organizations that do not meet specified performance standards will lose reimbursement.

A better idea would be to discipline bad doctors. Unfortunately, very few states that even have an independent medical disciplinary board. Also, unfortunately, there are countless lobbying efforts to protect doctors' interests over patients' interests. For example, the AMA has mandated that any doctor who testifies against a doctor (and, as such, for the patient) is "practicing medicine." The doctors would therefore set themselves up for professional discipline and libel, slander and interference with business lawsuits by the defendant doctor. In fact, the litigation section of the AMA has actively assisted defendant doctors in suing the doctors who testify for patients in court cases.

3. Require logical changes to the current medical malpractice situation.

a. Stop the unreasonable amount of political lobbying by the American Medical Association, Pharmaceutical companies, State Medical Societies. The logic behind ceasing this type of political lobbying is that such lobbying reflects that the organizations have chosen to ignore the best interests of the public (who constitute patients) and, instead, chosen to devote the substantial amount of its efforts to benefiting and protecting physicians and their errors.

It is my humble opinion that these organizations actually owe a duty to the patients. In fact, their respective websites purport to help patients. Few patients even understand what their doctors' political lobbying efforts involve. Certainly various doctors will have different personal and professional goals. The most interesting cases often include physicians (who are repeatedly sued for negligence by their patients) who are politically motivated to engage in lobbying and financially supporting candidates who want to set caps on non economic damages.

The example that comes to my mind is Carle Clinic Association (Illinois) orthopedic surgeon Chris J. Dangles, MD. Query why physicians such as Dr. Chris Dangles would not be interested in lobbying for support for helping injured United States soldiers or crippled children? The query is unnecessary. The facts are that the lobbying efforts from physicians are nothing more than scare tactics and intimidation. The physicians will claim that they are very concerned about patients' access to medical care if all doctors flee a particular jurisdiction. But, in reality, the agenda of the lobbying physicians is focused square on at the financial interests of the physicians. There are no statistics to support the AMA or Medical Societies or physicians' claims that
patients have or reasonably will have no access to medical care.

b. Discipline bad doctors. It is such a simple concept and yet one that terrifies the medical community. A small percentage of doctors are repeat offenders. It is about protecting the public and reducing the costs associated with litigation.

c. Adopt policy of no fault medical malpractice insurance. The doctors would not be forced to admit liability. This policy seems critical if Medicare and various commercial insurance companies are refusing to pay on "never event" claims.

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