Big on Health, Light on Reform

Big on Health, Light on Reform

Paraphrasing Sen Ron Wyden (D OR) produces the most accurate soundbite description of the House' health reform bill.

Is this the best we can do?

If the answer is yes, we're in deeper trouble than even I thought. I'm really disappointed with the Republicans. They are supposed to be the budget hawks, but instead they've spent their time railing against abortion funding, illegal immigrants, and death panels, along with scientific research and taxes on device manufacturers. Instead of attempting to govern responsibly, they've abandoned all morality in their quest to re-energize the lunatic fringe of their once-dominant party. Now comes news that Maine's Susan Collins is convening news conferences to rail against the cost of the bill.

With all due respect, Senator, this isn't exactly new news. Now you're getting concerned about cost? After nine months of debate, discussion, and appearances on Meet the Press? Not to single out Collins; at least she's finally saying something rational about cost.

While there's plenty of blame to pile at the door of the Republicans, it is the Democrats who are to blame for coming up with a huge entitlement program set up to do nothing but grow.

Cost containment as proposed in the bill is in the form of cuts to Medicare totaling about $420 billion, including:

- $155 billion (about) from price cuts to hospitals,

- reductions in Medicare Advantage subsidies,

- increasing drug rebates payable to CMS, and

- requiring CMS to negotiate with pharma for Part D drugs.

Then there's a potpourri of funding for Accountable Care Organizations, better primary care coordination, research on quality and effectiveness, and other should-have-been-doing-all-along initiatives.

As for real cost containment, methods/techniques/tools that can actually reduce cost over the near term in the public and private sectors? Bupkus. Nada. Zippo.

Sure, at some point in the future this research will result in data we can use to recommend more changes. But by that time we'll be broke, and will own everything of substance.

Oh, and when insurance underwriting reform kicks in health plans will have to take all comers, yet at 2.5% of adjusted gross income, the mandate penalty is not tough enough to force compliance. What we'll get is individuals and families buying coverage when they need it, only to drop it when the condition is fixed/surgery completed/rehab over. And under the terms of the House bill, you could fall off your motorcycle, buy insurance, get treated, and then stop paying premiums when your rehab is over.

I'm no fan of the insurance industry, but that just isn't fair. And lest you think this isn't going to happen, talk to Charlie Baker, former CEO of Harvard Pilgrim Health in Mass. It's happening in Massachusetts today.

Drastic times call for drastic measures. If we aren't going to seriously consider Wyden-Bennett - and more's the tragedy if we don't, then we need cost containment with teeth

How about starting with normalizing treatment costs for specific conditions? The huge and wildly inappropriate variation in practice patterns and costs associated with conditions such as COPD and back pain and prostate cancer and diabetes and dozens of other conditions have to stop. Medicare should, and could, gradually ratchet down reimbursements across the country till they are match global reimbursement for care delivered by delivery systems that are demonstrably efficient and deliver quality outcomes - Mayo, Lahey, Geisinger, et al.

Or develop an all-payer fee schedule (similar to the one in Japan) allowing all payers access to the Feds negotiating power.

Crazy? Sure. But the current bills will not reduce cost inflation. And therefore, sure as the sun comes up tomorrow, within ten years you will be paying $30,000 for family coverage. And pretty poor coverage at that.

What does this mean for you?

Despair? Disgust?

© Copyright 2009 by Joseph Paduda. All rights reserved. Reprinted with permission. This blog originally appeared on Managed Care Matters.