|
|
| |
|
Community For Better Health Care
|
|
|
Medical Myths
Current
Issue: (previous
issue) (past issue)
|
Rationing will be Rational? Isn't that Un-American?
|
|
It
all sounds very reasonable: to set priorities, to use the most
effective therapies, to serve the neediest first. Rationing is a
given, say reform advocates. Insurance companies already do it.
Let's just make it rational and fair.
Some
say that Comparative Effectiveness Research (CER) isn't really
about rationing. "Nothing in the legislation…provided for
payment restriction based on CER findings," writes Jerry
Avorn (N
Engl J Med 2009;360:1927-1929). It's "Orwellian"
to suggest such a thing. Anyway, "unaffordability rations
care far more than comparative studies ever could."
The
end-stage of rationing actually has little to do with comparative
effectiveness. There are more basic questions: "Have you
suffered enough yet?" And "Can you get through the
clinic door?"
One
young Canadian mother suffered from pain and incontinence and
required a walker, because of spondylolisthesis. She aggressively
presented herself at four surgeons' offices before or after hours
or at lunch, pleading her case. Four surgeons saw her. Three said
she'd just have to wait, as others were either older than she was
and/or had already suffered longer. Finally a surgeon took pity on
her and worked her in - only 6 months later - because she was
"too young to have to live like that." Never mind the
need for emergent surgery in the event of neurologic compromise,
or more than 2 years of total disability.
CER
results can't be applied until a patient can get a diagnosis. A
video team documented efforts to get help from Canadian clinics,
and then interviewed
a number of Canadians.
CER
is not needed to determine that it is traumatic and less safe to
give birth in corridors or reception areas because labor beds are
full - as 4,000 mothers did in the UK in 2008. The government cut
maternity beds by 22%, although birth rates were up 20% in some
areas, and spending on the National Health Service was tripled (Daily
Mail 8/26/09).
A
pediatric ophthalmologist, in the only such practice in Georgia
still accepting Medicaid, writes that Medicaid will not pay for
the antibiotic needed for an infected corneal ulcer. It takes a
year to approve a contact lens after surgery for neonatal
cataract. Private funding fills the gap. No research is needed to
tell the difference between successful treatment and likely
blindness (Zane
F. Pollard, M.D., American Thinker. August 2008). But
how many such treatments would be denied while approval wended its
way through a
system with 111 bureaucracies?
With
or without CER, government plans always ration care. "The
idea of an omnipotent board that makes unpopular decisions on
access and price isn't a new construct. It's a European import. In
countries such as France and Germany, layers of bureaucracy like
health boards have been specifically engineered to delay the
adoption of new medical products and services, thus lowering
spending" (Scott
Gottlieb, Wall St J 6/25/09).
We
have our own
examples in the U.S., as in Oregon.
Throwing
$1.1 billion into CER is guaranteed to produce no new
knowledge - only poorly controlled data about the
implementation in different practice settings of methods already
tested for safety and efficacy in well-controlled studies (Naik
AD, Petersen LA. The neglected purpose of
comparative-effectiveness research. N
Engl J Med 2009;360:1229-1231). It will provide the
rationale for rationing.
Read
the entire myth . . .
Feedback . . .
Subscribe
MedicalTuesday . . .
Subscribe
HealthPlanUSA . . .
Medical
Myths Originate When Someone Else Pays The Medical Bills.
Myths
Disappear When Patients Pay Appropriate Deductibles and
Co-Payments on Every Service.
subscribe
|
Previous
Issue: (current
issue) (past issue)
|
Don't Profits increase the cost of health insurance?
|
|
Myth
25. Medical care costs too much because private corporations make
a profit.
Sunday,
November 15th, 2009
In
his address to Congress on health care reform, Barack Obama cited
Alabama as a state in which almost 90% of health insurance is
controlled by one company. "[A]n additional step we can take
to keep insurance companies honest is by making a not-for-profit
public option available in the insurance exchanges."
The
"People Before Profits" slogan also reflects the belief
that it is not only inefficient and costly but morally wrong to
make a profit from providing health insurance or medical care. (Also see Myth 22.)
By
far, the dominant players in the health insurance market are
nonprofits, especially Blue Cross and Blue Shield. The largest
insurer in virtually every state is a nonprofit (John
Lott, FOXNews.com 9/16/09).
About
55% of insured employees receive coverage through their employer's
"self-insured" plan. For Alabama, the correct percentage
insured by one company is 36%, not 90%, when the employees of
self-insured companies are in the denominator.
Getting
rid of profits would not reduce costs, Lott writes. Costs would go
up because without profits there would not be the same incentives
to hold them down. Profits are the reward for figuring out what
consumers want. "Profit maximization combined with
competition is the only reliable way we know to keep costs
down," states Baylor economics professor Earl Grinols
(ibid.).
A
reality check on health insurers and profit: (more…)
Feedback
. . .
Subscribe
MedicalTuesday . . .
Subscribe
HealthPlanUSA . . .
Medical
Myths originate when someone else pays the medical bills.
Myths
disappear when Patients pay Appropriate Deductibles and
Co-payments on Every Service.
|
|
Past
Issue: (current
issue) (previous
issue)
|
Medicare is Efficient
and Fair
|
|
Myth
24. Medicare is the model of efficiency and fairness.
Medicare
is immensely popular, has very low administrative costs, is
already a working model, … it is said: Why not just have
Medicare for all?
At
one time, calling Medicare "socialized medicine for the
elderly" caused stunned silence in the Congress. Now, if one
opposes "socialized medicine," at least one listener is
bound to dare you to say you're opposed to Medicare.
Government
may bumble at almost everything, but in a handful of areas it does
better than the private sector, writes Nicholas Kristof. He lists
firefighting, police protection, and health care. Also postal
service and education (NY Times 9/3/09).
And
even if government is inefficient, he writes, at least it is fair.
It doesn't cancel your coverage if you get sick.
Here's
a reality check on Medicare:
-
It is structured as a Ponzi scheme. Or should
we call it a Madoff scheme? Its unfunded liabilities - an
estimated $38 trillion - are unpayable. Promises made to Baby
Boomers, who were forced to pay into the system throughout
their working lives, simply cannot be kept. Their money is
gone, just like that of Madoff's "investors."
-
Its low administrative costs are a mirage. See
Myth 2.
-
It is sustained by the general fund and by
cost-shifting.
Medicare Part B premiums pay only about 25% of the
cost; the rest must be made up from the general fund. In
addition, Medicare underpays hospitals and physicians, and
costs are shifted to private insurers. The hidden tax on
private insurers to subsidize Medicare and Medicaid amounts to
$89 billion/year, or $1,788 per average family in a PPO plan (Grace-Marie
Turner and Joseph Antos, Wall St J 9/11/09).
-
It is unfair to both patients and physicians.
Payments to physicians are often so paltry that patients are
having increasing difficulty in finding a physician who can
afford to see them. Coverage of prolonged serious illness is
poor; seniors who exceed the allowed number of hospital days
are on their own. Neither is Medicare a model for
comprehensive coverage of non-catastrophic costs. Seniors pay
50% of their medical bills out of pocket, and most buy
supplemental coverage (ibid.).
-
The system is rife with fraud. An anti-fraud
campaign went into high gear with the passage of the Kassebaum-Kennedy,
Health Insurance Portability and Accountability Act (HIPAA) of
1996. Hundreds of millions of dollars were made available to
prosecutors, along with huge penalties and new tools: a fraud
hotline, bounties of up to 30% of amounts collected, and money
laundering charges, on which the accused can be convicted
without being convicted of any underlying fraud. This amounted
to a post-hoc criminalization of medicine. Still, despite
allocating $1.13 billion for "program-integrity" and
enforcement activities in 2008, government-wide "improper
payments" allegedly amounted to $72 billion that year,
writes John Iglehart (N
Engl J Med 7/6/09). "[I]n our freewheeling
society driven by capitalism, there is a strong distaste in
many quarters for overzealous investigations," Iglehart
opines. While physicians may be ruined or even imprisoned over
alleged coding errors, the threshold for investigating a
Medicare carrier is $200 million (Theresa
Burr, J Am Phys Surg, winter 2003). The
Government Accountability Office found that CMS enrollment and
inspection procedures were so poor that it routinely granted
billing privileges to fictitious companies with no clients and
no inventory (GAO-09-838R
Posthearing Questions; 2009).
-
Government care costs much more. The passage
of Medicare led to an immediate, enormous jump in spending.
Between the introduction of Medicare in 1965, and 1970, real
hospital expenditures jumped 23%, reports Linda Gorman (Library
of Economics and Liberty 6/1/09). Since 1970,
Medicare's per-patient costs have risen 35% more, and
Medicaid's 34% more, than all other medical care in America.
This analysis greatly underestimates the cost of government
care by counting all Medicare prescription-drugs purchases as
part of private care; not adjusting for billions of dollars in
cost shifting from Medicaid to SCHIP; and counting care
purchased privately by Medicare and Medicaid patients
(including Medicare copayments and Medigap premiums) as
private, without counting those patients as recipients of
private care (Jeffrey
H. Anderson, New York Post 7/18/09).
-
Medicare taxes impose uncounted costs. Among
the hidden costs of government programs is the deadweight cost
of taxation. The taxes that finance Medicare impose costs on
society in the range of 30% of Medicare spending (Michael
Tanner, Cato Policy Analysis #642; Aug 6, 2009).
Additional
information:
-
"A
Brief History of Ponzi Schemes," by Craig J. Cantoni, J
Am Phys Surg, Spring 2009.
-
"U.S.
Suffers from Fiscal Cancer, States U.S. Comptroller David
Walker," AAPS News of the Day 1/23/08.
-
"Crime,"
AAPS News, June 1996.
-
"Anti-fraud
activities thriving," AAPS News, February 1998, p. 3.
To
read the Entire AAPS Myth 24 . . .
To read more myth busters
from AAPS. . .
Feedback .
. .
Subscribe
MedicalTuesday . . .
Subscribe
HealthPlanUSA . . .
Medical
Myths Originate When Someone Else Pays the Medical Bills.
Myths
Disappear When Patients Pay Appropriate Deductibles and
Co-Payments on Every Service.
top
|
|
For other issues, please visit our archives.
We
invite you to sign up for this
biweekly newsletter.
|
|
|
