Day: August 7, 2009

Another Government Run Program

The health care debate has turned from informative to one of hate and bashing.  All on the Right have used many analogies to downplay the effectiveness of the government to run a health care system.  Their arguments have been that the government is not a reliable manager because of the stimulus plan or the cash for clunkers or yada yada.

First of all, the economy is looking minutely better, but there is a far way to go.  Cash for clunkers is creating a demand that the industry desperately.  Unfortunately these “good” signs are just show or a hiccup, if you will, unfortunately, there is no economic engine right now to feed the economy.

Maybe the Dems should try using a success to make their case and stop trying to dazzle us with lots of information that we cannot use and seldom understand.

That out of the way, the Right has said many, many things about the Dems health care proposals, but the loudest has been that the government is incapable of running health properly.  Is that really true?  Or is it just politics and the game?

The GOP has used a report by the CBO that says that proposals on the table would be disastrous for the future economy of the country.  Repubs like the CBO…why?…it is because it is a non-partisan group and they have no stakew in the debate.  At least that is their reason for quoting the CBO reports on numerous occassions.

Since the government is being accused of being ineffective in actually running a health care plan, let us look at a report by the CBO on the program of health care for the Veteran’s Administration.

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 “Safe—avoiding injuries to patients from the care that is intended to help them.

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 Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively).

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 Patient-centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

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 Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care.

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 Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy.

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 Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.”

These were the suggestion of the Institute of Medicine made to the VA and in turn has incorporated into the care plan.  The CBO went on to say:

Department of Veterans Affairs provides a large integrated delivery system financed primarily by public budgets.

VA’s experience demonstrates the potential for improving a system’s performance by sustained efforts to monitor indicators of quality, access, and satisfaction. Most of the criteria that VA uses for assessing the performance of senior-level executives, mid-level managers, and even health care providers relate directly to indicators of quality, access, and satisfaction for the facilities or units for which the individuals are responsible. The result has been notable improvements in many of the indicators, suggesting that tracking such indicators closely and consistently may be key to improving a health care system’s performance in those areas.

VA’s structure as a vertically integrated system that operates on an appropriation may have helped the system to focus on providing the best quality of care possible for a given amount of funds. As noted earlier, for many private providers, fee-for-service payment creates an incentive to perform more billable services and procedures. Although VA’s integrated structure and capitated budgeting alone do not give providers or managers incentives to focus on quality, those attributes may have made it easier for the department to implement its management plan built around tracking and rewarding both managers and employees for improvements in performance.

Improvements in quality might also be encouraged in private settings through the development of more capitated payment systems or a blend of capitation and fee-for-service payment of physicians. Another alternative would be payment systems based on an aggregated physician-hospital unit, in which high volume is penalized. The Medicare Payment Advisory Commission has suggested changes to revamp Medicare’s payment systems in order to improve incentives for quality of care.

But I guess the CBO is only as good as it is when it makes their case for them.

I visited a local VA hospital and talked with several people in the buiulding waiting for their appointments…..I found that not one had anything bad to say about the treatment they were receiving….the only negative thing they had to say was that there was a long wwaiting period before they could get onto the program….but after that there was nothing that they could say negative.

Yep, GOP another badly run government program.

What The Hell Is A Health Co-op?

Professor’s Classroom

Subject:  Health Care

A health co-op?

Single payer health care is DOA…..public option is on life support…..now the latest idea, but not an original one, is a health co-op.

I know…I know…what the hell is a health co-op? I will answer that in awhile but first let us look at why it is a priority, at least in one Senator’s little mind.

Sen. Conrad threw this out there in the beginning of the health debate, back in June. Here is what Slate.com says about co-ops:

A cooperative is basically a not-for-profit patient-run insurance organization. Instead of executives running it, you’d have people who are themselves enrolled. There would be relatively little overhead compared with a private insurance company—no profit means less advertising and no commissions or underwriting—and every patient would have a say in how it’s run. Many such cooperatives already exist. Group Health Cooperative of Puget Sound near Seattle and HealthPartners in Minnesota are two of the most successful examples

The co-op idea is being pressed by Sen. Kent Conrad (D-ND). “I believe they’re a good idea because they can provide competition to for-profit insurance companies, and one of the things we need in the system is more competition,” he says.

Conrad is trying to deal with objections from the insurance industry, as well as from some health care providers and some Republicans, to something called a public option. This would be a government-run plan designed to nudge private insurers into lowering prices and make health insurance more widely available. Opponents are concerned the government plan would pay too little to doctors and hospitals and would drive private insurers out of business because they couldn’t demand the same kind of deals from doctors and hospitals.

But what does Conrad’s proposal say?

The proposal also says:

* There are no free rides in co-ops. Every person would have to pay dues, whether they have the money on their own or they get a government subsidy (which would have to be worked out). Costs are not spread among paying and non-paying members.

* The feds could pay the start-up costs for a co-op, but could not pay to sustain it.

* Co-ops could be different sizes — local, regional, or national. NYC might have several, while parts of North and South Dakota could team up to offer one.

* Every state would be required to have at least one co-op option.

What would the costs look like to the individual?

The cost for a mid-30s single, self-employed woman runs from $78 per month for a catastrophic plan to $277 per month for full coverage, with big swings in deductibles and cost sharing. A family of four, with no employer support, would pay $244 per month to $862 per month.

NPR is reporting that there are some drawbacks to the co-op idea.

Several co-ops have failed because of tension between the board and health care providers such as doctors and hospitals. The providers wanted more money or autonomy or better facilities than the co-op was willing to provide. The relationship between doctors and HealthPartners appears to be good.

Now with that drawback how would a massive co-op be with massive amounts of cash at their disposal? The failure rate would most likely be huge….greed and power would kill this type of effort….as it does with most other efforts.

Now my question is–what will the co-op regulation look like to make sure that the people are being treated fairly and honestly? Good question and there is NO mention of what regulations will look like. I guess that is for another day.

Personally, I think this idea sucks! It is to keep the insurance companies in the loop and to help protect them from health care losses. Wondering how much cash Sen. Conrad has received from Insurance companies…that should be looked at closely.

Will There Be Higher Taxes For Health?

This is the tennis ball of the health care debate…..basck and forth….back and forth…..prez will raise taxes….no!  there will be no new taxes on people making less than $250,000…..on and on and on and ………..

On a recent Sunday round of talk shows the leaders of the Obama economy seem to hint at the possibility of higher taxes down the road.

As reported by Peter Gorenstein of Health Information:

After Tim Geithner and Larry Summers opened the door to higher taxes to fight rising deficits and fund health-care reform on Sunday, White House press secretary Robert Gibbs scrambled to clear up the situation on Monday: “I don’t think any economist would believe that, in the environment that we’re in, that raising taxes on middle-class families would make any sense.”

“If we get a more balanced view of our balance sheet we’ll realize that if we spend our money well then these great extra expenditures are going to actually make our economy more productive in the future,” he says. Spending on technology, education and infrastructure “will generate revenues that will allow us in the future to pay back any borrowing or lower taxes.”

Besides, when it comes to health-care reform the Columbia economics professor claims we’re already paying a virtual tax. “Right now we’re often paying for it in hidden charges so it’s like a tax but it’s a hidden tax,” he says in reference to the costs associated with paying for 50 million uninsured Americans.

Bottom line: Stiglitz says like so many of our issues, the health-care problem is not going away: “If we don’t do [reform] today, the problems will fester, they’re going to get worse and worse and in 15 or 20 years we still have a very big problem and will be even more difficult to make the adjustments.”

Of course, we can find an economist that will take the other side of the equation.  But I have said in the past that if health care fails this time as it did in ’94, then it will return in 20 years to take a bigger bite out of our butts.  Yes, health care will be paid for..but personally, I have rather see my money go to providing health care to Americans than  to see it used to foment war.  But that is just me.  I still feel that the American people, ALL of the people deserve the best from its government.

Hopefully, Americans realize that without income the government cannot provide any services that we, as Americans,  are use to.  Without income a budget is a worthless piece of paper.