Health Care 2009
July 7, 2008

Washington is caught up in another one of its health-care spending burlesques, and liberals are belting out their favorite tunes. The GOP wants to “wipe out Medicare as we know it,” sings Harry Reid. “The Bush Administration is perfectly happy to have billions of dollars going to insurance companies instead of Medicare beneficiaries,” croons Pete Stark.Republicans should be flogging themselves – for falling into this political trap. Doubly so because the theatrics are a preview of the health-care market if Democrats control both Congress and the White House. If John McCain needs another health-care red alert, here it is.The fight over doctor fees is merely an appetizer for such a system, where competing interest groups would clash for their share of the spending pie. Highly politicized Medicare-like price controls on providers and services would spread to every health decision. The result would be rationing and declines in quality of care….The GOP is losing the Advantage fight because Democrats are pitting physicians against the insurance industry, which is about as popular as Big Oil. The Bush Administration has imposed a regulatory freeze that will give Congress three days to work out a new reprieve for doctors when it returns from recess today. But the fuse will still be burning – and Republicans will continue to lose if they don’t get behind a reform alternative.

Go HERE for the entire column.

WASHINGTON – The Bush administration said Monday it will delay paying doctors for treating Medicare patients in early July to give Congress more time to block a scheduled 10.6 percent fee cut. The decision by the Centers for Medicare and Medicaid Services doesn’t block the cut, scheduled to take place Tuesday. It’s up to Congress to decide that.

See here for the full article.

If you consider the top five options noted in the report, with respect to anticipated revenue gains, this is a grim report which bodes ill for physicians and patients, effectively addressing in only one respect an urgent health care need.1. A center for medical effectiveness essentially marries data doctors have, about efficacy of treatments, to data on the cost of those treatments, which we don’t have. By making patients and physicians consider not just the benefit but the cost of a given treatment, and by increasing co-pays for treatments judged to be cost ineffective, the study projects the single largest savings — $368 billion over ten years. This is essentially rationed health care; I do think it’s coming, and it’s not going to be popular.2. By taxing sugar in sweetened drinks, the study projects savings of $283 billion, the next largest area of projected savings. Um, don’t bother. Obesity is by far the most important health care problem in the US. Effectively addressing it would save gobs of money. But any primary care physician will tell you the sugar in sweetened drinks is not even the tip of the iceberg that defines this problem. Obesity has to do above all with inadequate exercise, and that has to do with lots of things – depression, television, lack of discipline and abdication of personal responsibility, the burdens of working parents, the architecture of our towns and cities which abjure sidewalks for an extra lane on the road for cars, fast and processed food – I mean the list goes on and on. The consequences are devastating, including arthritis, diabetes, heart attacks, strokes, peripheral vascular disease, sleep apnea, insomnia and increased susceptibility to infection. The study is right to focus on this problem but wrong to suspect this feeble measure will make a difference.3. The next most valuable benefit comes from changing the basis for reimbursement from office or inpatient visits to a disease based model, ie, you’re paid a single amount for a given illness, regardless of the number of visits required to address the problem. Bad idea:
a. there are already incentives to limit the number of office or inpatient visits, in the forms of copays and the inherent limitations of time available for both patients and physicians;
b. there’s no way this model would accurately account for the varied needs of patients and would therefore encourage pruning from our practices the sickest patients. For instance, I see one patient about every two weeks, in my office. She has multiple medical problems, has a niece who lives nearby but who works two jobs and can’t pay her aunt the attention she needs, and I’ve found from hard experience that seeing this woman less frequently – let’s say once a month – results in hospitalizations to deal with the accumulated problems that have gone unaddressed. Switch this patient to an “episode of care” model and she’s in big trouble.4. Next comes a two dollar tax on cigarettes to reduce smoking, saving projected $191 billion. Good idea!5. Finally comes reducing reimbursements in high cost areas based on national averages, saving $158 billion. This is just a cost cut to physicians. Good luck with that and get ready for the increased attrition of doctors willing to accept Medicare.Overall, I think the study is discouraging and, from a primary care doctor’s perspective, all but ignores the single biggest area of potential savings – dealing with the awful consequences of our lack of daily sustained aerobic exercise – which by the way means an hour a day, seven days a week, on the treadmill, at four miles per hour or better. If you’re not doing that then stop fooling around, put on your sneakers and get going. And if you are doing that, guess what? You’re going to live a long healthy life, with relatively few incurred medical expenses. Joel Keenan

Here’s a new post from a concierge physician, whose blog link has been added to the Blogroll (see conciergedoc):

“Ironically, I’m in the midst of starting our own retainer model practice, from scratch.  It’s actually along the lines of a hybrid model, where I am seeing both concierge patients, as well as traditional PPO,Medicare patients.  This way, I hope to have a better balance between the economics of startup and the downstream benefits of a retainer practice.  So far, we haven’t started really marketing the practice. But we are getting some patient’s from jsut word of mouth. The area the practice is in is fairly affluent and people to have higher expectations of service, which is also a reason why I think my practice will eventually have demand. However, I agree with the people above… there isn’t a line waiting to join…yet.  Maybe next year I’ll be at the conference. I did attend last year and found it very useful. I made some good contacts, including you John.”