I think we found out today: magic!
Obama got the SEIU and various corporate entities involved with health care provision in a room and got them to promise to slash 150 basis points from the annual rate of increase in health care spending. How will we achieve this? Whitehouse.gov has a fact sheet which outlines the concrete proposals that came out of this meeting:
- Improving Care after Hospitalizations and Reduce Hospital Readmission Rates payments will be bundled to include the 30 days post discharge; readmitted patients will become a cash drain. If hospitals really are making patients sicker (or not bothering to make them well) because readmissions are lucrative, it should be interesting to see what lengths they will go to to avoid readmitting very ill patients.
- Reducing Medicare Overpayments to Private Insurers through Competitive Payments. Bye-bye, Medicare Advantage. Maybe. Medicare Advantage seems to cost more because it, er, provides more benefits. It also apparently has good patient satisfaction. Directly playing with senior health care can be politically dangerous.
- Reducing Drug Prices Only for Medicaid. No dollar item attached to it, probably because the savings are relatively trivial; Medicaid is a small part of the overall budget, and prescription drug prices are a small part of its budget, and an 8% decrease in a small part of a small part doesn't sound as good as Reducing Drug Prices.
- Improving Medicare and Medicaid Payment Accuracy aka the infamous Waste, Fraud, and Abuse. Traditionally much harder to get out of the system than promised by reformers, in part because the Waste, Fraud, and Abuse subsidizes other services, so if you eliminate Medicare overpayments, you suddenly get higher prices. This is why retailers do not actually attempt to push "shrinkage" to zero.
- Pay for Performance The Holy Grail of health care wonks. Good luck. Projected cost savings: $12 billion
This is all very well as political theater; politicians convene never-never working groups all the time. But, being perhaps too cynical, I suspect that the announced plan to save $2 trillion is going to be used to sell Obama's healthcare plan as if we'd already found it. Then when oh, darn, the SEIU doesn't agree to hold down wages or eliminate jobs, and pharma ratchets up the average price it charges the private sector to make sure it doesn't lose too much on its mandatory Medicaid discounts, etc, well, we'll all just have to dig into our pockets to pay for it, won't we?
I think the hope is that by bringing most of the players to the table, we will achieve a compromise that prevents any one or two players from making out like bandits. A vain hope? Possibly.
For myself, I'm pinning my hopes on the fact that our school district's health care premiums went up 16% THIS YEAR, and double digit increases are have been the rule for the last ten. While probably not typical, it is representative of the reason why health care reform cant fail.
ANY option is more cost-effective than what we have now. And in all likelihood it will end up being more efficient as well.
The problem will be finding out who/what is driving these cost increases and reducing their role.
no one is talking about what all this reform is doing to physicians. the insurance companies are going to benefit but doctors' pay is decreasing dramatically--thanks to state cuts in medicare and medicaid. i am a cardiothoracic surgeon and trained for 9 years after medical school to see my practice dicated by insurers is depressing--patient care isnt important but saving dollars for these companies is. med student enrollment is going down and specialties like my own are seeing rapid decreases in their numbers. why would one train to be a surgeon if it requires one to sign one's personal life away due to long hours and huge responsibility to patients when you can be a dermatologist, earn more, and live more stress free? the administration doesnt realize that they are disincentivizing the brightest in our country from pursuing medicine as a career and this attrition is going to have dramatic effects on their healthcare plans.
What you are describing sounds like a 'pre-existing condition'. Not really Obama's fault. Unfortunately, some sort of administration of the process will exist. Govt. or Private. Pick your poison. One of them has shareholders who want to see increasing profits. Both have huge bureaucracies.
I'd like to get a real look at the VetAdmin health network as a potential model, to forecast costs and perhaps test solutions.
VA hospitals are among the best set ups i've seen.
The only thing distinguishing socialism from capitalism is the absence of motivation. Losing a talented heart surgeon is an ominous sign, and one entirely unappreciated by the bean counters. The dumbing down of medical care is inevitable as physicians become salaried government employees, providing services to consumers in a de facto rationed care environment. As America's best and brightest choose other professions, it's goodbye excellence, hello NHS. National Healthcare Workers Union, unite!
For Woowoo and Whitecoat,
Well, first of all, money does motivate some people, relatively so. As for most all of us, however, work motivation doesn't come down only to doing what would earn us the most money. A world like that doesn't have many people doing all the work that they currently do. Also, people like me gain INTRINSIC satisfaction from actually doing my work. The workplace and colleagues are other factors.
Woowoo, you may be one of the majority in your profession who chose to be a doctor for money. It's very sad, actually, because the medical field is not a net bonus to the economy. If you are intelligent enough to become a doctor, you could have studied science. Science research is what can actually give rise to technology which can make life better and expand the economy in a good way.
More... I have a family member who is a cardiologist, and I know that you're basically lying about not making a substantial salary. What other work in your city pays more do you think? Percent of workers doing said work? Would you consider becoming a nurse? That way, you wouldn't be pissed off so much about payments from insurance companies. Or perhaps, what, store manager? Check out clerk, an hourly employee; even better, right?...you already know for sure what you'll be earing! See, as these rhetorical questions illustrate, US doctoring has too much become a 'ticket' for money: earn a lot, then invest, then don't work, that's the idea. Tragic part is that doctors get soaked by their investments. Better system is the UK or European system...high salary, but not obscene with normal hours. Govt can fund the education (BTW, Doctors biggest group not paying back their student loans!)
Lastly, role of doctor 'excellence' and 'experience' far over stated in outcomes of well being. That's why we can see so many different routes of care for same presenting conditions across the country with varying outcomes.