Cost Control Efforts in MA

Oregon efforts at health care reform are consumed with regulating insurance in isolation from providers, but eventually people will figure out that the only way to get cheaper health insurance is to get cheaper health care.  Massachusetts, which is a good proxy for life under PPACA is addressing the issue head-on:

The governor recently proposed legislation that would allow the insurance commissioner to scrutinize contracts setting the amounts insurers pay hospitals and doctors and reject health insurance premium increases based on excessive fees for providers.

The administration has scheduled four days of hearings starting June 27 on how to control health care costs. Legislators held their own hearing this month and are grappling with whether to support the governor’s bill, a process they have warned could take months.

Developing an effective doctrine for how, what and why providers should be compensated is the central dilemma of health care reform.  I wish MA good luck.

Health care reform turns doctors into slaves?

Rand Paul seems to think so.  Histrionics aside, there is a real issue there.  The term Rand Paul seems unfamiliar with is 'public servant', i.e. if health care is to be a public good then care providers are going to be more like fire fighters or police officers and less like lawyers.  That is a big change, for patients and doctors alike.

Good Government

25 Good Ideas, per Harvard Kennedy School.  Of the bunch I think the Civic Consulting Alliance in Chicago sounds the most interesting, not exactly how I remember Chicago politics.

Vermont Single Payer

That Vermont is on the cusp of adopting a Single Payer health care system is getting notice across the nation. What gets less notice is the structure of that particular arrangement.

At heart, what has been agreed to is a grand bargain between people and providers. Providers will provide necessary care and people will pay for it, under a mutually agreed rate structure and limitations. That is the key hurdle single payer plans must climb, getting providers to accept pricing regulation. Other aspects of single payer have been done before, taxes and government health care are not new but the provider pricing regulation is unprecedented.

In Oregon proponents of Single Payer generally brush aside cost control with hand-waiving about “negotiating”. They ignore the reality that providers have choices, either to not participate and effectively create a second, smaller and much more expensive private market or to even move out of state. Buy-in from providers is critical, as it is from people with respect to limits (i.e. no “death panel” drama). Without the cost control mechanism single payer is nothing but a new tax plan.

I expect Oregon will learn a lot from Vermont, I hope we learn the right lessons.

Correction: Provider pricing regulation isn't totally unprecedented, but Vermont's plan is significantly tougher and broader.

Things I like: Portland Police Edition

I was impressed with a recent speech by Portland Police Chief Mike Reese to City Club.  A former counselor with Boys and Girls Club with an educational background in psychology and public administration, he seems as suited to run a non-profit as he does a metro police force.

A story in today’s paper suggests his influence on the department, and I like it.

Doctors as Angels?

I have a lot of respect for Paul Krugman’s writing, but he’s off in lionizing doctors:

The idea that all this can be reduced to money — that doctors are just people selling services to consumers of health care — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.

In reality, doctors are people.  They are subject to the same frailties, vanities, and flaws that every human being suffers from.  And at least some people know this and are using it to their advantage:

Novartis persuaded doctors to promote Trileptal, and five other of its blockbuster drugs, for off-label uses through millions in “kickbacks” disguised as speaker fees at continuing medical education programs. The company implemented an aggressive recruitment effort in order to train up to 4,000 physicians to speak at these events. Furthermore, the speakers were not recruited based on professional credentials but rather targeted those based on prescription-writing volume potential. According to whistleblower Jeremy Garrity, “As long as they had a prescription pad and were willing to prescribe our products, they qualified as Novartis speakers.” Once speakers were accepted on the speaker circuit, minimum prescription levels were required by some Novartis managers. According to Garrity, he was required to tell underperformers that they would be removed unless they raised prescriptions to a certain level. The company conducted return-on-investment analysis of its kickback scheme.

Note that physicians faced no consequences for their participation, only the drug company.  Is there any other profession that can take bribes in return for robbing the public on a massive scale, get caught and unambiguously exposed, and then walk away without any legal liability?  That’s what you get for pretending doctors are angels.

…

On second thought, Wall Street is an obvious example.  I guess doctors can be added to the upper class of Greenwald’s two tiers of justice.

20 people in a room saying they want to pay less for health insurance

It’s a question I posed in a comment on this post, and I’ll repeat it here:  What is the point of a public hearing on health insurance rate increases where the only people in the room are the public and the insurer?