WILL THE HOSPITALS SHUT DOWN?

NO, THEY WON'T.

Today, I was going to post my thoughts on The Soul of Republicanism, but I changed my mind when I saw Don McCanne's latest post:

US Hospitals Will Thrive Under Medicare For All

When you read it, you'll see that on April 4th of this years, a JAMA article, dated April 4th of this year, supposed that under Single Payer or Medicare For All,  hospitals would suffer grievously. Their income would be markedly reduced due to the lower reimbursement rates currently being paid by Medicare and Medicaid -- rates that hospitals are now able to recoup by charging private patients more -- a strategy which would be unavailable to them under Single Payer. Its conclusion is dire:

In the absence of exceptional public-mindedness among hospital leaders, supporters of Medicare for all should anticipate strong hospital political opposition, especially from leaders who have pursued strategies less focused on efficiency than on extracting ever-increasing payment rates from private payers.

Never particularly friendly to M4A, the New York Times, on April 21st, jumped on the bandwagon with an article whose headline was: Hospitals Stand to Lose Billions Under ‘Medicare for All'. Though the article did close with Dr. Adam Gaffney's assurance that decreased income would be offset by greater efficiencies, that assurance seemed, to this reader at least, not quite able to dispel the gloom of the Times' pessimistic headline.

On April 20th. The Huffington Post observed that hospitals ... alone account for roughly one-third of the nation’s health care spending. No other sector, not even pharmaceuticals, rivals it. Under the Medicare for All proposals from Sanders as well as some other potential reforms getting attention these days, the federal government would limit payments to hospitals, quite possibly reducing their incomes significantly.  Consequently, the hospitals have become part of an industry-wide lobbying effort to defeat any expansion of government-run health insurance, even relatively modest ones that wouldn’t do much to affect their revenue.

To clear the air, Matt Breunig, writing for the People's Policy Project,

Hospitals Will Do Fine Under Medicare For All

points out that in the U.S., 25% of hospital revenue is spent on administrative expenses, whereas hospitals in the Canadian Single Payer system spend only 12% of revenue on administration. What this means, Breunig continues,  is that the administrative efficiencies available under a Medicare for All system allow hospitals to offset 13 points of the 16-point revenue cut without digging into the actual cost of care. The remaining 3 points could come out of hospital profit margin (bringing the margin from 7 percent to 4 percent).

But there's more to it than that. Check out Woolhandler and Himmelstein's

Importance of Aligning House and-Senate Single Payer Bills The Right Way

which I present in my post, "Why Is American Healthcare So Expensive: Part Two." There  I discuss their analysis of the high cost of healthcare facilities like hospitals, dialysis centers, etc.  Woolhandler and Himmelstein write:

At present, hospitals’ success, and even survival, depends on generating profits (“surpluses” in non-profit facilities). Hospitals with a favorable bottom line can invest and add new buildings and programs, while unprofitable ones can’t modernize or expand, risking a downward spiral toward takeover or closure....It’s this profit imperative that drives hospitals’ financial gaming, e.g. upcoding, and concentration on the most lucrative services, such as elective cardiac and orthopedic services, rather than money losers like mental health. This payment mechanism ... also leaves the door open to investor-owned providers.

The answer to this, they write, is adopt the strategy used by some European countries, like Scotland, where the hospitals are paid not by procedure, but globally, with one payment intended to cover all  operating expenses. It's the way we in this country pay for firehouses, which, like hospitals, are resources for the public good. And if the firehouse needs to get a new fire engine, the firehouse applies to the municipality that governs it. No government is likely to last if it holds back on improvements the public sees is for its good. It would be the same with our hospitals. They would be expected not to show any profits at all. They could concentrate on their business -- which would not be making money, but healing.

In his discussion of all this, McCanne concludes:
Right now the two major hospital associations are partnering with other members of the medical-industrial complex to publicize [the notion] that hospitals will have to shut down if we enact and implement a single payer Medicare for All program. NOT TRUE! You should be prepared with your response when this comes up:


"Single Payer Medicare for All not only recovers a tremendous amount of administrative waste, but it also uses regional planning, global hospital budgets - like fire departments have - and separate budgeting of capital improvements to ensure that we will always have adequate capacity in our hospital system."

Amen.

The Soul of Republicanism is for our next post.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

"The Republican Party will soon be known as the party of health care – you watch."

In George Orwell's 1984,  the term "wordfact" is used to describe a government pronouncement which is demonstrably false, yet accepted as true by an abject populace which has to swear allegiance not only to the beloved leader, but also to whatever comes out of his mouth. To such a state do we seem to be descending when the leader of the GOP asks us to believe that his party will generate any healthcare program at all -- let alone a serviceable one. 

Putting it charitably, anybody -- other than White House sycophants -- who would endorse that fiction simply hasn't been paying attention. The GOP is the party of providing no meaningful healthcare whatsoever. So fiercely have they opposed healthcare that Paul Krugman, in today's New York Times,  describes their hatred of it as "pathological." I prefer to think of it as a natural consequence of their chief credo -- that entitlement to life, liberty, and the pursuit of happiness can be quantified in dollars: the more of them you have, the more entitled you become, and the less of them you have, the less deserving apparently, you must be of any good thing in life. From which it follows that to require the rich to help the poor is unutterably wrong -- "confiscatory," to use one of their favorite words.  Redistributing wealth downward in anathema to them, whereas redistributing upward is natural and right, the inevitable triumph of the stronger -- celebrated, they suppose, by Darwin.

Indeed, in today's corporate world, Cain's question, "am I my brother's keeper?" has developed a sinister answer, for our corporate masters do "keep" us, the way corporate  agribusiness keeps the sheep or cows it owns -- for their wool and their milk. And when we are no longer worth the shearing, or the milking, our owners dispose of us as efficiently as possible.

Thus our Republican overlords either approve of, or acquiesce in the abolition of ACA, and the gutting of Medicare and Social Security.  To them, it makes perfect sense: We are, from their point of view, simply not worth the money -- their money. For it is, increasingly, becoming all theirs.  According to an article in the Washington Post dated February of this year,  the top .1 percent own more than the bottom 80 percent.

Wealth Concentration Returning to Levels Last Seen During the Roaring Twenties

Arguably, the super-rich already own our government. Pfizer Pharmaceuticals alone devotes three lobbyists to each Senator and Representative; doubtless the rest of Big Pharma is similarly devoted: One of the results is that Medicare is forbidden to negotiate drug prices. And the only way Obama could get ACA passed was  to agree to the parameters stipulated by the Medical/Industrial establishment. It was imperfect to begin with, and Trump's continual weakening of it made it even less satisfactory,  But we should be grateful for it, wobbly as it is, for 20 million people are insured by it, and it's the only thing standing between many thousands and certain death.  And if in the courts Trump succeeds where he couldn't in the legislature the results will be catastrophic.

And as if that weren't enough,  I've just received a post from Don McCanne, who quotes an economic report signed by Trump. Its bottom line is there is no reason why Healthcare cannot operate in a market governed by free choice  -- thus dismissing the work of eminent economists asserting that the unique features and conditions of healthcare make it impossible to function effectively in a free market system. (One of many reasons: To lower costs, the risk must be spread as wide as possible. Competing systems divide the pool and thus raise the rates. In addition, many people who need medical care are in no position to "shop  around" for the best value, nor have they the information to make an informed choice. This is no time for ideology. ) McCanne says with breathtaking understatement "we can conclude that our health care financing system is not in good hands. We have to do something about that."

Oh yes we do, friends, yes we do. We live in a country which is not only in thrall to corporate interests, it has seemingly become hypnotized by its propaganda.  There are people who actually believe that National Socialists (Nazis) and Democratic Socialists (Progressive Democrats) are equivalent. And there are people who think that taking the profit motive out of medicine is an attack on our Capitalistic system. If they mean the Capitalism of unrestrained and unregulated greed, they are right.

What can we do?  We must each of us contact our representatives -- on the federal level -- and insist that only Medicare For All will satisfy us, and that we don't buy the Trumpian free market bulls**t.  And on the State level we must contact our State Assembly Members and State Senators, and tell them that the New York Health Act is what we need and what we insist on. For more info on NYHA you can click on:

New York Health Act Campaign

They've got everything from a brief, entertaining animation (see it!) longer videos with  more wonky explanations -- and everything in between. And it will have more suggestions about what you can DO.

And we must do all the above not only forcefully, but repeatedly. Don't rely on your friend or your neighbor to do it -- do it yourself.  Make time for it. Do it.  The revolution begins with us.

Everybody gets sick now and then. And when it's your turn, whose policies do you want  in place -- the Republicans (who really don't care what happens to you so long as their beloved free market is allowed to fly unconstrained) or the Democrats, whose guiding principle is EVERYBODY HAS A RIGHT TO  HEALTHCARE -- NO MATTER WHAT THEIR STATION IN LIFE.

Tell others how you feel.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

EXCUSE ME, BUT I HAVE TO BARF

This was how Don McCanne -- the distinguished physician and policy analyst -- ended his commentary upon reading the Health Affairs study of women who had been switched from Low Deductible commercial health plans to High Deductible Health Plans (HDHP'S), and who had been diagnosed with Breast Cancer. Most of them -- even those who had the money to pay for it -- delayed their care for many months, risking what the study termed, euphemistically, "sub-optimal results." McCanne writes:
We have serious problems with our health care financing system - a system that costs twice the average per capita of other wealthy nations yet falls miserably short in performance. In the meantime, the policy community busies itself with fixes that have clearly failed to bring our expensive system up to the standards of other nations. One of those fixes is high-deductible health plans....The policy community is quite smug now because moving to higher deductibles is working, according to their terms. People are limiting or delaying care because of these deductibles, thus meeting the goal of reducing health care spending. [But,] in our terms, is it really working? Is it smart health care shopping if the financial exposure causes patients to delay diagnosis and treatment of breast cancer? Should women be waiting to be sure that they really need this care by seeing if they develop further invasive or metastatic disease? Just asking that question depresses and even nauseates me. 

Where McCanne was nauseated,  I was enraged! I dashed off a missive -- more like a missile -- to my local network, shouting in bold type:
Hey, all you women out there, and all you men who love them, are concerned about them, and/or who are appalled by the disaster we call healthcare in the United States: We already know that mortality rates in child delivery are higher in this country  than elsewhere. But now, read Don McCanne's commentary, and then, to any of you still waiting to take direct action on behalf of the New York Health Act, I ask:

WHAT THE DEVIL ARE YOU WAITING FOR?!?! VISIT THE NEW YORK HEALTH ACT WEBSITE; JUST CLICK ON: 

https://www.nyhcampaign.org/

and read about all the things you can do, and do something. Don't wait for someone else to do it.

Wake up, people : The war against women is a war against EVERYONE! 

But then I calmed down a bit, and thought, "maybe I should learn more." So I looked at the original document and saw that its authors had suggested a palliative -- the implementation of  something they called,  "value-based features" in the HDHP's. That didn't sound very good to me, since "value-based pricing" means that if you need a pill to stay alive, the Pharma robbers are allowed to gouge you $1000 or more per pill. But no, this was seemingly more benign: 

Value-Based Insurance Design

seemed to mean, among other things, having little or no deductibles for things that are needed to keep you well,  and higher deductibles for things deemed unnecessary, or of no proven value. Leaving aside the question of whether this would work, I noticed that the aim of the authors was "cost-efficient health care services" -- that is more healthcare for the consumer dollar. But that, I realized, is exactly the converse of what the insurance companies are aiming for: more profit from each diagnosis -- more consumer dollars taken in, and less spent.  

In short, the authors of the study supposed that the only viable solution to the problem was within the current profit-driven health care system, when in truth, THE ONLY SOLUTION IS A SINGLE PAYER SYSTEM WHICH WOULD, OF NECESSITY, ELIMINATE VIRTUALLY ALL PRIVATE INSURANCE!

Having got that off my chest, I feel better.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

 THIS SUMS IT UP LIKE NOTHING I'VE SEEN BEFORE

In 1961, The American Medical Association was so upset about the approach of Medicare, that, as part of "Operation Coffee Cup," it hired the young Ronald Reagan to record on a vinyl LP (remember those?)  an attack on this legislation as the harbinger of a "Socialist Dictatorship."  In those days, I saw the AMA as the essence of die-hard, rock-ribbed conservatism. 

Boy, have things changed!  On February 13 of this year, Howard Bauchner, MD, the Editor in Chief of the Journal of the American Medical Association, published an editorial titled

Rationing of Health Care in the United States -- An Inevitable Consequence of Increasing Health Care Costs

In this editorial, the good doctor surveys the history of healthcare in this country since the sixties. He shows that advances in science have come with concomitant increases in healthcare costs, with every indication that these advances, and these costs, will continue to increase way beyond the rate of inflation -- providing increasingly critical challenges to our society. 

Don McCanne MD,, who comments on this editorial, says that before reading his commentary, you should read Bauchner's last three paragraphs.  So I'm supplying these paragraphs here,  followed by all of McCanne's commentary -- for me, both Bauchner and McCanne sum up what's going on. 

Here's Dr. Bauchner:

The United States is mired in a great philosophical debate. Is health care a right or a privilege? In part this debate is embedded in the historical, underlying sociopolitical discourse in the United States — is this a nation that champions individual rights and achievement at the expense of the common good? This philosophical debate plays out in health care. Rationing of health care is likely always going to occur, but for those who maintain that health care is a privilege, attention to rationing and attempts to ensure that rationing is minimized may not be a priority. Yet, even for those who assert that health care is a right and that health care coverage should be provided to all individuals in a more just and fair way, unless the relentless increase in the cost of health care is addressed, rationing of health care is likely to become more common.

Identifying approaches to mitigate the increase in health care costs has been elusive. Debates about waste in health care, prices of drugs and devices, volume, fraud, defensive medicine, inappropriate testing, and misaligned incentives have been ongoing for more than a decade. Each of these potential areas of cost containment provides income for specific groups, making change difficult. However, there is one area — administrative costs — about which there is broad agreement that it adds needlessly to the cost of health care, frustrates physicians and other clinicians, provides little benefit beyond employment, and clearly is one area in which the United States leads the world. These costs involve, but are not limited to, billing, excessive documentation, and the need to obtain prior approval for certain medications, radiological procedures, and specialty referrals. Although there is uncertainty about what percentage of the $3.5 trillion in annual health care spending is accounted for by administrative costs, if that amount is 10%, and could be reduced to 5%, an estimated $175 billion could be saved or redirected to provide care to patients and avoid rationing of some health care services. Reducing administrative costs should be the major focus of national efforts to reduce waste in health care and help control increases in health care spending.

For the United States to prosper in the 21st century, controlling health care costs is critical — indeed, it is the single most important challenge facing health care. Greater rationing of care is inevitable if health care costs continue to increase. Controlling health care costs is the only way to ensure appropriate investment in other areas, such as education, the environment, and infrastructure, and to provide a more equitable, just, and fair distribution of the remarkable health care advances that have been achieved with even more on the horizon. It has been said many times that in the richest country in the world, in which many of the greatest scientific and medical advances are developed, it is a blight on the US soul that each of its residents does not fully benefit from available health care.

https://jamanetwork.com/journals/jama/fullarticle/2725150

And here's Dr. McCanne:

For those of you who skip the quoted text and go right to the comment (often a wise move as a time-saver), please pause here and read the last three paragraphs of Howard Bauchner's editorial, and then return here.

How many times have you heard the opponents of single payer Medicare for All say that if we adopt such a system here then we'll have rationing like the socialist health care systems of other nations? Yet the irony is that we already have a major problem with rationing, and it is perhaps the cruelest version of all since we ration by ability to pay in spite of spending far more on health care than any other nation.

So how did we end up with both high spending and rationing? Quite simply we have the most administratively complex health care financing system of all nations, which is very expensive to run, wasting funds that could be used on health care for those who are victims of rationing, not to mention that our financing system is profoundly inefficient. Remember that tens of millions of US residents remain uninsured, tens of millions more face excessive financial barriers to care due to excessive out-of-pocket spending, and personal bankruptcy due to medical debt has not declined with the implementation of the Affordable Care Act.

Bauchner has defined the problem: profound administrative excesses. We know the solution: administrative efficiency through a publicly-administered, equitably funded Single Payer Medicare for All program.

There has been a surge in support for a public option such as a Medicare buy-in, but that only adds one more player to our administratively complex, wasteful system. There is also support being expressed for our employer-sponsored plans and for other private approaches such as the Medicare Advantage plans, but these perpetuate our costly, dysfunctional, multi-payer approach to health care financing.

So what about rationing? With Single Payer Medicare for All we would essentially eliminate rationing by insurance design, rationing by restriction of benefits covered, rationing by prohibition of obtaining care outside of narrow provider lists, rationing by unaffordable out-of-pocket cost sharing, or rationing by administrative barriers such as prior authorization requirements. These forms of administered rationing are harmful and should be done away with. Inability to pay for care would no longer be a barrier since a Single Payer Medicare for All program finances care equitably such that it is affordable for everyone. Maldistribution of health care professionals and institutions would be corrected through central planning and equitable distribution of our health care resources. Although all nations, including ours, must deal with queues, other nations have shown that the delays can be minimized by improving distribution of health care resources and funds, and also by simply applying the science of queue management, though that requires that we select to run our government stewards who actually care.


Bauchner says, "it is a blight on the US soul that each of its residents does not fully benefit from available health care." But we can fix this, and the sooner the better.

Near the end his commentary McCanne stresses the importance of electing to our government stewards who actually care.  I added the emphasis, because I think that requirement is paramount. What we too often get are people who claim to be stewards, but whose chief concern is staying in power. But to get some who actually care? I know they're out there. We just have to find them.

In his final comment, McCanne returns to Bauchner's comment that our failure to ensure that each of our residents benefits from available health care is "a blight on the US soul."

To heal that blight is our cause -- and it's a noble one. It won't be easy: Arrayed against us are the vast power of our corporate culture and even some of our leaders. 

They are banking on their privilege.

We are fighting for our lives.

Dio

PS: If you'd like to leave a comment -- and we hope you will -- simply click on the number of comments area and share your thoughts in the "comment box" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

ADVANTAGE? FOR WHOM?

A few days ago, I emailed the following to my local networks:

Hi Guys.

Way back in the day, Carol and I rejected Medicare Advantage basically because we didn't trust For-Profit interests -- namely the private insurance companies -- to look out for our interests. We wanted to feel that if -- God forbid -- we had a very serious medical condition, we would be able to go to a very big city like New York, or Boston, for the best doctors available, and not be restricted to the network offered by any Medicare Advantage Plan.

After all, we thought, unlike traditional Medicare, which pays by procedure, the government pays Medicare Advantage insurance companies a fixed amount per client, regardless of what is or isn't wrong with them.  So the less the insurance company spends on your care, the more money they make.

I then saw a release by AHIP -- the American Health Insurance Plan trade group -- which promotes the virtues of big insurance:

America’s Health Insurance Plans (AHIP)
February 7, 2019
AHIP Thanks Congress for the Overwhelming Support for Medicare Advantage


368 bipartisan leaders in Congress signed their support for the Medicare Advantage program. On behalf of the nearly 22 million Americans who depend on Medicare Advantage, America’s Health Insurance Plans (AHIP) thanks the 66 members of the United States Senate and the 302 members of the House of Representatives who signed bipartisan letters to express their strong support for the program.

There followed two links -- the first to a letter from the Senate, with 66 signatures,

Letter From the Senate

and the second to one from the House, with 302 Signatures

Letter From the House

I checked out the Senate letter and was relieved to see that neither New York Senator Gillibrand nor Schumer had signed it. I checked the House letter and was unsurprised to see that it had been signed by the newly elected Congressman from CD19 (our district) who, during the primary and general election campaigns, had made no secret of his coolness -- if not outright hostility -- to Single-Payer. I'm not including his name here because he is not the main issue -- which is welfare to Big Insurance.

I did, however, mention his name in the email I sent to my networks, including McCanne's admonition that

This is a clear rejection of single payer since most of the efficiencies and the egalitarianism of single payer are lost under a multi-payer system that includes private insurers...[It]  automatically eliminates any consideration of a bona fide Single Payer Medicare for All program.

What a brouhaha ensued! Many folks wrote me to say that they were going to seek clarification from our Congressman, who was shortly to appear at a local activist organization, which in turn asked me to inform "my people" that this was a benefit (for themselves, not the Congressman), so that coming to speak with him would cost them $19 each -- a fact which set off another round of emails. In the slew of emails was one from someone who said she had used Medicare Advantage for 10 years, and though she lives in Hunter, had never been prevented from seeing her doctors in New York City and on Long Island.  I saw that I needed to learn more about Medicare Advantage.

So I checked out an article by Austin Frakt in the New York Times, August 18, 2014: Medicare Advantage Is More Expensive, but it May be Worth It. 

Medicare Advantage Is More Expensive but it May be Worth It.

I urge you to read it, not only for the article itself, but also for the comments, which I found very revealing.  For one thing, apparently not all Medicare Advantage plans are the same, and some clients professed themselves satisfied with the service they receive. But the majority were critical of Frakt's article, claiming it was inaccurate at best and biased at worst. I urge you to confirm this for yourself. You'll see, among other critics of Medicare Advantage, the words of  a doctor from Albany, California, who wrote:

Can't we just be honest about this? The so-called "Advantage" plan is nothing but a poison pill to destroy a vital protection senior citizens of our nation now have. Dressing it up to make it appear to be slightly better in the short term does not alter the reality that without true Medicare to compete against we will be right back where we were before its inception. We really need to focus on quality, single-payer health care for all now, not down-spiral to another for-profit scheme that will continue to skim the cream from the middle working class.

Medicine is very hard work. Medical personnel require long, extensive and expensive training, supported by costly infrastructure. There is no "profit" for share holders and CEOs in good medical practice.

Darla Totten, MD

From Syracuse, NY, came these blunt words:

Medicare Advantage is corporate welfare, plain and simple. People who want to buy these plans should be able to do so, but the taxpayers should not have to subsidize insurance companies to make these plans feasible.

When the GOP kept criticizing Obama for "Medicare cuts," they were talking about cutting subsidies for Medicare Advantage. They are defenders of corporate welfare, not your health.

While I was writing this, I got a phone call from a volunteer from the activist group I mentioned above. She urged me to attend the benefit featuring the appearance of our new Representative. On the phone, I conveyed to her a summary of what I've been writing now, and she said, "I work in a doctor's office, so you don't have to tell me about Medicare Advantage: they're horrible, horrible! Sometimes they even deny needed care!" 

She urged me to attend the benefit and confront the Representative with my thoughts. I replied that I wouldn't mind embarrassing the man, but that I wouldn't want to embarrass the activist group, which has done good work around here. Indeed, the Representative himself may also do good work in the future -- it's just too early to tell, yet.

I've come away with the impression that so long as you don't need any serious medical interventions, Medicare Advantage might suit you. But, Heaven forbid, if you should need extensive, and expensive care, the wolf will remove his sheep's clothing and reveal himself as the bloodthirsty beast he is.  And if the enemies of traditional Medicare -- and there are many -- get their way so that a senior's only option becomes Medicare "Advantage,"  there'll be no more sheep's clothing -- only the wolves.

Dio

PS: If you'd like to leave a comment -- and we'd love it if you would -- simply click on the number of comments area and share your thoughts in the "comment box" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

NOT THE WAY TO CONTROL COSTS

In my post of 12/21/2018 (Why Is American Healthcare Se Expensive -- Part Two), I cited my heroes Woolhandler and Himmelstein, who said, "Medicare's (and other payers') Pay for Performance initiatives impose substantial costs on providers, with no evidence that they've improved patients' outcomes in any setting." [Emphasis added.]

This would seem to conflict with the assertions of those touting what they claim is the success of Medicare’s Hospital Readmissions Reduction Program (HRRP) in lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals.

But now (in January, 2019) comes a Paper in Health Affairs titled Decreases In Readmissions Credited To Medicare’s Program To Reduce Hospital Readmissions Have Been Overstated. The  Paper's abstract presents a statistical analysis far beyond my sphere of competence. But Don McCanne of the PNHP (Physicians for a National Health Program) comments:  "This study shows that, at a minimum, the benefits of penalizing hospitals for readmitting patients have been tremendously overstated."  Moreover, he points out the additional concern that

patients are often held on observation status rather than being readmitted, sometimes to avoid the readmission penalties. This can significantly increase out-of-pocket costs for the patient since they are billed as outpatients (Part B), with greater cost-sharing, rather than as inpatients (Part A). More importantly, there is also the risk that the patient may receive less care as an outpatient when the patient's condition warrants full inpatient services. Thus the readmission reduction program may be causing significant patient harm, both physically and fiscally.

In conclusion, he states :

The government bureaucrats and the policy community are fixated on these various programs that they just thought up out of the blue that supposedly would control spending, even though their track record overall is dismal. Yet they keep avoiding a proven solution that would reduce our uniquely outrageous administrative waste that costs hundreds of billions of dollars. That solution is a single payer national health program, an improved Medicare that would cover everyone. We should at least enact that and then we could examine other innovations as long as they are designed to truly benefit patients.

Of course he is right:  Single-Payer would save administrative costs more reliably than any of  our government's fiscal schemes, which have proved so far to be, in  McCanne's words, "a dismal failure."  But whether Single-Payer in New York State (NYHA) would control non- administrative costs -- such as hospitals gaming the system in order to make profits, and whether payments to hospitals would reflect current market realities (e.g. regional differences in payscales, etc.) and different standards of excellence (e.g. Memorial Sloan Kettering vs a provincial outfit like Poughkeepsie's Vassar Hospital) has not yet, to my knowledge, been figured out.

The last time I checked, the House of Representatives proposal for Single-Payer adopted Woolhandler and Himmelstein's suggestion that medical facilities such as hospitals should NOT be privately owned and should be compensated NOT by procedure, but should be publicly owned and compensated globally for operating expenses, with capital expenses (MRI machines, etc) awarded by government grants, not by any profits or surpluses, which they would not be supposed to make.  Sanders' Senate Bill keeps the current setup, where hospitals are expected to make profits and are tacitly encouraged to game the system in order to do so. But the House proposal, as I understand it, is currently being rewritten, with results yet to be announced. And how the NYHA would treat these matters is yet to be determined.

With all these uncertainties, why go to single-payer, or for that matter any new system?  The answer is simple: Our current system is fiscally unsustainable and morally bankrupt. Single-Payer seems the best avenue forward. Inaction is not an option. Hence this blog.

Dio

To make a comment, (and we encourage you to do so), simply click on the number of comments area, and share your thoughts in the "comment box" that appears. Thanks!