Thursday, May 28, 2009

When We Really Do Health Care Reform They'll Know It In McAllen Texas

In recent posts I have expressed my concern that the Congress has all but given up on real health care reform and seems more interested in entitlement expansion.

I worry that the Democrats have found the path to paying for a health care bill (note that I did not say health care reform).

I will suggest that path includes a little cost containment window dressing so they can spin that they have a way to bring costs under control, shaving some provider payments but not too much that it actually hurts, and lots of new taxes.

Real health care reform, on the other hand, would be about crafting unambiguous changes in incentives that drove providers—doctors, hospitals, drug and device makers, and insurers—toward sweating that 30% of the waste out of the system thereby paying for universal care and making the system sustainable.

Just what do all of these words—waste, cost containment, unambiguous changed incentives—mean in real world?

Atul Gawande has an article in The New Yorker that is worth your time: The Cost Conundrum—What a Texas Town Can Teach Us About Health Care.”

Here is a piece:
One afternoon in McAllen, I rode down McColl Road with Lester Dyke, the cardiac surgeon, and we passed a series of office plazas that seemed to be nothing but home-health agencies, imaging centers, and medical-equipment stores.

“Medicine has become a pig trough here,” he muttered.

Dyke is among the few vocal critics of what’s happened in McAllen. “We took a wrong turn when doctors stopped being doctors and became businessmen,” he said.

We began talking about the various proposals being touted in Washington to fix the cost problem. I asked him whether expanding public-insurance programs like Medicare and shrinking the role of insurance companies would do the trick in McAllen.

“I don’t have a problem with it,” he said. “But it won’t make a difference.” In McAllen, government payers already predominate—not many people have jobs with private insurance.

How about doing the opposite and increasing the role of big insurance companies?

“What good would that do?” Dyke asked.

The third class of health-cost proposals, I explained, would push people to use medical savings accounts and hold high-deductible insurance policies: “They’d have more of their own money on the line, and that’d drive them to bargain with you and other surgeons, right?”

He gave me a quizzical look. We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? “I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.”—that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”
When we have a health care bill that starts to change things in McAllen Texas then it will be worthy of the label, health care reform.

I highly recommend you read the entire article here.


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