If we want to look at costs, we need to look at malpractice insurance and lawsuits. I don’t mean just for the healthcare systems either but also at the private practice level. If a clinic or physician office can handle it, it’s probably cheaper to do it at their practice, but some types of services have priced them almost out of business in some areas, like OB GYN. If anyone doesn’t get a healthy baby, there’s a good chance lawsuits could fly around. And we’re all horrified at the idea of a surgeon practicing drunk, or leaving gauze behind, or any other terrible thing you can think of happen due to human era or gross negligence but other countries don’t have the lawsuit and reward system we have in healthcare. They just don’t.
Sure, but that is not an argument on why we shouldn’t have a more standardized care environment, a la Spain. Instead it is making the argument that we need to reign in the malpractice abuse at the same time we implement such a system.
Which, to be clear, would be a position I would support.
Well I am not making the argument we shouldn’t have more standardize care. I am simply presenting the fact at the micro level, three different systems, the healthcare providers were heavily resistant to the idea. If you have physicians telling you are going to get worse care if the government or suits tell them to follow Best Practices, which can actually vary from site to site although there are some really good industry standard ones, what do you think the public is going to do with that?
if my physician and healthcare providers tell me they think it’s a terrible idea, and it will be worse for me, it seems unlikely to pass.
To be clear, our healthcare system doesn’t really do what is suggesting now. Medicare, for example, might flat out refuse to pay for something but the physician can still order it, in many cases, we just don’t get paid. That is a cost that doesn’t’ go away, it’s spread out most likely through commercial payors.
To be fair to physicians, there are many groups, like I said, that follow Best Practice procedures, like in the ED and with heart attack patients… heck we even have a bypass system around here where a patient is stabilized and they go past the other hospitals to take them to the one with the pest cardio program… saved a lot of lives. That wasn’t forced and there were some business arguments against it.
Wow… that is fascinating. Thank you for posting it. As someone insured under a gold plan, it offers a bit of comfort as well.
You get into an interesting mix of health care providers going for best outcome, actuaries going for most cost-effective, and regulators trying to find a bare minimum acceptable level.
And let’s not forget that each group has a vested self-interest in the process; providers get more money the more services they provide, actuaries get more money by identifying risk and reducing costs, and regulators have political pressures they face or else risk losing their jobs. That’s a mess waiting to happen. Well, I guess it already did happen.
Good news is, we’re slowly moving away from the per visit, per charge payment system. Even if the government winds up sitting on it’s hands for years, the industry is already shifting away to outcome based performance and payment systems. A number of payors are already there and the health systems are shifting to accommodate. Commerical payors tend to loosely follow the government though so it would be nice if they didn’t gut Medicaid and Medicare while they’re at it.
Fascinating. Who, besides the government, is driving this? Is it private insurance companies? Which ones?
Their are some cash-only clinics that do it as far as I know, but there’s likely more as it’s popular for the consumer.
On the issue of whether the ACA contains conservative ideas, there has been some dispute here as to the old Heritage Foundation health care plans. Upthread, there is a link from the Lawyers, Guns & Money blog which characterizes ACA and the Heritage plan as extremely different.
Here’s a link to the actual 1989 Heritage Plan
It’s very clear that although the plans are different overall, the ACA contains a number of significant ideas from the Heritage plan.
The #1 proposal in the Heritage plan is to “change the tax treatment of health care” specifically to remove the exemption for employer provided health insurance, which was partially implemented in the ACA as the “Cadillac Health Plan Tax”.
The #2 proposal is to" mandate all households to obtain adequate insurance." Yes, really.
The #3 proposal is to “provide help to those who cannot afford protection” via refundable tax credits to lower income households.
The Heritage plan also contained a 4th element, to raise Medicare co-pays and add a voucher system to Medicare, which is fairly similar to the recent Ryan plans. This was not incorporated into the ACA.
So basically the ACA adopted, incorporated or adapted 3 of the 4 main Heritage principles but did not incorporate the 4th. I won’t say the ACA is “based on” the Heritage plan, but it clearly includes significant elements from that conservative source.
The big picture reality is that the ACA was offered as a legitimate starting point for bipartisan discussion and compromise. The fact that the 2009 GOP did not give it even a single vote is not a condemnation of the ACA but rather a striking indictment of the GOP as extreme and relentlessly partisan.
This really shouldn’t be in question by anyone, considering it was their stated goal to provide unified resistance to all Obama initiatives (and that’s what happened).
The GOP’s complete opposition to the ACA was 90% politics 10% policy, if I’m being generous.
Elective surgeries, keeping in mind elective does not mean you don’t need them so much as you can hold off on them and you know, not die, are a more common area we’re seeing. This is also the area patients have an easier time to shop around too… you don’t necessarily get more money because someone has to come in after their
Another area you see it is repeat visits, like if you come in for one issue and have to return the same day or next day for the same thing. This used to be mainly government payors commercials are doing it now too. You have to combine those accounts, and you only get say one level charge for that ED visit.
This all very contract specific but the basic idea is your either treating the patient, capitation, or the issue/problem and you don’t get more or in rare cases less, simply because they have to come in again.And because it is contract specific this region might have the per surgery thing but this other doesn’t… but many commercial payors are shift away from basic percentage of charge, which often had a bit of a cap anyway, to DRG/APC and these other models.
Be careful what you wish for. If you’ve been following the Charlie Gard story, you’ll have an idea of what can happen when doctors are required to follow practice guidelines.
The TL;DR version is that an English infant was born with a terminal genetic disorder. The parents found an American doctor willing to treat him, and they were even willing to pay the costs of transfer and subsequent care.
However, this treatment was experimental. Hospital guidelines did not allow the infant to be transferred out, in fact, they required withdrawal of life support. There wasn’t really any choice in the matter: life support was withdrawn despite the parents’ objections, and the infant died.
I suspect that is not a system that most Americans would be comfortable with.
That is not an accurate summary of the Charlie Gard story. Charlie Gard had two serious problems, one was a genetic disorder which then caused the second problem: permanent structural brain damage on the cellular level. Although there was an American facility willing to treat the first condition, there is not treatment at all for the second problem. The brain damage was both irreparable and severe, to the point where Charlie Gard couldn’t breathe on his own.
The reality of the Charlie Gard story is not about treatment guidelines but rather about accepting the reality of brain damage / near-equivalent-brain-death as in the Terry Schiavo saga.
It has been spun as an attack on nationalized medicine but that’s not actually the point. The point is, there was no cure at all for poor Charlie’s severe brain damage, which damaged his brain to the point where he could not survive without artificial breathing support. The rest of it is just window dressing and wishful thinking.
I think the reality of the Charlie Gard story is whether or not parents have a right to try and save their child. What happened over there is highly unlikely to happen here. The question is, in a changing health system, are we going to be comfortable saying in order to have a great national system that is efficient and provides general good health to the populace, do we have to give up these rights to take our children out of one hospital and seek help somewhere else that is willing to provide more? That’s a valid question to have. I think most American’s are not going to be comfortable giving up that choice.
That’s a tough one - you can’t expect his parents to make a dispassionate decision about the life and death of their year old child and cutting them out of the decision looks heartless. I can’t say I would have fought any less hard for my kids even though realistically there was never any real hope.
Actually in the US Charlie Gard would not have gotten the treatment through insurance. Any insurance company would have cited the medical opinion that his brain damage was irreparable to refuse to spend millions on his treatment. Charlie Gard was also way over any lifetime limits as advocated by Strollen up thread. It is true that due to the celebrity of the case, the Gard family raised enough money to treat him some more, but that’s a bizarre situation that would not apply to the vast majority of families.
You are also glossing over the fact that the doctors treating him felt that although his brain damage was so severe that he could not breathe, he did respond to stimuli and they felt he was in pain. So the parents forced this infant to live for seven months in pain, when there was no medical hope for improvement. That’s not freedom; that’s cruelty.
Doesn’t this conflict with DT’s “Let Obummercare die” plan?
They can play around at their meetings as much as they want, but no bipartisan solution is going to come up for a vote. Unless McConnel and Ryan are forced out of their leadership positions, at least. And it’s equally, if not more likely that they’d be pushed out in favor of even crazier right wingers.
Death panels!
Also, please note; my understanding of the Charlie Gard case is that the monetary aspects did not matter at all. The UK health system did not advocate terminating his life support to save money but b/c they made a medical determination he could not be helped and that he was suffering. There was no “death panel” and no “bean counter deciding who lives and dies” as far as I know. This was a medical determination and there was a dispute between the UK health system as to the medicine versus Charlie Gard’s parents and a US doctor who had never examined Charlie. When the US doctor examined Charlie and looked at the brain scans as described in the article above, he changed his opinion.
I fully understand the desire of parents to fight for their children at all costs but that was not the issue here. The issue was whether or not the medical science was correct.
And again, the fact that the Gards raised enough money to treat Charlie due to celebrity does not make that a viable option. In the US if this came up, unless the family was really photogenic and got great press, they would not get the treatment either. Weirdly, their best chance for the treatment would probably be Medicaid in the US as opposed to private insurance.