23 July 2009

'Cause I don't feel like writing anything original today

As conservatives and skeptics ask, "What's the rush?" to reform health insurance:

Crisis: Nearly Five Million Adults Have Lost Insurance Since Sept. '08
A survey of more than 29,000 individuals in June by Gallup shows that 16 percent of Americans over the age of 18 are currently without health insurance. That number reflects what the survey's authors describe as a "small but measurable uptick in the percentage of uninsured adults."
And our friends at Open Left remind us:
22,000 Americans die every year because they lack adequate health care coverage.
Strangely, after a two-year presidential campaign in which health care reform was a central issue for both parties, after reams and reams of policy papers and public debate, after seven months of active legislative work, and not to mention after sixty-five years of failed incremental reforms, now that we get down to the finale, all of a sudden reformers find themselves accused of "rushing."  Weird.

Meanwhile, Reuters channels KevinMD:

Shortage of doctors could damage healthcare reform
A growing shortage of primary care doctors could place a major burden on the U.S. healthcare system if President Barack Obama succeeds in extending medical insurance to millions of Americans who currently lack it.

As healthcare legislation works its way through the U.S. Congress, most of the focus has turned to how to finance it [...] Less attention has been paid to what might happen if millions of new patients join a healthcare system that is unprepared and unequipped to handle the load.  The United States already has a shortage of between 5,000 and 13,000 primary care doctors, according to the Robert Graham Center. Add millions of previously
Truth be told, for ER docs, not much would change but we would do much better financially.  The soon-to-be-insured folks come in to my ER now, and I see them for free.  Universal coverage won't decompress the ERs right away, but we'll be better paid.  More importantly, the on-call consultants who currently balk at caring for the uninsured will be more willing to provide ER back-up services, and hospitals might be better able to dedicate capital and operating resources to bolster emergency care.

On a stranger note, KevinMD channels, um, me:

Will the lack of primary care doctors make universal coverage useless?
[Shadowfax:] Both universal coverage and primary care reforms are necessary, but it is not an either-or proposition. Both must proceed on parallel tracks.

[Kevin:] Providing universal coverage is an imperative moral obligation, but one that must be accompanied by forceful cost control. Again, I point to the Massachusetts model as the example of what happens when universal coverage takes precedent above all else. [..]  Taking the politically expedient route, by promising universal coverage without strengthening the underlying primary care infrastructure first, will be doomed to failure.
Doomed, you hear that? DOOMED!  And I should point out that I agree on the cost control point, and I worry most about that aspect of all the reforms out there. Is IMAC our silver bullet?  Uber-nerd Peter Orszag thinks so:

The Independent Medicare Advisory Council (IMAC) would be an independent, non-partisan body of doctors and other health experts, appointed by the President, confirmed by the Senate, and serving for five-year terms. The IMAC would issue recommendations as long as their implementation would not result in any increase in the aggregate level of net expenditures under the Medicare program; and either would improve the quality of medical care received by the program’s beneficiaries or improve Medicare’s efficiency.

As with the military base-closing commissions, this proposed legislation would require the President to approve or disapprove each set of the IMAC’s recommendations as a package. If the President accepts the IMAC’s recommendations, Congress would then have 30 days to intervene with a joint resolution before the Secretary of Health and Human Services is authorized to implement them. If either the President disapproves the recommendations of the IMAC or Congress passes such a joint resolution, the recommendations would be null and void, and current law would remain in effect.

This approach would free Congress from the burdens of dealing with highly technical issues such as Medicare reimbursement rates while rightly giving them, your representatives, a say in the matter. Moreover, this kind of body would enable the health care system to respond to a very dynamic market and technical landscape, making Medicare policy more responsive and effective in the future. All together, the IMAC proposal would make sure that there is someone always on the beat, looking for ways to bend that curve.
The Moonie Washington Times hosts three former AMA presidents who are hopping mad that the AMA endorsed HR 3200, but their credibility is undermined by the opening line of their op-ed:

Government threat to world-class medicine
We have the best health care system in the world. Most Americans live within an hour's drive of a world-class medical facility filled with expertly trained individuals and state-of-the-art technology delivering medical miracles every day.
You hear that?  You're within an hour of being able to look at a building where you could get health care if you're lucky enough to afford it. (h/t DKos)

1 comment:

  1. "22,000 Americans die every year because they lack adequate health care coverage."

    Stats? I love stats. Let's compare that to traffic fatalities:

    In 2007, about 41K fatalities, of which ~13K were related to drunk driving ( http://www-nrd.nhtsa.dot.gov/Pubs/811016.PDF )

    Or look at preventable life-style related deaths, such as smokeing @ 467,000 per year ( http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/13925 ).

    I hate to draw any conclusions from those numbers, but perhaps the US should be dealing with other issues before tackling the health care "problem". Not only could we save money upfront, but would make the overall healtcare problem a bit smaller.



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