Saturday, May 21, 2011

Health Reform Assumptions and Realities

Most of our assumptions have outlived their uselessness.

Marshall McLuhan (1911-1980), The Media is the Message

May 21, 2011 -When the Patient Protection and Affordability Act passed in March 2010, the legislation the new law, it was assumed, would,

• save $500 billion over ten years by curbing waste, fraud, and abuse and would change the way physicians were paid;

• cut physician payments by 21%;

• “protect” patients from health plan “abuses;”

• make health care more “affordable;”

• Be patterned after the successes of the Massachusetts universal health plan, which was then four years old.

How useful, or useless, are these original assumptions? It depends on who you ask.
If you ask the New York Times, the Massachusetts plan has been a success.

In a May 21, editorial, The Times asserts.

Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he (Governor Romney) signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.

Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.

Sally Pipes, President and CEO of the Pacific Research Institute, a Canadian and a refugee from the Canadian health system, begs to differ. ("Candid Romney Would Own Up To Mass. Fiasco, Investors Business Daily, May 20, 2011):

“Massachusetts health reform is in the news — driven by reports of long waits for care and its architect's presidential ambitions. Former Massachusetts governor and GOP presidential hopeful Mitt Romney delivered a widely panned speech the week before last on health care.

The three-part speech attempted the impossible: It defended his Massachusetts plan, lambasted President Obama's copycat plan that took it nationwide and laid out an agenda at odds with his signature achievement.

Unfortunately, he passed up the opportunity to declare the experiment a failure and detail the lessons learned.

The first is that health insurance does not equal access to health care.
The Massachusetts Medical Society just released a study that showed waiting times are, on average, 48 days to see a family doctor, and up to a year for some specialists. Getting a new doctor is tough. One in two family physicians isn't accepting new patients.

The best definition of socialism is a utopia in which everything is free and nothing is available. That's long been the case in Canada, where people wait 18.2 weeks on average from seeing a primary care doctor to getting treatment by a specialist. The lines are now extending south.”

As for me, I would note that the fundamental assumptions of the health law, taken for granted by the Obama administration, have yet to be demonstrated, namely, that;

• government, not doctors, or consumers, know what’s best for their health and medical treatment;

• treatment for minor and episodic illness requires a multidimensional, multidisciplinary organization team to address;

. Capitated or bundled payments for care over superior to fee-for-service payment and will be more efficient, cheaper, more effective, and provide better value for the dollar.

• a national universal interoperable standardize computerized information system with an electronic health or medical record in every doctor’s office and every hospital setting will measurably improve care;

• improving care requires rewarding doctors for pay-for-performance;

• new or revisited organizational models (HMOs, PPOs, MPOs, PHOs, ACOs, or other OWAs – Other Weird Arrangements) are necessary to improve and standardize care;

• government mandates are more important than individual choice, freedoms, and ability to opt out of the system.

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