Sunday, January 28, 2007

Blogging, general - Grand Rounds of Blogging Competition Entry*

The Grand Rounds of Blogging have requested I enter a blog to compete for the best blog on the importance and status of the consumer healthcare movement.

Here’s my entry.
I’ve been asked to comment on the healthcare consumer movement; whether it will solve economic, treatment, and societal healthcare problems; and on my personal experiences with the consumer movement.

Here goes.
1. The consumer movement will prevail. Why? Because everything else has failed to stem costs and to rationalize care. Medicare has failed. Managed care has failed. Self-funded employers have failed. The only alternatives left are cost-conscious consumers spending their own money, or a government single payer system. Our culture is not likely to accept the latter.

2. Will consumerism solve healthcare problems? Not all at once, but perhaps in the long run. Market-based solutions lurch forward in incremental, experimental bursts and reverses. An HSA, HRA, and FSA here. A high deductible or high co-pay there. A tax system tweak here. A tax subsidy there. A specific comprehensive consumer-oriented website here. Inexhaustible Internet-rich health information lore there. A technological innovation here. A political setback there. But always forward the market will go.

3. My personal experience? As a practicing physician in Minneapolis, I was present at the creation at one of the centers of the HMO movement and of United Healthcare. I predicted physician-punishing and patient-depriving HMOs would ultimately fail (And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota, Media Medicus, 1988). Doctors and patients, I said, would rebel. I saw first hand how powerful market forces could be — how they forced Mayo to set up satellite sites in Jacksonville and Scottsdale, closed multiple Twin Cities hospitals, force Minnesota doctors into economic servitude, pushed the University of Minnesota hospital into economic retreat and into an unwelcome acquisition by a community health system.

Based on these and subsequent experiences, I believe market-based innovations - HSAs, high deductible health plans, technological innovations, and cost-sensitive consumers — will, for better or worse, be stronger change agents for lowering costs and rationalizing care than government.

Our capitalistic culture demands individual freedom and choice. The market is more likely to provide these attributes than government.

This submission argues healthcare market forces are more powerful and more likely to prevail than a government single-payer system. My blog is http;//
Comment by Richard L. Reece, MD — January 27, 2007 @ 11:43 am

* Grace Marie Turner, founder of the Galen Institute sends this correction and clarifying comment on my last blog which implied that a national single payer might be illegal,

“ I have a quibble with your blog: You say that “Three of the Democratic candidates for President – John Edwards, Barak Osama, and Hillary Clinton – don’t share the Journal’s views” and are pressing forward with universal health coverage. The Journal is writing about the illegality of state-based universal coverage schemes. But ERISA preemptions wouldn’t apply if the federal government creates a new, national single-payer health care system. ERISA only is there to protect companies from having to comply with 50 different state regulatory schemes.

I worry even more about the risk that Sen. Kennedy will prevail with his Medicare-For-All plan than I do about the attempts by the states, which are failing of their own weight.”

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