tag:blogger.com,1999:blog-6076839327674215825.post5447064293475232415..comments2024-03-27T05:14:34.288-04:00Comments on Medinnovation And Health Reform: Obamacare - DOA for NowRichard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-6076839327674215825.post-62506117779240695752009-08-01T10:21:52.322-04:002009-08-01T10:21:52.322-04:00Correction...
In #8 I confused Abraham Maslow and...Correction... <br />In #8 I confused Abraham Maslow and Frederick Herzberg. My bad. <br />I developed the idea more fully this morning in a comment at Maggie Mahar's blog.<br /><br />http://www.healthbeatblog.com/2009/07/healthcare-reform-and-the-culture-wars.html?cid=6a00d8341d843653ef01157250447a970b#comment-6a00d8341d843653ef01157250447a970bJohnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-6076839327674215825.post-18525596895733839112009-07-31T21:59:51.484-04:002009-07-31T21:59:51.484-04:00#1 Check
#2 Then how has Medicare managed for the...#1 Check<br /><br />#2 Then how has Medicare managed for the last forty years?<br /><br />#3 I thought the "affordability" question was a matter of tax credits and subsidies for those with incomes under certain defined levels. That's a cost, of course, but not linked with risk and actuarial metrics cited.<br /><br />#4 This is a valid criticism, but a public option would present a jobs program ideal for experienced insurance pros.<br /><br />#5 If this is referring to tort reform, malpractice awards account for about 1% of the health care budget.<br />http://www.atlanet.org/cps/rde/xchg/justice/hs.xsl/8686.htm<br />http://www.insurance-reform.org/issues/MedMalSystemCostsFactSheet2009F.html<br /><br />#6 Good point, but the longer people live the higher their health care costs. Same faulty logic that argues that well visits will lower costs. Not true. Those who die prematurely from untreated conditions may cost dramatically more at the end, but if they die quicker they cost less. Cold-blooded metric, I know, but I can't stand faulty reasoning even when it's not advancing my own agenda.<br /><br />#7 Check. (maybe even more...)<br /><br />#8 Check. As long as they never get to see the real costs, they don't care. The real cost of health care has vanished from the minds of those whose premiums are subsidized, either by Medicare or an employer. In terms of Abraham Herzberg, what once was a "motivator" has become a "hygeine" factor, like covered parking or a well-lit work area. <br /><br />#9 So what happens to the "alphabet" plans once called "medigap"?<br />#10 American rationing takes the form of allowing a sixth of the population to remain uninsured. And anyone who imagines that group is being cared for with "prompt access to the latest technologies" is living in a fool's paradise. And why else would there be so-called "Cadillac plans?<br /><br />#11 Check. However, during my last six years working in retirement communities I have seen many examples of needless suffering when palliative care was only used for a few days or weeks prior to death. Old people are not the problem. For the most part they have come to terms with their mortality. But overwhelming numbers of other family members are in denial for far too long.<br /> <br />#12 Check. But the PCP is becoming an endangered species. I'm not aware of any bureaucrat who is or will be in charge of anyone's medical care plan, but I am aware of the "medical home" concept which will be modeled on the old PCP concept, whereby one physician or clinic will be accountable, ombudsman-style, for patient care plans. Mayo, Geisinger, Kaiser and others are mentioned as models of efficiency and good outcomes with lower costs as a dividend.<br /><br />#13 Check. I hear complaining about everything from helmet and seatbelt laws to municipal no-smoking restrictions. That's who we are. (And don't, by God, make me even <em>think</em> about advance directives.)Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.com