Health Wonk Review, a round-up of some of the very best health-care blogging, was posted today on Managed Care Matters. There, host Joe Paduda has done an outstanding job of pointing to the diversity of opinion in the blogosphere. He opens with a letter from Senator Dorgan, Chairman of the Senate Democratic Policy Committee (DPC), addressed to HWR’s readers. (The Review has been getting attention from policy-makers in Washington.)
Click here and enjoy.
Health Beat by Maggie Mahar
A National Coalition for Cancer Survivorship poll found that 89% of Americans said that the distinction between oral and intravenous applications should be abolished so that Medicare beneficiaries can have access to the best drugs to treat their form of cancer. Oral chemotherapeutic agents are easy to use and offer the promise of less frequent visits to oncology-based offices or hospital clinics and their infusion rooms. Medicare had gone far in accomplishing that task. Nearly all generic cancer drugs and 70% of brand-name cancer drugs were covered by the Part D plans. Most of the brand-name drugs not covered had generic equivalents that were covered.
However, when Congress created the Medicare Part D prescription drug benefit, it did two things: it guaranteed premium pricing for pharmaceuticals, by prohibiting Medicare from negotiating drug prices, and it provided hundreds of billions of dollars in U.S. taxpayer subsidies to pay for these premium drug costs by subsidizing private insurance Medicare plans. Medicare has been paying private Medicare Advantage plans much more per enrollee compared with what the same enrollees would have cost in the traditional Medicare fee-for-service program. The monies to pay Advantage insurers is coming out of traditional Medicare.
Granted, the new Medicare D program was filled with lots of “patronizing” holes – like the doughnut hole. The biggest problem was in designing the program. The previous administration did not want the Medicare drug benefit to be administered directly by the federal government (where Medicare is run efficiently). Instead, it devised a public program run by hundreds of competing private plans, each with its own prices and coverage policies. In other words, it tied Medicare’s hands behind its back and told it to go out and “compete” with the for-profit plans.
U.S. for-profit health care fundamentalism has the most de facto rationing, higher rates of uninsured, exclusions for pre-existing conditions, excessive deductibles and copayments, and shorter hospital stays and physician visits. It also has the most waste on administration, billing, marketing, profit, executive compensation, and risk selection.
The U.S. for-profit health care system is good at creating new drugs and technologies and marketing them to hospitals, physicians and patients. Our pharmaceutical-based health care system is very good at creating new health care products that will make a lot of money, and where our health care system isn’t profitable, it is a total failure.
Normally, my overall take for healthcare would see a greater need for market forces. If doctors were paid by their patients for their expertise and pharmaceutical companies were paid by patients for their products, patients would force the costs to come down by voting with their feet. The market could be an elegant, efficient and fair. However, people are not a commodity and market forces have not had a good track record in health care. We have to think of people and not products.
Physicians respond to economic forces just like everyone else. If a physician is a specialist, like an orthopedic surgeon, I’m sure he/she feels more reasuring than if they were a gastroenterologist. They can feel free to become an orthopedic surgeon in a free-market health care society, but do patients have to suffer because they have a problem with their digestive tract and can’t find a gastroenterologist because the free-market doesn’t pay enough for them to do their operations?
The porous policies of the private market: imposing preexisting condition exclusions, insurance rates that vary by health status, gender, class of business, or claims experience, and levy lifetime or annual limits on benefits and limit the cost sharing for certain preventive services and immunizations, have cost this nation billions of dollars of uneeded health care costs.
Access to basic health care has deteriorated terribly in this country by the free-market system, because much of the growth in expense is in procedures performed by specialists, and doctors who work in these specialty areas have the most to fear from a single-payer system. Big government would be more responsive to the people than big insurance. And doctors will still work independently, and not for the government.
Private insurers will keep placating physicians because they fit into their overall plan. Under the present HMO-for-all type systems, doctors are becoming employees of the hospitals, instead of remaining as independent contractors.
It seems like deja vu all over again with health care reform (Republican Health Deform). Greedy powers that be want to fill it with lots of “patronizing” holes.