From the diaries by Erick
According to this Boston Globe article, the good ole Commonwealth of Mass is trying to save its universal health care plan — by doing pretty much the same sorts of things that liberals whine that HMOs and private insurance plans do.
The state’s ambitious plan to shake up how providers are paid could have a hidden price for patients: Controlling Massachusetts’ soaring medical costs, many health care leaders believe, may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want.
Efforts to keep patients in a defined provider network, or direct them to lower-cost hospitals could be unpopular, especially in a state where more than 40 percent of hospital care is provided in expensive academic medical centers and where many insurance policies allow patients access to large numbers of providers.
But a growing number of hospital officials and physician leaders warn that the new payment system proposed by a state commission would not work without restrictions on where patients receive care – an issue some providers say the commission and the Patrick administration have glossed over.
So let’s see… Members of the Kennedy family will be able to get all the health care they want at any place of their choosing, and this will get some of the riff-raff out of their way. But wait, it’s really worse than that if you read on.
A state commission recommended in July that insurers largely scrap the current fee-for-service system – in which insurers pay doctors, hospitals, and other providers a negotiated fee for each procedure and visit – and instead pay providers a per-patient annual fee to cover all of the patient’s medical care.
It doesn’t take a genius to figure out what will result from this. If a doctor or a facility is going to receive a set amount per person per year regardless of the person’s medical needs, specialist disciplines will get wiped out and all providers will be looking to do as little as possible for each patient, since every extra test or procedure is taking money out of their own pockets.
The release of the report sparked a lobbying campaign by Massachusetts health care executives, who are urging Governor Deval Patrick’s administration and state legislators to move cautiously because they fear a new payment system could bankrupt some providers and compromise patient care. Many changes recommended by the commission would have to be approved by the Legislature before being put in place.
As I was saying…
But Sarah Iselin, head of the state Division of Health Care Finance and Policy and cochair of the payment commission, said the panel understood the importance of addressing the effect of its recommendations on patient choice, but “felt these issues could be figured out’’ later by a board that would be created to oversee the transition to a new payment system.
Amazing – they punt on the big question until it’s too late. I guess this is the Mass equivalent of Washington’s voting a blank sheet of paper into law and then filling in the details later.
The commission recommended that all residents choose a primary care doctor, because many patients will listen to their doctor’s recommendations about where to get care, she said. Under global payments, those doctors would have an incentive to refer patients within their organization. And, she said, educating patients about low-cost, high-quality providers also will play a major role, and may preclude the need for forced restrictions on choice. “Over time, patients may very well be inclined to go there all by themselves,’’ Iselin said.
And if the patients don’t voluntarily give up their current freedom of choice, it once again doesn’t take a genius to know that they’ll figure out a way to force on the poor and middle class.
Daniel Horowitz
Neil Stevens
Steve Maley
Jake Walker
But Romney and now Obama say these are "good" healthcare plans....
JadedByPolitics (Diary) Tuesday, October 13th at 6:41AM EST (link)I could have sworn that Romney just a couple of months ago was LAUDING how WONDERFUL his MA state takeover of the Healthcare of all of their citizens was a GREAT thing and he was PROUD of it! Why Obamacare is just the federal government’s take on it!
I am shocked that it leads to rationing…just shocked… /snark off
Unified Patriots – How-To:
Activists Taking Action
Liberals should be kicking themselves.
Jim Tomasik (Diary) Tuesday, October 13th at 7:55AM EST (link)Look at this editorial by Mitt Romney back in 2006.
http://www.opinionjournal.com/editorial/feature.html?id=110008213
The libs voted in the wrong guy. Romney would have had ‘National Health Care Ruin’ in the bag already.
Coming soon: the nationwide sensation
izoneguy (Diary) Tuesday, October 13th at 9:56AM EST (link)that is healthcare rationing!!!
Most libs say that we already have rationing with the current health insurance system. No we do not. Just wait – if they vote National Health Care in then we will have REAL rationing and it will start in months – 20 years from now the US healthcare system will be much worse then what Britian has with their NHS. All of us that are 50 or above are in the fight of their lives – literally….
The point cannot be made often enough: Modern liberalism, as embodied in the Obama presidency, is the defender of the status quo. And the status quo is a road to economic ruin. Political forces cannot redistribute the wealth that the economic system does not produce.
Beating the flat rate: Doctor meet Auto Mechanic
Achance (Diary) Tuesday, October 13th at 10:06AM EST (link)The game at the ER or the Doc’s Office will become just like the game at your car dealer’s service department. The only way the Doc can make any money is by doing the 2 hour procedure in 1 hour. Before long we’ll be needing laws that make them do estimates and give us back the used parts they took out.
In Vino Veritas
part of your analogy may be a little bit off I think
bk (Diary) Tuesday, October 13th at 10:19AM EST (link)Medicare and Medicaid are kind of like auto repair today – they pay a fixed amount for the procedure regardless of the actual cost, kind of like you or I often pay according to how long some book says a certain repair should take. As you say, there is some incentive to skimp in cases where the repair tech thinks the “book” is too low.
The corresponding auto repair situation for Masscare (and no doubt down the road for Obamacare) would be that we pay the shop $X on January 1st and that covers all our car repairs for the rest of the year. Gee, you don’t think they’d skimp on any of those repairs later, do you?
There would be a huge incentive on every “repair” situation for us humans in the Masscare scenario. We might want to invest in the human equivalent of auto salvage yards, as people will need to bring in used parts they scrounged if they need something replaced by their state-assigned doctor.
And even more bk...
mbecker908 (Diary) Tuesday, October 13th at 11:10AM EST (link)Check this out. And I apologize for flacking my diary, but it’s on point with your comment.
So the Mayo Clinic is just another evil greedy hospital now eh?
bk (Diary) Tuesday, October 13th at 11:31AM EST (link)This actually could work out. Once they get rid of the riffraff at Mayo, any members of Congress who need more than Bethesda and others in the DC area offer can always take a taxpayer-funded junket to Rochester for free care.
Airplane! quote
this started with DRGs and I don't know why nobody ever talks about them nt
mom2oneson (Diary) Tuesday, October 13th at 11:55AM EST (link)Looks like I'll have to go to Mexico to get my healthcare...nt.
NightTwister (Diary) Tuesday, October 13th at 11:03AM EST (link)The best argument against democracy is a five-minute conversation with the average voter. – Winston Churchill
I wonder how many American docs will be "crossing the border"
izoneguy (Diary) Tuesday, October 13th at 11:06AM EST (link)to practice healthcare?
Won’t that be a kick in the pants?
I am sure many mexican doctors make a nice living from
just having the drug gangs as cash paying clients.
The point cannot be made often enough: Modern liberalism, as embodied in the Obama presidency, is the defender of the status quo. And the status quo is a road to economic ruin. Political forces cannot redistribute the wealth that the economic system does not produce.
Or to Cuba - there's even a movie out about how great theirs is
bk (Diary) Tuesday, October 13th at 11:07AM EST (link)Lot's of Americans already go to Mexico. Good Docs aren't cheap,
Achance (Diary) Tuesday, October 13th at 11:12AM EST (link)but they’re a lot cheaper than in the high cost areas of the US. I know a lot of the people we see when we’re in Puerto Vallarta set up elective surgeries, cosmetic procedures, or dental work in concert with their vacation. There’s a huge nip-tuck business there. Don’t know how the costs compare to The South or Mid-west, but they’re attractive compared to the West Coast.
In Vino Veritas
My dad had a lot of dental work done there.
NightTwister (Diary) Tuesday, October 13th at 11:15AM EST (link)It’s extremely affordable, and they do very good work.
The best argument against democracy is a five-minute conversation with the average voter. – Winston Churchill
I buy my Rx from overseas pharmacies
mom2oneson (Diary) Tuesday, October 13th at 11:24AM EST (link)the price is soooo much lower than here. I’m sure they charge a lot too compared to what they pay but it is still a lot lower.
I'm not sure but I think some primary care
mom2oneson (Diary) Tuesday, October 13th at 12:07PM EST (link)is already set up like this with insurance except it’s a monthly fee not annual. They get the co-pay if the patient comes in but it’s a set amount per month for keeping the patient. That is why they started offering all this wellness stuff vs admitting people and running as many test as they could. I’m not sure but I think to some degree it’s already like this with insurance. I know for sure they get a set amount for keeping the patient as “their patients” from the insurance.
I live in Germany.....
jackhammer Tuesday, October 13th at 12:31PM EST (link)And the public insurance system runs a fee per patient per quarter system. At least for GP’s. It is currently at 25€ a quarter…what does it lead to?
It leads to there being a dearth of doctors in areas where there are only publicly insured patients, especially in areas with lots of elderly patients or rural areas where they cannot generate the numbers to cover their overheads.
In Germany about 85% of people are on the public system, which has premiums at a minimum of 1800€ ($2600) a year, split 50/50 with employer/employee (no other split allowed unless self employed) and a maximum of about 8400€ ($12,000) based on 15% of your salary (on the half half basis). The other 15% are self employed or employees who earn more than 60k€ ($90K) a year and can opt out of the public system….they, like myself, often end up paying significantly less than they would on the public system, but are barred form opting back in, unless their income falls dramatically for a sustained period of time.
Well, the doctors rely on these privately insured patients to have any chance of making any money…and this in a country with low malpractice insurance and significantly different tort laws (no % of winnings cases allowed). You will find doctors en masse in neighbourhoods with high income people who tend to be privately insured, you are lucky to find any in poor parts fo town, or rural areas, and in towns with lots of old people, forget about it….
Try and get into any good doctor, and the first question is “public or private”…if you are privately insured,a nd they know you will be paying the fair rate, you get an appointment same day, if you are public, expect to hear that the doctor is not taking any new patients, or a couple fo weeks wait. The left here rails against the private patients,a dn woudl like to see them banned, but truth be told, they are the only thing keeping german Medicine anywhere near being first world….
Good doctors who want to see their renumeration stay in line with their talent will flock to areas where people can pay their fees,a dn will largely opt out of taking patients where they don’t earn enough money….the effects might not come right away, but years down the road, the migration will occur, adn america will suffer a dire shortage of specialists, GP’s and rural doctors, a phenoma most countries with rationed care know all too well…..
Here is a guy from Michigan who read some of the bill.
gekster (Diary) Tuesday, October 13th at 2:43PM EST (link)when I got this today it only had about 25,000 hits
http://www.youtube.com/watch_popup?v=G44NCvNDLfc
The more we read, the more we find out.
They say Republicans are for the rich, Democrats are for the poor.
If they need more voters,
then they have to make more of who they are for.
We are there in the various Tea Party groups, leaderless, but not rudderless.
We steer always toward the Constitutional principles this nation was founded upon.
Erick Brockway
Ok folks, 2012 is here. Get involved
Olimpia Snowe just sold out her Republican constituants by voting for the Bachass bill.
gekster (Diary) Tuesday, October 13th at 3:03PM EST (link)They say Republicans are for the rich, Democrats are for the poor.
If they need more voters,
then they have to make more of who they are for.
We are there in the various Tea Party groups, leaderless, but not rudderless.
We steer always toward the Constitutional principles this nation was founded upon.
Erick Brockway
Ok folks, 2012 is here. Get involved
the pre-existing conditions thing?
jackhammer Wednesday, October 14th at 10:05AM EST (link)Can someone explain to me what the provision is supposed to be? Is it a one time amnesty period, where anyone with a pre-existing condition can sign up fro insurance for let’s say the next 16 months and not be denied….or is the idea that you can go without insurance claiming you can’t afford it, and then when you find out you have a condition that would lead to bills that are higher than your premiums, you can then sign up for the program? The second just seems asinine…..
I mean I will be honest, a pre-existing cancer condition is definitely keeping me from moving back to the US to be self employed. I have been covered my entire life, but no new insurance company is goign to take me…..I am more than willing to take a high deductable policy with a HSA, to really just insure agaisn tthose bills over $10,000 a year. I have tried to apply for insurance prior to considering a move back to the states, but once I mark the pre-existings, I get denied every time. My only chance would be to work for someone else, whcih I don’t really want to do. This means I am trapped in the country I currently reside in, with the insurance company I have been with for the past 15 years (and am very happy with).
I think there should be consumer protections which stop insurance companies from denying coverage to people who have been continually insured, potentially with mandated reinsurance programs to mitigate the individual policyholder risk. I would much rather see that than the many minimum coverage mandates the states have that push prices up, and portable insurance that crosses state lines would also be the greatest reforms possible.
But I don’t understand why anyone would sign up for pre-emptive insurance when they are healthy if they cannot be denied once they find out they have something…..
Like you say, it doesn't become insurance in that case
bk (Diary) Wednesday, October 14th at 10:14AM EST (link)Compare it to car insurance. Suppose I drop my coverage and then six months from now I get into a wreck. I call an insurance company the following day and they have to sell me a policy that covers the previous night’s accident.
Sure there are problems in the other direction too, but only one side of the story is being told.
I can get behind
jackhammer Wednesday, October 14th at 11:10AM EST (link)government mandates that say that once an insurance company picks up a client, they are stuck with them for life, with premiums based on an age and gender scale amid various coverage plans (varying deductibles, coverage options etc.)…or maybe the idea of mandated re-insurers making anyone who can show continual enrollment in coverage fully eligible for any insurance policy out there.
This could be combined with incentive rebates for people with continued low claim rates, to reward those who are frugal with their health care, or who lead healthier lifestyles.
But I cannot get behind the idea of a free ride for people who didn’t cover themselves when there was no perceived risk.
Reform, in my opinion, should focus on high deductible, true “insurance agaisnt catastrophe” with HSA’s to bring consumerism into the medical sphere…it should nto continue to be a lobbying for mandates in an all you can eat buffet type of system that drives costs up. It should also gradually do away with employer coverage,a dn allow more freedom of the consumer to make their own decisions on what sort of coverage they want…but it must guarnatee access to those who have been continually covered….this allows for people to move form state to state, or feel free to start their own companies without the major disadvantage against the corporations who can spread their risk across a broader range of employees.
Does anyone happen to know the largest company in America that does not have one single registered lobbyist, or pays no money to lobbying firms….it would be really interesting to know.
Lesson from Massachusetts
rconley507 Wednesday, October 14th at 10:57PM EST (link)RomneyCare should be a lesson for all of us. Government intervention and control of health care inevitably lead to rationing.
If we don’t stop the federal government from further socializing our medicine, we’ll have similar problems in every state. One good way to send Congress a message is with the pink slip effort. Almost 3 million pink slips are heading to Congress now. Go to SendCongressAPinkSlip.com to find out more.