Comments on: Ringing in the healthcare-reform debate

By: laytonlang

laytonlang — Sat, 27 Jun 2009 11:10:46 +0000

I am a National Healthcare Consultant who possesses years of experience with health policy reform. Based upon the past and current conduct of the key stakeholders, I am convinced that the primary participants are not prepared for the onerous and labyrinthine journey that lies ahead to meet Mr. Obama’s three health reform policy objectives. I maintain that we will have to experience a catastrophic event to compel all parties to the figurative table for substantive cooperation. I define such an event to be similar to the recent General Motor’s bankruptcy that brought the American auto industry to its knees. Here is an industry that has been aware of its internal problems for years, but had not been able to resolve the issues because the stakeholders’ desires were diametrically opposed. Once, GM emerges from the bankruptcy, I anticipate it will be a leaner company focusing on designing automobiles that travel over 100 miles per gallon, that cut emissions by 60% , and even reshape our American foreign policy. We will no longer amalgamate with regimes and foreign powers based upon potential oil reserves, but, instead, affiliate with countries that pledge an allegiance to our ideals and people. In sum, the health care industry needs to experience a symbolic bankruptcy to bring it to its bottom, which would rescind all parties’ hidden agendas and allow healthcare reform to flourish.

By: VentureBeat » Peeling back the veil of ignorance — why medical costs vary so much, and what Health 2.0 might do to help

Tue, 12 Feb 2008 22:54:19 +0000

[...] coverage grows ever more miserly. At least, that is, in the absence of some sort of comprehensive nationwide healthcare reform, although that’s a subject to revisit another day. For more stories on VentureBeat Life [...]

By: VentureBeat » Life sciences briefing: Wednesday, Dec. 19, 2007

VentureBeat » Life sciences briefing: Wednesday, Dec. 19, 2007 — Tue, 29 Jan 2008 19:05:47 +0000

[...] more “responsible” users of medical care; in practice, sick patients are often in a terrible position to be good medical “consumers,” and the plans have have proven generally unpopular to [...]

By: VentureBeat » Turkey weekend update: Brain-scan your teen, probe your Nubian ancestry, learn healthcare economics, and more

Mon, 26 Nov 2007 17:16:19 +0000

[...] fragmented and inefficient insurance industry — that we’ve noted in occasional pieces (here and here, for instance). The NYT’s proposed solutions, however, are a real mixed bag. More [...]

By: VentureBeat » Health Evolution Partners unveils its plans to transform healthcare

Mon, 10 Sep 2007 15:23:15 +0000

[...] that aims to actually reverse the seemingly endless spiral of medical costs, which as I’ve described earlier, has no shortage of dire consequences for the average American worker. But it will be interesting [...]

By: VentureBeat » Extend Health raises $15M for “defined contribution” health plans

Mon, 13 Aug 2007 17:22:03 +0000

[...] certainly an understandable business model, even if it seems likely to make the country’s healthcare crisis worse rather than better. There’s also growing evidence that these sorts of plans are highly [...]

By: VentureBeat » Healthcare reform debate — crucially important, and we’re covering it

Fri, 10 Aug 2007 23:42:58 +0000

[...] he has thrown an entire palette of views about the raging healthcare reform debate into his latest p…. From here, he will start narrowing on various themes, and forge conclusions about policies as they [...]

By: David Hamilton

David Hamilton — Thu, 14 Jun 2007 18:25:36 +0000

Thanks to Maggie and Alan for their comments. I do highly recommend Maggie’s book, by the way — it’s an excellent and highly readable introduction to major problems in U.S. healthcare. I’ll have other recommendations and perhaps even some mini-reviews as I get deeper into other tomes on the subject. I’ll also have more to say on the future of insurance down the line.

Alan, you raise some good points about the potential pitfalls of centralizing healthcare decisions. On the other hand, the outcomes data I’m referring to — particularly the research of Dartmouth’s John Wennberg and Elliott Fisher — strongly suggests that doctors and patients aren’t doing a great job of selecting the most appropriate care either. (Maggie Mahar wrote about the Wennberg-Fisher work for Dartmouth Medicine earlier this year.)

One solution to the problem is “evidence-based medicine,” in which researchers rank the efficacy of procedures and drug treatments after subjecting them to rigorous controlled clinical trials. These sorts of studies can result in top-down guidelines issued from afar, but applying more analytical rigor to the question of which treatments work and which don’t surely can’t hurt. Of course, such evidence can also be used to drive reimbursement decisions, and that’s a stickier subject that I’ll happily punt on for the moment.

By: Alan

Alan — Thu, 14 Jun 2007 17:32:16 +0000

Good roundup and bravo for stating your bias. I agree with your premise that the system is bad but fundamentally disagree with your conclusion.

Let’s look at the assumptions being discussed
- we’re spending too much for healthcare in the US
- the current decision makers are not making the best decisions
- limiting spending and changing who makes the decisions will improve the results

What you are fundamentally arguing is that some person remote from the the point of care can make a better decision about whether someone deserves access to a certain drug or procedure better than the doctor and the patient can AND if the patient doesn’t like it, tough. Today, if you’re health insurance provider won’t pay for something, you can still pay for it yourself. In Canada, you can’t – by law. When the government comes into an industry, you merely trade one set of behavioral incentives for another – and lose a lot of freedom in the bargain.

For an extreme result of where things can go, look at the recent move to forbid access to certain types of procedures to smokers in Britain.

So, I fully support your investigation of the alternatives to what we have today and hope you find some compelling paths for us to follow.

Just remember, that if you haven’t lived in one of those blessed OECD countries that are obviously more enlightened than the US, then tread carefully about your assertions of life under such a system. Data at the aggregate level doesn’t equal data at the individual level.

Living under such a system is far from a panacea. Perhaps the US can find a different path forward and your research will contribute to that.

By: Maggie Mahar

Maggie Mahar — Thu, 14 Jun 2007 17:11:26 +0000

This is a great round-up–I’m keeping it for my file.
I would add today’s piece on Bloomberg News http://www.bloomberg.com/apps/news?pid=20601109&sid=aJqICWb9TzZw&refer=exclusive. regarding insurers’ stepped-up efforts to sell cheap, high-deductible coverage to “young immortals.” It’s worth noting that under one policy, the patient pays 20% of his ER bill AFTER paying the high deductible. The Bloomberg story also notes the industry’s profits.
Thanks for mentioning the book.