June 30th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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The use of economic incentives to motivate behavior is neither a Democratic or Republican idea. It is human nature to be motivated by economic incentives. The concept of individual responsibility is an American idea. It has been tarnished in recent years.
There is no question in my mind that government has the responsibility to be compassionate and help the needy. It is my view that government should help individuals help themselves.
The costs associated with Medicare and traditional healthcare insurance are rising. Every stakeholder points a finger at the other stakeholders as the cause.
President Obama’s Healthcare Reform Act is raising costs higher in anticipation of cuts in the future. He is in the process of forcing individuals to be more dependent on the government rather than promoting individual responsibility.
Obamacare will fail to control costs.
All anyone has to do is look at a Rand Corp. study of 29 years ago to see what works and what doesn’t work. Read more »
*This blog post was originally published at Repairing the Healthcare System*
June 13th, 2011 by Dryden Epstein in Opinion, True Stories
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I graduated from medical school in 1985, am board certified in EM and practiced 25 years—mainly inner city/trauma/teaching centers. However, the last 5 years were in a rural 25-bed hospital, 60 miles from a shopping mall or hospital with higher capabilities and specialists. My hourly rate was competitive and the hospital provided benefits included: malpractice, health, dental, & vision insurance, prescription coverage, paid vacation/CME allowance, and pension contribution.
Palliative Medicine (intensive symptom management for chronic or serious illness, coordination of care and clarification of patient/family treatment & life goals) is a subspecialty in urban settings but is lacking and most needed in the rural community setting. The chronically ill patient who is also typically elderly may present to the ED and be denied hospital admission after an ED physician evaluation. The doctor can “request” admission from an at-home Utilization Review nurse who checks the admission guidelines and if not met, reports the patient is to be sent home—even if it is over the objections of the physician who has evaluated the patient. There is no systematic follow-up of these patients, and they are told to “contact your primary care physician.” No one is making sure this happens. Some do not have primary care physicians and may be unable to obtain a timely appointment. The hospital does not have a social worker to coordinate care or provide assistance in the confusing navigation of insurance/appointments/outpatient testing, etc. There is no 24-hour pharmacy. Many of these patients do not have transportation or no longer drive and often live many, many miles from the hospital relying on neighbors, church folk, or county ambulance when they become ill.
In 2010, I opened Read more »
June 10th, 2011 by Happy Hospitalist in Health Policy
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Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.
One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins from Medicare have been negative for almost a decade. In addition, the rapid rise in private insurance premiums and industry’s gradual but accelerating exit from the health insurance benefit market all tell me that hospitals must find a way to reduce the cost of providing care.
There are many ways hospital costs can be reduced. Administrators are paid handsomely to make it happen. Either they do or they don’t succeed. Either they survive the coming Armageddon of hospital funding or they don’t. The hospitals least able to reduce their expenses in a market of decreasing payment will fold and other hospitals will become too big to fail. You want to be too big to fail. That’s the goal. If you can survive the coming tsunami, you will be saved and bailed out when you are the only one left standing. That is what history has taught us.
So, how can hospital costs be reduced? One way is to Read more »
*This blog post was originally published at The Happy Hospitalist*
June 10th, 2011 by EvanFalchukJD in Opinion
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Almost half of health plans in the US have deductibles of at least $1,000 according to a new study. It’s called “cost shifting” and it’s a big part of the future of American health care.
There are two major reasons why employers are doing this.
First, higher deductible plans are cheaper, since there is less risk to insure. Think of your car insurance – why would you make a claim for a ding on your door when it’s cheaper for you to just pay to have it fixed (or fix it yourself)? The higher the deductible, the lower the premium, even if it means more out-of-pocket cost for you for the small stuff.
Along these same lines is the second reason. If employees spend more of their own money on health care, maybe they’ll be smarter about how they spend it.
It sounds good – but does it work?
Yes. And No. Read more »
*This blog post was originally published at See First Blog*
May 29th, 2011 by John Mandrola, M.D. in Opinion
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I have been in Hamburg, Germany for the past five days. I enjoyed an amazing opportunity to visit one of the world’s most respected heart rhythm labs. Among other things, the main purpose was to learn a new way to ablate atrial fibrillation.
It was an incredible learning experience, one for which I owe an enormous debt of gratitude to the kind and generous people of Dr Karl-Heinz Kuck’s EP lab. Though these people are famous, they treated me as a respected colleague.
Details of all that I learned regarding this newly-approved ablation technique is a matter for future posts. Suffice it to say, I already feel like a better AF doctor.
For now, may I highlight a few of the more striking differences between Europe and the States, as noted by a Kentuckian on his first trip across the Atlantic? Read more »
*This blog post was originally published at Dr John M*
