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 9th, 2011 by Dr. Val Jones in News, Opinion
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The World Health Organization (WHO) and the World Bank just revealed the first-ever global estimate of disability. The report suggests that at least 1 billion people are currently disabled, and about 1/5 of those are experiencing significant difficulties with their activities of daily living. Since people with disabilities experience poorer health, lower educational achievements, fewer economic opportunities and higher rates of poverty than people without disabilities, this vulnerable segment of the population needs much closer attention.
I’m a physical medicine and rehabilitation (PM&R) specialist by training, and there are only about 8000 of us in the United States. Some have called PM&R specialists: “primary care physicians for the disabled” and I think that’s a reasonable description. The task before us is daunting – with hundreds of millions of people who are not living their lives at maximum functional capacity, rehab physicians should be in great demand.
My experience is that while the demand is great, funding is limited. I’ve seen tragic cases of children being denied critical wheelchair parts, and Read more »
April 30th, 2011 by DrRich in Health Policy, Opinion
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The last two weeks have made clear that the debate over our national debt will play a major role in the next election cycle.
On one side, many Republicans, lead by Representative Ryan, insist that the rate of growth of our national debt – especially the massive projected growth of Medicare and Medicaid – promises to destroy our society within a generation or two; and that the only way to avert that catastrophe is to make substantial structural changes to our entitlement programs. The subtext of their message is: Federal debt is bad, and debt of this magnitude will be fatal.
On the other side, most Democrats, led by President Obama, stress that our entitlement programs are promises that simply can’t be changed in any substantial way, insist that such entitlements are “investments in our future,” and suggest that whatever shortfalls our current system might encounter can be remedied by taxing millionaires and billionaires. The subtext of their message is: Federal debt can be a force for good, and in this case will trigger a much-needed redistribution of wealth (which is a primary goal of Progressives).
The debate over the national debt is as old as the Republic. In the original version of this debate, the part of the modern Republicans (i.e., debt is bad) was played by Jefferson, and the part of modern Democrats (i.e., debt is an investment in the future) by Hamilton. Read more »
*This blog post was originally published at The Covert Rationing Blog*
April 7th, 2011 by Toni Brayer, M.D. in Health Policy, Opinion
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I am all for any proposal that will improve heath care in America. Improvement means controlling costs, covering all Americans so no one has to worry about going bankrupt to pay for health care. Improvement means access to quality care without having to worry about losing your job, which means losing your coverage. Improvement means a system where all incentives are aligned to prevent disease, rather than using expensive technologies and hospitals to treat disease after the fact. Any proposal that gets us there has my vote.
In the GOP “Path to Prosperity” budget for 2012, they propose a few things that are good and a few big things that are bad…really really bad. First the good. Capping the medical malpractice lawsuits for “pain and suffering” would be a huge step forward. Patients should be compensated for medical errors but the “hit the lottery” windfalls for pain and suffering are costly drivers that make no sense. There is no place in the world, besides the USA, that has such onerous medical malpractice lawsuits. And they drive up cost for everyone. Read more »
*This blog post was originally published at EverythingHealth*
April 1st, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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The larger the bureaucracy the more inefficient a system becomes. Several things can happen in the decision making process.
1. The decision making process can become opaque rather than transparent.
2. Decisions are made by a committee by consensus.
3. Consensus committee decisions might not sharply define the original goals.
4. Blame for errors gets dissipated.
5. Decisions are only as good as the information that is gathered.
6. Changing a wrong decision can be difficult and costly.
President Obama’s healthcare reform law is creating 256 new agencies to gather information and recommend decisions for other agencies to write regulations.
The following decision is being made by an agency in Washington state. It is not only the wrong decision, but is a decision that will set back the care of Type 2 Diabetes Mellitus 15 or 20 years. It is a decision being made using the wrong information. Read more »
*This blog post was originally published at Repairing the Healthcare System*
