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eridani's Journal
eridani's Journal
October 30, 2013

Why competition in health care sucks

--and why it should be a public good.


The bronze and silver policies that most people will select under Obamacare have enormous deductibles so that people are discouraged from seeking routine medical care and from getting the companies to provide something in return for the premiums. And the companies will continue their efforts to avoid caring for the sickest patients and to deny coverage whenever possible. The “choice” in the “healthcare marketplace” is limited to policies of companies whose bottom line is not patient care, but profit. (The “not for profit” companies have the same bottom line as those that are “for profit”--they just have to call it something else.)

Is competition among drug companies a good thing? One would think that “ethical pharmaceuticals” would compete to offer the best products at the lowest prices. But like the health insurance business, the “competition” is only to see who can derive the maximum profit. We get the drugs that are most profitable and most easily marketed, not the drugs we need. And the price of the drugs is whatever the drug companies can get away with.

The business model of competition and profit seeking is even being foisted on doctors. “Pay for performance” is promoted as a way to get doctors to improve the care they provide. What an insult to the medical profession! Doctors don’t need a financial incentive to be motivated to provide quality care for their patients. When pay for performance has been put into effect, doctors and hospitals have shown that they know how to game the system, but there has been no evidence that pay for performance has actually improved patient outcomes.

If competition is so wonderful, why don’t we have competing police departments, fire departments and armed services? Clearly, the business model--competition and making a profit--is not always appropriate. The competitive model for healthcare is a terrible idea--inefficient, immoral, and colossally expensive. A recent study estimated that a single payer system would save $592 billion in administrative and pharmaceutical costs. Will we ever get a system whose bottom line is not making money, but caring for patients?

October 28, 2013

Report on Healthcare Now! (HCN) Strategy Conference 2013, Nashville, TN


The conference began with a plenary on the strategy in the south. The speaker talked about the need for a special strategy in the south due to the legacy of white supremacy, the plantation mentality (where whites feel oppressed by the government and the northern whites, and the blacks are oppressed by the whites), and the atmosphere of fear, distrust , and envy. They went on to talk about the particular challenges and opportunities that exist for organizing in the south.

Next, HCN’s Director of Organizing, Ben Day, highlighted some resources they’re putting together. They are publishing a Single Payer Activists Guide to Affordable Healthcare Act to help with education, media, and outreach during this time of transition. These Guides will be out soon. They are also planning to conduct Everybody Institutes, trainings they plan to conduct nationwide.

We then touched on Healthcare Justice in Tennessee. There wasn’t much there, but a good story about the women’s suffrage movement and how the last state to approve the amendment was Tennessee. The decisive legislator changed his vote to pro suffrage due to a letter from his mom saying something like “Dear Son, Be a good boy. Hoorah for suffrage! Your mother” It is a powerful story of the persuasive impact of finding an effective secondary target (in this case it was mom).

There was then a break out session on the Challenges and Solutions for State Single Payer Legislation. We spoke about two different strategies, one is passing a bill without funding and then following up to pass another with the funding mechanism, the other is passing a bill that contains the funding mechanism. We also talked about whether to include a laundry list of things covered by the law or to create a body to make those tough decisions. Finally we spoke about some obstacles such as ERISA and getting money from the federal government programs. Additionally, there were questions about the role and necessity of conducting studies.

October 18, 2013

Consolidated health care systems forbid you to see your regular doctor


For several hundred patients at the University of Pittsburgh Medical Center, it started with a certified letter informing them that they were no longer allowed to see their physicians. The reason? They were unlucky enough to have insurance called Community Blue, which is offered by a rival hospital system. Astoundingly, they were barred even if they could pay for the care themselves.

One patient, in the middle of treatment for lung cancer, said at a hearing before a State House of Representatives committee that she was prohibited from seeing her U.P.M.C. oncologist. Another, with the debilitating autoimmune disease scleroderma, said she was dismissed from the U.P.M.C. Arthritic and Autoimmune Center. A third, a five-year breast cancer survivor who needs follow-up care every six months, was cut off from the doctor who had been with her since she was first given her diagnosis.

Community Blue is sold by a company called Highmark. Like U.P.M.C., it is both a hospital system and an insurance provider, part of a growing trend toward vertical consolidation in the two industries. These and other companies insist that such consolidation streamlines the caregiving system and thus benefits the patient. But in the short term, they are waging a vicious war over patients--and as the experience in Pittsburgh shows, it?s often the patients who are losing.

Comment by Don McCanne of PNHP: Integrating health care is a great concept that theoretically should improve coordination of care, reduce duplication, provide incentives to meet quality and outcome targets, improve access to appropriate specialized care - in general, improving quality while reducing costs. That is the idea behind the Accountable Care Organizations established by the Affordable Care Act. How is it working out in the real world?

We've watched as insurers have consolidated. Although they tout that they are providing higher quality at lower costs through managed care, in fact they have used their oligopolistic leverage to limit patient access to their selected network providers. Although they contend that they are selecting the highest quality providers, in fact, they are excluding quality institutions such as academic medical centers and going with the cheapest contracts they can extract from the health care community.

In response, we are witnessing an explosion in consolidation of health care providers - hospitals and physician groups - often into single entities. Obviously this results in "must have" groups that in turn have leveraged their oligopolistic negotiating power in dealing with the insurers.

Not to be outdone, we are now seeing insurers and consolidated health care systems joining together to increase their control of markets, and thereby share in the spoils. When you see patients with lung cancer, breast cancer, and scleroderma being cut off from their care strictly on the basis of realignment of the health care business models, you can dismiss the concept that these changes are changes that are designed to benefit patients. The ugly competition that is taking place between Physician-hospital-insurer entities (Phi) is cutthroat and certainly not in the patients' best interests. (Phi seems to be an appropriate symbol for these entities since, in Lacanian psychoanalysis, it is the symbol for "the phallic function.&quot

The Affordable Care Act very specifically was designed to keep control in the private sector. Private sector business models will always do what they are designed to do - anything to make more money. If we really do want a system designed to provide the best care possible with our available resources, we need to dismiss the private insurers and put our own public stewards in charge. They would have the responsibility of answering to us.
October 12, 2013

Breitbart: First Obamacare, Then a Single Payer System

Time for Satan to start looking through heating catalogs?


Republicans must live with Obamacare. They have few prospects for electing 60 senators needed to repeal the law, and unless they work to make it more palatable--something they have few ideas to accomplish--the nation is headed for socialized medicine.

The burden to find solutions will take congress to places that Republicans are very reluctant to go.

The German and other European systems accomplish lower costs and universal coverage by imposing tight controls on prices for services, drugs, and devices. Britain's National Health Service doesn?t bother with insurance companies and claims forms--by eliminating insurance company overhead it accomplishes much lower costs than even the German system.

Even before Obamacare, federal and state governments, through Medicare, Medicaid, and other programs, paid more than 50 percent of U.S. health care bills. That was more than the 9 percent of GDP, and the amount Britain spends to accomplish universal coverage ? without the additional $4,600 per person American businesses and individuals pony up.

Reducing U.S. doctors fees and drug and device prices down to German levels won't be easy or likely possible, but politicians, providers, and businesses still providing health insurance will need a solution--likely a scapegoat.

Enter the insurance companies that have been screwing down doctor's fees, hassling everyone with mindless paperwork, and paying executives like royalty.

The federal government could probably pay doctors, drug companies, and device manufactures pretty reasonably directly, and without the insurance company middlemen, through an American National Health Service.

(Peter Morici is an economist and professor at the Smith School of Business, University of Maryland, and a widely published columnist.)

Comment by Don McCanne of PNHP: Professor Peter Morici, an expert on international trade, is known for holding no punches. Here he suggests that Republican intransigence could lead us to an American National Health Service--true socialized medicine.

In the full article, available at the link above, he explains why Obamacare is unsatisfactory, likely with the intent of cajoling Republicans into working with Democrats to improve it. He seems to be using the prospect of a national health service as a threat to Republicans as to what could happen if they failed to cooperate. In doing so, he does present some very persuasive arguments for making the change.

Maybe he's serious. He does make private insurance companies the scapegoat. Get rid of them and then what options do we really have?

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Gender: Female
Hometown: Washington state
Home country: USA
Current location: Directly above the center of the earth
Member since: Sat Aug 16, 2003, 02:52 AM
Number of posts: 51,907

About eridani

Major policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity
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