For John, BLUF: Not that high on my reading list. Nothing to see here; just move along.
From The New Yorker is a book on the creation of the Patient Protection and Affordable Care Act (Obamacare to some). The book is America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System and the author is Mr Steven Brill. The theme of the book is how health care reform went wrong.♠
The review is by New Yorker perennial, Mr Malcolm Gladwell. Mr Gladwell doesn't like the writing style, but the book was good enough (or the payola big enough) for it to rate a review in The New Yorker. The book I co-authored didn't make it. It didn't even make Amazon.
Regards — Cliff
♠ And I agree, but probably for different reasons.
Probably because you didn't offer it as an e-book.......
ReplyDeleteI have read the NYT review of the book and listened to Mr. Brill interviewed on radio and TV, though I have not read the book. I would characterize his conclusions is that problems with the process resulted in healthcare reform that did good things, but not enough. Because of the lack of political acumen on the part of the White House and a Republican attitude of doing anything to deny the President any success, we have health care reform which did not address the most important issue: controlling irrational and spiraling health care costs. The drug makers came away happy since we can't buy our drugs from Canada and the providers aren't strong enough to be effective in the market place; the insurers are happy since there are more people insured and no effective control on what they can charge; the providers are happy since they can still do every test, every procedure and charge, charge, charge. And a few more people were insured, though many are still uninsured and those that have some coverage underinsured, resulting in family death panels and the rationing of health care absent a national policy that would actually provide leverage. The advantage is that the actions/decisions are being taken at the lowest levels, though in this case by the least capable of making changes.
ReplyDeleteMaybe
ReplyDeleteThe number of uninsured is like it was at the end of the Bus Administration ("W").
The real problem is not yet spiraling costs but rather the fact that we have areas where there is insufficient medical provisioning. Not just a lack of providers, but also a lack of health care knowledge and a cultural understanding of the role of the medical provider, the pharmacist and the patient family.
The swipe at Republicans in the immediate above post is a little unfair. As we recall, Prof Gruber at MIT said that the bill was passed with a little slight of hand, which was possible because the voters are stupid (that would be stupid), but the Tea Parties and the like saw the problems and opposed the bill.
My question is, can we get coverage (actual medical care) to the areas where it is not at this time? Just giving more people more insurance suggests that the PP&ACA Architects think there is an excess of physicians, physicians assistants and nurse practitioners. I am dubious about that. To stretch the present corps of providers over millions more people means that some now being provided for will face longer wait times or even not have coverage.
Regards — : Cliff
This has always been about Single Payer health care....aka...government run health care. It has never been about QUALITY or QUANTITY health care. The proponents will never give up trying to achieve it...and many of those proponents are Republicans.
ReplyDeleteSadly, the proponents and a sizable portion of the American population refuse to acknowledge reality. Healthcare in Britain under the NHS succeeds only in terms of metrics that speak to "equality of care" which is achieved only by rationing it. They cherry pick the statistical data that favors the success of single payer systems. Yes, they are ultimately cheaper, because they aggressively restrict the amount of healthcare given for various conditions and age groups. A good friend's father who was 68 was told he had bone cancer...and was told simply to go home and get his affairs in order that he was too old to be treated for the condition.
PP&ACA is already worsening a dire dearth of primary care practitioners as many are retiring early or moving on to academic medicine or other medical pursuits in which the long arm of the government is not intruding. In my area and Health Care Organization (Foundation Medical Partners) there are currently only 3 nurse practitioners accepting new patients...and a number of physicians, NPs and PAs have left. More will follow.
Life is not fair and fee for service is the only "successful" health care funding system that "works."
It seems CR is too focused on provisioning and not the chaos which is in our delivery system. Certainly there are areas of insufficient provisioning, but why would that drive costs? Perhaps it effects the number of uninsured, but I don't see why. In fact it seems like a minor issue. And concentrating on it can help explain why the comment about the Republicans can seem undeserved, but I can't blame Obama entirely for not getting the Republicans to the table for a grand bargain that would provide some rationality to the costing process. In that process of course we can consider the number of providers and their disposition, but this entire discussion argues for something other than solving the problem family by family and educating them. If not a single payer, then something else that can tackle the issues and bring the leverage to bear.
ReplyDeleteSingle payer is simply government controlled medical care. What that means is that all providers and support folks are government employees, paid what the government wants to pay them. There is little or no consideration for "provisioning" in terms of geography. If you live 250 miles from a provider who is your "gate-keeper" you must drive the miles. The government can't afford to bring that provider closer....not enough population density.
ReplyDeleteMy cousin's husband has been a physician and surgeon in North Dakota for the better part of 50 years. He has an airplane that he flies to see his patients. trust me, that is an exception not a rule. Now, if you put him on a government salary, the airplane goes away as unaffordable. In fact, you take a major portion of primary care physicians and providers completely out of the equation and make the provisioning issue even worse.
In health care, cost is achieved or lost family by family. One size fits all simply doesn't fit. And, as if to drive that point home, the Federal CEPB IS a death panel.
BTW, the military has been at this rationing thing for some time. In the mid-90's, military pharmacies began to employ three different formularies. One was for active duty and employed some high cost drugs. The second was for active duty family members and employed lower cost drugs, and the last was for retirees and their family members. It featured the cheapest generics that could be purchased regardless of efficacy and left huge gaps in what could be prescribed such that many had to pay out of pocket on the economy. BTW...there IS a difference in efficacy between labeled and generic drugs.
Its not about user affordability, or quality, or quantity of care. It is about government gaining total control of health care as a means of making everything equally accessible and free. Think rationing.