Monday, May 16, 2011

The Whac-A-Mole school of health care policy

Boy, if you ever needed a summary of how messed up our health care system is, check out this story by Robert Pear in the New York Times. Entitled, "Nursing Homes Seek Exemptions From Health Law," the essence is that nursing homes want to be exempt from the employer requirement to provide health care benefits to their staff because the payments nursing homes get from Medicare and Medicaid to deliver care to patients are too low to provide enough cash to those institutions to offer those benefits.

I am sorry to beat a dead horse, but this is a direct result of political figures -- Democrats and Republican -- who give the impression that we can have it all. I don't know what the President meant when he said that he would deliver access, choice, and lower costs. But I always felt that by "lower costs," he meant "lower appropriations" by the federal and state government for Medicare and Medicaid payments.

This feels like the government equivalent of Whac-A-Mole. Pass a law-- Bam! Reduce government payments -- Bam! Exempt employers -- Bam! Add more people to government subsidized insurance plans -- Bam! Reduce government payments -- Bam!


Keith said...

Want to guess how frequently doctors offices don't offer insurance to their employees?

This is all just another example of how out of killter the costs of health care have become and how it is tearing at our ability to provide for the other essential investments we need to make for the future of this country.

The ability to pay for adequate health insurance has become too expensive for most of the middle class, and instead of limiting and/or rationing procedures and tests of questionable benefit, we just keep piling them on the menu of items that are covered and increasing the premiums. Then we raise the deductibles so that it becomes essentially catastrophic health insurance.

All are symptoms that we have created a monster that will gobble up ever increasing amounts of our GDP till it actually loweres our quality of life (if it hasn't already).

Mark Graban said...

"Lower payments" (or slashing prices) is not the same as reducing the true costs in any system.

This was true in the auto industry (GM beating up on suppliers for a lower cost usually did nothing to reduce the real costs in the system and often came back to bite GM and the rest of the Big 3).

Toyota showed a different way of working collaboratively with suppliers, working together on improvements that reduced real costs, sharing the savings. This requires trust and more than an arms-length relationship.

CMS and private insurers need to stop acting like GM.

Anonymous said...

All true, Paul. And now the Governor wants the legislature to work swiftly to change the way providers are paid. Fiddling with the way one-fifth of the state's economy is financed without a shred of evidence that it will be effective seems irresponsible at best. Pretending that "whole patient" payment reform is something new and hopeful is downright dishonest. The most expensive multi-specialty group in the state has been paid globally for more than a decade and it has done nothing to reign in their costs. Even adjusted for the underlying health of the population they serve, it is an open secret that the three groups with the longest history of "whole patient" payment are among the most expensive groups in the state. Healthcare folks have known this to be the case for a very long time- and finally those numbers were released in last year's cost containment report. Yet, the Governor and his allies have failed to explain why they support a policy that directly contradicts very good data supplied directly from our largest insurers right here in Massachusetts.

Instead, the Governor has repeatedly said that "powerful groups opposed to a Global Payment conversion have deep stakes in the status quo", implying they are opposed to global payments out of greed. Is it possible that some politicians have "deep stakes" in legislating changes that will take years to prove completely ineffective and counter-productive, but for now they can sell these changes as a panacea that will solve complex problems without any sacrifice by those on whom they rely for votes and political favors? I don't think that powerful providers are the only ones with "deep stakes" in the healthcare cost crisis.

I sincerely hope the legislature will not fall for this. We need real solutions, not the smoke and mirrors of global payment reform. Powerful groups can negotiate high fee-for-service payments, and they can just as easily negotiate high global budgets. Let's hope DHCFP's cost containment hearings will shed more light on the fatal flaws the Globalists don't want to discuss. The Administration needs to respond to the very real concerns raised instead of deflecting.