tag:blogger.com,1999:blog-32053362.post5334059580926052175..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Are monopolies the answer?Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-32053362.post-68102123976535319892009-06-15T19:00:15.851-04:002009-06-15T19:00:15.851-04:00Paul Levy said: I used to run the regional water a...Paul Levy said: <i>I used to run the regional water and sewer system in Eastern Massachusetts. Among the things I liked best: I was providing an essential public service, I had a monopoly, I could set my own prices, and people had to pay.</i><br /><br />That is a scary prospect. Think of the Massachusetts Turnpike Authority running the "Big Dig": Massive cost overruns, quality problems with slurry walls and concrete, and death from falling roof panels. Think of unions of tenured teachers effectively running most educational programs. Think of AMTRAK with costs per passenger far greater than the cost of a ticket.<br /><br />Find a way to apply competition and efficiency to health care.Engineer on Medicarenoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-37591277940408048722009-06-15T16:00:34.267-04:002009-06-15T16:00:34.267-04:00From your description of Christensen's ideas, ...From your description of Christensen's ideas, it doesn't sound like monopoly is a requirement for his ideas, it's just the only area where we see these kinds of integrated value networks today. <br /><br />That said, it seems to me that the major requirement is not <i>monopoly</i> with respect to the patients (you can always compete for patient dollars, especially if you're reducing costs and improving quality), but <i>monopsony</i> with respect to the doctors - that is, Geisinger is the only one buying doctors' services, so they can put them on salary and have a great deal more influence over the doctors' behaviors. <br /><br />Does this ring true? Are there examples of Mass. hospitals that have salaried doctors (other than the VA!)? If not, why not? Are salaried doctors the key to building a truly integrated value network? <br /><br />It has always seemed to me that doctors are the real key to cost containment, but no policymaker is willing to propose or implement frameworks that adversely affect this powerful (and well-liked) constituency.Aron Bnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-31033036622453096622009-06-15T14:21:24.540-04:002009-06-15T14:21:24.540-04:00I had several immediate reactions.
First, was to ...I had several immediate reactions.<br /><br />First, was to recognize the siren call of the all knowing all powerful beneficent leader. It's tempting, but the siren's call has consequences.<br /><br />Second, was to think about the difference between water and healthcare in terms of goals and ability. The ideal goal for a water system is to provide pure safe water to every location in unlimited quantities for no cost. The actual ability of current technology is less but we can deliver pure enough water in sufficient quantity for acceptable cost.<br /><br />The ideal for healthcare is to eliminate all disease and illness, and repair all injuries fully at no cost. We are not even close. The really big disease elimination was the introduction of water and sewer. (See, you've been in healthcare for years. :-)) Then there was the slow bump with the introduction of immunizations. Now there is a very long slow slog dealing with all that is left.<br /><br />We do not know how to get close to the ideal, nor even what path takes us in that direction. That is a large part of the nature of the healthcare problem. We don't know what next steps will improve the situation.<br /><br />Third reaction was around monopolies and semi-monopolies. Medicare, VHA, and Indian Health Service are three huge monopolies. Kaiser and Mayo are two large competitive providers. Each has taken very different strategies. None is considered close to the ideal. None is held out as the clear answer for the next target. They all have major successes and major flaws.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-22286743161092847372009-06-15T14:20:57.532-04:002009-06-15T14:20:57.532-04:00Perhaps so. The last thing I want is the governmen...Perhaps so. The last thing I want is the government to run health care top to bottom. They're not even that far with Medicare/Medicaid it's a complete disaster. What I want to see is the government to get out of health care. <br /><br />I live in New York and there is no such thing as private health care. NYS has regulated the health care industry so much you can't tell where Albany stops and the private companies start. It makes me wonder how much cheaper and better health care would be in NY if Albany would just stop meddling.<br /><br />It's sad when NY citizens cheer when their state government is paralyzed and grinds to a halt. If the masses only knew how far NY's hand is up the medical industry's backside they might decide enough is enough.Unknownhttps://www.blogger.com/profile/11228992629065531924noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-14518027853937654222009-06-15T14:08:43.412-04:002009-06-15T14:08:43.412-04:00If Mr. Christiensen is correct in his notion that ...If Mr. Christiensen is correct in his notion that general hosptials are an unsustainable model, then is the future of community hospitals even more untenable? Given that their mission is to serve a local population without the intention of advancing the practice of medicine can we expect them to survive in the long term? Perhaps aligning around with a focus on specific local skills and partnering with an academic medical center will insure their survival.John Greenbaumnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-6475630369382192722009-06-15T13:51:13.071-04:002009-06-15T13:51:13.071-04:00In complete agreement with author's argument! ...In complete agreement with author's argument! This definitely fits the mantra offered by Atul Gawande in his "Health Care Cost Conundrum" piece in the New Yorker earlier this month.<br /><br />Gawande frames the debate by asking who will be the 'anchor tenant' in medicine; while he contrasts the cost per Medicare beneficiary profile between Mc Allen Texas and other markets. He also goes on to suggest that the 'Mayo's' of the world (which by definition include Geisinger, Kaiser/Permanente, and other integrated - both financial and clinically systems) are losing the anchor tenant battle.<br /><br />Lets hope not!<br /><br />Thanks Paul. We are going to witness a second hundred days of the Obama tenure that is likely to scale the 'HillaryCare' drama exponentially. <br /><br />Integration aka 'managed monopolies' is a large part of the solution based on our current finance and delivery paradigm's architecture. Yet, there is more to the story not to mention the direct practice model and emerging boutique, concierge and retainer based approach in tandem with HDHPs.<br /><br />We have a way to go. I can't rule out that Obama may not come to know the despair of HillaryCare in the white waters of healthreform; he (we)faces a challenge like no other!Gregg Mastershttp://preferredhospitals.comnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-20571824976773739062009-06-15T13:02:43.539-04:002009-06-15T13:02:43.539-04:00Not sure what you mean, Lee. The point I make abou...Not sure what you mean, Lee. The point I make about ACOs is not at all sarcastic. If the government wants to create these monopoly-like structures, who will hold them accountable?<br /><br />Perhaps we are agreeing?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-35250455191854895692009-06-15T12:59:34.627-04:002009-06-15T12:59:34.627-04:00Really does make life easier when you have a capti...Really does make life easier when you have a captive audience. You can turn the screws as much as you want, and the only choice is to accept it. It works so well for the DMV, Medicare/Medicaid, and schools that doing the same thing for health care will make the system just as good.<br /><br />I hope your post is sarcastic. If not I think you should get out of your current regulated industry and go work in a relatively unregulated industry and see how competition really does work.Unknownhttps://www.blogger.com/profile/11228992629065531924noreply@blogger.com