Ideas for Reform

[Daniel Kaplan]

As we've seen in the comments section, just having Uncle Sam pay for medical bills has not helped slow rising costs.

Making the gov't pay for everyone is more about whether you think health care is something like the fire dept or the police dept, a public good that everyone should (ideally) have equal access to.

However, the deeper issues with this debate is that costs are becoming exorbitant. There are a lot of reasons for this. Conservatives like to highlight malpractice lawsuits, which bring about defensive medicine. This is part of the problem, and conservatives should continue to press on this front.

But there's way more going on than that. One thing I've talked about is getting more general practitioners out there. The best way I see us doing that is by encouraging the creation of vastly more medical schools that will be able to train more doctors. These schools should offer incentives to students to go into GP. Obviously, there are many factors that influence doctors' choices about specialization, but I think one big problem is the vicious circle that is created by the outflow of doctors from GP. This solution won't offer any short term reduction in costs, but its an important investment in the future.

Anyway, that's just one idea I've had. We NEED to find ways to make health care more affordable. If health care weren't so expensive, people wouldn't be so quick to ask the government to pay for all of it.

[Josh Branson]

From the blog I co-write: The Wrong Approach to Health Care.

"A WSJ editorial this week talked about Obama’s administration having learned from the mistakes of HillaryCare in the 90s. Tom Daschle, the incoming Secretary of HHS, criticized the Clinton administration for not being aggressive enough. Daschle wrote in his health care book Critical: “I think that ideological differences and disputes over policy weren’t really to blame.” I beg to differ, and I’ll explain why the new administration’s approach to health care is wrong."

Read the whole thing.

[Josh Branson]

From the blog, I wrote about the direction of industry regulation and the importance of selecting an...:


We’ve discussed the major issues of health care that need reform, and I’ve been an advocate for one of the most overlooked aspects of health care reform, which is industry regulation. I recently mentioned the names being considered for FDA Commissioner while examining the incoming administration’s incorrect approach to health care reform. It is essential to understand how regulatory policies affect the cost of medical products.

Henry I. Miller and David Gershon wrote an article in The Weekly Standard this week that explores this subject. On innovation and development, the write:

"In fact, at a time when drug development should have been spurred by innovative new technologies and a decade of steady increases in R&D expenditures–which tripled to more than $45 billion between 1995 and 2007, drug approvals have steadily declined. The 19 new medicines approved in 2007 were a 24-year low. Bringing a new drug to market now requires on average 12-15 years, and costs more than $1.2 billion–in no small part because the average length of a clinical trial increased 70 percent between 1999 and 2006. Perhaps the most ominous statistic is that drug manufacturers eventually recoup their R&D costs for only one in five approved drugs."

Read the whole thing.

[Peter Curka]

Ben Spivey said:

Thank you for creating this discussion group Peter. The best model for this discussion may be this discussion group for a list of solutions, and additional discussion groups for specific solutions as I began for malpractice costs.

Here is a summary of very general solutions proposed thus far on the comment board some of which are repeats of your list:

- Transfer insurance ownership from companies to individuals: tax breaks for individuals not companies to provide medical care.
- Address any possible conflicts of interest between big pharma and medical care providers. Companies are the source of innovation in the field, but new technology should not always be the first answer from providers.
- Malpractice/Tort reform
- Address the issue of high costs for primary care physicans - possibly by transferring more power to nurses and pharmacists, reduced education costs for those studying to be GP versus specialists. I am not sure how our regulation or tax system affects medical education.
- Deregulate healthcare insurance across state lines
- Examine regulations that prevents hospital size and locations and how this affects availability of care

[Peter Curka]

Josh Branson said:

Marla, what I was saying is that public spending in health care is too high, so we are in agreement there. We know that Medicare and Medicaid are bloated, but the government also subsidizes much of the private health care industry. My suggestion was to determine who really needs public funds and focus that money on them, which should allow us to significantly reduce spending.
Josh, Who says health care spending is too high? Or too low? Compared to what? Compared to 50 years ago when 2 thirds of the treatments we have today didn't exist Compared to 1968 and the beginning of the Medicare Program when the average beneficiary was only expected to live another 5 years? Compared to Western Europe and Canada where care is de facto rationed? Maybe this is what rich democracies in the 21st century spend? We can't know since we've never been here before. My point is that only a real market can allocate goods and services efficiently. We can't know ahead of time what the right amount might be. It might be higher or lower. It would probably be distributed differently if patient's were put back in the payment loop. (See also my reply to Ben Spivey today)

Marla said:

Hi Josh,
Sorry for taking so long to reply, I thought you were saying we needed more regulation. I too work in healthcare but a different sector than you do.

[Peter Curka]

Peter Curka said:

Ben Spivey said:

Thank you for creating this discussion group Peter. The best model for this discussion may be this discussion group for a list of solutions, and additional discussion groups for specific solutions as I began for malpractice costs.

Here is a summary of very general solutions proposed thus far on the comment board some of which are repeats of your list:

- Transfer insurance ownership from companies to individuals: tax breaks for individuals not companies to provide medical care.
- Address any possible conflicts of interest between big pharma and medical care providers. Companies are the source of innovation in the field, but new technology should not always be the first answer from providers.
- Malpractice/Tort reform
- Address the issue of high costs for primary care physicans - possibly by transferring more power to nurses and pharmacists, reduced education costs for those studying to be GP versus specialists. I am not sure how our regulation or tax system affects medical education.
- Deregulate healthcare insurance across state lines
- Examine regulations that prevents hospital size and locations and how this affects availability of care

[Peter Curka]

Peter Curka said:

Peter Curka said:

Ben Spivey said:

Thank you for creating this discussion group Peter. The best model for this discussion may be this discussion group for a list of solutions, and additional discussion groups for specific solutions as I began for malpractice costs.

Here is a summary of very general solutions proposed thus far on the comment board some of which are repeats of your list:

- Transfer insurance ownership from companies to individuals: tax breaks for individuals not companies to provide medical care.
- Address any possible conflicts of interest between big pharma and medical care providers. Companies are the source of innovation in the field, but new technology should not always be the first answer from providers.
- Malpractice/Tort reform
- Address the issue of high costs for primary care physicans - possibly by transferring more power to nurses and pharmacists, reduced education costs for those studying to be GP versus specialists. I am not sure how our regulation or tax system affects medical education.
- Deregulate healthcare insurance across state lines
- Examine regulations that prevents hospital size and locations and how this affects availability of care

[Jim Johnson]

If you are serious about market based solutions for healthcare, I have a must see video for you of success. A USA coporate lawyer has setup a series of successful drug shops in Keyna (No collaboration with Obama). It is working wonderfully. It includes PROFIT, ACCOUNTABILITY, REGULATION, SCALABILITY, AND FLEXIBILITY (even despite genocide)!! PBS actually covered this last summer as a humanitarian piece last summer. Watch the video now! Also offered are images and transcript..

[Josh Branson]

BlueCross BlueShield wrote a report not too long ago called "The Uninsured in America." I recommend it because it has some important statistics.

One important lesson to take from the study is that about a third of the uninsured are making at least $50K a year. While there will be some people who may struggle to afford private insurance, even with a tax credit and a better marketplace, it is important to recognize that a significant number of people without insurance can afford it.

CBO figures show that almost 50% of duration without insurance is under four months. This implies that a lot of time without insurance is due to circumstances like changing or losing a job.

I also think the idea of allowing small businesses to pool together for insurance is a good one.

[Josh Branson]

2009 has been rough for conservative health care advocates. SCHIP expansion passed. Then we had the expansion of Medicaid and unemployment insurance requirements for employers through the stimulus. Now, the President is calling for cuts to Medicare Advantage without fixing the physician payment problem. We're also hearing about pharmaceutical importation, and a slew of new regulations on the drug and device industries.

On top of this, liability has increased for drug manufacturers with the Wyeth v. Levine decision, and would increase for device makers as well, if Congress passes the Medical Device Safety Act, which would effectively overturn Riegel v. Medtronic. There are also several legislative proposals that would hurt medical innovation by weakening the patent system. Those bills include The Promoting Innovation and Access to Life Saving Medicines Act and the Patent Reform Act.

The health care industries are being hit from every direction, and patients will be the ones likely feeling the unintended consequences. We need to advocate smart reform in each of these areas to promote the best system for doctors, insurance providers, public programs, producers and manufacturers, and most of all, the patients.

[Josh Branson]

Here is what I just blogged on the subject of preemption cases and their effects on health care.

[Josh Branson]

Disclosure: I work for a drug and device manufacturer.

[Dan Croft]

More medical schools are not the answer here. While I will agree that there is a lack of quality general
practitioner's out there, creating more medical schools isn't the answer. Most medical students don't go into med school expecting to be neurosurgeons or dermatologists specializing in erythema nodosum, they went because of multitude of reasons, not the least of which is to help others, financial security for the family. General Internal Medicine on the outpatient side has become unpalatable to many med student/interns/residents and not a particularly viable career decision given the many options there are in the medical field.

One of the biggest reasons for the decline in general internal medicine speciality has been the rapid growth of Hospitalist. Hospitalist's are the fastest growing speciality in medicine. They take care of patients from admission until discharge. Managing day to day care, implementing treatment plans and coordinate discharge plans and follow up. These are people, much like myself, who found that this medical speciality suited them. Most of these hospitalist's are coming in large numbers from outpatient practice and residents who choose hospitalist over general internal medicine.

More medical schools will not fill the void unless the market supports it and in this environment the market doesn't. General Internists work long hours, manage every system of the body, submit to mountains of paperwork all to an alloted 15 minute visit that turns into a 4 hour marathon for the patients and families. It's hard to stay happy in this environment. I think there is a lack of autonomy. Each visit is at a set "price" as mandated by medicare/medicaide. The example is set and other insurers follow suit. It isn't a business friendly environment! Physicians didn't go through the rigors of med school and training to be working for the government and yet that it what many providers now find.