The Mayo Clinic, which President Obama and his supporters tend to (rightfully) hold up as an example of strong health care, even if they do misdiagnose the reasons why it is best in the country, has come out clearly against the health care bill currently floating in the House:
Although there are some positive provisions in the current House Tri-Committee bill – including insurance for all and payment reform demonstration projects – the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.
In general, the proposals under discussion are not patient focused or results oriented. Lawmakers have failed to use a fundamental lever – a change in Medicare payment policy – to help drive necessary improvements in American health care. Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States.
Link: http://healthpolicyblog.mayoclinic.org/2009/07/16/mayo-clinic%E2%80%99s-reaction-to-house-tri-committee-bill/
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So in other words, they are arguing for what I said in my other argument (you may have to flip back in the commentary): Paying based on results and effectiveness of treatments so as to demand doctors and hospitals to perform at their best and provide quality and not quantity. I even cited the Mayo Clinic as a a proponent of that type of system and said that the House, Republicans too unfortunately) haven't been willing to do it.
ReplyDeleteI do not know why but it undid my own edit. The last sentence originally said:
ReplyDeleteI even cited the Mayo Clinic as a a proponent of that type of system and said that Democrats haven't been willing to do it (and in the House, unfortunately Republicans haven't been arguing for it much either).
They are saying nothing about government-based "effectiveness research." They are talking about changing Medicare/aid payment systems, which have a tendency to favor high-cost, low-quality states, and Republicans are supporting that (in fact, it, along with more portable health care, is the focal point of the most co-sponsored Republican plans). And they openly call out the fact that Democrats are so focused on getting everyone covered, that they are actually going to drive up prices without increasing quality.
ReplyDeleteMost articles concerning the benefits of comparative effectiveness directly target Medicaid and Medicare as the ones who are more willing to pay on cost and not effectiveness (in fact, government funded research in the field has even turned up results reflecting this). Demanding that improvements are made to meet medical effectiveness hits me as the logical step once you know what is effective. What I would like to know is how YOU would suggest increasing efficiency and how you would expect your concept to be funded (as simply asking for them to be better won't help). Because there is no doubt that our system now has huge problems with how the payout works period (private or public).
ReplyDeleteAnd I agree that the Democrats are rushing the bill and thus have kinda screwed the pooch. I have been reading what I can on the bill, and I am not as happy with it as I hoped I would be.
Comparative effectiveness will happen without the government if you simply switch the way doctors and hospitals are paid, making it based on outcomes rather than based on procedures. This is where switching medicare and medicaid come in handy. Once you make it outcome based, hospitals will have the incentive to rely on the doctors to do the best job possible at the lowest cost, making them the most money. At that point, it is like any other market.
ReplyDeleteThe problem with government-mandated comparative effectiveness is three fold. First, as stated many times already (including this post) it doesn't attack the root problem, the payment scheme. Second, it puts the government on the road to rationing, if and when a public plan pops up. Of course, I oppose a public plan all together, but that is a story for another day. Finally, it stifles innovation by putting incentives into using already existing technologies and disincentivizing experimentation, even if the doctor feels that it is right in this case.