Monday, June 21, 2010

Bad News on the Cost Front

Whenever we get serious about the cost of health care, it is inevitable that some of the measures taken will be unpopular.

Whether unpopular measures will be tolerated by the public depends on the level of concern about the cost issue.

Polls in the past have indicated that the cost of health care ranks high among the issues of public concern.

However, a poll reported in the June 8 issue of The Boston Globe asked the question in a different way and tells a somewhat different story.

The poll was conducted by an organization called Mass Insight. The main finding was that most people don’t find the price they pay for health coverage to be a serious problem. Though the report didn’t say, one supposes that is because someone else is paying for most of the insurance, which is paying for most of the cost of care.

The poll also showed that a large majority of people don’t want to give up anything when it comes to health coverage or the freedom to choose whom they see for medical help.

William Guenther, president of Mass Insight, was quoted as saying “While there is increasing concern about cost, the majority of people still don’t see health premiums and prescription drug costs as enough of a burden to cause them to support reforms that might change their habits.”

That is bad news for those who are trying to bring the cost of health care under control.

Resolving that dilemma is the main hurdle to be overcome if significant progress is to be made on the cost issue.

Tuesday, June 08, 2010

Single Payer and Politics

National Health Insurance (also known as single payer) has many advocates who offer a number of arguments to support it. However, there are less favorable implications that need to be included in the debate.

They include the inevitability of decisions that seem arbitrary and political interference.

A clear example was the subject of an article in the May 31, 2010 issue of The Boston Globe.

For a number of years, Medicaid paid $140 for medical imaging examinations used to test bones for signs of osteoporosis, mostly for elderly women. The rate attracted commercial operators to provide the service by means of mobile scanners that moved about among medical office facilities. Many doctors also installed the equipment in their offices.

At some point Medicare decided it was paying too much for the test and cut the rate to $50 per exam. This drove a number of operators out of business, but also stimulated a lobbying campaign by doctors, scanner operators, manufacturers and groups devoted to women’s health.

The result was a provision buried deep in the recently enacted health care bill, legislatively setting the rate for the test at $97.

The Globe article pointed out that this price-setting measure was included in a health reform bill that claimed to point the way to a more rational system, where decisions are made on medical evidence and patient outcomes.

But apparently the realities of democratic politics are not to be denied.

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