Monday, November 11, 2013
Dilemma
For some years now I have been wrestling with a
dilemma. On the one hand, I have been
suspicious of commercial approaches to health care, believing that the
interests of patients should rank higher than those of investors. On the other hand I have increasingly become
convinced that economic incentive is the only thing that will cause anyone to
get serious about addressing the cost of health care.
Then I read an article in the New York Times Magazine of
Sunday, November 3 about Tom Scully and his new company Navicare. During the 1990’s, Scully was head of the
Federation of American Hospitals – the trade association of investor-owned hospitals
– and from that position became head of the federal Centers for Medicare and
Medicaid Services under President George W. Bush.
Navicare was formed to manage the care patients receive
after hospitalization, known as post-acute care. The prevailing routine has been that when
post-acute care is needed, the doctor discharging a patient from
hospitalization prescribes nursing home, rehab, or home health care and then
has nothing further to do with it.
Providers of those services are paid on a fee-for-service basis and so
the more service they provide, the more revenue they generate. Navicare undertakes to reduce cost by managing
the process and makes money by contracting with health insurance companies to
share the savings.
The prospects look bright.
One can imagine opportunities for commercial abuse, but they seem rather
unlikely to present problems.
Maybe we are beginning to discover workable and acceptable
ways to use economic incentives to get cost under control.
Friday, November 01, 2013
When quoting cautious Norwegians, Garrison Keillor, the St.
Paul raconteur, makes common use of the word “mostly;” as in “Lutherans are hard-working
people, mostly.”
If President Obama had followed that pattern when promoting
his healthcare reform bill, he would have said something like “People who like
their present health care insurance policies can keep them, mostly.”
But he left off the qualifier. For that he is getting the
Pinocchio award. And deservedly so.
Actually, what he should have said to be completely forthcoming
was that people who like their present health care insurance policies can keep
them, if they continue to be offered
by the insurance company. The
Affordable Care Act, a.k.a. Obamacare, prescribes the basic benefits that
health insurance policies must cover, but it exempts policies that were in
effect at the time the law was passed.
As it happens, however, insurance companies change their
policies frequently –notifying subscribers by means of unintelligible documents
sent in the mail - and so by now, some three years later, many of the policies that
were grandfathered have been modified and have lost their exemption. A common reason for not meeting requirements
is that the benefits are too skimpy, meaning that policies that qualify for
approval offer more coverage and often cost more.
That may give the President a technical out, but does not
let him off the hook, in my opinion.
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