The Long-Term Challenge: Next Steps for Healthcare Reform

That's the title of the panel now up at something called "America's Fiscal Choices: Strengthening The Economy And Building For the Future." The moderator is The American Prospect's Robert "American Taliban" Kuttner. The panelists are Karen Davis of the Commonwealth Fund, Maggie Mahar a TCF Fellow and Bill Hoagland of CIGNA. Of the 3, I'm betting Hoagland will have the most influence on "The Next Steps For Healthcare Reform."

You can watch the panel here.

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    Next steps? (5.00 / 1) (#1)
    by Ga6thDem on Tue Oct 05, 2010 at 01:52:14 PM EST
    But I thought the bill that just passed was the most wonderful evah!!/snark.

    The next step should be getting rid of the current bill, opening up Medicare for everybody and then restructure a new bill.

    Omigawd (5.00 / 1) (#2)
    by Big Tent Democrat on Tue Oct 05, 2010 at 02:28:19 PM EST
    The most depressing panel ever. These people are fools, except for the insurance guy. He's a knave.

    It turns out you don't need to co-opt (5.00 / 2) (#5)
    by observed on Tue Oct 05, 2010 at 03:19:29 PM EST
    the opposition. All that's needed to keep the skids greased for corruption is to ensure that only idiots get invited to explain things to the public.

    After all, you have to keep the stakeholder (5.00 / 1) (#7)
    by ruffian on Tue Oct 05, 2010 at 03:40:17 PM EST
    (Cigna) at the table, according to Daschle in his new book even if it takes giving them the whole meal.

    Wrong title for book (5.00 / 2) (#9)
    by MO Blue on Tue Oct 05, 2010 at 04:10:39 PM EST
    Back Room Deals: Selling American Health Care

    Can't believe how willing Daschle and other Dems are to document and brag about how the Dems sold out to the insurance and medical industries.


    So that would be (5.00 / 1) (#10)
    by gyrfalcon on Tue Oct 05, 2010 at 04:11:00 PM EST
    steak-holder, actually.

    THEIR next step is euthanizing it (none / 0) (#3)
    by Dadler on Tue Oct 05, 2010 at 02:52:13 PM EST
    Or at least the worst parts of it for them. They really couldn't hope for a better outcome. Get one part through by paying off the Dems, get the rest through by paying off Repubs.

    To reword the old Schoolhouse Rock "Conjunction Junction" jam: "Corruption junction, what's your function? Hooking up pols and masters and money."

    Wow, I'm so pissed I almost can't (none / 0) (#4)
    by Militarytracy on Tue Oct 05, 2010 at 03:11:44 PM EST
    breathe.  I'm listening to these a$$holes talk about "investment" spurring "innovation" and "job growth" being of the utmost importance.  What a bunch of bull$hit, total bull$hit.

    I have met a lot of the people who are the cutting edge in the fields of genetics and orthopedic injury.  I KNOW people who have invented the most amazing and cunning devices you could imagine.......and investment spurring innovation had nothing to do with their success and often impeded the development of the next life saving or life enhancing development because it threatened some existing market.

    We are talking about our lives.  You don't have to feed this market, it feeds itself.  And success in this sector of life and living is not driven well by the dollar.  The cutting edge best you can find are not dollar driven......they are physicians, most of them planned their whole lives to save other lives whenever they could.  They had ideas that they drew on out on cocktail napkins that had nothing to do with dollars, just preserving life.  These people I have met are many things, sometimes they are GIANT GEEKS of an unexplainable proportion, and often they have no bedside manner.  They tend to be antisocial in varying degrees geniuses, some of them are horribly arrogant too......BUT THEY AREN'T ON THE PHONE WITH A HEDGEFUND MANAGER.

    Have these people ever known any of the people that work in emergency rooms, the doctors or the nurses?  They need a paycheck, everyone needs one, but they don't do it for big bucks.  They do it because they believe in it, they thrive making a difference, and when they fail it doesn't destroy them like it would others (like me for instance).  All this market equals innovation is BULL$HIT, that reality only lives in this panel's own mind and in fact the "market" alone has helped to KILL MORE people than it ever treated or healed.  Boy I'm pissed.

    Well, the panel could have been worse, (none / 0) (#6)
    by KeysDan on Tue Oct 05, 2010 at 03:39:08 PM EST
    and included Peter Orszag, former budget director and self-minted health care/health economics expert.  In Orszag's op ed in the NYT (Oct 3, 2010) he noticed the "lost weekend" of health care wherein doctors do not like to work weekends and, as a result, our great health care industry's capacity is sitting idle a quarter or more of the time.

    Orszag cites a work of NYU to deploy assets throughout the week.  If hospitals, were in constant use, costs would fall as expensive assets like operating rooms and imaging equipment were used more fully.  Moreover, if work flow were spread more evenly over the entire week, patients could more often enjoy privacy of single room beds.

    It is as if he feels that spreading the work flow, without more assets, such a professional personnel or down-time free equipment, is the answer. (Sort of like lamenting the idleness of school classrooms over the summer, and placing students and teachers on shifts.  Or, having the benefit of longer school years without added costs.)

    As much as Orszag is taken with NYU's idea, he seems compelled to note with admonishment that NYU has not stacked up well historically in cost comparisons with other hospitals, dragging out, as he did during the flawed health care "savings" discussions of the WH, the Dartmouth Atlas as the authority.

    NYU, according to the Atlas he cites, is twice as costly as America's most efficient hospitals, and no clear benefit came from the high costs and may have made matters worse, what with more doctors involved in more care, and more chances for more error.  No clear benefits if comparing those that die, but the Darmouth Atlas is silent on those who live. After the health care debate we learned of the misinterpretations and misrepresentations of the Dartmouth Atlas, and it seems like Orszag still needs a tutorial, or just likes it as he learned it.

    Weekends at the hospital (none / 0) (#8)
    by gyrfalcon on Tue Oct 05, 2010 at 04:09:09 PM EST
    Boy, isn't that the truth!  My elderly mother has to be admitted to the hospital on a Thursday morning through the emergency room some years ago and needed a standard non-high-tech exploratory GI examination.  She was ready on Friday, but the department in question was all booked up.  So she had to stay in the hospital over the weekend because that department doesn't come in to do these procedures on Sat. and Sun.

    It's nuts.  Medicare had to pay for two full days of unnecessary hospitalization because these guys don't work weekends, not to mention my already very much debilitated and frail elderly mother had to endure two extra days on that minimal liquid diet.

    The really fun next part is that they forgot to add her to the schedule for Monday, so the exam didn't happen until Tuesday.  (That's now 6 days with no food for an already rail-thin, weak and malnourished old lady.)  Then there were a couple of medication errors that had to be figured out and fixed, and by the end of it, she'd been in the hospital 11 days for what should have been at most a 3-day admission, most of it on liquid diet.  By the time they were ready to discharge her, she couldn't even get out of bed by herself and had to do 6 weeks in a rehab place before she could go home again.

    And this was one of the top hospitals in Boston, renowned for their "patient-centered care."

    So what should have been a 3-day admission for routine tests turned into almost 8 weeks of institutional care, plus weeks of follow-up visits from physical therapists and visiting nurses after she came home.  I can't even begin to calculate it, but it was surely at least 20 times the cost of what it should have been, and all of it unnecessary.


    Wow (none / 0) (#12)
    by Militarytracy on Tue Oct 05, 2010 at 06:43:02 PM EST
    Wow for sure and (5.00 / 2) (#13)
    by gyrfalcon on Tue Oct 05, 2010 at 10:59:09 PM EST
    not counting the toll it took on her.  And that was the SHORT version of what happened!  I left a whole bunch of stuff out.

    Her medical issues piled up in her last years, as they do with many people, as did her misadventures with the medical system.  Her memory was badly degraded, so she would ask me periodically to recount our adventures and would marvel and laugh herself silly over how ridiculous it all was.

    When I found out the GI department had forgotten to put her on the schedule and her misery would be extended by yet another day, I made the resident come in and give her the bad news himself.

    He very apprehensively told her and apologized, and she just stared at him.  Then she began with mock bitterness, "Tomorrow and tomorrow and tomorrow creeps in this petty pace from day to day, to the last syllable of recorded time" and recited the whole thing (from Macbeth).  The doc and the nurse didn't even recognize it and thought she'd completely gone batty until they looked over and saw me collapsing with laughter, followed quickly by my mother.

    Her memory was shot and she was pretty miserable, but she had not lost her wit.  Great lady.  I miss her a lot.


    I think it's worth mentioning (none / 0) (#11)
    by CST on Tue Oct 05, 2010 at 04:43:07 PM EST
    "Massachusetts, which has already been the model for the national health-care overhaul, recently gave its regulators the authority to strike down excessive rate hikes--and the result was a nearly 90 percent rejection rate when insurance companies pitched their new premiums for the second quarter. At a time when the average national rate hike for individual insurance plans is 20 percent, the Bay State tabled everything above 7.7 percent. Earlier this month insurers made their cases to the state for third-quarter increases. But again the state mostly said no, rejecting about 70 percent of 200 proposals and approving only a handful of single-digit bumps."


    emphasis mine.

    Also, the next big battle here is going to be about payments to doctors/hospitals.  Right now insurance companies here are operating at a loss which is unsustainable.  Frankly, this is one battle where I'm on the side of the insurance companies.

    "A report by the Massachusetts Health and Human Services' Division of Health Care Finance and Policy that looked at spending trends from 2006 to 2009 found more than 88% of premiums collected in Massachusetts are spent on medical expenses, compared with less than 84% nationally. The report also found that premiums increased 12.2% during that time frame, and the increase was caused almost entirely by growth in medical expenses."

    Link 2

    It just doesn't work (5.00 / 1) (#14)
    by gyrfalcon on Tue Oct 05, 2010 at 11:03:05 PM EST
    relying on private insurance companies, and I do think that's finally beginning to dawn on a few people.

    I guess my point is (none / 0) (#15)
    by CST on Wed Oct 06, 2010 at 08:39:20 AM EST
    ...and this goes along with your experience listed above, and some personal experience dealing with hospitals and family members as well...

    That the problem isn't necessarily the insurance companies (in MA - with this legislation in place).  Especially in this neck of the woods, the hospitals and doctors are doing whatever they can to make the most money possible out of each customer, whether they are getting better or not.

    Right now, doctors and hospitals get paid based on the "amount" of care they give, not based on outcome.  My guess is, they made a ton of money off of insurance companies from your mother for all the extra care she required due to the fact that they made her sit in the hospital for days and then required extra procedures.

    That's not an insurance company problem.  That's a problem with doctors and hospitals.  Granted, one of the benefits to public insurance is the ability to negotiate prices - but at the end of the day there needs to be a system-wide change.  Doctors and hospitals don't want to take cheaper patients.  So we've got to change the way they get paid from private insurers as well.