I mentioned this yesterday; today Sen. Murray came out with her health care cost agenda. AP's got the rundown:
BOSTON—Massachusetts would be required to adopt a statewide electronic medical records system and be the first state to ban pharmaceutical marketing gifts under a bill unveiled by Senate President Therese Murray on Monday.
The bill is also designed to rein in spiraling health care costs in part by authorizing a public review of any insurance company submitting rate increases of more than 7 percent a year.
(There's a lot more in the article, and as I type, now John McDonough has posted his thoughts. OpenMass.org has the text of the bill, and Jim has collected links to the various news orgs' stories.)
Naturally, the pharma companies are real, real concerned that the marketing ban could “negatively impact information flow to practitioners and ultimately hurt patient care.” Well, something's flowing, that's for sure …
The insurers are on board — not too surprisingly, since the cheaper they can make their plans (at the same profit margin, of course), the more folks can be required to buy them. The question is how much they're willing to take a grilling on how their own practices are contributing to premium inflation. What does that “public review” consist of?
I'm not so impressed with the $25 million for electronic medical records — not that we're rolling in cash, but I've heard that it's going to take more like $500 million over five years to implement properly. So I don't know what kind of magic Murray's got in mind.
there’s three major costs:
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p>1. Designing the system — what data, who stores it, how’s it entered, yadda yadda.
2. Implementing the system — lots of coding, lots of computers, lots of security [I hope!], etc.
3. Entering all the dang data for everyone alive.
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p>So, you’ve got to do all of (1) before rolling this out for a single patient. But, it seems to me that if you only require it for newborns, and then work backward (ex: in 2009, anyone born after 1/1/2009; in 2010, anyone born after 1/1/2008, etc), that you can save lots of money initially on (3) and some money on (2) since you wouldn’t have to roll the hardware out in lots of medical offices at first — just OB/GYNs, pediatricians, and some parts of hospitals and emergency care units. In the latter cases, you wouldn’t need enough equipment to process all patients, just the young ones at first.
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p>This will allow a slower transition to electronic records, which will help institutions ease in to the huge capital costs associated with (3), and since people will pass away before their birth year comes up, reduce the total number for which their entire record will have to be entered at once, instead of incrementally.
Hi All:
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p>As I have been a medical collection agent for most of my adult life, I understand where the problem regarding the absurd cost of health insurance coverage lies.
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p>Administration and record keeping of providers of health care is a nominal cost in comparison to the record profits insurance carriers have made and continue to make. Let’s address the real problem Senator Murray, the insurance companies were given a blank check with the mandatory coverage legislation which was overwhelmingly passed by the legislature.
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p>The only way to truly decrease costs is to make insurance a not for profit transaction. Even though it means that my profession will be made obsolete, it makes much more sense.
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p>Respectfully Submitted,
Sincerely,
Wayne Wilson
Roslindale
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p>Just like non-profit Medicare and Medicaid which make up almost 1/2 of health care payment, have decreased costs?
I am glad to support “Medicare for All” legislation. Are you aware what the difference is between what Medicare and other private insurers pay for certain services and procedures? I have seen that some insurers are paying up to 8x the Medicare rate where others only pay double the Medicare rate. Does that make sense?
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p>Sincerely,
Wayne Wilson
Roslindale
A few things:
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p>1 – While true that Medicare cost containment apparently bested private insurance cost containment through 2000, since 2000, the two (private and Medicare) have matched one another (using Cumulative Growth in Per Enrollee Patient statistics).
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p>2 – Medicare/medicaid is an form of welfare, and it makes some sense that there be limited much the same way that any welfare must be limited. By contrast, with private insurance or private consumption, you’re entitled to buy as much as you want. So, Medicare rates are lower for some procedures and that–depending on the procedure–affects the supply. For example, nursing home rates are much lower for Medicaid than private pay, but the number of nursing home beds in Mass in the smaller homes, is declining because the smaller homes are opting for the private pay rather than the Medicaid patient.
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p>3 – Re: Medicare and private pay rates. Look at the specialty hospitals. Take for example the Cardiac Care Hospitals. Rates are less for Medicare patients than private pay, BUT those same hospitals actually discharge the Medicare patients quicker. What’s that mean for care? I don’t know but it definitely means the Medicare rates are lower.
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p>4 – Along the same line, in Journal of the AMA, the Journal reports that Medicare recipient receive recommended care less than 2/3 of the time. No weblinks for you, but the Journal is 11/2000, 284 number 18–a study by Steven Asch.