Atul Gawande, the surgeon and writer, has a keen eye, and his prose reveals a very good ear. He has a thoughtful piece in the January 26 New Yorker on health care reform. In it, when he thinks we aren’t looking, he reveals himself as Dr. Smarty Pants. Gawande takes what I would call the “meliorist” position, rejecting structural changes in favor of an adaptive approach. He makes a big deal of the principle of “path-dependence,” enlisting Paul Krugman to appear to be supporting an evolutionary position that Krugman, in fact, does not hold. Krugman wants a single-payer plan. He praises the Massachusetts reform plan. Then, almost at the end of the piece, he notes that “The Massachusetts plan didn’t do anything about medical costs, however….” And that’s about it. End of discussion.
My take on health reform is that a decent policy needs to be universal (everyone is covered) comprehensive (all reasonable procedures are included) and affordable (co-payments are reasonable AND the overall cost to taxpayers is reasonable). That’s where Gawande, like so many other meliorists, looks the other way. Costs are absolutely critical elements that need equal weight along with universality and comprehensiveness. Otherwise any reform plan won’t work (which Massachusetts is rapidly discovering).
Charles Baker, CEO of Harvard Pilgrim and a non-doctor, follows a similar path. Near the end of a piece, he forthrightly says of the Massachusetts plan, “Finally, the health care cost problem wasn’t addressed by the MA health care reform plan.” Note that very first word: “finally.” Why “finally?” This, too, comes near the end of his piece. Costs? No big deal.
A big percentage of health care costs are driven by the administrative costs of private insurers. These costs pay for the tens of thousands of insurance company employees whose job it is to find ways to deny or reduce coverage. Come on, Dr. Smarty Pants, let’s deal with it. If you won’t acknowledge the importance of controlling costs (along with, presumably, your costs as a physician), then your views need to be discounted.
does anyone have real numbers on where health insurance companies money goes? How much is administrative, how much to Doctors, hospitals…
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p>Also, maybe before we fix this colossal problem we could figure out how to get our public employees in the state on GIC. Immediate cost relief. Then we can move them off the $5 co-pay many still enjoy. Finally, we’ll get them to pay more than 15% of the healthcare premiums. Then we can go chase Dr. Smarty Pants…
Are you saying that the problem with health care is that workers don’t pay enough of the costs? That employers pay too much? Or is that just for public employees?
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p>How does shifting health insurance costs (from employers to workers) decrease those costs? It doesn’t.
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p>Here’s what would decrease them: getting rid of the middleman.
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p>The reason the GIC leads to cost savings is that their pool is larger. Single payer gives us the largest pool of all.
The State did a study on this. You can read it here. For the major health plans in Massachusetts, administrative costs are between 10-12% of the premium dollar. One quote:
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would that fix the system? I don’t think so. I do not believe the system runs perfectly now but let’s stop talking about the “evil” health insurance companies as being the problem (although they may be complicit).
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p>IOt seems to me we should have an element of going to differing levels of a Doctor, sort of like you can pay more for a name brand drug or pay less for the generic. I’m struggling with putting this in words but patients with insurance have no stake in the cost of services. I have had some very minor heart issues over the last few months and the bills have been handled by insurance completely. I see the itemized bills/services and frankly don’t give a rats ass about them since they are paid by insurance. I go as often as I want, ask for almost any test to be done and don’t have to pick the most inexpensive doctor since it is paid for by insurance. It is too bad there is not a method to get me responsible for some of these costs to help me self-mitigate them. Don’t attack me on this as I am just thinking out loud.
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p>I also listened to Jim and Margery yesterday and they were talking about trying to get people more responsible for their health and suggested the idea of giving health care discounts to people who are in good physical shape (or low blood pressure, lower body weight…). It sounds like a good idea but can you imagine trying to implement this in the poor areas where obesity is endemic? I’m sure this would be completely regressive even though it “sounds” good.
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p>I think we ned some serious reform on health care benefits (not a right) but I don’t think we can lay fault on the health care companies alone.
Health care providers also have considerable administrative costs related to billing those insurance providers.