Bacon's Rebellion

Democracy Thrives in Sunlight

A Hairy, though Worthwhile, Endeavor

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by

James A. Bacon
in

If 2006 was the Kaine administration’s “year of transportation,” 2007 could be shaping up as the “year of health care.” Last week, Gov. Gov. Timothy M. Kaine announced appointments to the Commission on Health Reform. The commission has two top priorities: (1) providing insurance coverage to the more than one million Virginians who lack it, and (2) addressing the growing shortages of health professionals across all disciplines.

According to the Governor’s press release: The Commission is tasked with identifying and implementing national best practices at the state level with emphasis on access, quality, and safety of care.

Talk about a blue-ribbon panel! Marilynn Tavenner, the commission chair, knows a thing or two about health care: She was CEO of HCA’s Richmond-area operations. Other senior health care excecutives representing a broad cross spectrum of the industry will serve with her. Kaine also has taken care to seed the commission with Republican lawmakers as well as his fellow Democrats.

There’s one name missing from the list that would give the commission even more credibility in my book: Ramesh Shukla. A professor of health care administration at Virginia Commonwealth University, Shukla is arguably the state’s leading expert on hospital productivity. If the Governor is looking for “win-win” solutions, as Secretary of Technology Aneesh Chopra indicated he was in an interview a half year ago, there’s no greater win-win than boosting the productivity and efficiency of the system.

Health care, which consitutes nearly one-sixth of the state GDP, is so huge, so cumbersome, regulated at so many levels, and so guarded by vested interests, that I don’t have high hopes that the commission will agree upon anything more than window dressing. But we have to try. As with transportation, we cannot long afford Business As Usual.

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12 responses to “A Hairy, though Worthwhile, Endeavor”

  1. James Atticus Bowden Avatar
    James Atticus Bowden

    As I wrote in the Rebellion this summer, you can put seed money in individual health savings accounts for EVERY Virginian by re-directing the budget surplus from the increase in the sales tax.

  2. Toomanytaxes Avatar
    Toomanytaxes

    When government officials talk “win-win,” they are seeking yet another tax increase. I suspect that Senator Chichester is ready, willing and able to begin the fight.

    If we were serious about making changes, we’d spend some effort looking at the root causes of why we spend so much on health care, yet have so many people without coverage. The two results might just be connected in some way.

    JAB probably has some validity to his argument. Putting more control in the hands of consumers would help bring down the cost of medical services. Take a look at Laser eye surgery, which is generally not covered by insurance. Thus, the health care professionals must persuade people to spend their own money for the surgery. People do spend their own money, so competition must be working. Quality service for lower prices.

    It would, however, likely be easier to reform transportation than health care. Reform means those who win today, will not will by the same margins tomorrow. Bottom line: Senator Chichester will again jump to the rescue by proposing one more tax increase. Maybe then we can spend well more than one-sixth of the state GDP.

  3. Gold_h2o Avatar
    Gold_h2o

    I am no expert in healthcare, but IMO, it’s a system that, in the long run, would benefit from a little competition, particularly in terms of preventative medicine, i.e., staying healthy.

    When’s the last time you saw a sign that read, “20% off on check-ups”, or some other incentive for seeking preventative care.

    Oh, and tort reform wouldn’t be a bad place to start looking for savings either.

  4. Toomanytaxes Avatar
    Toomanytaxes

    How does one get competition with most of the medical funding coming from government and insurance companies? Neither of those entities would likely give up the business readily? I’m not arguing that it cannot be done, but entities tend to seek self-preservation.

  5. Gold_h2o Avatar
    Gold_h2o

    TMT –

    Not sure. Again, my focus would be on preventative care, i.e., keeping you from getting sick and catching illnesses early.

    Once you are sick, particularly with a long-term illness or a catastrophic injury I am not sure competition really matters….you will seek the care you need no matter what the cost.

    Also, I think a lot could be done in regards to the cost of prescription drugs. I recently purchased an antibiotic (no insurance) and it cost me $100 for 10 pills….do the math.

  6. Larry Gross Avatar
    Larry Gross

    re: “If we were serious about making changes, we’d spend some effort looking at the root causes of why we spend so much on health care,”

    re: 20% off on check-ups

    Right.. this is the same exact issue with transportation, schools, et al – anything done by the govt .. or in this case – private industry that essentially functions like the govt in that there is virtually no competition and virtually no way for consumers to look after their own interests much less force out of business providers that are too expensive, inefficient or just downright miserable.

    ALL of them not only stay in business but do not have any motivation to do anything beyond what they do now which is precious little.

    Two examples:

    My personal physician tells me I need a bone scan. I ask: “where is the best place” – She says: “they’re all the same” – I ask: how expensive is it and who does it for less” – and she says “why do you care – you’ve got insurance”

    Second example: Go see a specialist. Okay. Will that specialist have access to my records that my Primary Care Provider has.

    Well – No… they’ll ask you to fill out a form.. detailing your medical history.

    Electronic records that can be shared by your care providers so that all are on the same page and that your care is consistent and uniform?

    Forget it.

    Health Care Providers – in my humble opinion are no better than auto repair places except because they work on humans they are perceived to be more “noble”.

    The Medical Care Industry has got a stranglehold monopoly and do not intend to losen their grip.. unless consumers demand new laws to force them to and right

    I would LOVE to be able to determine who provides the best service and who provides the best price .. and make my own decisions instead of being treated like a child with a fat wallet that needs to be picked.

  7. Jim Bacon Avatar
    Jim Bacon

    Larry, You sound like an advocate of consumer-driven health care — empowering and incentivizing people to put as much energy into selecting health care providers as they do selecting a new car or house. I agree that consumer-driven health care is part of the solution, but only part. First of all, consumers need information about price and quality of care. The Virginia Health Information Foundation does provide some of that information, but only some, and it’s not disseminated very widely. Second, there are severe distortions in the system. I’ve recounted the list on this blog before: Malpractice lawsuits and defensive medicine. Mandates requiring gold-plated health insurance plans. Certificate of Public Need that restricts the entry of new hospitals, surgery centers and other providers into the medical marketplace. The requirement that hospitals provide indigent care, and the underpayment by the Medicaid program for treatment of Medicaid patients, and the resulting recovery of costs from insured patients. The two-tier pricing structure in which uninsured patients paying cash get charged two or three times more than patients with insurance. And those are just the state-level distortions!

  8. Larry Gross Avatar
    Larry Gross

    Jim – Yes. Here is my simple calculation:

    We know more about DVD players in terms of quality and price and availability than we know about services for our specific health care needs.

    This is a classic VDOT-type issue.

    How much confidence do you have in going to a hospital or a doctor you’ve been referred to when NOT only do you have a clue with respect to the quality – good,bad,indifferent nor the price and on top of that… the get YOUR medical history – rather than having a look at your actual records – YOU are supposed to fill in a bunch of forms the best of your ability to remember ..much less put info that your primary care physician has recorded in the record they keep.

    How many times have you noticed that the referred provider does not know something important about you that is well documented by your personal physician and .. it’s YOUR responsibility to inform them rather than THEIR responsibility to obtain your records and .. perhaps.. even look them over BEFORE they see you…???

    It’s a absolute mess .. much worse than VDOT… and like I said.. people worry more about whether there might be trans fat in their food than whether their Doctor has a clue about health issues that are affecting you.

    We are all so trusting… when the moniker M.D. is on someone’s name.. never ever even thinking that somebody graduated in the bottom 1/4 of their class.. and now you are entrusted to their care.

  9. Anonymous Avatar
    Anonymous

    State issues official finding of ‘gross negligence’ in death of man in Lynchburg.
    http://lynchburguncovered.blogspot.com

  10. Toomanytaxes Avatar
    Toomanytaxes

    Gold_H20 – You make good points about preventive medicine. Are there any studies or experience where a country/health care plan has offered more generous health care coverage on preventative medicine and achieved overall cost savings? Open question to all.

    We’ve got a system where third parties pay for much health care. The consumer has no incentive to make sound purchase decisions. Yet, at the same time, there are some public benefits in spreading risk through insurance pools. Moving to health care savings accounts would truly have an impact on prices and and quality, but what happens to the people who have huge medical bills? I could have a stroke tomorrow and need care for years.

    I suspect that there’s probably ways to balance individual pay for routine matters (tax-free health savings accounts) and risk sharing at the high end. But I still submit that moving to such a concept faces big barriers — those who win under today’s system.

    One of the biggest barriers to Social Security reform has been the many people who work for the Social Security Administration. The Al Gore reinventing government group concluded that huge savings could be made by mailing SS checks throughout the month instead of all at the same time. I seem to recall that the government staff could have been reduced by at least one third. Union opposition killed the recommendation.

    Just how interested in health care reform are the countless number of people in the health care and insurance industries if reform would eliminate one third of the jobs? A large number of D.C. law firms have huge health care practices. How would then react to reform that eliminated most of the reimbursement work, etc.?

    I’m not trying to be overly critical of those who fight for their livelihood, just pointing out that a large number of people and institutions have strong vested interests in preventing reform because they lose, even though more in society might actually win with reform.

    The path of least resistence is raising taxes. It permits all of us from making hard choices.

  11. Larry Gross Avatar
    Larry Gross

    I think … when we can do the better do medical equivalent of:

    .. know that you need a 12lb hammer rather than a sledge hammer or perhaps even a screwdriver (yes, it is that bad sometimes).

    .. know how to determine the level of quality of that hammer – know the better brands and know the reputations of the better brands specifically with respect to performance and durability.

    ..know that the same hammer is available at different prices and know that it is cheaper at Ace than Lowes

    then, only then, will Health Care change for the better.

    In my mind, the reason there are such disparities and inequities is because health care is so expensive to start with due to the lack of qualifty factors which leads to mistakes and redundancies that all add up to more expense.

    An example:

    I can go to Quest and get a full panel screen not only of my lipids, but liver, thryroid, etc.. about 30 different key indicators for about $100.

    When my Physician orders tests Ala Carte – ONE test that is INCLUDED on the $100 screen .. can cost $100.

    Now if Quest can do 30 tests for $100 then what is going on with doing one of those 30 tests for $100?

    And why would your Doctor send you to a Lab that charges so much for that single test in the first place?

    But even the “haves” in our society, as pointed out, do not truly receive quality health care – which would BEGIN with preventive and proactive care.

    If you have a system that is grossly inefficient and wasteful.. then you end up with not enough of it to go around especially to those at the lower end of the financial spectrum.

    Compare our health care system to other industrialized countries AND compare the relative health of US folks to citizens in those other industrialized countries AND no suprise that the US is not a leader.

    Everytime – I have to go to a referral – I get steamed.

    1. – First .. it’s very clear my time is not their time

    2. – They gleefully dump a bunch of forms on you to fill out – ALL of which is information being maintained by your Primary Care Physician – but is it shared electronically?

    NO.. of course not.. you’ve got to fill it out .. once AGAIN…

    and why is there not an electronic shareable version?

    well of course .. it’s the concern about protecting the patients personal data.

    Agreed on the need . but don’t we have the same exact issue for financial and other records?

    How about we go back to paper for the rest of our worlds?

    The electronic forms issue is a handy crutch for .. health care providers – who see no benefit to THEM and actually potential for harm to them because THEN they WILL have ALL of your records and they no longer can claim that you didn’t fill out their forms “completely”.

  12. Larry Gross Avatar
    Larry Gross

    Actually, upon further reflection, the electronic file sharing issue is completely solveable right now.

    Anyone with a casual familiarity with USB Flash Drives knows the answer.

    If health care provides don’t want to share over networks then let them download your info to a USB drive and then you carry it to the next place where you receive health care services and they upload the info and VOILA – no more forms to fill out and also… they have your complete info.

    I have a theory as to why this is not done and it’s an ugly thought.

    What IF you COULD do this?

    Then… what would keep you from leaving your current primary care physician and moving to another one?

    What would keep you from .. shopping around .. for any health care provider.. ??

    as long as you had your complete medical record on your USB drive… you’d have more independence and freedom with regard to choosing your own health care providers.

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