Comments on: The Obama-Romney-McCain Health Plan

By: A Health Plan for Barack Obama | John Goodman's Health Policy Blog

A Health Plan for Barack Obama | John Goodman's Health Policy Blog — Fri, 02 Jan 2009 20:54:46 +0000

[...] I've done versions of this for the Health Affairs blog and for the National Journal's health [...]

By: acavale

acavale — Mon, 01 Dec 2008 23:18:26 +0000

Christa: Mr. Goodman’s WSJ article has many fantastic ideas. I doubt that any of them will see light of the day. What I meant in my earlier comment was that there has been no effort by anyone in government or NGO to involve practicing physicians in designing a new method to deliver and pay for health care. If we leave it up to the govt or insurance companies, we will get more of the same.

Catherine: The comment is good on face value. The devil is obviously in the details. Again, I find it “interesting” that the blog on Nationaljournal that you mention, allows participation only by invitation. What this tells me is that its the same crowd of ivory tower insiders that are involved with the discussion. They don’t truly want to hear about different ideas – just want to continue the usual bickering amongst a familiar few. Again, hardly any physicians participating (or invited?)

That’s why I applaud Health Affairs that allows free flow of ideas, irrespective of where they are coming from….

By: Catherine Daniell

Catherine Daniell — Mon, 01 Dec 2008 20:58:03 +0000

Senator Max Baucus, tells us more about his ideas at the National Journal’s blog today. While not going as far as John Goodman suggested, he seems to partially endorse the idea of
redistributing tax subsidies for employer-provided health insurance from higher income to lower income workers.

Link here: http://healthcare.nationaljournal.com/contributors/Baucus.php

By: Christa Bieker

Christa Bieker — Tue, 25 Nov 2008 20:06:55 +0000

Acavale made the comment “Finally, it is very distressing to note that none of the proposals makes any effort to involve physicians in any sort of constructive manner.”

John Goodman describes on his blog why a restructured subsidy would help liberate the doctors to repackage and reprice medical services in innovative and patient-pleasing ways.

http://www.john-goodman-blog.com/mccain-vs-the-critics-part-i/#more-659

By: DONALD STROMBECK

DONALD STROMBECK — Sat, 22 Nov 2008 17:38:40 +0000

Health care costs are close to 20 percent of our gross national product and are increasing. The only way to slow this down and possibly reverse the increase is to make people accountable for their health. With 8 of the 9 leading causes of disease and death caused by human behaviors why does almost everyone ignore the need to introduce incentives for preventing disease rather than providing more band-aids for treatment. This will require measures that many will hate because it will cost them. More can be seen on this as http://www.healthcareforall.us

By: acavale

acavale — Sat, 22 Nov 2008 16:02:11 +0000

John Goodman’s ideas are quite logical and possibly implementable. A few points to ponder, however. It is naive to expect decreasing utilisation of health care services as the overall population ages. It is more naive to ignore the real probability that incidents of frivolous law suits will increase under the umbrella of a Democratic administration and Congress. Combine these two processes, and it is a recipe for marked increases in “cover-your-back” practices among physicians, hospitals, etc. Whether one likes it or not, the truth is that is far more expensive to fight even a winning law suit than overutilising medical services. Therefore, significantly stronger legal protections will be necessary (at federal and state levels) for healthcare providers who are mandated by government to minimise utilisation of services.

Unfortunately, Jonathan Ross’ idea sounds very familiar to the current (and failed) SGR formula that Medicare uses and is likely to meet a similar fate.

Another important decision to make will be whether the business of providing medical care will be a “nationalised” one or a “free market” process. The current system being “one-size-fits-all, rate-fixed, volume-based, unincentivized” does not serve any purpose other than fill up insurance company coffers at the expense of everyone else (patients, physicians, employers). The ability of a healthcare consumer to purchase medical services based on need, and pay for it based on the quality of care provided, must be the fundamental idea. “Universal coverage” as a policy must be eliminated unless the administration wishes Mediocrity for everyone. It would be helpful to read the most recent article by Cunningham and O’Malley in Health Affairs on why the Medicaid system is failing in some states and not in others.

Finally, it is very distressing to note that none of the proposals makes any effort to involve physicians in any sort of constructive manner. Romney’s MA program has run into the same problems – not enough participating physicians to actually provide care for all the “newly insured”. Lest we forget, there will be no health care system without physician participation.

By: SauerC

SauerC — Fri, 21 Nov 2008 21:38:08 +0000

Taxpayers don’t deserve more of the same old thing, as much of the Obama Health plan would employ, like maintaining the current tax system that rewards employees with extravagant high cost plans more of a tax break than an employee with basic plan. As Goodman points out, incentives need to be re-aligned in health care policy to lead to good and productive choices, not avoidance and extravagence.

That said, health care programs need to be reformed. I can only hope that they listen to people like John Goodman when they finally sit down at the table and attempt reform.

@Robert,
“This system works well, and there is no reason to scrap it. No one has more stake in an individual’s health than his employer, and this is a vital link.”

I understand that an employer based system feels comfortable and safe, but employer based health care shouldn’t feel comfortable and doesn’t provide a safe medical home. Most employees don’t stay with one employer for very long (I myself have had 4 employers in 5 years…..with good recomendations), and I only maintained the same insurance plan once. This means that the insurance company had no incentive to keep me healthy until I was fifty, they only needed to make sure I was healthy for a year.

A beneficial incentive of privately held insurance is that an insurance company benefits from life long health and would act accordingly with preventive care, testing, etc.

By: Johnathon Ross

Johnathon Ross — Fri, 21 Nov 2008 20:38:15 +0000

Is anybody else having problems conceiving of what kind of a sickness care non-system is being proposed here? 300 million different health insurance policies seems like a jobs program for insurance bureaucrats and brokers to me with no possibility of coordinated improvement of care.
How about this for straight forward and simple:
To control costs, we set a generous national health care budget and stick to it.
Public boards will request and allocate funds for capital expenditures in local health systems service areas. These public funds could be used as challenge grants to encourage local charitable giving to hospitals and other providers for their capital projects.
The same boards will review hospital and other care facility operating budgets. Once operating budgets are approved, the facilities receive a monthly operating stipend. Failure to stay on budget means mandatory new management.
Physicians and other direct care providers will be paid on a negotiated fee schedule within a budget for their services. If they begin to exceed the budget before the end of the year, fees get clawed back to stay within budget.
Utilization rates of providers are monitored and publicly available so that those that over utilize will be identifiable to their peers and the public.
We raise the revenue needed for this system with a combination of graduated income taxes, sales taxes and sin taxes and place it in a national health trust fund.
We hire the insurers to just process bills as they do for large companies that self insure. Since everyone will be covered there is no underwriting or risk rating insurance function. We will be self insuring as a country.
We reward all providers together when they reduce the rates of disease, disability and costs. We pay for system performance not individual performance.
We all will reap the benefits or pay the costs of a high or low performing health care system.

This proposal is about 250 words and simple enough for anyone to understand. It is a national health insurance program like that proposed in HR 676. This is an improved and expanded Medicare for all. It will save hundreds of billions of dollars and save tens of thousands of lives. We must develop the political will to overcome the greed that grips the current system and stands in our way.

By: Devon Herrick

Devon Herrick — Fri, 21 Nov 2008 20:16:15 +0000

Robert Burney states…”No one has more stake in an individual’s health than his employer, and this is a vital link.” Yet, the Obama plan may well weaken that link. Barack Obama has repeatedly said if you like your employer’s health plan you will be able to keep what you have. But, this is unlikely to be the case. Analysis by Roger Feldman (http://www.hsinetwork.com/Obama_HSI-Assess_08-21-2008.pdf) of the University of Minnesota found that a likely outcome of Obama’s Health Proposal is that 70 million workers would leave their group HMO or traditional PPO. Some would enter a different PPO while 57 million would join a “public plan”. Some of those projected to leave their employer plans will be forced to switch when their employers drop coverage. Stuart Butler of the Heritage Foundation made a similar argument NPR (http://www.pbs.org/newshour/bb/politics/july-dec08/healthagenda_11-20.html).

By: Brian R Williams

Brian R Williams — Fri, 21 Nov 2008 18:31:56 +0000

There is virtual unanimity that all federal health care programs are broken, in need of some sort of reform. Medicare is unsustainable, unable to collect enough revenue to meet its costs in the long run. Medicaid is perpetually underfunded, with states increasingly demanding a bigger federal payment to make ends meet. SCHIP inefficiently distributes benefits, sometimes to adults well above the poverty level, while failing to enroll qualified poor children. The Indian Health Service and VA systems can’t meet demand. Locally, The Washington Post recently ran a series of stories about filthy hospital rooms and leaky surgical rooms in federal military hospitals.

What makes us think that the federal government is competent to deliver health care? Expanding federal health care programs – or, worse yet, creating a new federal health care program, will only make the current problems worse.

The best thing to do is what John Goodman suggests. President Obama should work with Congress to restructure the tax code to give consumers an incentive to be involved in their own health care spending decisions.