Fixing the fixing. Health care Deja vu

by separated single like BushResponding to a couple of comments to my post yesterday, I want to present some history. PARCA. Patient Access to Responsible Care Act. 1997 by Alfonse D'Amato (R-N.Y.) and Rep. Charlie Norwood, a Georgia Republican and approved dentist who argues: "If we can defend trees and animals, why cannot we defend patients?" (Well there is a long extinct animal!)PARCA had this in it: PARCA states, "No cover issuer might discriminate...in any activity that has the effect of discerning against an individual on the basis of race, national origin, gender, language, socioeconomic status, age, disability, physical condition status otherwise anticipated need for physical condition services."The bill was defeated. The bill was part of a reply by consumers and providers to what managed care was action in the late 90's. People were not happy at all.From the Frontline article: According to a recent survey by Robert Blendon at the Harvard School of Public Health, some 48% of Americans say they personally have experienced problems with HMOs' care, otherwise have close friends otherwise relatives who have run into such difficulties. Complaints include difficulty getting access to medical specialists, problems with crisis care, and excessive crimson tape when trying to file grievances otherwise appeals.From: A report from Families USA, April 1998: ...almost three out of five Americans say that managed care plans make it harder for sick people to see medical specialists. Over not whole say managed care has decreased the quality of care for people who are sick. More than three out of five say managed care has reduced the quantity of time doctors spend with patients. And 55 percent say they are at smallest amount "somewhat worried" that if they are sick their "health plan would be additional worried about saving money than about what is the most excellent medical treatment."Yet, with nothing really changed previous than consolidation of the physical condition cover industry, we hear arguments that people are happy? Bull! Come on people, do not you remember?From Duke University, Marc A. Rodwin: Backlash as Prelude to Managing Managed Care, is this summary of the then conventional pro managed care thoughts: Managed care organizations (MCOs) and the private sector, so the story goes, are not perfect, but the alternative--having legislatures manage physical condition capital and bureaucracies make physical condition care decisions--is even worse. Experts in the private sector should manage physical condition care... Over the long run, however, the market will make sure that MCOs deliver high quality physical condition care. Consumers will leave poorly performing MCOs for ones that respond to their concerns (Enthoven 1993). A summary of the potential defeat of PARCA presents the arguments against it as this: Insurers and employers also are lining up to defeat the bill, claiming that its provisions could drive up the cost of cover by 23 percent to 39 percent. The naysayers argue that if this bill became law, it would cause “thousands” of employers to stop contribution insurance. They also maintain that the senior cost of premiums will force millions of lower-income workers to drop their insurance... The cover companies are clearly worried because PARCA will hold them liable.Same story today. Government bad, regulation not needed, do not worry the market will fix it. Mr. Rodwin's closing statement: Backlash is unlikely to disappear until the industry matures and thoughtful narrow authority protects the public, and the industry from itself. Prophetic?We even were worried in 1998 about CEO compensation for the insurers. From the Families USA 1998 report: In custody with the industry's accentuated focus on costs, this report analyzes a very different facet of managed care costs--namely, the costs linked with compensation for high-level HMO executives. The report examines 1996 executive compensation for the 20 for-profit, publicly traded companies that owned HMOs with enrollments over 100,000.7 These 20 companies owned 64 of the nation's largest HMOs in 1996.The 25 uppermost waged executives in the 20 companies deliberate complete $153.8 million in yearly compensation, excluding unexercised stock options, in 1996. The average compensation for these 25 executives was over $6.2 million per executive. The average compensation for these 25 executives was over $4.8 million. The 25 executives with the largest unexercised stock alternative packages in 1996 had stock options valued at$337.4 million. The average value of unexercised stock options for these 25 executives was $13.5 million. The average unexercised stock alternative package for these executives was over $7.2 million.(Go at this time to see what it's value today.)In fact, we are so having the same debate again, yet, still that, I found this concerning the 1998 congressional timing for the physical condition care issue: All sides in the governing body debate have used the August recess to push their managed care proposals... We are soooooooo action it once additional that we are right down to the same time of the year! AHHHHHHHHHHHH!Which brings me to Save the Rustbelt's comment "...but it is not some conspiracy to drive up administrative costs." My point was not that there is a conspiracy concerning administrative costs, certainly not by Massachusetts. It is that in order to fix what was fixed they are reaching for additional of the same reasoning: Control the cost via administration of the costs. It is the very reasoning that has allowed the cover industry (just look at the sub corps that UHC owns) to develop an entirely new business that is only expending but is not delivering the product results as advertised as it adds costs. And now, we will shift the cost by uneven the administrative model to the providers via a model that is questionable. This Massachusetts model of capitation via "accountable care organizations" (ACO) is really just a new twist on the staff model HMO. Only now the insurer will collect the money and just pass it on according to the state charge schedule (yes it is still a charge schedule whether charge for service otherwise charge for head count), and keep the difference. If there is not state location of premiums, then where is the cost investments to the purchaser of insurance. If there is state location of premiums, then why go through all this when we could just have a single payer system and cut out the profit and reduce the duplication of claims management to get our savings?Also, to make this work, a enduring will have to remain with the same "accountable care organization" at smallest amount through to the conclusion of their physical condition problem. Being that the new fix is just a go over of some old models, it is reasonable to assume that there will be some warning of the customer of physical condition cover to change ACO's. Bet it will be like the Medicare drug program; single year, which I believe is by now part of the Massachusetts cover program. I doubt that locking a customer into a program for 1 day is long enough for an ACO to have pretentious a change in the consumption of physical condition care services by the consumer. In fact, you will not know if not that customer gets sick in such a way that there are lifetime residuals and then starts ACO shopping. Will the customer place up with having to be locked into the ACO for additional than a year? Consider that physical condition care outcomes are looked at over 3 and 5 day periods to determine success. Can you say "administration of cost"? How will the customer know which ACO is in fact getting the product of physical condition and curative correct for the smallest amount price without additional administration? How will the customer come to appreciate value before in fact having to purchase?Which leads me to Vtcodger's comment: "About the most excellent I can say for this idea is that it is new." I hope I am creation clear that this is not new. Nothing about the current discussion of the physical condition care problem is new. It is just the game of hot potato. It is just a uneven of the costs down the line. (An approach we appear to have been using since "trickle down" theory was created.) I do agree and it is why I believe capitation did not catch on and staff model HMO's declined, when Vtcodger states: " I do not think that your average primary care doctor wants to be an insurer...". But, let me correct single supposition that like the myth of Reagan lives on concerning managed care. Again Vtcodge: Actually, HMO/PPOs etc did and do appear to work to some extent. When they were first introduced, increases in physical condition care costs did moderate for a while. Yes, cost did appear to moderate. But there were very specific reasons and it had little to do with manage care in fact plummeting the "unneeded tests and procedures". From the Frontline article: In the mid-1990s, HMOs complete some people think that they had vanquished medical price rises -- as rates to big employers greater than before just 0.5% to 2% a year. But the managed care plans "paid dearly for competitive pricing in 1997," says John Erb, a benefits consultant at William M. Mercer Inc. "Many lost money and margins were slim for most of the rest. It was the old business model to market share, cut your pricing and hope your competition folds first. It's the big box store model. It worked. In RI land we were reduced to BC and UHC. Two years ago, UHC be condescending BC to win the state contract. Prices are up.There was a report place out by think & Associates for the pro PARCA coalition. In it they renowned two previous reports when creation a conclusion about costs. Quoting from an article from my national association's journal 4/98 (I have no link):"Private sector average premium costs, for HMOs, the most tightly controlled form of managed care, are 18.4 percent lower than traditional indemnity plans. Other researchers have come up with estimates reassuringly alike to the Towers Perrin figure. For example, the Lewin Group, in a 1997 report, estimated direct investments from managed care at 19 percent. So, think & Associates are on sound footing in concluding: "Clearly, overall managed care investments could not go beyond 20 percent. The most excellent evidence strongly suggests that 15 percent of the 20 percent investments comes from managed care organizations plummeting supplier prices..."We're chatting the same old approach to what really is a problem with the product. At smallest amount in the bad socialist physical condition care programs they recognize that a for profit third party only adds cost and thus do not have to account for that part of our problem (it's called savings). They just need to resolve the product quality issue. It is the only common issue to all nations. I'm captivating bets on the date of the new fix of the newly fixed, fixed system.
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