Monday, November 24, 2008

Coming Soon - An Overdue Debate About Free Market Health Care

Today I learned that PhRMA, the pharmaceutical lobbying group, is about to launch a multimillion dollar PR campaign on behalf of free-market health care (see here). Television ads are scheduled to appear soon. (I'm not much of a TV watcher, so if the campaign has already started, I haven't seen the ads.)

PhRMA has reason to be concerned. The fact that Medicare Part D forbids Medicare to bargain over drug prices got lots of negative attention during the campaign. That issue, along with the latest analysis of private Medicare health insurance plans, which reaffirms concern that the Bush administration's effort to privatize Medicare - especially the private fee-for-service plans - may be adding cost without adding benefit (see here), make it likely that the Obama administration will be taking a very hard look at the U.S. health system's reliance on free-market mechanisms.

The debate is not likely to line up as "conservative business" against "liberal government." Businesses like PhRMA and device manufacturers that sell health care services will line up on behalf of the "free market." (I put the term into quotes because the market is obviously not free, as in the policy decision not to allow Medicare to bargain over drug prices!) But businesses that buy health services for their employees may well line up in favor of new forms of regulation. Some businesses may lobby to bring the U.S. system of employer-based health insurance to an end.

My strongest hope is that debate about the health system becomes more evidence-based. Since the Reagan administration U.S. political dialogue about health has been dominated by free market theology - a faith-based belief that a "free market" will by divine ordination drive improvements in value and cost as it does for manufactured goods. But the pendulum is swinging. Less than a month ago former Federal Reserve chair Alan Greenspan, a faith-leader for "free markets," acknowledged with "shock" that his faith that markets would regulate themselves to serve the public good was "flawed."

As I wrote the previous paragraph lines from Matthew Arnold's poem "Dover Beach" popped into my mind:

The Sea of Faith
Was once, too, at the full, and round earth's shore
Lay like the folds of a bright girdle furled.
But now I only hear
Its melancholy, long, withdrawing roar,
Retreating, to the breath
Of the night-wind, down the vast edges drear
And naked shingles of the world.
The global economic crisis appears to be prodding the sea of "free market" faith into retreat. We in the U.S., who have guided our health system by that faith for 30 years, are in for an interesting ride!


Anonymous said...

The following are facts that are believed to exist regarding the present U.S. Health Care System. This may be why about 80 percent of U.S. citizens understandably want our health care system overhauled:
The U.S. is ranked number 42 related to life expectancy and infant mortality, which is rather low.
However, the U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses. Health Care costs are now well over 2 trillion dollars of our gross domestic product. This is three times the amount nearly 20 years ago- and 8 times the amount it was about 30 years ago. Most is spent with medical institutions, as far as health expenditures are concerned. One third of that amount is nothing more than administrative toxic waste that doe
s not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.
We have around 50 million citizens without any health insurance, which may cause about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children, which alone covers about 7 million kids.
Our children
Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage is largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits to a damaging degree.
About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported. Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system. The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than a third of all physicians are members of the AMA, according to others.
Our health care we offer citizens is the present system is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.
Health Care must be the priority immediately by the new administration and congress. Challenges include the 700 billion dollars that have been pledged with the financial bailout that will occur, since the proposed health care plan of the next administration is projected to cost over a trillion dollars within the first year or so of the proposed plan to recalibrate health care for all of us in the U.S. Yet considering the hundreds of billions of dollars that are speculated to be saved with a reform of the country’s health care system, health policy analysts should not be greatly concerned on the steakholders who may be affected by this reform of our health care system that is desperately needed. Tom Daschle leads this Transition’s Health Policy Team. And we also have Ed Kennedy, the committee chair and a prolific legislator. So if the right people have been selected for this reforming team, the urgency and priority regarding our nation’s health care needs should be rather overt to the country’s citizens.
Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported, which should be addressed as well.
It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health. This specialty makes nearly 100 thousand less in income compared with other physician specialties, yet they are and have been the backbone of the U.S. health care system. PCPs manage the chronically ill patients, who would benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them. Nearly have of the population has at least one chronic illness- with many of those having more than one of these types of illnesses. A good portion of these very ill patients have numerous illnesses that are chronic, and this is responsible for well over 50 percent of the entire Medicare budget. .
The shortage of primary care physicians is due to numerous variables, such as administrative hassles that are quite vexing for these doctors, along with ever increasing patient loads complicated by the progressively increasing cost to provide care for their patients. Many PCPs are retiring early, and most medical school graduates do not strive to become this specialty for obvious reasons. In fact, the number entering family practice residencies has decreased by half over the past decade or so. PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers.
Yet if primary care physicians were increased in number with the populations they serve and are dedicated to their welfare. Studies have shown that mortality rates would decrease due to increased patient outcomes if this increase were to occur. This specialty would also optimize preventative care more for their patients. Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms. This is due to the ideal continuity in health care these PCPs provide if numbered correctly to serve more, the quality improves, as well as the outcomes for their patients. Most importantly, the quality of life for their patients is much improved if there are enough PCPs to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty that is suppose to increase in the years to come. The American College of Physicians believes that a patient centered national health care workforce policy is needed to address these issues that would ideally restructure the payment policies that exist presently with primary care physicians.
Further vexing is that it is quite apparent that we have some greedy health care corporations that take advantage of our health care system. Over a billion dollars was recovered for Medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations who deliberately ripped off taxpayers. These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy, so it seems.
Health 2.0, a new healthcare social networking innovation, is informing patients about their symptoms and potential if not possessing various disease states- largely based on the testimonies of other people on various websites. This may be an example of how so many others rely now on health concerns from those who likely are not medical specialists, instead of becoming a participant, if not victim, of the U.S. Health Care System.
Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up this system as it exists today, which is why the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens, it appears. We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals, potentially. It should be and likely will be funded by a combination of payroll taxes and general tax revenue:
Access- citizens do not have the right or ability to make use of this system as we should.
Efficiency- this system strives on creating much waste and expense as it possibly can.
Quality- the standard of excellence we deserve as citizens with our health care is missing in action.
Sustainability- We as citizens cannot continue to keep our health care system in as it is designed at this time- as it exists today.
Dan Abshear

Anonymous said...

Upon information and belief, evidence-based medicine is where the health care provider applies statistically significant and relevant evidence acquired through quality and valid clinical trials utilizing the scientific method. The health care providers assess the risks and benefits of how they choose to treat or not to treat their patients. This paradigm of a practicing health care provider is to better predict the outcomes of their treatment of their patients. Such providers recognize the need for quality in medicine and place tremendous value on their patients' lives. This paradigm of restoring the health of others protects public health.
There are three areas of evidence-based medicine:
1. Treat patients according to what is reasonable and necessary based on the evidence that exists regarding the treatment options health care providers select.2. Health care providers review this evidence in order to judge and assess the best treatment for their patients.3. Recognize that evidence-based medicine is in fact a movement that emphasizes the usefulness of this method to practice medicine.
Two types of evidence-based medicine:
1. Evidence-based guidelines- Policies and regulations are produced to ensure optimal health care.
2. Evidence-based individual decision making- This is how restoring the health of others is practiced by the health care provider.
This is the preferred way to practice medicine instead of medical guidelines, which are created from a combination of clinical studies in which conclusions are drawn to reflect national standards of care for a particular disease state. Guidelines were implemented during the 1980s. At times, these guidelines are privately sponsored, which makes them unreliable due to bias and without independent systematic review or quality considerations by others. Unlike evidence-based medicine, guidelines can have major flaws and inaccuracies due to toxic factors used to create such guidelines. In fact, most doctors do not follow medical guidelines, yet are rewarded by programs such as Medicare if they do follow medical guidelines that are established.

Dan Abshear

Dan said...

Billy Tauzin, with incredible shock, became CEO of PhRMA immediately after he got done with harming seniors with the Medicare part D plan.

It’s the lobbying by the health care industry that is going to, and has, harmed our health care system.

700 lobbyists from pharma alone, these obsequious bastards become lobbyists after working in some capacity for the federal government- with senators, congress, and so forth often.

It’s the revolving door problem that is by design regarding who these lobbyists are that few know or read about, or care to do so.

Jim Sabin said...

Dear Quiact -

I agree that the revolving door - from government service to lobbying the government - is a flaw in our democratic system. I don't think of this as a flaw in the individuals who make the shift (as long as they are complying with the relevant laws). Our system allows them to make that move and our economy rewards them for it. As I see it, it's our relatively lax regulations and the tremendous need for money our form of the electoral process generates that's at fault.