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Enthoven's schizophrenic health care finance solution |
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Written by Andy Pollack
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Monday, 29 December 2008 19:31 |
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Well-known health care analyst Alain Enthoven had an op-ed in the Times yesterday with his solution to the health care spending crisis. It's a bizarre combination of market and nonmarket measures. On the one hand, he points to the virtues of large, multispecialty physician practices "in which doctors work together to improve quality and keep costs low. Their doctors share values and cultures of teamwork. They keep comprehensive electronic medical records, they share information, and they emphasize disease prevention and chronic disease management as a matter of course. These doctors are usually paid salaries, not fees for services. Research and experience suggests that these practices — which exist in all regions of the country, including both rural and urban communities — can reduce costs by 30 percent." In other words, within the practice these doctors rely not on market mechanisms (i.e. price and competition with each other) but on cooperation to cut costs and improve care. On the other hand, he wants to shift patients toward such practices by increasing competition, i.e. by creating incentives that will force patients, their employers and their insurers into such practices. Medicare and the VA have already shown the economies of scale, and the potential for teamwork, in large, integrated healthcare institutions. The evidence is there for making such models universal. Trying to do it through competition will just maintain the fragmentation among providers and insurers, which will force them to continue wasting money on competing with each other. - Andrew Pollack
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Last Updated ( Monday, 29 December 2008 19:36 )
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Junk fax sells you junk health care insurance |
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Written by Administrator
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Tuesday, 29 April 2008 20:15 |
Have you received a junk faxes selling you healthcare? I get them a lot but the latest one caught my eye. It throws a lot of statistics about the high cost of healthcare in the USA, like that we spend $6,700 per person and this is about 16% of our GDP). But not to worry! This company has the solution to high medical costs.
"Our low-cost nationwide healthcare package is the solution. We have contracted reduce rates with one of the largest PPO networks of Doctors and Hospitals in the US in order to provide wholesale prices to the public"
What a fool I've been, all my life paying retail for health care!
"Be informed! Healthcare for you and you family can be affordable! $369 for a family - regularly $399"
I called and learned some details. This is a PPO plan on the "Beech Street Network"...which I've never heard of. It's hard enough finding a provider willing to take my CIGNA plan, can't imagine how hard it is to find a "Beech Street" provider. This plan has $25 PCP co-pays. But whereas I pay nothing for "in-network" services with my Cigna plan, a subscriber of this plan foots the bill for 30% of all diagnostic services (blood tests, x-rays, MRI's etc.), therapies (he mentions a massage, but think Dialysis, etc.), and prescriptions ("You only pay $1.20 if you get a generic from Walmart!") There is also a $40,000 cap on ICU or ER, and you only get 60 days in the hospital, after that you have to pay 40%. After I ask a couple more questions to suss out these details, he flat out says that if I'm planning on having a heart attack or coming down with cancer that this wouldn't be a good plan for me. It's really only for healthy people. I asked "isn't the point of insurance to eliminate risk of financial ruin in case of disaster?" he says... "well there are different plans for different people." Exactly... Cadiliac plans for the wealthy who can afford $1,000 monthly premiums and Pinto plans for those who get swindled by low teaser rates.
I'd love to see a show where some American Dad type sets about to insure his family in today's broken system, and is forced to become an expert on insurance and copays and lifteime limits, and in-network, out of network, and all this other garbage just to understand what he's really buying. Compare this to Taiwanese or Japanese Dad, who never has to deal with the stress, and never gets junk faxes selling him him junk health care insurance.
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