Sunday, December 2, 2012

Politically Driven Healthcare, or Healthcare for the Loudest


Every time, and I mean every single time, you speak of the inefficiencies and mis-spending that takes place under our current health care system I shake my head (in despair) and ask given your views on those items how you could possibly be in favor of the Affordable Care Act. How could you possibly be a proponent of IPAB. How could you possibly think that a politically driven healthcare system, called ACA, will be better than the prior politically driven healthcare system that resulted in these poor spending decisions you keep bemoaning. You continue to assert the best way to change the Federal Government's unsustainable spending trajectory on Medicare and Medicaid, and the price distortions that creates in the private market is: DO MORE OF IT.

Your latest complaint against healthcare spending focuses on the possible lack of utility of mammograms. Let's assume mammograms, as the New England Journal of Medicine study quoted in the Times claims, are essentially useless. How does that poor decision get changed in the current health care system and under ACA? For ACA, I suppose your answer is, "A panel of smart people will be appointed, the IPAB, to make these decisions." I think you are dreaming. Medicare payment decisions, which then drive a lot of the practices adopted by the private insurance market, like mammograms for women, or prostate cancer screens for men, are driven by the the politics of the loudest. Scream loud enough and long enough and the Federal government and private pay insurance companies cave and offer "free" screenings for these types of cancer. The latest example of this is contraception. Sandra Fluke hasn't figured out Walgreen's sells condoms so we must create "free" access to contraception. Right now we have healthcare goodies for the loudest. The IPAB institutionalizes this.

I don't know who makes mammogram screening equipment. I suspect it is GE. What are the incentives for GE? Obviously, lobby CMS (today's version of IPAB) to reimburse providers for mammograms. Lobby providers to urge CMS to reimburse mammograms. The consumer is completely separated from any of these decisions.

I know you don't like to even consider the possibility that the lack of consumer involvement in healthcare is the reason healthcare spending is too much (whatever that means) but is seems pretty plain to me. And every time, and I mean every single time, you bring up one of these vignettes  I'm completely befuddled why it isn't plain to you as well.


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