…the general view among independent health care economists is that these changes will not fundamentally bend the cost curve. The system after reform will look as it does today, only bigger and more expensive.
As Jeffrey S. Flier, dean of the Harvard Medical School, wrote in The Wall Street Journal last week, “In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it.”
…the current estimates almost certainly understate the share of the nation’s wealth that will have to be shifted. In these bills, the present Congress pledges that future Congresses will impose painful measures to cut Medicare payments and impose efficiencies. Future Congresses rarely live up to these pledges.
Hm. This is a vague and misleading article.
A better article, by far, is [url=http://politics.theatlantic.com/2009/11/obama_and_the atlantic.php]here[/url]
John Wilkins,
Way to criticize both the article and the Judgment of Dr. Harmon for posting it.
“In these bills, the present Congress pledges that future Congresses will impose painful measures to cut Medicare payments and impose efficiencies. Future Congresses rarely live up to these pledges.”
A legislature cannot bind future legislatures. If a sitting legislature will not make painfull decisions what make them think a future one will? This is just another example of kicking the problem down the road for someone else to fix (or not) and letting someone else deal with and preferably after they have retired.
“Future Congresses will impose painful measures to cut Medicare payments and impose efficiencies. ”
This will definately happen. It will happen by inflation and by services vanishing. It is already happening. If your child has auditory processing disorder (a common mimic of ADHD that is readily curable by intensive auditory exercises) you will find that no family physician has heard of this. If you look for a pediatric specialist, unless you live in a major metropolitan area you will not find a pediatric specialist. If you do find a pediatric specialist it will take six months to get in, and if the specialist has heard of the disorder, she/he will inform you that it is not available under insurance/medicaid but will need to be obtained privately by a local provider (usually a speech/language pathologist) at a cost of about 2,000-6,000 depending on the area. But most likely the specialist will be unable to say anything about it because, thanks to Medicaid price controls, even if you have private insurance he/she will only have about 30 minutes in which to see you, which will be barely enough time to write for Ritalin. This is not enough time to discuss the differential diagnosis of learning disorders, their treatment and ways and means of obtaining them.
That is the state of affairs in pediatrics. And it saves money, yes? So Congress is happy with it.
Now, fast forward five years. You have a mother who has mild dementia and is falling. The nurse practitioner who sees her for your family physician thinks she has alzheimer’s disease but she continues to get worse. Actually she has normal pressure hydrocephalus, a disorder that is readily treatable. Unfortunately, although you are eventually able to obtain an MRI that strongly supports this diagnosis, you will find that there are no neurosurgeons who will put in shunts unless you live in a major metropolitan area. Even in such major areas there are few who operate on brains these days, most confine themselves to operating on backs and necks where there is less likelihood of getting sued. If you do find a neurosurgeon it will take six months to get in. You and your demented mother will need to travel several hundred miles multiple times in order to get first the evaluation, then the surgery, and then monthly for monitoring where you will drive over night to get a 15 minute outpatient appointment for shunt checks and the like (no, your family doc will not be able to do this for you).
Many patients will not be able to do this. They will end up in hospice receiving “palliative care” for their “end stage dementia”. Those who can comply will be few, and comparatively wealthy (at least in family members who can take off work and drive them around the country if in nothing else).
And costs will come down. They are already coming down. It is working. The “painful measures to cut Medicare payments and impose efficiencies” are already being felt by real people (mostly parents of children with serious illnesses, but soon family members of older people with serious illnesses, and in about 10 years folks of all ages with serious illnesses. But most people do not have serious illnessses. They have minor, easily treatable illnesses like flu, broken bones and appendicitis. For them, there are no painful measures. It’s all free, and it’s all good.
So we are not kicking the problem down the road. We are pretending we are doing so, but in fact the “problem” is being “fixed”, slowly, stealthily, inevitably.
It’s not going to change except by becoming bigger and more expensive because insurance and pharma companies have blocked any meaningful, systemic change. In stead we’ll end up with a system that makes them more money.
The money isn’t there. Therefore it will become bigger, and poorer in quality, but will (probably) not become less expensive, because if you cut prices, people will stop offering services. They already are, which is why there are no pediatric specialists in arkansas outside Little Rock, and those have a six month waiting list, soon to rise to a two year waiting list. This is not because none were trained. They have simply chosen to be urgent care docs, or work in other fields. I used to see kids as well as adults as a neurologist, and now I work at a VA so it is adult only. The best pediatric endocrinologist I know works as a pharmaceuticals representative. A pediatric rheumatologist I know works part time at various ERs.
So prices will stabilize (though probably not decrease, since bureacracies are expensive). But hey those are good government jobs that are being created by the bureacracies, so this is stimulus in action.
We are seeing rationing by access (the Canadian approach to cutting costs). It is working. Soon as it begins to bite into other age groups (beginning with the over 65s) it will work even better.