tjcmd
Retired
My wife or daughter's boot would place you into orbit.
All the wisdom and experience you've acquired wasn't necessary to write off a single payer system as impossible simply because of vague "politics" and "economics". America is America, we all get it, that doesn't mean things can't change. The private health care insurance industry is a divisive blight on our society, and its existence only serves our capitalistic pride.Theres a lot of opinions on this thread and I applaud you becoming more informed on the system. Ive enjoyed reading some of what you've posted.
I've dedicated 20+ years of my professional and academic life to making the system better. I've worked with CCIO and CMS on cost control demonstration efforts. I've worked with HHS and implementing various aspects of reform from Clinton through Obama. I've worked on the front lines enrolling Medicaid dual eligibles. I've worked with the state of NC and CCNC on developing an improved and efficient Medicaid system. I have the opportunity to work and negotiate with provider systems, ACOs and PBMs. I've worked on creating tools to identify cost/quality metrics to help manage network costs. I work with large employers trying to control their medical spend. I wish I could simply "link" to these experiences and how things really work but I can't. I don't spend a few hours reading about the system on a blog. I work in it 60 hrs a week trying to make it better. You can accept that or ignore it but don't act as if Im uninformed or simply pushing a personal agenda. I'm not.
And I don't disagree its broken. Special interests on all sides (from pharma to AARP) have sway in the process. The whole system is broken, from medicaid to medicare to the unacceptable # of uninsured we have. And based on my experiences, its incredibly naieve to think this country could easily adopt single payer as the panacea. Politics, culture and economics are highly intertwined in this. To suggest otherwise is misguided IMHO.
Why won't you tell us the country?
Was it Never Never Land?
My wife or daughter's boot would place you into orbit.
Theres a lot of opinions on this thread and I applaud you becoming more informed on the system. Ive enjoyed reading some of what you've posted.
I've dedicated 20+ years of my professional and academic life to making the system better. I've worked with CCIO and CMS on cost control demonstration efforts. I've worked with HHS and implementing various aspects of reform from Clinton through Obama. I've worked on the front lines enrolling Medicaid dual eligibles. I've worked with the state of NC and CCNC on developing an improved and efficient Medicaid system. I have the opportunity to work and negotiate with provider systems, ACOs and PBMs. I've worked on creating tools to identify cost/quality metrics to help manage network costs. I work with large employers trying to control their medical spend. I wish I could simply "link" to these experiences and how things really work but I can't. I don't spend a few hours reading about the system on a blog. I work in it 60 hrs a week trying to make it better. You can accept that or ignore it but don't act as if Im uninformed or simply pushing a personal agenda. I'm not.
And I don't disagree its broken. Special interests on all sides (from pharma to AARP) have sway in the process. The whole system is broken, from medicaid to medicare to the unacceptable # of uninsured we have. And based on my experiences, its incredibly naieve to think this country could easily adopt single payer as the panacea. Politics, culture and economics are highly intertwined in this. To suggest otherwise is misguided IMHO.
Theres a lot of opinions on this thread and I applaud you becoming more informed on the system. Ive enjoyed reading some of what you've posted.
I've dedicated 20+ years of my professional and academic life to making the system better. I've worked with CCIO and CMS on cost control demonstration efforts. I've worked with HHS and implementing various aspects of reform from Clinton through Obama. I've worked on the front lines enrolling Medicaid dual eligibles. I've worked with the state of NC and CCNC on developing an improved and efficient Medicaid system. I have the opportunity to work and negotiate with provider systems, ACOs and PBMs. I've worked on creating tools to identify cost/quality metrics to help manage network costs. I work with large employers trying to control their medical spend. I wish I could simply "link" to these experiences and how things really work but I can't. I don't spend a few hours reading about the system on a blog. I work in it 60 hrs a week trying to make it better. You can accept that or ignore it but don't act as if Im uninformed or simply pushing a personal agenda. I'm not.
And I don't disagree its broken. Special interests on all sides (from pharma to AARP) have sway in the process. The whole system is broken, from medicaid to medicare to the unacceptable # of uninsured we have. And based on my experiences, its incredibly naieve to think this country could easily adopt single payer as the panacea. Politics, culture and economics are highly intertwined in this. To suggest otherwise is misguided IMHO.
You and I probably agree on more than we disagree. We both agree the current system is broken, and we both agree that Obamacare is a bad idea that will make the current system more broken. I appreciate the conversation.
Respectfully, I think you should consider whether your long experience in the industry has induced a bit of "Stockholm syndrome" or just made it hard for you to imagine the possibilities of radical change. My overall point, as you understand, is not that we should import the British system or the Canadian system or the Austrian system, but that we should try to craft a single-payer system that works for America. I agree that will be very, very hard. In fact, I am not sure that it can be done until we do something to fix the very serious problems we have with our overall electoral system, primarily the extreme gerrymandering of Congress and the extreme influence of monied interests in our politics. Because the simple fact is the only way to get our health cost-to-benefit ratio down to international norms is for a lot of very rich influential people to make a lot less money.
Perhaps where we disagree is the idea that moving toward a more "free market" approach to healthcare will achieve that goal. I just don't think there's anything in the historical record or my personal experience with healthcare that supports the idea that a reasonably well-functioning market can ever happen in healthcare. the knowledge gaps between supplier and consumer are too big to be bridged, especially when the conditions creating the need for the services - sickness and injury - inherently erode the decision-making skills of the customer and his/her family. The serious inefficiencies in the market mean that more "market freedom" is primarily going to result in more profits for suppliers.
The only way for that not to be the case is to reduce utilization by customers - which translates to rationing care based on who can afford it, i.e. more of what we have now. The studies I have cited indicate that in some ways, Americans already utilize services less than some other countries - we see the doctor less, we spend less time in the hospital. Reducing cost by reducing utilization is not a step in the right direction. We need to reduce the cost of the utilization.
You and I probably agree on more than we disagree. We both agree the current system is broken, and we both agree that Obamacare is a bad idea that will make the current system more broken. I appreciate the conversation.
Respectfully, I think you should consider whether your long experience in the industry has induced a bit of "Stockholm syndrome" or just made it hard for you to imagine the possibilities of radical change. My overall point, as you understand, is not that we should import the British system or the Canadian system or the Austrian system, but that we should try to craft a single-payer system that works for America. I agree that will be very, very hard. In fact, I am not sure that it can be done until we do something to fix the very serious problems we have with our overall electoral system, primarily the extreme gerrymandering of Congress and the extreme influence of monied interests in our politics. Because the simple fact is the only way to get our health cost-to-benefit ratio down to international norms is for a lot of very rich influential people to make a lot less money.
Perhaps where we disagree is the idea that moving toward a more "free market" approach to healthcare will achieve that goal. I just don't think there's anything in the historical record or my personal experience with healthcare that supports the idea that a reasonably well-functioning market can ever happen in healthcare. the knowledge gaps between supplier and consumer are too big to be bridged, especially when the conditions creating the need for the services - sickness and injury - inherently erode the decision-making skills of the customer and his/her family. The serious inefficiencies in the market mean that more "market freedom" is primarily going to result in more profits for suppliers.
The only way for that not to be the case is to reduce utilization by customers - which translates to rationing care based on who can afford it, i.e. more of what we have now. The studies I have cited indicate that in some ways, Americans already utilize services less than some other countries - we see the doctor less, we spend less time in the hospital. Reducing cost by reducing utilization is not a step in the right direction. We need to reduce the cost of the utilization.
Thanks for posting.
This is just one more example....out of millions....documenting how screwed up our healthcare system is in this country today. It is a bureaucratic mess.
Thanks for that post. Appreciate your experience.
I will mention a couple things. First, one of your paragraphs seems to indicate that you don't think people could choose their doc in a single payer system. This is untrue in most countries. In most single payer systems like France and Canada you choose your own primary care doc that is your medical home. I don't know the extent you are allowed to choose a specialist. Maybe bad can weigh in on the Austrian model.
Utilization is an interesting thing. The data is scanty, but I think there is reason to believe that our system encourages over utilization of the wrong things (name brand drugs, end of life desperate measures, elective surgery) but rations good things (like primary care and hospital stays) in the name of cost control. It appears that some single payer systems control cost by restricting the former and encouraging the latter. Again, it is undeniable that these systems do a better job on cost control.
I am sure this will really help things if it stands. http://www.cnn.com/2014/07/22/politics/obamacare-subsidy-ruling/index.html?hpt=hp_t1
A lot of good insurance, health care, and outcomes discussion the past couple pages.
I wanted to bump the thread this morning because there's a bill that's going to go in front of Congress early next week from Senator Harkin, the chair of the Appropriations subcommittee, about funding biomedical research.
The association I work for has a lobbying arm in Washington that sent this email out to the board of directors, heads of cancer centers around the country.
Essentially, this is the fight faced when trying to get more NIH money. You gotta try to get bipartisan support, and it typically means cutting from other programs.
Biomed research means funding cures and creating jobs, that should be both parties' line.
I couldn't really glean this from the CNN article, but is this just an oversight in the wording of the ACA?