Aiming health reform at doctors' pay
The Senate Finance Committee is scheduled to vote Tuesday on a bill that would dramatically expand health insurance coverage. But if it is going to control spending, experts say, it will have to change how doctors are paid. Joel Rose reports.
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Kai Ryssdal: For all the months of debate and endless negotiation, the real work of figuring out what a health-care bill might eventually look like will start not long after 10 o'clock tomorrow morning. That's when the Senate Finance Committee is scheduled to vote on its reform plan. The three House proposals and two Senate versions will eventually be married up into one plan for the president to sign. It will, probably, expand insurance coverage and do some other things. But it might not actually do much to control health-care costs. You want to do that, you have to change the way medicine is practiced. Joel Rose explains.
JOEL ROSE: For all the talk in Washington about reshaping our health-care system from the ground up, some say the Senate Finance Committee's aims are relatively modest.
DANA Goldman: This is a rather historic effort to provide insurance to most Americans. But this is not an effort to do anything on cost containment.
Dana Goldman teaches health policy at the University of Southern California [where he is director of the Schaeffer Center for Health Economics and Policy]. If you really want to control spending, Goldman says, you have to stop paying doctors for the quantity of services they provide and reward them for using treatments that save money and lives.
Goldman: If the patient does well, then the hospital gets paid, the doctor gets paid. And if the patient doesn't do well, then they're going to have to bear the cost. And ultimately, that would've been a really valuable change.
There are some pilot and demonstration projects in the Senate Finance bill that are supposed to lead to that kind of change. Goldman says they're little more than a "fig leaf." But for others, they're better than nothing.
ELLIOT Fisher: If you're going to change the delivery system to improve care and lower costs, you can't do it all at once.
Elliot Fisher teaches health policy at Dartmouth College. He says skeptical doctors and hospitals need to see that these innovative payment structures can be made to work on a small scale.
Fisher: This bill provides the foundation that will let us all start to work together to make those changes that will slow the growth of health-care spending.
In the meantime, experts say that none of the bills in Congress would do that.
I'm Joel Rose, for Marketplace.
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From Chicago, IL, 11/02/2009
"...stop paying doctors for the quantity of services they provide and reward them for using treatments that save money and lives.
If the patient does well, then the hospital gets paid, the doctor gets paid. And if the patient doesn't do well, then they're going to have to bear the cost."
Are we taking post-treatment, patient responsibility into consideration?
Many people smoke and drink despite SG warning labels. Most consume highly processed foods and beverages with little to no natural nutritional value and carry extra weight that leads to the diseases that they now look to the physician to treat.
You can't hold a physician nor hospital responsible for a patient that does little to prevent disease and is not willing to make the lifestyle and dietary changes necessary for successful post-treatment healing.
Everyone coming in for treatment has very different health histories and immune systems that are obviously malfunctioning or are overtaxed due to genetics, stress, environment, or poor lifestyle choices.
I think this idea is faulty. Withholding pay because a patient doesn't heal? Every patient's capacity to heal is complicated and unique.
From Atlanta, GA, 10/13/2009
I applaud you for advancing this story. The human body is a complex bio-chemical engine, so it is extremely difficult to treat it like it is automobile maintenance. Additionally, who will judge is a treatment was successful. It's an interesting premise, but it will be diffilcult to enact. If we could pull it off, it will drive innovation in treatment.
From NC, 10/12/2009
To lower costs try a cap & trade scheme for health care administrative costs.
In a manner similar to the cap & trade scheme for carbon credits, create a cap & trade scheme for administrative costs. Start with a target of say 10% for administrative costs. If the insurance company has admin costs less than 10% they get to sell their credits to some other insurance company that cannot meet the 10% goal. If there are no credits available to purchase then the govt. sells the credits and uses the proceeds from the sale of the credits to fund the uninsured and underinsured. Periodically the level of allowable admin. costs is reduced until it eventually gets to say 3%, or whatever is the best that any of the developed nation with universal care has achieved.
From NC, 10/12/2009
"...changes that will slow the growth of health-care spending.
In the meantime, experts say that none of the bills in Congress would do that."
Of course not. The purpose of "reform" legislation is not to reduce costs. The purpose is to increase government control.
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