Monday, February 01, 2010

Until The Healthcare System is Fixed....


You need to stop spending on healthcare. No, not me - you. I'm entitled to business as usual with my gold-plated plan. At least, that's what Robert Samuelson seems to be arguing:
Before spending more, we need to spend better. If we don't, all possible outcomes are bad: high deficits or higher taxes; stunted take-home pay (squeezed by insurance premiums and taxes); lower spending on other programs; or meat-cleaver cuts in health spending. The vast medical-industrial complex -- doctors, hospitals, drug companies and more -- should be forced to change, just as other industries (autos, media, airlines) have had to adjust. The changes need not involve the mass layoffs of other industries, but they must alter how medical care is financed and delivered.
Sure, he says "we", but it ain't the royal "we". He's talking about health care access for others, particularly the uninsured and underinsured. The only "we" that includes him is a financially secure, insured "we" that doesn't want to pay for the expansion of healthcare coverage to those less fortunate populations, and will latch on to one excuse after another for why it shouldn't happen.

Of course, Samuelson's entire concept of the pre-reform reform is unachievable. Apparently, despite his eager endorsement of unlimited deficit spending for things he supports (such as perpetual war), it seems that we can't have healthcare reform without first balancing the budget.
By now, it ought to be obvious why President Obama has wanted his health-care overhaul passed quickly. It would be (and now will be) inconvenient to promote expanded government health spending while simultaneously pledging to rein in future budget deficits -- when unrestrained health spending is a major cause. It's like promising to go on a diet but first treating yourself to one last binge.
A significant reduction in the budget is something that is exceptionally unlikely to happen unless and until we end Samuelson's beloved wars.

And, of course, the healthcare system reforms Samuelson demands aren't going to happen.
Hospitals, doctors and clinics would consolidate into networks that embrace electronic recordkeeping, information-sharing and the search for "best practices." Getting from here to there would not be easy. Mongan and Lee say networks would need at least 100,000 patients to make consolidation worthwhile.

Their improved health-care system would require a shift from fee-for-service reimbursement, which sustains fragmentation by covering most services that doctors and hospitals order. But moving toward "capitation" -- fixed annual payments per patient, adjusted for medical risk -- would trigger opposition. Doctors would feel their independence threatened by dictates from the network. Patients would correctly fear that their "choice" was being restricted. Payment limits would raise the specter of important care being denied.
That's right - for his pre-reform reform, Samuelson wants the government to impose pretty much every concept that had the political right shrieking about a government takeover of healthcare. Strangely, I can't seem to find the column Samuelson wrote explaining to those same factions that none of those elements of a takeover were actually in either the House or Senate reform bill. Go figure.

To summarize, Samuelson opposes any healthcare reform that occurs before we implement a massive (apparently government mandated) coordination of medical practices and patient care, a compensation system likely to reduce doctor compensation and intended to cut off patient care (for those not fortunate enough to be Robert Samuelson able to pay for the additional care themselves), and to effectively reduce the cost of the healthcare system by limiting access to medical care and treatment.

And to Samuelson it's a "failure" of our political leaders, most notably President Obama, for failing to endorse pretty much every hysterical right-wing talking point against reform.
"Goverment bureaucrats limiting your care? We've got that covered. Inability to choose your own doctor or hospital? That's right - we'll tell you where you can go. Doctors choosing between their own profits and authorizing treatments? Absolutely - otherwise they may give you too much care. Death panels? I'll have to check with Robert Samuelson and get back to you."
To remind you, Samuelson insists that all of that come first - the stick must be passed in its most extreme form before we can even start talking about a possible carrot.

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