The attack on government at every level is unending. As others have pointed out, this is not new. During the late 60s, protesters railed against both the Johnson and Nixon adminsistrations. Today we have the tea parties demonstrating agains the government takeover of the United States.
In both times we experienced a dramatic decline in our faith in government. But these time are different and more dangerous. The loss of faith in government is occurring at a time when our economy is at its lowest point since the Great Depression. For many Americans, the only source of support they have is support provided by unemployment insurance, a government program.
I believe, however, that the loss of faith in government goes much deeper. It is, in fact, a loss of faith in those who are in power to provide needed national leadership. In his book, The Power Elite, Charles Wright Mills articulated that political, industrial, academic, and military positions of leadership represent an elite that is driving and control public and economic policy.
Any even casual examination of recent history will find many of the same players regardless of the party in power. There are those who suggest we are headed toward socialism, and they may be correct, but it is a socialism that is rooted in plutocracy . Now I wish that this was government by a Disney character, but unfortunately its root is the Roman God Pluto, the god of the underworld and its riches. Plutocracy, then, it government by those who hold wealth.
It is no accident that as a candidate from either party rises in the polls, the donations from wealthy interests moves to the projected winner. Time and again politicians make the argument that their decisions are not influenced by campaign contributions. But this is simply semantic parsing to avoid what the contributions do accomplish.
The principle driving force behind government policy is access. Wealth and contributions afford access. Common sense alone tells us that what someone believes and does will be fundamentally shape but what he is exposed to. If the circles in which the politicians walk are always the circles of the wealthy, then they will make decisions that are in tandem with what supports the needs of those with wealth.
Rightly or wrongly, the Supreme Court recently ruled to allow corporate campaign finance, ultimately widening the access doorway to the wealthy. How does this all go back to the loss of fairth in government? At some level most of us recognize that the government is not some sort of neutral entity operating separate and appart on behalf of constiuencies. It is an entity that is at best a collaborator with the other members of the "Power Elite." What we have seen in recent years is the failure of that group at every level: failed government, failed industries, and failed military strategy.
These were not simply mistakes, but profound errors in judgement and ethics that have taken the United States and much of the rest of the world to the brink.
Sunday, March 7, 2010
Saturday, February 20, 2010
Health Reform Part 2
The amazing thing in the process of health reform is that neither party appears to have the slightest idea about how the actual system works. I can only assume that they have been so taken over by special interests that they lack the capacity to express anything close to what is real.
As I said in the previous comment, a big part of the problem is the reimbursement system. One additional complicating factor is balance billing. Balance billing laws prohibit physicians from charging more than the negotiated contract price, even if they do so openly.
Let's put this in perspective. Can you imagine any product or service that was price controlled such that differences in quality could not be accounted for in the price? Of course not. Yet, that's what physicians are stuck with.
The arguments in favor of preventing balance billing focus primarily on preventing physicians from adding fees that are not specifically covered by insurance. This seems like a good protection for patients, especially in th4e face of a health crisis. But, unfortunately, the baby has been thrown out with the bathwater.
The laws also prohibit the patient from negotiating with the physician. What if I want to establish an agreement that the physician will see me in no more than 10 minutes, but I'm will to pay 10% more for that? You can get express passes at Disney World, but you can't get an express pass with your physician?
Let's put some economic reason back into health care. The desire for economic reason is not at odds with a goal of ensuring all Americans have the health care they need. How someone gets health care paid for is separate from how the reimbursement system works and the mess it makes things.
As I said in the previous comment, a big part of the problem is the reimbursement system. One additional complicating factor is balance billing. Balance billing laws prohibit physicians from charging more than the negotiated contract price, even if they do so openly.
Let's put this in perspective. Can you imagine any product or service that was price controlled such that differences in quality could not be accounted for in the price? Of course not. Yet, that's what physicians are stuck with.
The arguments in favor of preventing balance billing focus primarily on preventing physicians from adding fees that are not specifically covered by insurance. This seems like a good protection for patients, especially in th4e face of a health crisis. But, unfortunately, the baby has been thrown out with the bathwater.
The laws also prohibit the patient from negotiating with the physician. What if I want to establish an agreement that the physician will see me in no more than 10 minutes, but I'm will to pay 10% more for that? You can get express passes at Disney World, but you can't get an express pass with your physician?
Let's put some economic reason back into health care. The desire for economic reason is not at odds with a goal of ensuring all Americans have the health care they need. How someone gets health care paid for is separate from how the reimbursement system works and the mess it makes things.
Friday, February 19, 2010
Health Reform Breakdown
I started my career back in the days when we were trying to control health care costs by using certificate of need reviews. For those of you who don't remember, that was the effort in the late 1970s to control health-related capital spending. The assumption was that we were duplicating too much capital investment. Not much has changed.
Then came diagnostic related groups. I'm afraid the folks in Washington didn't figure that hospitals would figure out how to game the system. Again, health care costs kept going up.
In spite of evidence that DRGs did not work, a similar system was imposed on outpatient services based on what are called relative value units. Doctors don't get paid for an office visit, they get paid a standardized fee based on the diagnosis. If you wonder why your doctor doesn't spend time with you, it's because after somewhere between 7 and 10 minutes, they don't get paid especially well for their time.
The fact is that nothing in health care reform has even begun to address this Byzantine system that ends up requiring physicians to have specially trained staff to help them properly code their bills.
Don't think for a minute that somehow the single payer system will help all this along. The brain trust behind DRGs and RVUs is the Centers for Medicare and Medicaid Services (CMS http://www.cms.gov/).
Can we fix this mess? You bet. It starts by freeing physicians from this absurd reimbursement system and letting payments become a transaction between the patient and the doctor. Consumer driven health plans are a step, but without getting rid of the current reimbursement system, they simply cannot work. Doctors don't know what the cost of a visit will be until after the diagnosis, so price transparency is impossible. Other professionals charge for their time. Why can't doctors?
Then came diagnostic related groups. I'm afraid the folks in Washington didn't figure that hospitals would figure out how to game the system. Again, health care costs kept going up.
In spite of evidence that DRGs did not work, a similar system was imposed on outpatient services based on what are called relative value units. Doctors don't get paid for an office visit, they get paid a standardized fee based on the diagnosis. If you wonder why your doctor doesn't spend time with you, it's because after somewhere between 7 and 10 minutes, they don't get paid especially well for their time.
The fact is that nothing in health care reform has even begun to address this Byzantine system that ends up requiring physicians to have specially trained staff to help them properly code their bills.
Don't think for a minute that somehow the single payer system will help all this along. The brain trust behind DRGs and RVUs is the Centers for Medicare and Medicaid Services (CMS http://www.cms.gov/).
Can we fix this mess? You bet. It starts by freeing physicians from this absurd reimbursement system and letting payments become a transaction between the patient and the doctor. Consumer driven health plans are a step, but without getting rid of the current reimbursement system, they simply cannot work. Doctors don't know what the cost of a visit will be until after the diagnosis, so price transparency is impossible. Other professionals charge for their time. Why can't doctors?
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