Hillary and Barack, chapter 2: Health Care
14 April 2008 6:39 pm EDT
As we did last time, let’s start with Barack’s web site:
Health Care
The nation faces epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Yet despite all of this less than 4 cents of every health care dollar is spent on prevention and public health.
I don’t know about bioterrorism, but he’s spot on about obesity. Wish he’d mentioned smoking.
Simplified paperwork and reined in health costs.
Certainly, paperwork is a huge factor in high medical costs. What else will he rein in?
The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.
That sounds like simply adding regulation to the existing system. I don’t like his dependence on the “private insurance market.” They’ve had their day in the sun. They bilked us, and now they should go away.
Obama will require that providers that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care, give doctors better information and lower costs.
I’m sorry, that’s just pie in the sky.
The Exchange would evaluate plans and make the differences among the plans, including cost of services, public. . . . Obama will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.
This sounds like a free marketplace approach: the very approach that got us into this mess. Isn’t it a bit simplistic to think that health care profiteers will lower prices if they public learns where the money goes? What are we supposed to do: choose the provider that overcharges us by 250% vs. the provider that overcharges us by 251%?
Align incentives for excellence. Both public and private insurers tend to pay providers based on the volume of services provided, rather than the quality or effectiveness of care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare and FEHBP will be rewarded for achieving performance thresholds on outcome measures.
OK, so they’ll have an incentive to say you’re well when you’re not.
He will also challenge the medical system to eliminate inequities in health care through quality measurement and reporting, implementation of effective interventions such as patient navigation programs, and diversification of the health workforce.
I have no idea what any of that means.
Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality or reduce medical errors and which costs twice as much as electronic claims. Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT.
Spot on. Medical record-keeping in this country is ludicrous.
Barack Obama will prevent companies from abusing their monopoly power through unjustified price increases. His plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration. His new National Health Exchange will help increase competition by insurers.
So, they get to keep their monopolies? Why should we hand over health care financing to the same people who created the crisis?
Lower prescription drug costs. The second-fastest growing type of health expenses is prescription drugs. Pharmaceutical companies are selling the exact same drugs in Europe and Canada but charging Americans more than double the price. Obama will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S. Obama will also repeal the ban that prevents the government from negotiating with drug companies, which could result in savings as high as $30 billion. Finally, Obama will work to increase the use of generic drugs in Medicare, Medicaid, and FEHBP and prohibit big name drug companies from keeping generics out of markets.
Or we could just prohibit Big Pharm from overcharging us in the first place. Instead of making them sell medicine to us at a fair price, we’ll let them continue to overcharge us but allow us to have the drugs shipped to another country and then shipped back here. Bonkers.
As president, Obama will support mental health parity so that coverage for serious mental illnesses are provided on the same terms and conditions as other illnesses and diseases.
Hear hear.
Barack Obama has a plan to significantly reduce the amount of mercury that is deposited in oceans, lakes, and rivers, which in turn would reduce the amount of mercury in fish.
Hear hear.
If you have a plan you like, you keep it. If you want to change plans or aren’t currently covered, you can choose from dozens of the same plans available to members of Congress, or you can opt into a public plan option like Medicare. And working families will get tax credits to help pay their premiums.
I’ve never been fond of pushing money around through tax credits. But I’m glad there’s a government-run plan, so we don’t have to rely entirely on insurance companies.
By removing hidden taxes, stressing prevention and a focus on efficiency and modernization, the plan will improve quality and lower costs.
Sounds like wishful thinking. Is this all she has to say about why health care costs more in the US than in other industrialized nations? I wish somebody would say, “My goal is to bring US health care costs down to a level comparable with other leading nations.”
Over half the savings come from the public savings generated from Senator Clinton’s broader agenda to modernize the heath systems and reduce wasteful health spending.
That’s great, but short on specifics. The detail is at http://hillaryclinton.com/feature/healthcare/, which says:
Senator Clinton proposed a series of initiatives that will cut the spiraling rate of growth by one-third over time. Her health care modernization strategy achieves this by targeting the drivers of health care costs, including (1) our back-ended coverage of health care that gives short-shift to prevention, (2) the nation’s reliance on an antiquated, wasteful, costly and even dangerous paper-based medical records system, (3) unmanaged chronic illnesses such as diabetes and heart disease which account for over 75 percent of health care spending, (4) the over-utilization of medical interventions that provide little added value and the under-utilization of those that do, (5) and excessive insurance, drug, and malpractice costs.
Good start. I would think that (4) should be (1). Very similar to Barack’s statements.
Americans pay the highest prices in the world for drugs, and no other nation spends what we do for health insurance. In the last decade, prescription drugs accounted for 15 percent of the total increase in health spending, despite the fact that they account for only about 10 percent of all health spending. When Congress passed the Medicare prescription drug benefit, language was included to explicitly prohibit the Secretary of HHS from using the purchasing power of the federal government to negotiate lower prescription drug prices. Excess expenditures are not limited to prescription drugs. MedPAC, a non-partisan congressional advisory committee, reports that Medicare pays private managed care plans, on average, 12 percent more than traditional Medicare pays to providers to treat the same beneficiaries. This has raised Medicare premiums by $24 for all beneficiaries, even those not enrolled in these private plans. The Medicare actuaries report that these overpayments are accelerating the depletion of the Medicare Trust Fund by 2 years.
Wow: concrete, specific facts. Thank you.
Give FDA the authority to approve safe and effective biogeneric drugs — ending the monopoly currently enjoyed by large biopharmaceutical companies.
I don’t know what this means exactly, but I like the sound of ending the Big Pharm monopoly. I wish somebody would just say, “And I would make it illegal for pharmaceutical companies to gouge consumers.”
About 30% of the rise in health care spending is linked to the doubling of obesity among adults over the past 20 years.
Right.
A systematic review of this literature evaluating workplace health promotion programs found that 88% of the 32 studies found that these initiatives reduced healthcare costs, and virtually all found they reduced absenteeism. The mean return on investment of the initiatives was $3.93 for health care costs and $5.07 for absenteeism savings.
Can’t argue with that. I like this part of the plan.
In 2000, for every dollar spent on direct-to-consumer advertising, pharmaceutical sales increased by $4.20.
I suspected as much, and I hope somebody puts a stop to it.
The page cites 70 references in footnotes. Although the issue of “the over-utilization of medical interventions” was cited, it wasn’t discussed (not surprising; one can’t expect any candidate to speak frankly about that issue). I’m surprised she even brought it up. Well done.
The Result
Points to both candidates for concrete proposals. Hillary provides much more detail, and I dislike Barack’s reliance on marketplace pressures to cure the problems that the marketplace created. Points taken away from both candidates for their timid approach. I’d like to hear a candidate say, “We know Americans are overcharged for health care. I’m going to find out who is gouging you and put a stop to it, let the chips fall where they may.”
Next: Energy and the Environment.
Leave a Comment
There are no comments for this article.