The longer the health care debate goes on, the more I become convinced that the American system needs fundamental reform. We need to transition away from a fee-for-service system to one that directs incentives toward better care, not more procedures. We need to move away from the employer-based system, which is eroding year by year. We need to move toward a more transparent system, in which people see the consequences of their choices.See Ron Wyden's ideas on healthcare reform here.
I’ve also become convinced that the approach championed by Senator Ron Wyden, Democrat of Oregon, is the best vehicle for this sort of change. The Wyden approach — first introduced in a bill with Robert F. Bennett, Republican of Utah, and now pared down to an amendment to the current bills—would combine choice with universal coverage.
People with insurance could stay with their existing health plans. But if they didn’t like the plans their employer offered, they could take the money their employer spends, add whatever they wanted to throw in, and shop for a better option on a regulated exchange. People without insurance would get subsidies to shop at the exchanges. Read the rest at NYT
This story NPR story nails the problem with health care. A study on hysterectomies in the city of Lewiston, Maine showed that more were women losing their uterus because there were more doctors competing to do hysterectomies. Doctors lower the bar on when to do a procedure if they have more competition. That way they make more money. The fewer doctors in an area, the fewer procedures and the better the turnout. When doctors do procedures, they tend to pick the most expensive ones. Surprise! (not) Doctors are motivated by money.
Never mind public option. Fee for service needs to be dumped before real reform happens.
Transcript
Never mind public option. Fee for service needs to be dumped before real reform happens.
Transcript
Here's another example: One of the many doctors I talked to while I was in Maine was an eye specialist named Frank Read, another doc from the study groups. He told me this story.
Dr. FRANK READ: My old partner that I joined here in 1971 was asked by a friend of his, you know, at what level of vision do you do a cataract operation? And he said, well, if there's one ophthalmologist in town, it's 20/200.
SPIEGEL: 20/200 is pretty bad vision.
Dr. REED: If there are two ophthalmologists in town, it's 20/80.
SPIEGEL: Not so bad.
Dr. REED: If there are three ophthalmologists in town, it's 20/40.
SPIEGEL: Pretty good vision, actually. In other words, when there are more doctors, surgery is being done on patients that are less sick. According to later work done by Jack Wennberg, the number of doctors in a town can influence the amount of medical services consumed across the board. If there's one doctor in a town with 100 patients, then he might schedule your heart checkups for once every six months. If another doctor comes to town, and now the first doctor has 50 patients, he'll just schedule your heart checkups for once every three months for a very simple reason, Frank Read says.
Dr. READ: I don't want to be sitting on my thumbs all the time. I want to be busy. And that may unconsciously loosen my criteria for doing a particular procedure.
SPIEGEL: Which brings us finally to the subject which incredibly was never, ever directly discussed during the nearly 20 years the doctors met: money, the way money affects medical decisions. Frank Read and Bob Keller told me that this subject was completely verboten.
