Sunday, December 20, 2009

All together now...


Sometime very soon, perhaps even tonight or early tomorrow morning, the Senate will be voting on the latest version of its health care reform bill. All indications are that the Senate Majority Leader has, by dint of persuasion and the copious use of 'inducements', lined up the 60 votes necessary to close debate and bring the bill to a vote. As such passage is then assured. Below are previous blog entries about hospitals and health care, and the current "health care reform" efforts.

An orgy of self-congratulations is likely to pour forth from the administration and the Democrats in the House and Senate. It is to be hoped that no injuries are suffered during all the back-slapping and high fives that will ensue... And then comes reconciliation and final passage.

The bottom line? As argued before, this is a health insurance reform bill and not a healthcare reform bill, no matter how many times politicians dress it up as the latter. The only thing going for it is that it greatly reduces, but for some reason does not eliminate, the vast pool of uninsured. The argument that this will save money over the long term is unpersuasive. As argued, many of the mechanisms intended to result in "savings" e.g. comparative effectiveness research, reductions in Medicare "waste", etc. will probably not pan out since they will prove politically risky when the time comes for implementation (for example, in this very bill the Senate added language prohibiting the implementation of the latest mammography recommendations)... It does not address most of the issues responsible for today's health care costs. The best case scenario is the hope that Atul Gawande's parallel to the changes that occurred in agriculture pan out similarly in healthcare, though this blogger is somewhat skeptical.

Back in 1988, albeit on a much smaller scale, the Congress passed the Medicare Catastrophic Coverage Act (MCCA) of 1988, which was intended to reduce the risk for catastrophic financial losses in the elderly due to illness. Its passage was followed by much cork-popping and champagne drinking, until a public backlash and fire-storm led to its repeal a year later. Given all the compromises made to achieve passage here, there is some risk of a similar outcome. A best case scenario will be that this small, initial step will have to be slowly built upon over the years to come. One has to say, the jury remains out on (true) health care reform...

Some previous entries referencing hospitals & health care:

Great quotes November 21st, 2009
Health care re-form XV (RIP CER) November 20th, 2009
Health care re-form XIV (The numbers) - October 31st, 2009
Health care re-form XIII (Bad math) - October 8th, 2009
Health care re-form XII (Random chart) - Oct 1st, 2009
Random chart - Sep 25th, 2009
Health care re-form XI (Sales job) - Sep 24th, 2009
Random chart - Sep 24th, 2009
Random chart - Sep 16th, 2009
Health care re-form X (Cowardice) - Sep 13th, 2009
Tempest in a teapot - Sep 5th, 2009
That explains it... (death panels) - Sep 1st, 2009
Health care re-form IX (Apologies due) - Aug 30th, 2009
Health care re-form VIII (More nonsense) - Aug 28th, 2009
Health care re-form VII (Nonsense) - Aug 26th, 2009
Health care re-form VI (Effectiveness) - Aug 15th, 2009
Health care re-form V (The sales job) - Aug 14th, 2009
Health care re-form IV (What is it?) - Aug 13th, 2009
Health care re-form III (Why we spend more) - Aug 8th, 2009
Health care re-form II (P4P) - Aug 4th, 2009
Health care re-form I (Issues) - Aug 4th, 2009
So? - Jul 27th, 2009
Random chart... - Jul 12th, 2009
Random charts... - May 22nd, 2009
Random chart... - May 9th, 2009
Wyeth v. Levine - Mar 22nd, 2009
Financial crisis & hospitals - III - Mar 22nd, 2009
Random chart... - Feb 1st, 2009
Financial crisis & hospitals - II - Jan 27th, 2009
Random chart... - Jan 26th, 2009
Hospitals' financial update - Dec 25th, 2008
Good for the goose - Dec 11th, 2008
Studies of intererst - IV - Nov 16th, 2008
Studies of interest - II - Nov 16th, 2008
Financial crisis & hospitals - I - Nov 14th, 2008

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