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Health Care Reform: Two Terms to Know

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We’ve gotten away from the notion of real health care reform, I notice, and are just concentrating on insurance reform. But insurance reform doesn’t control costs, and doesn’t make Americans healthier. It just tinkers at the margins of a problem that also includes how doctors are reimbursed, what society should pay for, and what constitutes rationing.

Here are two terms that should be in the discussion, and don’t seem to be. People who really understand how the system works, like perhaps the Mayo Clinic, Kaiser Permanente, have said repeatedly that reimbursement and incentives should be changed so that our health care system is less of a sick care system. Learn these terms, in case someone gets smart and the discussion changes focus:

Outcomes-based medicine: paying the provider (doctors or hospital) for things that actually work, rather than for treatments the patient comes in requesting, treatments that are worth a lot of money when the provider bills the insurance company, or treatments that take place in settings owned by the provider (the MRI machine owned by the syndicate of doctors).

For a number of reasons, mostly financial, that come from the current pay structure of Medicare and insurance companies, providers have to “game the system” to survive. So there’s a tendency to do what Medicare will pay for (or United Health, or Cigna) rather than what has been demonstrated to work.

For example, exercise, low salt diets, biofeedback and meditation have been shown to control blood pressure, but no doctor is paid for prescribing them. Nor are doctors paid for talking to or educating patients. We could save tons of money for paying doctors to get all the blood pressure patients in their practices under control (no matter what it took) rather than paying them for office visits to monitor the pressure, drugs to control it, or tests to determine it. This would mean the labs, drug companies and doctors would have to work together to get the patient’s blood pressure under control –or nobody would be paid.

Certain conditions and diseases, mostly chronic, plague the population and soak up 2/3 of our health care costs.

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EmpowHER Guest

Your article is pretty pointed and makes some generalized statements but does not cite any of the resources you have used. There are many studies which demonstrate that cardiac interventions have improved outcomes and saved lives compared to drug only therapy for patients with unstable angina or acute myocardial infarction. Even if there are studies out there showing drug therapy is close to as effective in some circumstances, there is simply far more evidence to state otherwise. I don't think any cardiologist would suggest simply giving medication to a patient undergoing an acute MI when a cardiac stent might actually prevent the infarct from progressing.

Physician payment makes up 8-10% of all health care costs. Even if you cut provider payment by 50%, you'll only decrease costs by 4-5%, hardly enough to blunt the rapid growth of health care expenditure. And you'll create access problems for people who need it most. I don't think cutting provider payments is the answer to our problems.

August 23, 2009 - 10:08am
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