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DJP Update 4-21-2010 When current government schemes fail to control medical costs, blame it on the doctors! As predicted in previous DJP Updates.

DJP Update 4-21-2010 When current government schemes fail to control medical costs, blame it on the doctors! As predicted in previous DJP Updates.

Here is an editorial in the New York Times that is favorable to the Massachusetts plan but the editorial verifies that costs are not contained and gives a comparison to the latest scheme in Washington, DC. The editorial suggests price-fixing as a solution to escalating costs. Always the end result of government control of medicine. First the government interferes with the marketplace and then blames failure on the doctors. Here is a hint that folks in our government should consider.

Government can take all payments away from the doctors or the doctors can work for free and the system will still fail to contain costs! Gravity doesn’t cease to exist because it is ignored. Put the patient in control with the doctor as trusted advisor. Publish fees, allow health insurance purchases across state lines, write policies in plain English, encourage Health Savings Accounts, and more. (More aslo includes real tort reform!) That will work.

True competition is what made America great, not government micro-management. And stop using funny math and flawed statistics. I am tired of hearing that Cuba has better medical care than America. Not true! Stop quoting the flawed and rejected WHO statistics of a study that no longer is repeated. We are on a path of fiscal bankruptcy. One day the bills become due. Borrowing money and printing money is a temporary measure that leads to disaster.

Only folks using YOUR tax money would continue and enlarge a failed Medicaid system. Give those individuals on Medicaid vouchers to purchase insurance in the marketplace. Don’t give them the illusion of coverage.

Hello! What about “Pay for Performance” for legislators and folks in Congress. Every time they make a promise about transparency, fair play, saving money, etc. and they fail to meet the performance measure set by a panel of citizens who work for a living and pay taxes, their pay is cut. These citizens know what it means to meet payroll and pay rent and all the myriad of expenses that one must cover with the sale of a product and have some left over for new equipment and innovation. That would make them reasonable experts to sit on the panel. Use experienced folks. Those in Congress who miss a certain number of benchmarks will active mandatory resignation. Give a quiz on what is in a bill. If those in Congress do not get a passing grade, the vote doesn’t count. Think about it. In Medicine we test procedures and drugs before we use them on patients. We don’t experiment. That is what Congress is doing and that is why the public’s rating of Congress is dismal! Leadership has at its core: integrity. Never forget that.

One last point that I repeat over and over. When the doctors decide the government scheme doesn’t pay enough to meet expenses, the doctor will exit the plan or go into foreclosure. But the government will then mandate participation as a condition of maintaining one’s medical license. When that happens, we no longer will have Liberty!

Looks like some legislators already thought of this approach:

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[Senate bill 2170 and house bill 4452] would require physicians and all other health care providers to accept 110% of Medicare rates for health insurance for small businesses. For physicians, acceptance of set rates would be as a condition of licensure! Moreover, physicians would have to accept all such patients – and such rates – if they participate in any other plan offered by that insurer.

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Check out Massachusetts House Bill 4452 at: http://www.mass.gov/legis/bills/house/186/ht04pdf/ht04452.pdf

filed on 1-28-2010. Regardless of what happens now with this bill, it shows the thinking!

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Read the entire NYTimes article so you can form your own opinion as to what the NYTimes is advising. Then call your friends in Massachusetts and ask them what they think about the plan and if they are happy. Make a note and call them again in six months. Let’s gather information in the manner of Dr. John Snow whose work gave birth to Epidemiology.

By the way, I disagree with the first paragraph quoted below where it is stated that the “new national reform law includes many provisions designed, over time, to reduce costs, …”

No way!

Get involved in the American experience. Study candidates. Ask tough questions. But do your homework first so you can quickly identify misinformation being spun to you. Then go and vote! The genius of America is our freedom and the ability to peacefully throw out of office those who fail our trust.

http://www.nytimes.com/2010/04/21/opinion/21wed1.html

EDITORIAL

Health Care Reform and Massachusetts

New York Times

Published: April 20, 2010

SOME EXCERPTS:

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It also needs to figure out how to rein in the escalating costs of medical care and health insurance. The new national reform law includes many provisions designed, over time, to reduce costs, but Massachusetts will have to move sooner.

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State leaders have commissioned studies and held hearings to come up with more fundamental solutions. Legislative leaders seem determined to end within five years the prevailing fee-for-service system, in which doctors and hospitals are paid for the volume of care they provide whether or not it is high quality or needed.

One possible substitute might be a system in which groups of doctors and hospitals are paid a fixed sum to provide whatever care a patient needs over the course of a year. There are also proposals in the Legislature to let the government regulate provider payments as a temporary solution, and some experts think regulation may be the most effective way to tame costs in the long run.

Massachusetts’s experience offers some useful lessons for the national reform effort….

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Stay well.

Donald

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Donald J. Palmisano, MD, JD
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