Wednesday, September 30, 2009

Healthcare - Thoughts after reading the Maureen Reed "cost containment" oriented op-ed on her website, from St. Cloud Times.

Reed's main focus was on cost containment, more-bang-for-the-buck possibilities. She wrote of how incentives in reimbursement policy from private insurers or under government programs can be tuned to lessen waste and unsound practice. Her focus seemed more on Medicare (but also on how its ripple effects relate to how private firms structure provider payments).

The Reed op-ed and one other item got me thinking on what academic [i.e., non-propagandistic, non-bombastic] material might be freely accessed online.

The second thing that got my attention is this opening excerpt, from this link:

How has opinion based reporting hurt the health care debate? To answer this, we must look at the way in which people get their news. We look to the 5 o’clock news or the cable 24 hour news sources. We trust that they are doing the work of fact checking before they put out information. But this is not necessarily the case

Take, for example, in the run up to the 2008 presidential election; we were bombarded with reports on the economy and Governor Sarah Palin’s choice of wardrobe as if they were of “equal importance” (Manderscheid, 2008). In his report discussing the need to seize the opportunity after the 2008 elections to reform our healthcare system, Ronald W. Manderscheid wrote:

We hope that the Obama administration will take on national health reform, involving universal coverage, system reform, and financing reform. However, if this happens, we will need to develop "new arguments" about health. For starters, we must ask how national health reform can help us rebuild the American economy.

Unfortunately, as the debate continued to intensify, we began to see propaganda pieces fill the airwaves. Everything from how reform would bankrupt the country, to public health care leading to the death of a loved one by a death panel.

Many of the elderly were quite vocal and concerned since such claims could directly affect them. This is a very real concern that is nothing new. We have been engaged in this fight for quite some time. Looking back to when Clinton was in office from 1992 – 2000, we have sought ways to get a hold of the increased spending. The fact that “Medicare is the biggest single source of payment for health care in America” (Binstock 1993) was true then, and is still true now, is telling. This highlights the need to get health care spending under control.

[...] by Malcolm X. Moore

References
Binstock, R H (July-August 1993). Older people and health care reform. American Behavioral Scientist, 36, n6. p.823(18).

Manderscheid, R W (Dec 2008). Change is coming! We must ensure our Agenda is on lawmaker's radars.(THE MANDERSCHEID REPORT). Behavioral Healthcare, 28, 12. p.36(2).


Particularly noteworthy, the three-way delineation, "universal coverage, system reform, and financing reform," brought the Reed item into focus: [1] as saying universal coverage is a worthwhile goal but little else about it, [2] dwelling on system reform, and [3] wholly ignoring financing reform [revenue generation - tax burden distribution to fund things on an ongoing reformed bases]. Once you accept her unwillingness to hit all three topics in depth, something hard to do in limited space op-ed guest publishing, what Reed said on system reform via cost containment was sound.

The approach of footnoting a "popular item" and the three-way viewpoint got me looking to see what helpful objective academic thinking might be accessible.

For those wanting a break from yammering rhetoric on the question, I present a few links (without excerpting, and without anything resembling full understanding of what is currently online free). Some things, as with Strib online, are open-access when fresh, but may be archived after a short time as for-a-fee material.

There is the following; with a focus on a single outlet, Health Affairs - The Policy Journal of the Health Sphere:

Homepage, blog, Web Exclusives, Issues Briefing.

In line with the Reed focus, that resource's page on "Bending the Cost Curve."

Details linked from there: an introductory op-ed item here, a Mayo Clinic view "The Hard Part is the Delivery System" here, one that I had always doubted when argued in favor of universal coverage - the more deaths annually than all of 9/11 from health policy, title, "Does Lack of Insurance Cause Premature Death?" here, public option thoughts linking to an item with abstract-only free availability here and here.

Looking a bit at PubMed there are health policy articles available via abstract and donwloadable pdf full files; examples being: here (and note the "related articles" sidebar for further search), here, here, and here.

I do not pretend to have downloaded and read a lot of that stuff. Also, more time searching might be needed to uncover better stuff. (Yet I am not expert enough to make too many "better stuff" vs "weak stuff" judgments.)

In effect, I present a few things, but I do not pretend to have the expertise to judge the relative quality of one item vs. another, within the medical policy area of expertise. I merely offer something as a break from the hum-drum of watching C-SPAN and wondering how some of those Senate committee individuals ever got elected, etc.

There is a host of stuff on the web, it is an interesting library, and I have started something readers could do on their own, but by my doing it and posting I might encourage others to have a look at things they might otherwise never see.