consultants are sandburs

Friday, January 03, 2014

If the right people decline to do the right thing, then perhaps the wrong people will do it. But would that then turn them into being the right people?

Single Payer. A reader emailed me this link.

Somebody, at some point will have to show good sense. It will happen. The question will then be who will get credit for doing things right. (Credit for politicians being winning elections and holding office.)

Breaking the log jam in the med schools might make sense. Currently, the market is manipulated so that supply of trained competent physicians is being artificially curtailed, relative to demand, and cronyism abounds. Republicans profess to want well functioning unbiased markets, as a Nirvana for everything. This item makes the argument that single payer fits that professed ideal.

One sentence in the item suggests a need for better proofreading:

A recent report by the Institute of Medicine, estimates that $750 of our nearly $2.5 trillion dollars spent on health care do not improve health.

Following that link is unhelpful, the specific reference being unclear when accessing the linked site. And this "Institute of Medicine," exactly who are they and what meat do they have in the fire?

Aside from that, was "$750" written with "75%" or some such claim being the intent? Clearly a seven-hundred-and-fifty buck waste in trillions would not merit discussion. That kind of inattention to fact, while puffing, hurts the item's veracity; although as a policy position suggestion, one detail in error in a general exegesis is not fatal error.

It just looks sloppy.

UPDATE: Perhaps this paragraph from here shows the word "billion" might have been omitted in haste by the author:

The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. The committee calculated that about 30 percent of health spending in 2009 -- roughly $750 billion -- was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state.

The same numbers are posted online in a parallel item, here, under the heading, "Building an Adaptive System." Sloppy linking - a failure to link specifically vs linking to a haystack while saying a needle's there - is something I try to avoid.

FURTHER UPDATE: As to the policy arguments the author asserts, readers are adult enough to form their own opinions without any advocacy or extended commentary on the item's arguments posted here. Decide for yourselves. That said, it is refreshing to see regulatory policy alternatives being suggested in unlikely places. Accept good where you find it. The item is worth thinking over. Certainly it merits more than cursory attention or knee-jerk dismissal.

FURTHER UPDATE: Do note that the item is vague about price-setting mechanisms inherent to single payer. Individuals seeking individual care somehow being influenced by a fully socialized cost of care solution - not wanting the best Cadillac care with everyone else paying for it - seems a strong presumption, one that suggests cost management imposition by the party writing the checks somehow would be finessed, so, is that a credible thing to do in authoring such a thing? Also, the item seems to neglect the med-school bottleneck, where supply-demand balancing clearly is artificially constrained. As always, multiple devils inhabit detail.

LAST UPDATE: This from the 10-point rationale suggested in the item:

Reason #3: Demonstrate a commitment for a free market system
The republicans’ commitment to a single payer healthcare system will reinforce their belief in the importance of free markets. The current dysfunctional healthcare system is complex and influenced by many interest groups that have corrupted the playing field to achieve an advantage in the healthcare market place. Obamacare has largely maintained the role of the oversized importance of special interests in the healthcare sector. Healthcare stakeholders such as AARP, The US Chamber of Commerce, unions, insurance companies, Pharma and healthcare providers, are about maintaining the crony capitalism that governs the inefficient healthcare sector. A single payer system, operating with transparency and accountability of all stakeholders, will create a truly free market where citizens and consumers can make meaningful choices about healthcare value. Many options such as vouchers to select among qualified insurance companies, a plan similar to the Federal Employee Benefits can maintain choice and control by the healthcare user and promote competition.

How exactly would there be "a free market system" per the voucher idea suggested [those Republicans how they love their voucher-think] and how would that operate, when somebody [Uncle Sam] will be setting voucher amounts? And then there is "Obamacare has largely maintained the role of the oversized importance of special interests in the healthcare sector. Healthcare stakeholders such as AARP, The US Chamber of Commerce, unions, insurance companies, Pharma and healthcare providers, are about maintaining the crony capitalism that governs the inefficient healthcare sector." This highlights the difficulty confronting the Republicans when Obama has handed them their own plan, and now they want to carp all day and all night over it. Remember, it IS pure vanilla Romneycare, what Republicans all along were advocating until it was implemented, with them now suffering a specific amnesia while casting about for what they should suggest as something different from their own plan, implemented by Obama. Surely it is an awful sop to the insurance conglomerates, as it always appeared when the Republicans were advocating it, but how can they cast blame without a cogent alternative? So, they move to single payer? Bless them if they do. It would advance the process. Finally, these mentioned vested interests, they are just going to shut up and go away, were single payer to become implemented? Get real. They will be as intent on jiggering the process in their favor as they were in putting Romney/Obamacare into place and dragging their heels if anything more effective were even suggested. This author seems a bit in Wonderland beyond where I would call him/her credible.

Now, after saying I would forego a critique, and then in UPDATES going there, I do apologize. Some things simply begged saying, however. Ask Max Baucus whether his cronies would roll over if the GOP were to say "single payer." Get real. Max "All you need is a good PR job on the folks" Baucus, after he wrote the frigging thing. He and his lobbyist cronies in the health-industrial complex. They wrote the thing. What a fellow. A Republican in Dem clothing. As disingenuous as Mitch McConnell.

For interested readers: The presidential exegesis is online here. Do a word search "train wreck" to hit that part of the press confrence transcript, wherein Obama says in part:

The challenge is that setting up a market-based system, basically an online marketplace where you can go on and sign up and figure out what kind of insurance you can afford and figuring out how to get the subsidies -- that’s still a big, complicated piece of business. And when you’re doing it nationwide, relatively fast, and you’ve got half of Congress who is determined to try to block implementation and not adequately funding implementation, and then you’ve got a number of members of -- or governors -- Republican governors -- who know that it’s bad politics for them to try to implement this effectively, and some even who have decided to implement it and then their Republican-controlled state legislatures say, don’t implement, and won’t pass enabling legislation -- when you have that kind of situation, that makes it harder.

But having said all that, we’ve got a great team in place. We are pushing very hard to make sure that we’re hitting all the deadlines and the benchmarks.

I’ll give you an example, a recent example. We put together, initially, an application form for signing up for participation in the exchanges that was initially about 21 pages long, and immediately everybody sat around the table and said, well, this is too long. Especially in this age of the Internet, people aren’t going to have the patience to sit there for hours on end. Let’s streamline this thing. So we cut what was a 21-page form now down to a form that’s about three pages for an individual, a little more than that for a family -- well below the industry average. So those kinds of refinements we’re going to continue to be working on.

The boogeyman's in our way. We shortened a form. Enough?

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