Is health care “reform” falling apart, probably not? Congress is still rushing full speed ahead despite growing realization that there is no reform going on, but rather expansion of coverage and little else. Health care reform in its current form should fall apart and rather than pushing an ideology, let’s try reform.
From Massachusetts to Washington, DC, old ideas are becoming new again. Physician capitation and group practice is in the news. In the Sunday July 19 Washington Post an article notes that a new idea is the use of team of health care professionals coordinated by a primary-care physician. Massachusetts wants capitation in lieu of fee for service.
Obama wants to expand health care without increasing the deficit, ok, but what does that to do with the growth of health care costs that are more than twice-general inflation? The President repeatedly talks about the stress on the economy caused by health care costs, again, ok, but what does legislation that expands coverage and does nothing to control future costs have to do with his agenda? Finally, controlling the cost of health care to the federal government is one thing, but that is not controlling costs for the rest of the economy. In fact, often the opposite is true.
As I have said many times over the years, the HMO was the answer to our health care cost and coverage problems. America rejected that idea, for all the wrong reason but rejected it nevertheless. Now the basic concepts that are part of a well run HMO are the things missing from any so-called reform package. In the meantime as I mentioned above, the concepts now thought of as new but long a part of the HMO, like capitation or better still salaried physicians, the idea of a primary care doctor as coordinator of all care are seeping up. Has the light dawned on those anointed few, probably not?
Capitation died because there were charges of physicians avoiding care because they could not make money. The primary care doctor as coordinator or gatekeeper was seen a preventing access to needed specialist and after all, who better than the patient to know when specialty care is needed? Capitation meant that to make money a doctor had to take on new patients and to keep up that workload; it was charged that only minutes were spent with a single patient.
None of this is new, those of us who have managed employer based health plans have heard it all before, tried it all before.
Controlling health care costs will not work until and unless the American people have a different, more educated, more realistic view of what health care can deliver, what true quality care is and that there is a point where the cost benefit must be determined. We are a long way away and our politicians refuse to make that case rather they are more comfortable in promising business as usual.