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Healthcare Efficiency
Explore the delicate balance of efficiency and quality care.
Are We There Yet?
Posted by:
Robert Burney on
October 14, 2009 at
9:53PM CST
Are we there yet? The answer depends on who you ask and how you define “there.” A bill did pass the Senate yesterday. And it does some of the things some people wanted done. Before that becomes reality, however, it must be reconciled with the House version, and that’s where the interest groups are focusing. Even before the Senate vote, the insurance industry indicated their dislike for the current version by releasing a report that said insurance costs would go up if the bill passed. That, of course, is a no-brainer and unrelated to any specific bill. Costs are going to go up, regardless of what the law looks like. For one thing, there is strong indication that the feds will tax insurance premiums by taking them out of after tax income. That means you will pay tax on the money before you pay your insurance premiums. Some may even be forced into a higher tax bracket by this added income, which they never see. Oh well. For another, there is agreement among thinking folks that Medicare Advantage is a rip-off. So the feds will stop subsidizing care for that part of the insurance industry. If you’re currently in a Medicare Advantage program, expect to pay more. True enough, there is nothing in the bill to address the costs of healthcare. The Congressional Budget Office would not offer an opinion as to the financial implications of the bill, saying it is to complex to evaluate at present. Much was made of the lone Republican vote for the bill from Sen Olivia Snowe (R-ME). However, the vote was 14 to 9, so they didn’t need her. And Republicans were vehement in their condemnation of the bill. So no hint of a bipartisan effort here. the President’s assessment: “. . . not perfect.” And later, “We’re not there yet.” Maybe it’s a good sign that this is a bill that no one likes. There is, in fact, a competing bill that emerged from the Senate health committee, and the task for the Democrats now is to merge the two while maintaining enough support to pass the result. There is a mandate that everyone must have health insurance. If not provided by your employer, you must purchase it. That’s where the insurance exchanges come in. Maybe. There is, however, no mandate that employers must provide coverage--something for unions to hate. The effort to cover everyone is behind a big expansion of Medicaid--something for states to hate. And what about tort reform? Not much for anyone to like, except for the things that weren’t there. Some thoughts of creating panels to review cases before they go to trial, but the plaintiff doesn’t have to accept the panel decision and can come back and sue anyway. And, most important, nothing to fix the problem. In our review of uh-oh’s, we consider three questions:
In the end, however, it’s mostly symbolic. Malpractice--including “defensive medicine”--plays a miniscule role in healthcare finance. Still, it would be nice to do the right thing. “Are we there yet” isn’t really the right question. We should be asking “Will we ever get there?” And maybe, “Where is there, anyway?”
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