Mayo Clinic Health Policy Center Recommendations

Mayo Clinic Health Policy Center Recommendations

IV. Provide Health Insurance for All

Provide guaranteed, portable health insurance for all individuals, giving them choice, control and peace of mind.

Requires action from: Insurers, employers, the government and individuals

• Require adults to purchase private health insurance for themselves and their families. Employers could continue to participate by buying insurance for their employees or giving them stipends to purchase it. However, the individual could own the insurance.
• Appoint an independent health board (similar to the Federal Reserve) to provide a simple coordinating mechanism for individuals to select a basic
  private insurance option. Allow people to purchase more services or insurance,
  if they choose.
• Provide sliding-scale government subsidies to help people with lower incomes
  buy insurance.
• Realign the health system toward improving health in addition to treating
  disease.

This is, more or less, a Bismarckian or "sickness fund" type system. I would argue against leaving the employers in the loop, as salaries/wages can easily be designed to provide appropriate compensation without including it as a benefit. Just makes it easier to administrate.

I'd further argue that a more strenuous effort needs to be made to make the benefits provide and the cost to consumers of a "standard" policy uniform accross the nation. The way other countries have done this is to stricly regulate the costs and benefits of the basic plan very rigidly, and then allow insurers to compete in the non-basic elements of a plan, such as optical, dental, wellness, etc.

I think this approach will win support from essentially all Democrats and more than a few Republicans. It seems to already be in the works.

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Those filthy commies at the Mayo Clinic...

An Egalitarian Culture [at the Mayo Clinic]

You may have heard that at Mayo, doctors collaborate. But did you know that after their first five years all physicians within a single department are paid the same salary? During those first years, physicians receive "step raises" each year. After that, they top out ,and "he or she is paid just the same as someone who is internationally known and has been there for thirty years," says Patterson. ("Most could earn substantially more in private fee-for-service practice." he adds.)

“It doesn’t matter how much revenue you bring in,” Patterson explains, “or how many procedures you do. We’re all salaried staff—paid equally. This is very good for collegiality, and people working together,” he adds. “The culture here at Mayo doesn’t encourage egos. There is not the same cult of personality that you find at other places.”

At Columbia, by contrast, the pecking order is quite clear: even the furniture on the floor where a physician works tells him where he stands. “The floor we were on was perfectly fine,” Patterson recalls. “But if you walked up a few flights to ENT (ear nose and throat) surgery, it was a different world—dark wood paneling, different furniture… These surgeons bring in a much higher return for their time,” he points out, “and they do some things that require remarkable skill and training. At the same time, if a psychiatrist spends two hours with a patient, he may get $200, while all a dermatologist needs to do is get out the liquid nitrogen…”

The dermatologist can make $200 in a matter of minutes, just by zapping the harmless crusty brown patches on the back of a middle-aged patient commonly known as “barnacles of age.”

That celebrity turns on how much money a doctor brings in hardly unique to Columbia. “Traditional medical centers are much more hierarchical,” Patterson notes.

The article goes on to say how the filthy socialists have significantly lower spending and excellent care, they value the patient over the revenue generated per procedure, thinking and taking care of patients is valued more than one's "revenue stream."

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NEJM -- Primum Non Nocere -- The McCain Plan for Health Insecurity

NEJM -- Primum Non Nocere -- The McCain Plan for Health Insecurity:

"By this standard, John McCain emerges not as a maverick or centrist but as a radical social conservative firmly in the grip of the ideology that animates the domestic policies of President George W. Bush. The central purpose of President Bush's health policy, and John McCain's, is to reduce the role of insurance and make Americans pay a larger part of their health care bills out of pocket. Their embrace of market forces, fierce antagonism toward government, and determination to force individuals to have more 'skin in the game' are overriding — all other goals are subsidiary. Indeed, the Republican commitment to market-oriented reforms is so strong that, to attain their vision, Bush and McCain seem willing to take huge risks with the efficiency, equity, and stability of our health care system. Specifically, the McCain plan would profoundly threaten the current system of employer-sponsored insurance on which more than three fifths of Americans depend, increase reliance on unregulated individual insurance markets (which are notoriously inefficient), and leave the number of uninsured Americans virtually unchanged. A side effect of the McCain plan would be to threaten access to adequate insurance for millions of America's sickest citizens."

As I've said elsewhere, I believe McCain's plan would blow up the current system fairly quickly and lead us to our much needed national debate on how we really want to do this, but the cost in every other way is too high to risk.

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BBC NEWS | Health | GP salary surge goes into reverse

BBC NEWS | Health | GP salary surge goes into reverse:

"Inflation-busting pay rises for many GPs in recent years have been halted - with the average salary falling in 2006/07, NHS figures show.

The average salary for 85% of GPs was £104,000, a fall of 2.4%.

This comes after sharp rises following a new GP contract in 2004 - as much as 58% on average , according to a spending watchdog.

The British Medical Association said most earned under £100,000, and further falls could risk damaging morale."

The exchange rate is about two to one, so, GPs are making the equivalent or $200K. Not too shabby. The downside is that their salaries seem to be so much more dependent on the prevailing political and economic winds than are ours. But, as we saw with the recent battle to prevent across the board Medicare cuts, we face this pressure as well.

Out of curiosity, I checked to see where this income fits in British households. The top quintile for household income in the UK starts at £72.9K

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Daily Kos: My Old Friend Karl

Daily Kos: My Old Friend Karl:

Karl is a previously very conservative republican physician in central PA...

"I got a sort of Norman Rockwell picture from it all, and the whole-cloth of that, I assumed, also included a strong commitment to the Republican Party.

I couldn’t have been more wrong. 'No,' Karl said. 'When you’re a G.P. like I am, and you see how people are struggling to pay their insurance, to buy their prescription drugs, to wrench hospice care out of their tight-fisted HMOs, you can’t support the Republicans.' My head exploded. I’d dreaded a political argument, but Karl had come over from the ‘Dark Side’! 'You know', he said, 'all of the G.P.s I know are voting Obama. We all feel that this country desperately needs Obama, that it can’t possibly afford another four years of these policies for the rich. The middle class will cease to exist with four more years of this. But it’s funny: all of the specialists I know, especially the plastic surgeons, the sports surgeons, the boutique doctors, they’re all supporting McCain. They’re making money hand over fist, and all they care about is tax breaks and lower malpractice premiums.'"

Amen. This is precisely how I see things shaking out. We may be in for a "class war" in medicine at some point in the near future, fighting for the soul of medicine and what it means to be physicians.

Cheers,

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Thomson Reuters Survey Finds Cancer Patients Forgoing Treatment

Thomson Reuters Survey Finds Cancer Patients Forgoing Treatment: "cancer treatment decisions of individuals.

Entitled “The Cost of Cancer,” the report aggregates survey responses from 1,767 adults currently being treated for cancer. It finds a clear link between patients’ annual income and their decisions to curb cancer treatments due to cost — even among patients with late-stage cancers.

The report notes that among the 569 survey respondents with late-stage cancer, 12.3 percent said they have passed up recommended treatment because it was too expensive. This figure varies dramatically by patient income level. Twenty-five percent of late-stage cancer patients who earn less than $40,000 a year said they have chosen not to undergo a recommended treatment due to cost — compared with 11.2 percent of those earning between $40,000 and $80,000 per year and 4.8 percent of those earning more than $80,000 annually.

Similarly, 65 percent of all respondents with late-stage cancer said the out-of-pocket cost of treating their cancer has caused them distress. Among all cancer patients earning under $40,000 per year, that number jumps to 77 percent.

“The physical and emotional burden of illness is not the only challenge cancer patients face,” said Bill Marder, PhD, senior vice president and general manager for the Healthcare business of Thomson Reuters. “Many also struggle to cope with medical costs. This survey shows that the cost of cancer treatment is affecting patients’ ability to get the care they need.”"

I think this research speaks volumes about the American healthcare system. This is why I have it categorized under so many topics (see links below and to right). It speaks to the de facto rationing by income in the US, it speaks to how consumers "drive" healthcare (i.e., decision making is not rational), how our waiting times are trimmed by not including those who don't seek care due to financial concerns, and how those who love to try to compare anecdote horror stories just don't geet how bad our system is for so many people.

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Drug Industry, Having Long Smiled on G.O.P., Now Splits Donations Equally - NYTimes.com

Drug Industry, Having Long Smiled on G.O.P., Now Splits Donations Equally - NYTimes.com:

"WASHINGTON — After favoring Republicans by a ratio of more than two to one for most of the last decade, pharmaceutical companies and others in the health care industry are now splitting their contributions evenly between the two major parties, campaign finance reports show.

Lobbyists and executives in the industry say the swing reflects the fact that Democrats control both houses of Congress, are expected to increase their majorities and may win the White House, giving them a dominant voice on health policy."

There's a surprise!

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FRONTLINE: sick around the world: five countries: health care systems -- the four basic models | PBS

FRONTLINE: sick around the world: five countries: health care systems -- the four basic models PBS:

"These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany.

For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital.

The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it's fairer and cheaper, too."

From the truly terrific PBS/Frontline site for "Sick Around the World"

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AMNews: Oct. 13, 2008. Baucus previews uninsured debate for next Congress ... American Medical News

AMNews: Oct. 13, 2008. Baucus previews uninsured debate for next Congress ... American Medical News:

"Washington -- Sen. Max Baucus (D, Mont.) will try to advance a major health system reform bill with bipartisan support next year. But the chair of the powerful Senate Finance Committee might consider using a budgetary tactic to force adoption of the measure with a simple majority vote if broad support does not materialize.

Baucus, speaking Sept. 23 at a U.S. News & World Report forum on the uninsured, said he plans to outline his measure later this year. The Senate Finance Committee -- a key stop for most health care legislation -- has held a series of hearings on health system reform in recent weeks to lay the groundwork for a major bill."

The article goes on to suggest caution will be in the air to avoid upsetting the status quo too much.

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Marty Kaplan: Gotcha? You Betcha!

Marty Kaplan: Gotcha? You Betcha!:

Excellent response to the McCain campaign's complaints about "gotcha" journalism, and focuses on the lack of same for many years in relation to our current economic crisis. I post this because I did hear the second Fresh Air interview with Greenberger and it was excellent and he was very comprehensible.

"There's no better way for a lay person to understand the current crisis than by listening to two episodes of This American Life - "The Giant Pool of Money," which aired last May, and "Another Frightening Show About the Economy," which aired last weekend. And while you're at it, check out the "Now You SEC Me, Now You Don't" segment of This American Life from last month, and the two interviews with former CFTC director Michael Greenberger that Fresh Air host Terry Gross did in April and September. ."

And in the spirit of "gotcha", check out this interview by Terry Gross of the author of "Gotcha Capitalism".

Cheers,

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Mental Health Bill sneaks through!

From the AMA Memeber Communications email:

Mental health parity bill becomes law.

The New York Times (10/6, A13, Pear) reports, "More than one-third of all Americans will soon receive better insurance coverage for mental-health treatments because of a new law that, for the first time, requires equal coverage of mental and physical illnesses." This "requirement, included in the economic bailout bill that President Bush signed on Friday, is the result of 12 years of passionate advocacy by friends and relatives of people with mental illness and addiction disorders. They described the new law as a milestone in the quest for civil rights, an effort to end insurance discrimination, and to reduce the stigma of mental illness." At present, "most employers and group health plans provide less coverage for mental healthcare than for the treatment of physical conditions like cancer, heart disease, or broken bones. They will need to adjust their benefits to comply with the new law, which requires equivalence, or parity, in the coverage."

According to USA Today (10/4, Elias), the legislation "will provide parity in insurance benefits for 113 million Americans. Employers with 50 workers or less are exempted." In addition, the measure "would bar insurance plans from setting higher copays or deductibles for mental health or substance abuse treatment than for medical care. Lower benefit limits also would be illegal, along with caps on the number of outpatient therapy sessions or inpatient treatment days." Notably, "employees also would have to be covered for out-of-network mental healthcare if their plan includes out-of-network medical coverage."

The bill is named for Sen. Pete Domenici (R-N.M.), who began work on the bill over a decade ago "after his daughter Clare...was diagnosed with schizophrenia," the Wall Street Journal (10/4, Lueck) added. The Journal noted that the bill "stalled for years largely because of opposition from Republicans who controlled the House."

The AP (10/4, Freking) pointed out that "employers and insurers were concerned that legislation would have required plans to cover a 'telephone book' of conditions, raising costs beyond what companies and their workers could afford, and potentially negating companies' ability to offer any health coverage at all." But, this bill "does not mandate that group health plans cover mental health or addiction treatment, only that when plans do so, the coverage must be equitable to other medical coverage. The insurance industry is now a strong supporter of the parity legislation."

Previously, "the House and Senate...disagreed about how to cover the cost to the federal government of the expanded benefit, estimated at $3.4 billion over five years by the Congressional Budget Office in 2007," Bloomberg News (10/4, Marcus) reported. This "estimate is related to tax revenue that would be lost because employers would pay more for health insurance premiums, to cover the expanded benefits, instead of turning over some of this money as taxable wages to employees."

Mental-health advocates praised the legislation, saying that the new law will help the estimated "67 percent of adults and 80 percent of children requiring mental-health services [who] do not receive help, in large part because of discriminatory insurance practices," the Boston Globe (10/4, Bender) noted.

The Houston Chronicle (10/4, Ackerman), the Chicago Tribune's (10/3, Graham) Triage blog, and Modern Healthcare (10/4, DoBias) also covered the story.

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