Monthly Archive for June, 2010

Read My Lips – You Can Keep Your Insurance!

June 27, 2010
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“If you are among the hundreds of millions of Americans who already have health insurance through your job, … nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.”

How much longer?

How much longer?

President Barack Obama used these words on September 9, 2009 before a joint session of Congress.

On other occasions the President has stated more bluntly, “If you have insurance you like then you will be able to keep that insurance.  If you have a doctor that you like, you will be able to keep your doctor.”

Read my lips

I predict that within five years these words will be tacked up along side, “Read my lips!  No new taxes!”  as examples of presidential overstatements. Continue reading ‘Read My Lips – You Can Keep Your Insurance!’

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Why Should Employers Offer Health Insurance?

June 21, 2010
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Mr. Gay Burke, writing for the Denver Post asks the question, “Why should employers pay for health care?”

To Mr. Burke:

An upside down world

An upside down world

Right question.

Wrong answer.

Employers tend to be a smart group.  Otherwise they would not be running successful businesses.  But on health care, they have been stupid, blind and stubborn.

I can say that, in part, because I have spent nearly thirty years in the employee benefits profession.

The stubborn follows from the blind and stupid.

So let’s look at stupid first

Mr. Burke is onto something when he questions the role of employers in providing health insurance to employees.  This is an admittedly illogical system.  For starters, the doctor patient relationship is one that relies on continuity.  Fostering that continuity is one of the major ingredients in proposals for health care delivery reform. Continue reading ‘Why Should Employers Offer Health Insurance?’

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Employer health insurance, Health Care Reform, Single payer, Taft-Hartley and health care benefits-- Tags: , , , , .

Accountable Care Organizations and Performance

June 12, 2010
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A reader responded to my recent post about accountable care organizations with the question, “How do you measure quality in an accountable care organization?”

Good question!

In other words, if a health care organization is accountable, what do you measure and how do we know that this organization is actually responsible for what is measured?

Vitality as performance

Vitality as performance

These are the two top challenges with the accountable care organization initiative.  How does one define and measure the desired outcomes, and how does one define the group of practitioners that are responsible for those outcomes.

In my post I wrote  the following:

The study first grouped physicians and patients around their primary hospitals.  What it revealed is that when the hospital performed well, the physicians and physician practices affiliated with that hospital or hospitals also performed well.

Mortality – the ultimate performance measure

The reader appears to be asking:  How do you know that a hospital is performing well and how do we know that the physicians are performing well? Continue reading ‘Accountable Care Organizations and Performance’

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Socialized Medicine – an Evolutionary Approach

June 5, 2010
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Accountable care organizations.  Patient centered medical homes.  Episodes of care.

What do they have in common?

They each attempt to use payment incentives to encourage disparate practitioners to collaborate to achieve quality outcomes.

A common purpose

A common purpose

Socialized medicine is progress

The key word is collaborate.  Countless research indicates that when doctors work in teams, they achieve better results at lower costs.  It is this transition from doctor as solo practitioner to doctor as a member of a team that is the key challenge to reforming our health care delivery system.

This transition from solo craftsman to a member of a team is not new to the evolution of our economy.

It is how Karl Marx differentiated capitalism from the mercantilist economy that preceded it.  He called it the socialization of work.  It was this contradiction between the socialization of work and the private ownership of the means of production – capital –that was supposed to be resolved by the socialist revolution.

Karl Marx recognized that this socialization of work brought tremendous increases in productivity to the world economy. Continue reading ‘Socialized Medicine – an Evolutionary Approach’

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