I'm not dazzled by the candidates described in this column by Pius Kamau, a Colorado thoracic and general surgeon, but its central point, that politically things are really confusing is well put:
If any proof was needed of the uncertainty and confusion of the election season, all one needs to know is that the Colorado Medical Society's political action committee decided to support both Ken Salazar and Pete Coors in the Senate race...
Every physician asks, "Will my premiums decline because of who I vote for?"
Doctors may detest trial lawyers, but the whole of America is to blame for this litigious madness. Lawyers are merely a conduit of our desires...
The overriding problem of American medicine today is the weighty burden of the uninsured. After four years, President Bush has something akin to a plan - medical savings accounts, MSAs - with high deductibles for catastrophic illness. His plan would shave off 7 million from the 45 million uninsured Americans...
It's not enough to curse lawyers whose brethren make the nation's laws. Businessmen, bankers and manufacturers hold political office. Physicians and nurses must also run for local and national office. Of 435 members of Congress, 211 - 40 percent - are lawyers, while just seven - 1 percent - are physicians. With such numbers, it's obvious that laws will continue to be passed by both Democrats and Republicans favoring the legal profession.Whoever wins, may the fate of the uninsured not be neglected as it has been for so long.
Recognizing reality is the first step toward finding a solution. And sometimes that requires admitting that we're really confused. Good column.
Regarding Oakland: The A's use statistical analyses to determine how to get the best value for the money they have (not much). We should use the same or similar methods for looking at all health care, but particularly at Medicaid. Does Oakland's failure to make the playoffs this year undercut the point? No. The A's know there are no certainties in any enterprise, just probabilities. And their goal has been expressed by their General Manager, Billy Beane as winning 95 games during the season 95 percent of the time. The goal is 95 games because that pretty much assures you entry to the playoffs and would have this year. (Anaheim, the division leader, won 92.) This year, Oakland won 91.
Regarding the Sox: Boston has adopted the same analytical methods as Oakland. In fact, Boston tried to hire Billy Beane away from Oakland. When Beane demurred, they hired Theo Epstein as GM and Bill James as a special advisor. They applied the same methods.
Red Sox owners John Henry and Tom Werner have hired some of the best analytical minds in the business and have spared little effort in acquiring sophisticated scouting software, computerized video analysis and business intelligence tools for mining the stacks of statistics at their disposal. The goal: Identify the best talent available, get it before their rivals do, and then figure out just how long to keep it before it stops producing. It's human capital management on steroids.
For John Henry, Boston's primary owner earned his money as a commodities trader in the world of sophisticated finance, where the use of statistics and statistical modeling is rampant, the use of similar methods in baseball must not only have been natural, but compelling.
Boston now combines the methods of the A's and the pocketbook of the Yankees. It's a formidable combination.
So science and analysis trumps superstition (curse of the Bambino) and intuition (traditional baseball management methods). But that's the regular season. Let's not forget what Billy Beane says about the playoffs and the series. Limited to seven games at the most, playoffs have a too small sample size to be useful statitistically, i.e., it's a crapshoot.
We're a long, long way to the Medicaid playoffs. Spending as much as we do and having as much data as we do in New York, we should be able to do much better during the regular Medicaid season. We can do better while spending more productively.
I was impressed with the speed with which my plan had acted and I speculated about whether I would receive any information from my pharmacy or my physician (who had been notified by the health plan).
Well, I got the letter from the pharmacy (CVS) sometime 10/16 or afterwards (I was away and can't be sure exactly when it arrived, but the 16th was the earliest). So we'll credit CVS for acting, but not with the same speed as CDPHP. Merck contributed to the mailing costs incurred by CVS.
Still nothing from my doc, but then he's using paper records.
Senator Frist has proposed a similar idea, but with a quasi-public governance structure:
That plan envisions a federally chartered but privately run reinsurance organization, analogous to the Freddie Mac and Fannie Mae mortgage companies that were established to assume the risk of lending so that bankers can give homeowners more affordable mortgages.
Dr. Frist has referred to it as a "national publicly chartered, privately run 'Healthy Mae.' "
The Times article also mentioned the similarity to New York's Healthy New York program. New York's program is more of a straight subsidy regardless of plan expenditure levels (or, in insurance terms, experience) rather than reinsurance. So mechanically, I think that's a stretch, but the purpose is similar, getting employers, especially smaller ones to get and maintain private coverage.
I'm in the Southwest right now and, along with all the obvious differences in geography, food, and climate, I've noticed a difference in advertising for the Presidential campaign. Unlike New York, they have some. A lot! Since this region is seeing tight races in the Presidential campaign, both sides are pushing hard.
All of the Bush ads I've heard have been about Kerry's health care proposals which we discussed here, here, and here. The ads claim that Kerry's plans would replace personal physicians with government bureaucrats and would cost trillions. The Bush ads are amazingly brazen BS.
My Mother would be appalled that I just wrote that for public consumption. I'm appalled at the Bush campaign.
According to CBO’s analysis, there is insufficient evidence to conclude that disease management
programs can generally reduce overall health spending. It is important to note that such programs
could be worthwhile even if they did not reduce costs, but CBO’s analysis focused on the
question of whether those programs could pay for themselves. The proposition that decreased use
of acute care services might offset the costs of the screening, monitoring, and educational
services in disease management programs is clearly appealing, but, unfortunately, much of the
literature on those programs does not directly address health care costs. Instead, the focus is often
on the processes of care or on intermediate measures of health, from which an overall impact on
spending cannot reasonably be inferred. The few studies that report cost savings do so for
controlled settings and generally fail to account for all health care costs, including the cost of the
intervention itself. Furthermore, if disease management programs were applied to broader
populations, the reported savings might not be attainable, and the programs could even raise
costs. So while a few studies indicate that disease management programs could be designed to
reduce overall health costs for select groups of patients (at least in the short term), little research
directly addresses the issues that would arise in applying disease management to the older and
sicker Medicare population.
They go on to say that the jury is still out and they will
...continue to monitor this research as new information becomes available—in particular, the results of disease management demonstration projects now being developed by the Centers for Medicare and Medicaid Services.