Health Policy - New York State

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April 14, 2005

Comments

fembup

I think Dr. Greenberg falls into a common trap - he confuses health care and health insurance. I think he's basically right about the nature of competition among health care plans. But he does not make clear why the health care PROVIDERS should not be the ones competing to keep down the cost of health care.

Health plans provide insurance. Their principal cost of goods sold is health care costs. If health care cost were not increasing, health insurance premiums would not be increasing. If health care costs were not high, health insurance premiums would not be high. Is not the more fundamental problem the cost of health care, not the cost of health insurance? I think so.

It's a common confusion among commentators in almost any garden-variety editorial page. It's not the sort of intellectual blurriness one expects from a Ph.D.

John

Need they be mutually exclusive?

Isn't the choice of a health plan the one opportunity (however fuzzy) the individual has to make choices regarding the totality of healthcare rather than individual services?

Isn't the choice of a health plan more often the decision the individual makes while not under the stress of illness or injury?

Since the fading of multi-specialty staff model, capitated HMOs health plans haven't done much to systematically and broadly integrate and coordinate care. But who else has done more or better on a broad basis?

It took less than 48 hours for my health plan to get in touch with me about the withdrawl of Vioxx from the market last October. (Check the Pharmaceutical category and scroll back to October 4 to the post "Who's got the data..." I still haven't heard from my personal physician and don't expect to. Nor, I suspect, would most patients. We know it should be better but our expectations are pretty low.

John

John Fembup

"It took less than 48 hours for my health plan to get in touch with me about the withdrawl of Vioxx from the market last October . . . I still haven't heard from my personal physician and don't expect to"

"And don't expect to." Well, why don't you expect to? This low expectation is consistent with my observation regarding Dr Greenberg's article. Why should competition among health plans - rather than among health care PROVIDERS - be expected to keep down the cost of health care? Why the low expectation of providers?

I think part of the explanation is that, in the public debate, even respected voices are often careless about the difference between health care and health insurance. That leads to confusion and inhibits rational discussion.

I think that the cost of health insurance cannot be contained in any meaningful way unless the cost of health care can be contained. Focusing on "health plans" or "health insurance premiums" misses the point. The cost of health care is more fundamental. Therefore, while it's fine for health plans to compete, IMO it's a forlorn hope that they can thereby succeed in containing the cost of either health insurance premiums, or health care. What health plans' competition brings is superior administrative services (e.g., the notice regarding Vioxx).

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