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AmSpecBlog
Too Big To Succeed
I participate in a number of discussion groups, often with highly educated experts in health policy. In recent months it has become increasingly difficult to even discuss the health reform proposals. There are so many versions and iterations of all these bills and amendments that it has become nearly impossible to discuss any of it. And some of it isn’t even exposed yet, like Reid’s bill. CBO keeps scoring this, that and the other, and it is hard to match up the particular CBO score with the right bill or amendment, let alone compare specifics.
Yet every provision is critically important, and not just by itself, but how it interacts with the other provisions.
It feels like a shell game, and it is small wonder people are edgy about the whole enterprise. Too many moving parts, too little clarity, too much rhetoric and jargon, and all tainted with political ambitions.
I think we are way beyond what the legislative process is capable of doing. There is literally no one in Washington who knows what it is they are voting on anymore.
It would be far better to take all these topics one bite at a time, by which I mean separate bills for --
-- Medicare payment reform
-- Insurance
regulation
-- Assistance to the
needy
-- Management technology
upgrades
-- Workforce
initiatives
-- Quality improvement
initiatives
-- Professional liability reform
Each of these is complex by itself. Blending them all together into a single bill is simply impossible.
For example, I agree that we need to completely overhaul the regulatory regime currently in place for insurance. Each state has completely different statutes for the individual, small group, and large group markets. Some states have separate regulations for Blue plans, commercial companies, and HMOs. Then ERISA exempts self-funded employers from any state regulation. Regulatory reform is an enormous challenge all by itself and the current bills are way too vague on how, or even whether, that is supposed to happen. For instance, it is not at all clear what will be the state and federal roles for regulating carriers that participate in the Exchange. Who oversees their solvency, reserves, accounting, investment practices? If a company markets exclusively through a national Exchange, what is its state of domicile? Will HMOs continue to be regulated by separate agencies than other carriers as they are in California? Who will regulate brokers?
Or take the workforce issue. We are facing substantial shortages of primary care physicians and nurses as the Baby Boom generation retires. Expanding insurance coverage will aggravate the problem. Plus there are new technologies coming on-line all the time. How do we get enough technicians to run the machines?
It is not just a matter of giving scholarships to med students or opening more slots in dental schools. The whole licensure and oversight regime currently in place needs to be re-examined. Everyone who looks at it concludes it is a mess. Why at least could there not be interstate reciprocity for licensing and disciplinary actions? Why can’t a physician who is licensed in Arizona prescribe drugs for patients in New Mexico? Or how is it that a doctor who is disciplined in one state can set up shop in the adjoining state?
And on and on and on. Because this thing is so big, we are not paying enough attention to the critically important REAL issues.
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Pingback| 11.7.09 @ 10:25AM
Twitter Trackbacks for The American Spectator : AmSpecBlog : Too Big To Succeed [spe links to this page. Here’s an excerpt:
Bob| 11.7.09 @ 11:32AM
Greg, generally AmSpec is a fact free zone. However, your short blog is directly on target and factually accurate. Having worked as a group insurance executive, I understand the problem from the business and regulatory frameworks involved. You did not mention the antitrust exemption that should be removed, however.
We have developed a framework for national banks, and we need to do the same for health insurance. You are not going to get competitive rates unless you have competition AND very large "groups". You cannot have large enough groups and 4-5 competitors in a state. Furthermore, there is a vast difference between paying for procedures and paying for outcomes. That must be decided (I'm in favor of paying for outcomes). Lastly, if we require hospitals and doctors to treat everyone, we should pay for it. Thus, I support government payments (single payer) ONLY for emergency and perhaps, catastrophic care.
Nick| 11.7.09 @ 1:48PM
Don't waste your time with 3/5 Bob folks.
In case you didn't know, until recently (last June), 3/5 Bob thought that blacks had 3/5 of a vote under the U.S. Constitution, as originally written.
He also doesn't know when biological HUMAN life begins because he is not sure when "ensoulment" takes place.
And I just learned he falsely claimed to have translated the Bible from the original Aramaic when he was 15.
He is a pseudointellectual, ignore him.
Pete2| 11.7.09 @ 2:44PM
You're right,Nick. what a bunch of hogwash from this guy and I noticed that about other posts he has made on here, and I've been reading these posts for quite a while before blogging. Thanks for confirming what I suspected about him.
Bob is a Troll| 11.7.09 @ 2:49PM
I wonder if Bob hassles President Obama with the "facts". He voted for him and can only nag people who are out of power and who he claims will never be in power again. What strange behavior, almost queer so to speak.
Ken (Old Texican)| 11.7.09 @ 12:11PM
Mr. Scandlen
Edgy?.....Edgy?
I am sorry to say, that "edgy" is a total dud of a conceptualization.
Hmmmmm...
Try out "infuriating" or "bleeding eyballs" or "shock at the outrageous cynicism" expressed in this bill .
Or, how about: "The most sinister naked power grab" in our nation's history, or, "once you gott'em by the b###s, their hearts and minds will surely follow".
click: "Mr. Jones, Welcome to Obama hospital. We need to get started on that bypass surgery, but here is a little paperwork to complete first. What? Oh, that is just a firearms registration form. Just fill in the appropriate boxes and lets get you upstairs. Well of course we need the calibers or guages.
Of course we need to know how many rounds you own for each firearm, dummy. How are we supposed to do surgery without the form being filled out correctly?
Pardon me? You are going where? Oh no Mr. Jones, you can't go there. We have suspended your passport I'm afraid."
Edgy?
Mr Scandlen that is the understatement of the twenty first century. Please...get your head out.
Pete2| 11.7.09 @ 2:51PM
Interesting points made in the article, however, we all know the current legislation is not to fix the poblems but to sieze control. Why has this escalated into crisis phase? It's the lawyers and other greedy people who have caused this. One thing I do not see mentioned a whole lot is the cost of AIDS research and treatment. This disease has escalated health care costs dramatically and was prophesized to be the downfall of the health care system unless brought under control. Now, this is my opinion only. AIDS is also a very preventative disease but it requires a moral solution. That goes for welfare /immigration reform among other things. Like the man said, let's start with the root problems before scrapping the system in favor of a takeover which will solve nothing.
Pingback| 11.7.09 @ 11:54PM
Dental Schools - Too Big To Succeed - Spectator.org « Dental Schools links to this page. Here’s an excerpt: