Opportunity for Coakley in March
By Jim StergiosFebruary 8th, 2010
While the Democratic party “commentariat” has had afield day with the AG’s campaign for US Senate, a funny thing happened. Ten days after the election, her office released an intriguing Investigation that showed nuance well beyond the campaign talking points on why health care is so expensive.
A. Prices paid by health insurance companies to hospitals and physician groups vary significantly within the same geographic area and amongst providers offering similar levels of service.
B. Price variations are not correlated to (1) quality of care, (2) the sickness or complexity of the population being served, (3) the extent to which a provider is responsible for caring for a large portion of patients on Medicare or Medicaid, or (4) whether a provider is an academic teaching or research facility. Moreover, (5) price variations are not adequately explained by differences in hospital costs of delivering similar services at similar facilities.
C. Price variations are correlated to market leverage…
E. Price increases, not increases in utilization, caused most of the increases in health care costs during the past few years in Massachusetts.
F. The commercial health care marketplace has been distorted by contracting practices that reinforce and perpetuate disparities in pricing.
Oh, yeah. Almost forgot “D,” which I found most intriguing. The AG also found limits on the benefit of reforms like “global payments,” all the rage these days in policy circles.
D. Variation in total medical expenses on a per member per month basis is not correlated to the methodology used to pay for health care, with total medical expenses sometimes higher for globally paid providers than for providers paid on a fee-for-service basis.
Coakley’s office is to issue the final report on March 16th, the day of hearings on health care cost containment. Looking forward to that if this is any indication of the seriousness of her direction on the issue.
Entry Filed under: Healthcare, News
1 Comment Add your own
1. David McKalip, M.D. | February 17th, 2010 at 3:45 pm
Coakley concludes (with no facts to support her conclusiosn) that price variation is: 1) bad, 2) not related to variation in quality or additional services and 3) must be stopped.
The fact is that Massachussetts and other third party payers for healtyh care seek to put patients, doctors and hospitals on a budget. They want Dr’s like me to spend no more than an arbitrary amount on a patient – based on what they can happen to raise from premiums or taxes. They would penalize me financially and professionally if I prescribe care that is over budget but that is needed by the patient.
They don’t even leave an escape mechanism for the patient: balance billing. It appears MAssachusetts not only wants to set a global budget for an “episode” of medical care (e.g. 90days around time of surgery), they want to deny the ability of a patient to pay out of pocket for more care or have a charity donate money to help them out.
Why must all patients live in the global budget cage? Because cowardly politicians won’t admit that their centrally planned medical economies require rationing. Because insurance companies want unnaturally high profits they get through unholy alliances with government. Because the nanny state knows best and it is the job of the patient/citizen to sacrifice for “The state”.
It is time to reject this faulty financial model for health care and grow personal out of pocket spending for routine annual medical care for patients. Health insurance needs to be deregulated to allow it to be more affordable? Why can Bay Staters by insurance from Idaho that is so much cheaper? Because the state says you can’t. Interesting you can still buy auto insurance from the Geico lizard….
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