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The easy and hard future of techno-medicine

 

Michael Kirsch, M.D., writes of the tradeoffs of technology-based medicine:

“The manner in which medical care will be administered will be beyond what we can imagine.  We are seeing glimpses of it already, but our vision of its trajectory is limited.  There will be huge advances, but as with all technology, there will be a cost.  The traditional doctor-patient relationship will fade out and will no longer be the bedrock of medical care.  There will be nostalgia for it from those who experienced it, much as I have warm memories of bank books, rotary phones, ice cream sodas and playing basketball after school in the school yard.”


Texas system CEO: Insurers should share savings

 

Dan Wolterman, president and chief executive of Houston-based Memorial Hermann Healthcare System, Texas’s largest not-for-profit hospital system, complains in a wide-ranging Q&A with Modern Healthcare that insurers don’t share savings from reduced utilization of healthcare resources.


Supremes rule against private Medicaid providers

 

The U.S. Supreme Court ruled that private-sector healthcare providers can’t sue to make states raise their Medicaid reimbursement rates to keep up with rising medical costs. Interestingly, the 5-4 cut across the court’s usual ideological lines, with Justice Antonin Scalia writing the majority opinion.


A series on Medicare at 50

 

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President Johnson signs Medicare into law in 1965, with former President Harry Truman, 81, the first Medicare card holder, looking on.  Mr. Truman had long pushed for national health insurance.

As we approach the 50th anniversary of Medicare, MedPage Today starts a fascinating series looking at the achievements and problems — especially its spiraling costs — of the program.

Some of us at Cambridge Management Group well remember how the American Medical Association tried to stop the program from becoming law in the ’60s, asserting that it was “socialized medicine.”

It wasn’t but it did make many doctors and hospitals rich. Only in recent years have its reimbursements lagged physicians’ costs (and/or their financial expectations), leading to  major initiatives  aimed at bringing  its many wasteful aspects under control before it bankrupts America.

Meanwhile, even  many of the most ardent Tea Party conservatives like to talk about how evil would be cuts in Medicare benefits. But then, many Tea Party people are over or approaching Medicare age.

The original idea for Medicare goes back at least to Theodore Roosevelt in the sense of a national insurance plan. But Republican opposition has prevented a real universal, single-payer plan from being implemented.

Since the elderly vote in high numbers and because  age-related illnesses make it very difficult for most to get private insurance, they got what liberals  have wanted for the whole population. Politicians have generally worried more about old voters than, say, kids.

It will continue to be politically impossible to kill Medicare. Like Social Security, it’s too much a part of American life. But the flood of aging Baby Boomers and other factors ensure that it will continue to undergo change, some of them  wrenching.


Will UnitedHealth Catamaran purchase slow drug costs?

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This Wall Street Journal news story raises the question of whether UnitedHealth’s purchase of pharmacy-benefits manager Catamaran will really result in lower drug prices. Pharmaceuticals prices have become an ever-more important part of healthcare inflation, even as some other costs in the sector have slowed.

 

Catamaran will be merged with UnitedHealth’s own OptumRx unit. The WSJ reported that the combined benefits manager ”will cover an estimated 31 million lives.”


Supremes won’t hear ‘death panel’ challenge

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Philippe de Champaigne‘s “Vanitas (c. 1671): Life, Death and Time.

The U.S. Supreme Court has  refused to hear a challenge to  the Independent Payment Advisory Board, or IPAB, a 15-member government panel  created by the Affordable Care Act (and called by some Republicans  a “death panel”) meant to trim  Medicare costs.

 

 


Moral or simply economic?

Shannon Brownlee,  at a Lown Institute conference, discusses whether medicine is a “moral endeavor” or simply a  set of ”economic transactions”.

 

“If we want to get to the right care, we must begin to envision a vastly different system.,” she said. “A just system. A system whose purpose is to serve patients and communities. A system that is not just reformed, but radically transformed.”


Painful shifting of costs to patients

 

A Los Angeles Times story notes:

“Though much has been made of a slowdown in the rate at which U.S. healthcare costs have risen in recent years, that trend hasn’t translated into financial relief for patients.

‘”The overall cost to everybody has slowed, but one of the reasons they’ve slowed is that there’s been a shifting of costs to patients,’ says Paul Ginsburg, director of public policy with the University of Southern California’s Schaeffer Center for Health Policy and Economics.”

‘”We’re reaching a backlash, because there is only so much pressure you can put on consumers,’ says David Newman, executive director of the Healthcare Cost Institute, a non-partisan, nonprofit organization in Washington, D.C.”


Obama immigration action and FQHC’s

 

President Obama’s executive order on immigration, if upheld in the face of legal challenges, would substantially increase the number of people with insurance coverage and thus have major effects on the U.S. healthcare system, says this article in The New England Journal of Medicine,

The authors write:

“Although the President’s … policy is likely to have a positive effect on insurance coverage of undocumented immigrants, it may, counterintuitively, do more to increase access to insurance for legal immigrants and even citizens than it does for those directly affected by the planned executive order.”

And:

“{T}he reduced threat of deportation may mitigate immigrants’ mistrust as they decide whether to pursue needed medical care, regardless of their insurance status. Ironically, any resulting increase in utilization may exacerbate the financial strain placed on safety-net providers that disproportionately care for immigrants, since many immigrants will remain uninsured if they are ineligible for Medicaid or premium tax credits. Policymakers will therefore need to continue funding streams to support providers who care for uninsured immigrants.”

Cambridge Management Group, which has worked with Federally Qualified Health Centers (FQHC’s),  which serve millions of uninsured and under-insured people, believes that the  Obama immigration action, if upheld, would tend to send more patients to these safety-net facilities. But litigation and Washington gridlock leave much in doubt. And would the Feds provide adequate funding to these FQHC’s?

 

 


More for little hospitals, less for the big ones

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The Berkshire Hills.

A proponent of reopening  the abruptly closed  North Adams Regional Hospital, in western Massachusetts’s Berkshire Hills, hospital says:

“Big hospitals get all the money and the little hospitals get strangled. It should be the other way around. The little hospitals should be getting more help and the bigger hospitals should be getting less because of volume.”


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