• Len Nichols’ seven health care challenges

    All seven are worth reading and discussing. Here’s just one:

    Challenge #2: Tell the American People the Truth

    It is stunning how hard it has become to move facts and logic to their proper places in the public mind. The truth is we can solve our current fiscal woes without abandoning our commitment to vulnerable citizens, and to ourselves. Health care cost growth, our most serious long-run fiscal problem, is coming down and will stay down if we are disciplined, and encourage the kinds of programs I described in my testimony. This is not to say every payment model has to work or the whole enterprise of health reform is doomed to saddle our children with unbearable debt. We can learn from failures and mixed successes; indeed, we rarely learn any other way. Our country is diverse, and we will need different models in different locations to reflect our differing assets on the ground, and values. Reform proponents are asking dedicated health professionals to effectively re-design the airplane they are flying without first landing it, as patients keep coming every second of every day, and because we cannot change our payment and information systems overnight. But the evidence is building that we can achieve the triple aim of cost containment, quality of care, and population health if we free our creative imagination. Furthermore, we are the least taxed advanced nation on the planet. Our federal and state governments take ten percentage points less of our gross domestic product (GDP) than the Organisation of Economic Co-operation and Development (OECD) average, and we have a larger military than all of them combined. The idea that our economy cannot tolerate tax increases and keep growing robustly is contradicted by extensive evidence. We may choose to keep taxes below what is required to support a decent social safety net in an aging society that should also invest in children and economic infrastructure and peace in a complex world, but that’s a choice, not a necessity. The debate should be framed that way. [Bold original.]


    • One comment on a subsection of Nichols’ list. He says that all-payer claims databases are going to be a vital tool to enable providers to transform the system. I entirely agree with the principle.

      However, the organizations staffing those databases need to really increase their staffing to deal with physician-level requests for data. This is what I mean: the Maryland Health Care Commission (our all-payer claims database) has, at the time of the last call I was on with them for a project, one programmer for the database. They were able to comply with an urgent legislative request for data on one particular procedure code. There is no way imaginable that they could serve even just the largest hospitals in the state requesting general cost of care info for their patients. They would need more programmers.

      Also, the data would need to be available in real time. MHCC does not have FY 2012 data available. In contrast, the organization I work with currently has FY 2012 Medicaid MCO encounters and FFS claims, and about half of the FY 2013 claims. We are staffed with a number of programmers.

      Getting competent personnel takes money. Programmers and analysts could work in the private sector for more money, sometimes a lot more. And unfortunately, I’m not sure states are currently in the position to do what Nichols suggests. In principle, though, one could fund the database staff through assessments on insurers and providers (e.g. a sales tax on every dollar of provider revenue or a tax on premiums).

    • Not sure I can agree with Challenge #1″ (“Be More Bipartisan”).

      We’ve seen plenty of this “both-sides-do-it” trope, and it’s wrong.

      Congressional gridlock at this point is the fault of only one party, and it’s not the Democrats. In the past two years, Democrats in fact have been more than accommodating in trying to reach accord with radically misguided positions advanced by the House Republican leadership. Thinking back to the passage of the ACA, Democratic Congressional leaders worked hard to incorporate ideas from the other side of the aisle. (I mean, what do we think the ACA is, if not the original Heritage-Republican-Romney formula?) And what did the Democratic leadership get in return? Treacherous back-stabbing. And this from a party that thinks it’s fine to renege on the public debt and trash the US economy on purpose.

      I, for one, hope that the Democrats will be less rather than more accommodating,and will stand strong for such “partisan” positions as public health funding, universal health care coverage, job creation, voting rights, campaign finance reform, fair wages, gun safety, and clean energy, among others.

    • He’s not familiar with Austin’s work on the myth of health care cost shifting. (See Challenge #3.) It’s a convenient and effective negotiating tactic by hospitals to command more money from private payers, but in reality, there are no costs to shift. There is only pricing strategy for different payers, based upon their willingness to pay.

    • We may choose to keep taxes below what is required to support a decent social safety net in an aging society that should also invest in children and economic infrastructure and peace in a complex world, but that’s a choice, not a necessity.

      The government collects plenty of taxes to support a decent social safety net. Military spending could be cut in half without danger. SS could be cut by a third if it paid the same amount to everyone instead of giving more to those who need it less. Education spending has doubled without positive effect so it surely could be cut in half without damage. Cut out corporate welfare spending.

      • On I forgot:

        Medicare should and medicaid and Government health plans should refuse to pay treatment that are speculative and should negotiate lower prices. I think that should save somewhere around 40% in healthcare spending.