A Katrina Health Care System

[fencesitter]

NYT...http://select.nytimes.com/2007/05/26/opinion/26gawande.html

This is my fourth week as a guest columnist. Let’s take a look at the health care news that’s transpired in that time.

First, DaimlerChrylser sold off 80 percent of its Chrysler division for three pebbles and a piece of string. O.K., the cash payment was actually $1.35 billion. But for an 82-year-old company that built more than two million cars and trucks last year, took in $47 billion in revenue, and owns 64 million square feet of factory real estate in North America alone, that’s almost nothing. Yet analysts say that it was a great deal for Daimler. Why? Because the buyer, Cerberus Capital Management, agreed to absorb Chrysler’s $18 billion in health and pension liability costs.

Stop and think about this for a minute. The deal meant that the costs of our job-based health insurance system — costs adding $1,500 to each car Chrysler builds here, but almost nothing to those built in Canada or Europe — have so broken the automaker’s ability to compete that giving it away became the smartest thing Daimler could do. Chrysler’s mistake was to hang around long enough to collect retirees and an older-than-average work force. As a result, it now has less market value than Men’s Wearhouse, Hasbro, the Cheesecake Factory, NutriSystem, Foot Locker and Pottery Barn. Oprah is worth more than Chrysler. This is not good.

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None of this news, however, did more than lift a few eyebrows. So this is the picture of American health care you get after watching for a few weeks: it’s full of holes, it’s slowly bankrupting us and we’re kind of used to it.

That leaves two possibilities: (1) We’ve given up on the country; or (2) we’re just waiting for someone else to be in charge.

[Solo_in_MD]

1. You posted from the paysite

[fencesitter]

2. So I did..sorry

can't find a free link

a bit more....

Meanwhile, officials at West Jefferson Medical Center outside New Orleans reported that the number of indigent patients admitted there has tripled since Hurricane Katrina. The uninsured are now 30 percent of their emergency room patients. Officials in Houston hospitals are reporting similar numbers. Conditions seem worse rather than better. Katrina caused a vicious spiral. Large numbers of people lost their jobs and, with them, their health coverage. Charity Hospital, the one state-funded hospital in New Orleans, closed. The few open hospital emergency rooms in the area have had to handle the load, but it’s put the hospitals in financial crisis. Four hundred physicians filed a lawsuit against the state seeking payment for uncompensated care, and massive numbers of doctors and nurses have left the area.

In Washington, a conference held by the American College of Emergency Physicians revealed that New Orleans may have it worst, but emergency rooms everywhere are drowning in patients. Mandated to care for the uninsured, they are increasingly unprofitable. So although the influx of patients has grown, 500 emergency rooms have closed in the last decade. The result: 91 percent report overcrowding — meaning wait times for the acutely ill of more than an hour or waiting rooms filled more than six hours per day. Almost half report this occurring daily.

[papau]

3. There is nothing there on Hillary's just released Health care cost savings ideas -? -

despite it being dated the 26th and the press clippings below being dated the 25th. As a summary of the week, it lacks a bit :-)


http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=45172

(kaisernetwork.org)Presidential Candidate Sen. Clinton Announces Proposal To Reduce Health Care Costs May 25, 2007

<snip>In addition, Clinton proposes to overhaul the method of care for the chronically ill, whose costs account for about two-thirds of all U.S. health expenditures. Her plan says it would seek to "en insurance discrimination" by requiring insurance plans to accept anyone regardless of health status (Kornblut, Washington Post, 5/25).

Under Clinton's proposal, insurers also would be prohibited from charging higher rates to people with medical problems (Reichard, CQ HealthBeat, 5/24). The plan calls for legalizing the purchase of lower-cost prescription drugs from other nations and requiring Medicare to negotiate for lower drug prices. In addition, the plan says Clinton will call for instituting "common sense" changes to the medical malpractice system (Washington Post, 5/25).<snip>

Another portion of the plan would establish a combination public and private "Best Practices Institute" to finance research comparing treatment efficacy. The organization would issue protocols based on its findings (CQ HealthBeat, 5/24). Clinton said the institute would determine whether new prescription drugs and technologies offer real benefits to patients compared with older therapies or whether they simply boost drug company profits (New York Times, 5/25).

Clinton's proposals announced Thursday were the first phase of what she said would be a three-part plan for correcting the nation's health care problems if she were elected president (CQ HealthBeat, 5/24). Clinton's advisers said that she will outline plans to improve quality of care and implement universal coverage in coming months (Washington Post, 5/25). <snip>

Comments

<snip>Clinton said, "In a system of universal coverage, insurance companies cannot as easily shift costs through cherry-picking and other means" of excluding older and sicker patients. She added, "That's how they profit: by avoiding insuring patients who will be expensive and then trying to avoid paying up once the insured patient actually needs treatment." Clinton said, "The money we save from the waste we eliminate and the way we change how we care for people should be used to help finance coverage for the 45 million Americans who have no insurance" (Young, The Hill, 5/24).<snip>

A kaisernetwork.org webcast of Clinton's speech is available online. http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2163

Text of Clinton's plan also is available online. http://www.hillaryclinton.com/news/speech/view/?id=1789

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http://www.latimes.com/news/politics/la-na-hillary25may25,0,7754092.story?coll=la-home-center

From the Los Angeles Times
Clinton offers health proposal
The topic is fraught for the Democratic presidential candidate, who stumbled famously in the 1990s.
By Jill Zuckman Chicago Tribune

May 25, 2007

WASHINGTON — <snip>Clinton offered a proposal Thursday focused on reining in healthcare costs. Two other proposals are expected — one seeking to improve the quality of healthcare and the other to insure all Americans. She has already introduced legislation in Congress to expand healthcare coverage to all children.<snip>

A rival for the Democratic presidential nomination, Sen. Barack Obama of Illinois, is expected to lay out his own vision Tuesday for bringing down healthcare costs and expanding coverage. Former Sen. John Edwards (D-N.C.) has already proposed insuring all Americans by 2012. Currently 45 million are uninsured.

On Thursday, Clinton argued that healthcare costs were out of control. Among the evidence she cited: Premiums have almost doubled since 2000; the nation spends 16% of its gross domestic product on healthcare; 30% of the cost increase is related to the doubling of obesity among adults during the last two decades; and administrative costs are the highest in the world.

"If we spend so much, why does the World Health Organization rank the United States 31st in life expectancy and 40th in child mortality, worse than Cuba and Croatia?" she asked.<snip>

"The whole point of insurance, lest we forget, is to spread risk across a group of enrollees," she said. "It's one of the reasons that the administrative costs of Medicare are so much lower — because they are actually insuring everyone."

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May 25, 2007
Clinton Plan Would Trim Health Spending by $120 Billion a Year
By CQ Staff, CONGRESSIONAL QUARTERLY
By John Reichard, CQ HealthBeat Editor

Sen. Hillary Rodham Clinton announced a health cost control plan Thursday she said would trim at least $120 billion a year from national health care spending. A key feature of the seven-point plan calls for a “National Prevention Initiative” that would require insurers doing business with the federal government to cover “high priority” preventive services as well as wellness programs to maintain health, the New York Democrat said.<snip>

Under her cost control proposal, insurers would have to follow the recommendations of the U.S. Preventive Services Task Force on what preventive care to cover. The federal advisory panel consists of academic researchers who sift through medical literature to determine which preventive services actually are effective in warding off disease and issue reports on their findings.<snip>

Other elements of the proposal would aim to:

• improve health information technology. To help hospitals and doctors upgrade, “I would invest $3 billion a year in grants to help ramp up the system,” Clinton said.

• streamline care for the chronically ill. “Americans with chronic disease such as heart disease and diabetes account for an astonishing” 75 percent of national health care expenditures, she said. Clinton would require that Americans with such conditions have access under Medicare and other federally funded plans to “chronic care coordination” plans providing a “medical home”— a provider or team of providers who would work together to avoid treatment complications or duplicative services.

• end insurance company “discrimination.” As part of a plan for universal coverage Clinton said she will detail in coming months, she said, “We would create large insurance pools that lower administrative costs for small businesses and individuals by spreading the risk.” She also said the plan would “end insurance company discrimination against people with pre-existing conditions.” Insurers would be required to allow anyone who wishes to join a plan to do so and bar insurers from charging higher rates to people with health problems.

• drive down costs with “best practices.” Clinton said she would start a public-private “Best Practices Institute” to finance research comparing the effectiveness of various forms of treatment. Based on its findings, the institute would issue practice protocols.

• control prescription drug costs. Clinton would give Medicare the authority to negotiate for lower drug prices, allow the importation of low-cost drugs from abroad and bring lower-cost generic versions of biotech drugs on the market.

• revise the medical malpractice system. She called for an approach that would encourage health systems to give liability protection to doctors who disclose medical errors to patients. Health systems that disclose these errors and move quickly to provide compensation are much less likely to be sued, she said.<snip>

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WASHINGTON (MarketWatch) -- <snip>On the technology front, Clinton's plan calls for the creation of a "paperless" health information-technology system.

The 14-page plan also outlined proposals to improve outcomes of the chronically ill, who usually incur catastrophic expenses and are a key driver of rising health-care costs.

Clinton criticized health insurers for steering clear of Americans with expensive, pre-existing conditions, and called for ending insurance discrimination. Under the plan, a "guarantee-issue" system would allow anyone to join an insurance plan and would bar insurers from carving out benefits or charging higher rates to people with health problems.

Wider coverage would reduce administrative costs by forcing insurers to compete on lowering costs and improving quality, the Clinton outline said.

The plan also calls for some medical malpractice reforms, including a program that would provide liability protections for physicians who disclose medical errors to patients and offer to enter into negotiations for fair compensation.