We hope the president-elect of the AMA has it right. Adoption of uniform medical information technology standards is essential to get to a more well established health information system. However, we must resist at all turns attempts by federal bureaucrats to interject THEIR beliefs about what is proper care and leave that to professionals and patients. Government assistance is needed to help move health information technology adoption forward, government control is not . . . jomaxx
GAMA president-elect advocates for HIT provisions of stimulus bill
In a letter to the editor in the Wall Street Journal , American Medical Association President-elect J. James Rohack, M.D., responds to a Feb. 11 editorial on electronic medical records (EMRs). He states that the AMA agrees that EMRs “might do some actual good,” and therefore supports “the health information technology [HIT] provisions of the economic stimulus bill.” The bill would “create important national HIT interoperability standards,” which are “essential to…help increase patient safety, improve care coordination and reduce unnecessary paperwork,” he explains. Dr. Rohack also notes that the “bill does not authorize the government to dictate clinical guidelines or national coverage decisions.” Rather, it “provides physicians with significant financial assistance for HIT purchases” that will allow patients to “begin to reap the benefit.”
I’m less interested in (and less threatened by) what “federal bureaucrats ” have to say about proper care and more interested in what works. The medical community used the term “outcomes” as a metric to determine the effectiveness of a procedure or medicine. Outcomes, unlike opinions, are a measurable statistic.
I’m just a layman looking into what I have learned to call “health care inflation,” but in the short span of a few weeks reading I have come to realize that both Medicare and private insurance plans are fighting that same demon. It’s gotten a little better over the last decade, but health care costs as a whole are still way over what they should be. Compared with other economies the US shows embarrassing “outcomes” in many categories, while our costs per person are higher than others and continuing to climb.
Something is wrong with this picture.
I’m coming to believe that there are two factors figuring into health care inflation costs. Too many drugs that cost too much. And too many medical procedures that are simply not necessary.
Ours is a sales-oriented economy, so selling is what we do best. In the case of drugs and health care, competition among vendors and providers coupled with an insured population with no real clue about costs adds fuel to the fire. Who gets medical care in our system? Those of us covered by company-subsidized group insurance, others who can afford private insurance, Medicare beneficiaries, and those at the bottom (the uninsured whose care is “written off” and Medicaid and welfare recipients who pay nothing). No where on this list really knows (or cares) what their care costs. Like patrons waiting in line for an “all you can eat” buffet, all want to get something for nothing. They (we?) expect to receive no less than “our money’s worth” which means individual money’s worth, by the way, whatever that may be.
And if there is any question about actual NEED or RESULTS, we will always choose to get it, just to be on the safe side, in the same way that so many people insist their doctor prescribe antibiotics for the common cold, ignoring the fact that viral infections are not treatable by antibiotics and the over-use of antibiotics has detrimental side effects, not only to the individual but in the larger population, resulting in time in antibiotic-resistant strains of infectious organisms.
As consumers we’re speeding down the health care highway in a gas hog. It’s time to take a look at a more fuel-efficient model, and until we pick one, we need to apply the brakes a little before we come to a sharp curve and crash.
John,
Thanks for the thoughtful comments. However, you should be concerned about too much government intervention in the provider/patient relationship.
The first issue is access. The President (including the last several) could have addressed in large measure access issues by executive action without the need for protracted, overly expensive, Congressional action, which will likely be outdated before it takes action. How you ask? By demanding that private insurers become insurance companies again, not money mangers in the risk arbitrage business.
For example, eliminating any exclusion for pre-existing conditions would allow many to get private coverage. Also, by removing sub-group rating to allow for expansion of risk over a large pool of subscribers.
There are many other changes in our system which are needed, and this site will be commenting on them across the board. No group is exempt from the need to participate in reform. In fact this site has indeed addressed a number of those items and we invite you to explore other posts.
Thanks for the commentary and hope you keep checking in!
By demanding that private insurers become insurance companies again, not money mangers in the risk arbitrage business.
For example, eliminating any exclusion for pre-existing conditions would allow many to get private coverage. Also, by removing sub-group rating to allow for expansion of risk over a large pool of subscribers.
Whoa! Help me out here.
This is language I don’t understand. I know all the words, but I’m confused.
What is the difference between “private insurers” and “insurance companies”? I thought they both meant the same thing.
Does “money managers in the arbitrage business” refer to the medigap “alphabet” plans? Or the now “advantage” products? Or TPA’s (that’s a cool new acronym I learned lately… Third Party Administrators”)?
So how do pre-existing conditions puzzle into all this? By disallowing those with pre-existing conditions, that certainly makes the “risk pool;” a lot cheaper to cover per capita, but at the same time it pushes those excluded into another horrendously expensive pool. I thought the mission of insurance was to do just the opposite… making it better for those in trouble by spreading pooled assets over a larger population.
Are you advocating excluding pre-existing conditions from access? And if so, how might costs for their treatment be covered?
As far as I can tell, the main revenue streams paying for health care are insurance premiums (in one form or another, including Part B deductions from SS checks), co-pays and deductibles directly from clients, and government funds (Medicare and Medicaid) from payroll taxes. The costs of treating uninsured people, indigents and others who do not pay for whatever reason are “written off” but that is only an accounting gimmick. The costs do not, in reality, vanish. If providers are not to go bankrupt they have to recover those costs from one or several of the revenue streams listed.
In the end, the health care pie is cut and paid for one way or another.
What am I missing?
Nice post! Keep it real.I have looked over your blog a few times and I love it.
Health Day,
Thanks for the commentary. First, you have misread one of my main tenants, that is that NO person should be barred from coverage for ANY pre-existing condition. I think you misunderstood that one. Second, by including larger risk pools, it spreads risk and premium costs over a larger group. Third, the current insurance industry is overly profited by the current system. It needs to be based, much like publicly traded utilities, on a cost plus basis with the plus set by and oversight board etc. Why do CEO’s of health insurance companies and health plans need to make 20 or 30 million while the companies in their charge deny payments to patients, doctors and hospitals? Fundamentally, what private health insurers have become is money managers. By expanding their margin over premiums they can invest millions of premium dollars to their advantage. I have nothing against profit. But I am very much against stacking the deck. If you are a health insurance company, sell to the market and take all comers. Period . . . obi jo
[…] response, Dr. J. James Rohack agreed by saying, “unless we have protection in a courtroom for not ordering a test, […]