Newt Gingrich and John Goodman have a thought provoking piece in the WSJ today. Ten GOP Health Ideas for Obama
All ten ideas are worthy of thought, but I will focus on the two I feel are the most important.
Allow doctors and patients to control costs. Doctors and patients are currently trapped by government-imposed payment rates. Under Medicare, doctors are not paid if they communicate with their patients by phone or e-mail. Medicare pays by task—there is a list of about 7,500—but doctors do not get paid to advise patients on how to lower their drug costs or how to comparison shop on the Web. In short, they get paid when people are sick, not to keep them healthy.
So long as total cost to the government does not rise and quality of care does not suffer, doctors should have the freedom to repackage and reprice their services. And payment should take into account the quality of the care that is delivered. Once physicians are liberated under Medicare, private insurers will follow.
I have consistently written that our fee for service (FFS) system increases total health care costs without improving care. FFS encourages more service and that is exactly what we get. I favor a modified retainer system, especially for primary care. We should determine the ideal "panel size" and pay a reasonable amount for that. Physicians can see patients, talk on the phone, and email patients. The physician and patient should jointly determine the best methods for maintaining continuity. I suspect we will see less visits, but longer visits. We would see more phone communication and more email communication. Patients would be happier and likely healthier.
Eliminate junk lawsuits. Last year the president pledged to consider civil justice reform. We do not need to study or test medical malpractice any longer: The current system is broken. States across the country—Texas in particular—have already implemented key reforms including liability protection for using health information technology or following clinical standards of care; caps on non-economic damages; loser pays laws; and new alternative dispute resolution where patients get compensated for unexpected, adverse medical outcomes without lawyers, courtrooms, judges and juries.
I have writer's fatigue on this issue. Regardless of the estimates, any physician will tell you that our current system increases unnecessary testing and sometimes damages the physician-patient relationship. Alternative dispute resolution would provide better protection for patients without the stresses of our current system.
I recommend reading and considering all their proposals. They have some right, and I believe they are a bit naive on others. As always, Gingrich makes one think. And clearly with respect to health care, we need someone making policy to think outside the box.
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Caps on damages is certainly at best only part of the solution. California has had caps on general damages (pain and suffering) for decades, but Anthem Blue Cross just raised its premiums by up to 39%. They are blaming this on adverse selection (an argument in favor of universal coverage). The rate increase did receive some media attention, but I did not hear any mention of the long-standing medical malpractice caps in that state.
A Proposal
Set aside 10% of insurance premiums in the form of vouchers for patients to purchase primary care. If healthcare spending is $2.1trillion for 300 million people that would equal $700 per patient on average. This would more than double primary care revenue per patient. Primary care practices would aggressively compete for these now lucrative patients. Your physician would be glad to call in prescriptions, exchange emails, do web visits not only to get your business, but also because it would be more efficient and cost-effective for them to do so. They could also be expected to implement chronic disease management models have extended office hours and create patient portals with interactive self-management tools. Physician innovation would be spurred to figure out creative ways to better serve their patients. Medical students might even show interest in this new exciting field.
These two points are of considerable value and moving to a concept of retained physicians seems like a very liberal and holistic approach to maintaining the health of the population. If doctors were spending far more effort in prevention and were charging a relatively fixed amount to care for patients, overall health costs could be cut drastically with likely better outcomes. Just think of the reductions in obesity if doctors were on the case of their patients as part of their job.
Rob, thanks for this fine post. We have 1 out of 2 tiems in common. We both zealously argue for tort reform. However, I don't have writer's fatigue yet. I'll keep at it.
If damage caps had been shown to do ANY of the things promised after 30 years of having them, perhaps they'd make sense. At this point though, it seems like just a talking point for the sake of having a talking point. It's not like we haven't had time to see if they work. But healthcare is no cheaper, rural areas remain underserved, and physicians do not seem to act any differently.
At what point do the facts speak for themselves and an idea dies?
Note that neither the authors, nor I, discussed damage caps. Read before ranting.
You need to read your own quote before sanctimoniously correcting. When you do you'll find this in it: "caps on non-economic damages;".
Besides, that's all tort "reform" is legislatively. You might as well be discussing fairy tales if you're talking tort reform without it. Even your tobacco lobby inspired "health courts" have caps in them. I do like the idea of no court to pay injured plaintiffs.
That would be interesting to see work – let's see, you're an injured party, with the type of injury where you can no longer work, and need treatment every day. It's now your job to, without a lawyer, gather all the medical information about your case, figure out what your lost wages and future care costs are, and try to get some kind of handle on what the value of your loss of quality of life is, and present it to. . . ? A panel of doctors? Who are getting information on the other side from a well funded insurance company with lots of experience doing this? Yeah, that seems fair.
This is what happens when you start making suggestions about things you don't understand. They end up not being grounded in reality. You should stick with working on improving the delivery of your own services. If you just did that, who knows what good things might happen!
Interesting read and I couldn’t agree with you more about our FFS model. The FFS model is the root of the problem. What about a healthcare model that is like a health club? Generating revenue by the members it supports – not by how many patients the doctors/nurse practitioners can cram into one day? Imagine paying a fixed membership fee that is only $420 a year per person and then having unlimited access to high-quality routine medical care that comes to you at work or at home for only $35 a visit, and NO claims filed against your insurance. Not only that but the visit includes medical care, generic Rx medications, foods, beverages, and over-the-counter remedies that all comes to you 365 days a year, 8am to 8pm within hours of your call. No more hassles with trying to get a doctor appointment, waiting in a crowded waiting room being exposed to germs, having to go the pharmacy, etc. This profitable model for healthcare is in operation today in Texas! I run a company that has thousands of members simply because they’re seeing a healthcare provider on their terms (in their house or office) and it’s surprisingly affordable – all the while, our company is making money. Quality healthcare is possible .
Sadly, our President has declared that tort reform would have no effect on the delivery of medical care. I've heard the same line from multiple law students who I've spoken with. They think that doctors are already artificially insulated from criminal penalties of malpractice. I'm afraid that as long as most politicians are attorneys we won't see too much progress on this front.
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