Senator Edward Kennedy came from wealth and privilege but believed in the obligation to serve the public—to give back to society and make it better. He will be remembered as the champion for the little guys–the people without a voice. But he spoke and acted for all Americans. He raised our consciousness. He channeled our outrage against injustice into solutions to help people live better lives. He reminded us of duty. He showed us the positive role that government can and must play in the lives of all Americans. He believed in equality and fought and won battles for social justice, health care, higher education, and labor. That was Edward Kennedy. There is talk of naming the health reform bill for him. He would not want the honor without substance—without health care legislated as a right for all. To remember one of the greats of history with a health care bill that does not live up to the ideals he fought for more than 50 years would be shameful. Kennedy wanted what was right for the little guy—not the rich, powerful, or corporate interests.
Archive for the ‘News’ Category
But wait………there’s more!
I recently learned that a large metropolitan health care institution is offering a “summer special” on coronary calcium CT scans at a reduced price of $99 from the regular price of over $400. These scans determine the amount of calcium in the coronary arteries. The result, known quantitatively as the Agatston score, is said to be predictive of the risk for heart disease, although this still needs to be fully worked out. Since this test is often not covered by insurance, patients who are offered the test must pay out of pocket.
The fact that certain, discretionary medical tests are being offered on “special,” should not be surprising as this is a natural progression of the growing role of market forces in health care. Some would argue that this is a good example of how market forces positively impact health care by enabling patients and their doctors to make more cost effective health care decisions, rather than relying on passive decisions made by insurance companies.
However, I find it a troubling example as health care becomes increasingly commercialized. Do we really want the practice of medicine to look like a late night infomercial: “The first 30 people to sign up for the test will also get a set of Ginsu Knives.” I recognize that there needs to be a balance between medical professionalism and the free play of market forces. But that balance is inexorably becoming skewed in the direction of the market.
The patient-provider relationship should be kept at arms-length from market forces so as to ensure that the care delivered is in the patient’s best interest. The market does not necessarily have the patient’s best interests in mind: its goal is to seek profit wherever it can be found. In some cases it does work in the patient’s interests; in some it does not. But special deals and price incentives for medical tests and procedures by their very nature undermine effective medical care decision making by substituting financial motivation for effective patient care decisions. Do medical infomercials and their equivalents really have a place in a reformed health care system?
No accountability for insurers in health reform debate
A friend of mine, an association finance officer, tells me that the insurance premiums for her organization are going up 10% for the coming year. Such blanket moves by the insurance industry—to raise premiums, deny coverage, change coverage options—reveal the problem at the heart of the health care debate. Who is monitoring the insurers? Who is holding the insurers accountable? Who asks the insurance industry about the raises? Does anyone push back? Does anyone ask why the money is needed and what it is used for? The White House and the Congress are intent on cutting physician and hospital payments. I have some sense about what happens with those payments, especially in the teaching hospitals that must educate the next generation of health professionals and pour money into research to advance science. I can’t say the same for the insurance industry.
I can’t remember in the last 20 years any time when the insurance industry has been called to task on Capitol Hill. The recent Washington Post article, Lawmakers Reveal Health-Care Investments, provides the answer. Almost 30 lawmakers helping draft the health care legislation have financial holdings in the industry. There’s a conflict of interest here. And the White House—already worried about re-election—is also conflicted. How can you have a strong public plan if you can’t figure out how to be sure your investment portfolios—and big political backers—don’t suffer? It’s easier to single out physicians and hospitals who must continue to provide patient care no matter what. It’s time to address the future of the insurance industry—and their future business model–if we have any hopes of health reform. It’s time to design a new and different role for the insurers in a new economy.
