Comments on: The Demand-Side Approach to Changing What Doctors Do

By: The Politics of the Senate Health Reform Bill: Obama’s Two Mistakes | John Goodman | NCPA

Mon, 30 Nov 2009 16:31:37 +0000

[...] as in the field of education (see my previous Alert), the only reform that can pass is one that does little more than spend more [...]

By: Bob B

Bob B — Wed, 25 Nov 2009 18:25:00 +0000

This is an interesting discussion. I think the bottom line is that people,us, need to have skin in the game to make a difference.
go to http://www.robertblades.com and check the book for a great disertation on this subject.

By: Dave

Dave — Wed, 18 Nov 2009 14:05:41 +0000

At the risk of sounding like a conspiracy theorist, here is something that has occurred to me over the last six months. Vouchers could be an important means of solving the uninsured problem while working with, rather than against, competition in a very transparent way. But as important as this would be for solving the problem of the uninsured, the potential gain to our society of vouchers being used in education is far greater. We are literally a nation that is making itself dumber over time. That is not sustainable.

I believe one reason for the hostility toward implementing a voucher program as a part of SERIOUS health care reform is that having vouchers prove their mettle with respect to something as complex and important as health care is terrifying to the NEA.

By: Ronald Feldman MD

Ronald Feldman MD — Wed, 18 Nov 2009 04:08:28 +0000

Having spent a few days a year at Mayo Clinic Rochester and witnessed the incredible amount of expensive equipment, the number of special procedures and specialty consultations, and it’s opulent surroundings, it seems clear to me that it can’t really be cost effective.

It isn’t quite nervana. Cross dept. coordination is not always efficient. Physicians have been fighting amoung themselves over work output inequities for years.

Some things stand out to me. 1. Donations to the Clinic have left a huge endowment, along with royalties for trademarks. 2. People often come for short stays from all over the world, many paying large sums of cash. Long-term continuity is not the responsibility many of us face. 3. The cost of living in Rochester, Minn. is very low, allowing for a lower salary structure.4. Mayo’s response to Gawande’s articles was to say Mayo can’t make it on fee-for-service Medicare pay, just like the rest of us can’t.

By: John Goodman

John Goodman — Tue, 17 Nov 2009 22:48:07 +0000

The Ford Foundation just announced a $100 million grant to encourage education reform. The recipient? Teachers unions! See the Wall Street Journal editorial here. http://bit.ly/2HTLHg

By: Nancy

Nancy — Tue, 17 Nov 2009 13:53:13 +0000

I agree with David. There are walk-in clinics all over the country. They are reasonably priced and there is very little waiting. That’s why some are called “Minute Clinics.” There are also surgi centers and free standing emergency care clinics that are reasonably priced.

Major surgery is a totally different animal. For that you have to cross the border to find reasonable prices.

By: David R. Henderson

David R. Henderson — Tue, 17 Nov 2009 03:56:17 +0000

Jennie Fiedler asks, “What is “affordable” health care and where do you find it?” I answer, “Wal-Mart.”
Best,
David

By: Jennie Fiedler

Jennie Fiedler — Tue, 17 Nov 2009 02:24:26 +0000

I think the scary part is that all health care is expensive. If you’re poor you can eat top ramen instead of steak, live in a studio apartment instead of a house, ride a bike, take a bus or drive a beater if you can’t afford a new car, and hit the thrift stores for everything else. But where do you go for medical treatment? What do you do when you don’t make enough to “spend your own health care dollars?” And considering how quickly the middle class is disappearing and the number of “working poor” is rising, there are a good many of us that could end up in that boat. Where do you go when your employer doesn’t offer health insurance and you can’t afford an individual policy? This is becoming an extremely relevant question in this current climate, but I sure haven’t seen any answers. Free clinics? “Income-based” health care? What is “affordable” health care and where do you find it?

By: John R. Graham

John R. Graham — Mon, 16 Nov 2009 20:36:44 +0000

My reading of examples of success in government-run health systems also comes down to idiosyncratically effective leadership. For example, the North Karelia Health Project in Finland, which is associated with sigificant improvement in cardiovascular indicators, is generally credited to Dr. Pekka Puska (http://tinyurl.com/ylegfzn). The VHA’s success in the 1990s, associated with improved HIT, is generally credited to Dr. Ken Kaiser (http://tinyurl.com/ykvl2u3). Just like in all areas of life, effective leadership is key. The idea that the government can pass a law to make it happen is ridiculous. The best you can do is allow people to spend their own health-care dollars as they see fit, and then the leaders arise.

By: Linda Gorman

Linda Gorman — Mon, 16 Nov 2009 19:53:57 +0000

Cash & Counseling type programs are “demand side” programs that do cut costs. They do it by giving Medicaid clients a budget to spend on home care as they see fit. Since Medicaid clients are allowed to buy home care from anyone they like under Cash & Counseling, it effectively “repackages” care in forms not normally allowed by Medicaid.

Various Cash & Counseling look alike programs have lowered costs by 20 percent, received rave reviews, and greatly improved quality.

They conclusively showed that health care can be improved by freeing people to spend what they regard as their own money free of excess regulation. This deregulation made everyone better off except, perhaps, the many fans of government run “command and control” medicine.