The HMO from Hell –

It Begins…

In today’s New York Times:

How can we learn to say no?

“The federal government is now starting to build the institutions that will try to reduce the soaring growth of health care costs. There will be a group to compare the effectiveness of different treatments, a so-calledMedicare

innovation center and a Medicare oversight board that can set payment rates.

“But all these groups will face the same basic problem. Deep down, Americans tend to believe that more care is better care. We recoil from efforts to restrict care.

Managed care became loathed in the 1990s. The recent recommendation to reduce breast cancer screening set off a firestorm. On a personal level, anyone who has made a decision about his or her own care knows the nagging worry that comes from not choosing the most aggressive treatment.

“From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing, and Medicare’s long-term budget deficit will grow.

So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform. “Being able to say no,” Dr.Alan Garber of Stanford says, ‘is the heart of the issue.’”


The “heart of the issue?” …or the heartlessness?

Entitlements will always drive limited resources to zero, always, always forcing painful choices.

The illusion of free medicine, with zero patient cost participation at the point of service, creates a culture of zombie-like dependency in which bureaucrats take over all the critical decisions from patients who are simply herded into “treatment models”, cookbook medicine increasingly devoid of fine tuned individuation.

The process of bureaucratization is incomplete in the US only because vestiges of the older physician-patient model still survive here. But the trend is clear and it has been accelerated by the latest health care legislation.

In the latest interaction of health care reform, bureaucratic limits will take even more choices away from physicians and patients and vest them with committee structures.

One result of denied treatment is death. Intelligent people in the public square are forced to use sound bites to encapsulate a complicated idea. Governor Palin used the term “death panels” and was roundly criticized. The architects of bureaucratic cost containment weren’t foolish enough to use that name. But the governor’s sound bite captured much more than a grain of truth.

It remains true that health care resources are limited and, given the looming public debt crisis, things will get worse before they improve.

The republicans and their blue dog democrat allies will have a brief time window to reset the course of health care into a much less bureaucratic model, one with more patient cost participation and greater physician professional independence.

More on that topic is on the way, but here’s a preliminary peek.

The option of privately held, tax sheltered medical savings accounts needs to be made available to every individual and family in the US. New legislation needs to provide a physician and patient bill of rights, guaranteeing unfettered private practice access for each. Subsidies for the poor are appropriate, of course. But any help-the-needy models need to preserve patient choice and cost participation, wherever and whenever feasible.

Stay tuned.


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