Thanks for sending this to us, Craig. But I would say it's worth reading to learn how confused some people are about why US costs are high. The author subscribes to the single most important piece of folklore about the health care crisis: That it is caused by the fee-for-service method of paying doctors. He ignores the insurance industry and the role that managed care has played in driving up costs by driving up prices via higher administrative costs and provoking mergers.
This paragraph in particular illustrates the author's confusion:
"The AMA’s plan to preserve fee-for-service medicine was successful, but its consequences for patient experiences and physician workdays have been disastrous. This system has, in part because of government efforts to catch and prevent health care fraud by private actors, produced ever-expanding documentation requirements that now constitute the bulk of American doctors’ workloads. This is a major factor behind the alarming rates of physician burnout. As the US faces an already severe doctor shortage, one in five physicians now plans to leave their job."
This is backwards. It isn't FFS that's causing "ever expanding documentation requirements" and physician burnout, it is managed care ideology -- the folklore about overuse first invented by HMO advocates in the 1970s and the hype that HMOs and other insurance companies that expose doctors to financial incentives and micromanagement (including "click for bonuses").
I used to be a Nation subscriber for decades. I stopped around 2010 when their coverage of the Affordable Care Act got so bad. I was thinking of resubscribing. Maybe I'll write and ask if they would entertain and article from me about the real causes of high US health care costs and the role the demonization of FFS played.
Kip
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On May 12, 2022, at 4:03 PM, Kip <ki...@usinternet.com> wrote:
In "The blind spot in Medicare for all," Eric Reinhart offers the wrong diagnosis for the US health care crisis and, not surprisingly, he offers no solution. Worst of all, his diagnosis -- overuse of medical services due to the fee-for-service (FFS) method of paying doctors -- is music to the ears of the insurance industry, proponents of the privatization of Medicare and Medicaid, and opponents of Medicare for all. His overuse-due-to-FFS diagnosis was invented by HMO advocates in the 1970s to justify subjecting doctors and patients to interference in the doctor-patient relationship by the insurance industry, and today is the number one excuse cited by advocates of privatizing Medicare and Medicaid. Today's advocates of turning Medicare and Medicaid over to insurance companies and newly invented entities called "direct contracting entities" routinely assert precisely what Reinhart asserts in this article: America's health care costs are driven up not by the excessive administrative costs of an insurance industry wielding managed care tools invented by HMOs, but by greedy doctors ordering services patients don't need, and America needs insurance companies to do the dirty work of making doctors knock it off.
In short, what Reinhart considers to be a "blind spot" among Medicare-for-all advocates -- single payer bills that rely on the FFS method payment -- is in fact an essential, deliberately selected element of the single-payer proposal. He has it backwards. He has a serious blind spot, not the single-payer movement, not Representative Pramila Jayapal and other legislators who sponsor single-payer legislation at the federal and state level.
It is not possible to offer a thorough rebuttal of Reinhart's piece in a short email, nor to offer documentation. I'll refer readers to a 45 minute presentation I made for One Payer States two months ago Kip Sullivan Kick Insurance.mp4 - Google Drive, offer a short summary of my critique here, and invite readers to peruse my comments in blue interspersed through the text of his article (pasted in below).
Reinhart's diagnosis consists of these three statements:
(1) The high cost of US health care is caused by overuse of medical care;
(2) the overuse is caused by the FFS method (which also causes other problems such as physician burnout); and
(3) the FFS method "is embedded in American health care" today "because of a long political campaign initiated by doctors."
Not one of these statements is true.
Re statement (1): US per capita spending is double that of other wealthy nations primarily because our administrative costs are excessive and because every sector of the health care system has become highly consolidated under the onslaught of managed care cost-control tactics, originally unleashed on the country by HMOs and subsequently adopted by virtually the entire insurance industry. Very little overuse has been documented (as opposed to discussed and obsessed about). Pockets of overuse exist in the US, but it is not the reason US costs are high relative to those of other countries. Americans actually get fewer physician and hospital services per capita than residents of other countries that spend half what we do per capita. Burgeoning paperwork and physician burnout are due not to fraud, much less fraud induced by FFS, but to the reigning managed care ideology Reinhart now promotes.
Re statement (2): No research demonstrates that FFS causes the pockets of overuse that do exist. For a quick lesson in how bereft of evidence overuse mavens are, see my reply to overuse gurus Chernew and McWilliams here The Case For ACOs: Why Payment Reform Remains Necessary | Health Affairs The rising load of paperwork physicians deal with is due to a problem Reinhart seems to know nothing about -- the spread of cost-control tactics pioneered by HMOs. It is not due to the FFS method of paying doctors.
On 2022-05-15 07:37, Craig Brooks wrote: