Sunday, August 16, 2009

Obama Considers Insurance Co-ops

All it took was ranting crazies talking about "death squads" and the Obama administration is caving on health care. No public health care reform. The idea of a "health co-op" is unproven anywhere in the world. There is no model to tell us how it would work, how it would deliver care or how much money it would cost.

The healthcare industry loves the idea of co-ops and says it would provide the competition needed for real choice. Well guess what? We already have competition between insurers. We have Blue Cross, Anthem, Blue Shield, Aetna, Cigna, United Health Care and hundreds of others to choose from. Do we need more choices that we cannot afford? Will the co-op be required to take the people with pre-existing conditions? How would a co-op hold down costs?

With the world wide embarrassment of thousands of people lining up in Los Angeles for free health care, you would think the white house could sail through true reform. Was it audacious to hope that we could really have change?

The Health Care Bill will not be effective without a public option. We will spin around for another few years appeasing insurance companies who support this compromise. We will remain the only major industrialized country in the world without national health care.


Raymond Bouchayer said...

Well Said Dr. Brayer . I had all my hopes on President Obama....looks like big business and corporations win again, we loose .

Anonymous said...

Don't mean to ask a stupid question but what are "health-co-ops"?

Michael Kirsch, M.D. said...

Toni, I disagree with you. I am skeptical of Obamacare and its beloved public option. There still is not credible way to pay for Obama's expansive health care reform designs. This alone is reason to oppose it. Moreover, despite the claims of a medical Nirvana north of the border, many of us don't have confidence in government administered or controlled health care. Access might improve, but costs will rise and medical quality will suffer. Polls consistently report that most Americans are satisfied with their current health care. Tort reform, an important issue for practicing MDs like me, and the cause of billions of $$$ of defensive medicine, is a dead issue. I've never been to a Town Hall meeting or to a 'tea party'. Not every Obama dissenter is a right wing wacko.

Anonymous said...

Well said Michael Kirsch M.D. Something does need to be done but not Obamacare..

Toni Brayer MD said...

MichaelKirschMD: There are many different "polls" and others say that the majority of people are not satisfied with the current state of health care. Medicare patients are very happy with their health care because they get whatever they want and it is mostly free (to them). I have said before that Medicare reform is needed to control costs and ensure access as part of health care reform. (see my post on "Fix Medicare" and other posts on the dismal, dangerous state of Primary Care)

With health care soon absorbing 20% of GDP, the uninsured at 40 million, the cost of insuring a family of 4 at $20,000/year and people with preexisting conditions being excluded, reform is essential.

We are acting as if this has never been done. We are the only Western industrialized nation that has these problems, yet we are terrified of any government involvement or public option. Why?

Obama has been open to other suggestions and, as I said, has acquiesced on many critical points. The insurance lobby and the pharma lobby have powerful influence that will keep their profits intact. For true reform, that will need to change. I do not think they are "bad". Everyone is responding to the incentives that are currently in place. If the American people want to take 20% of the health care dollar and give it to investors, so be it. If no one wants to discuss end of life care, or rationing or tort reform or cost controls because it is too scary, so be it.

Just understand that we will not have much to show for reform at the end of the day.

Michael Kirsch, M.D. said...

Toni, Even The New York Times, an overt Obama supporter, consistently reports poll results indicating that a majority of us are satisfied with our health care. Additionally, it's not a surprise that Medicare recipients are happy. They receive enormous medical benefits at little personal cost. This is an example of a 'public option' that is financially unsustainable. Is this a model we want to extend to the entire country? Let's look within the health care system to mine the billions of dollars that we are wasting. I presume you are a practicing physician so that you also must witness every day the unnecessary CAT scans, cardiac caths, consultations, etc., which cost a fortune and do not help patients. Tort reform, deliberately not on the Obama or any of the Democratic plans, would substantially decrease the defensive medicine that we are all forced to practice. Why does no Democrat support reforming our unfair and abusive medical malpractice system? Finally, there's nothing wrong with the profit motive. This has led to great advances and innovations in medicine and in other spheres. Why would a drug company assume the enormous financial risks of developing a cancer vaccine if they didn't stand to achieve a huge profit? Profit motivates individuals and corporations to do good work.

Anonymous said...

Another free-marketer run amok! Greenspan was another one of these Ayn Rand followers, and even he now sees limits to the free market. For them it's become a religion, and they are as emotionally attached to their theories as many an evangelist is to the lord's teachings.

Toni Brayer MD said...

MichaelKirsch,MD: Just to be crystal clear (if you read my blog you would know this...even though I try to be as neutral is possible)...

1.I support cost containment and agree about Medicare being unsustainable with "free" care. Currently Medicare drives the entire industry and reimbursements are not based on benefit to patients or society. The more you do, the more you get paid for, irregardless of benefit. Medicare underpays (85¢ on the dollar)so more is done and those costs are shifted to all of us.

2.I fully support Tort reform and caps on pain and suffering like we have in California. It is critical for a well functioning system.

3. I support capitalism but we have had 40 years of a free market that is now crashing badly. Change is needed and other countries that have better outcomes at lower cost have proven there is a place for government involvement. I do not support Medicare "for all" in its present form. It is already bankrupt.

4. I don't believe profit motivates corporations to do "good work".

Michael Kirsch, M.D. said...


I am pleased that we agree on the need for tort reform. We have similar caps in Ohio and they have helped. Now, we need a barrier on the front end to effectively filter out frivolous cases from being filed. There is a paradox in your comments. You state that you 'support capitalism' but then state that you 'don't believe that profit motivates corporations to do good work'. How do you reconcile this contradicion? I vehemently reaffirm my belief that the profit motive is a force for good. To reject this, in my view, is to support socialism.

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bobnelson said...

I stumbled across this blog in one of my many web searches to try to unravel this healthcare mess. People in your blog with differing viewpoints express themselves civilly and everyone seems well informed (at least in the comment chain I’ve read).
I am in the oil and gas business, a small independent landman in Oklahoma. I remember back in the 70s when the Dept of Energy was created. Its mandate was to reduce our dependence on foreign oil. Many years and billions of dollars later, we are worse off than ever. That is one reason I am so leery of government getting more deeply into healthcare.
I am a free-marketer in the Schumpeter sense. I see all around in the present and in history how the messy give-and-take of countless face-to-face transactions ends up settling on the most efficient (i.e. least costly) result. That is why my insurance is with Blue Cross/Blue Shield in a Health Savings Account PPO. The $5000 deductible allows me to make my own decisions vis a vis my doctor, so in that sense it is a partial free-market. (That is such a clumsy term-actually, there are no truly free markets, just like there are no rule-free games)
I am not defending the medical insurance industry when I say I am for free markets. Insurance companies are creatures of government, so-called regulated monopolies which are allowed by government fiat to fix prices. But I don’t understand why we expect insurance to cover doctors visits and non-catastrophic events.
Why isn’t medical insurance more like home and property insurance, or life insurance. And why can’t insurance companies compete across state lines, like car insurance where I have noticed a huge drop in premium prices since Geico et al could compete on a national basis.
Have you read that editorial by the CEO of Whole Foods? It seemed refreshingly helpful in the ongoing debate, but made a lot of his customers mad. What did you think of it?
Sorry about my long-windedness.
(By the way, my dad was an internist for 50 years in Tulsa OK. I applaud him and you)

Steven Reidbord MD said...

Just wanted to point out that while Dr. Kirsch is right that a majority of Americans are satisfied with our current health care, a notably larger majority are satisfied in Canada and in European countries with some form of universal coverage (often a publicly funded option).

Swetha said...
This comment has been removed by a blog administrator.
commercial property insurance said...

Hi Toni Brayer,
Good topic and as i see there is a long hot discussion on this.i agree with Toni Brayer overall but i too agree that there are large number of people who are satisfied with Obamacare.

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