Joe Paduda analyzes the candidate’s stand. I’ve mentioned before that I think that containing health care costs takes precedence over the uninsured, which is why some of McCain’s ideas intrigue me.
He is one of the few candidates that talks about reforming the physician reimbursement system, although he gives few details:
We should pay a single bill for high-quality health care, not an endless series of bills for presurgical tests and visits, hospitalization and surgery, and follow-up tests, drugs and office visits.
One drawback is that he is essentially describing capitation, which was soundly rejected by the public in the 1990’s. Maybe they need to reconsider.
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- How the economy may make health care costs soar
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{ 2 comments }
I don’t think that he is actually describing capitation, where one is paid for providing care to a population of people, mostly healthy and not needing care.
I think he is describing case billing, where one charges a flat rate for the care of a sick patient and provides whatever professional services, labs, hospitalization, re-hospitalization, etc is required.
I think McCain is saying we need to the free the system up to experiment a bit with different market models. An example would be for a hospital to set up a diabetic program and then charge a flat rate per annum for for all diabetic patients who enroll, covering routine care and complications.
This is done by at our local Ob facility as so many are uninsured–go and pay the flat rate early in the pregancy and it covers the doctor, the hospital, and complications—in effect insurance for a specific episode.
Normally the marketplace would generate these kinds of experiments but there is very little of the free market in US healthcare now and the providers play by the rigid rules of goverment and private insurers. The CPT code system itself is a fixative.
Capitation simply ran down. As rate competetion escalated it got down to who could best keep sick people off their panel, not answer there phones, and otherwise avoid providing care. With case rates, people will at least be selling to sick people. Now whether they will really give the care needed, I imagine will be variable. I can see the same kind of games unfolding there.
The bottom line will always be the professionalism of the decision makers, whether MBA’s or MD’s. I’ll take my chances with the MD’s, although they bear watching, however much they may resent it.
All the candidates’ health care plans, while interesting, mean little. Congress will set that agenda.
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