Friday, February 17, 2012

Remember how HMOs gave physicians more autonomy,ACOs will be even better

Remember how HMOs made patients happier,doctors more satisfied with their work and also brought about better care while bending the cost curve downwards. Well, we are told that ACOs will do that only even better.

Dr. Ezekiel J. Emanuel , in this commentary, in JAMA assures physicians who might have foolishly worried that joining an ACO would lead to some loss of autonomy. He and his co-author argue that actually ACOs offer the opportunity for more ( not a typo ) autonomy.

So how does working with (for?) a large vertically integrated organization which by definition will have a large bureaucracy lead to autonomy?

Here is quote from Emanual's article that suggests one way.

More relevant to physicians' autonomy, the ACA initiates payment reforms that will give physicians greater financial flexibility to redesign care delivery, and to provide services that may not have been reimbursed before. For example, traditional fee-for-service payment mechanisms do not reimburse for efforts to enhance medication compliance or to oversee the results of wireless physiological monitoring in patients' homes.

and more

Another provision of the ACA that offers physicians more liberty to pursue patients' best interests is the move toward accountable care organizations (ACOs), which are combinations of physician groups, hospitals, and other providers that will coordinate care for patients.6 The proposed ACO regulations require physician leadership and empower physicians to determine the information systems and infrastructure necessary for coordinating care. The freedom to redesign care occurs along a spectrum depending on how the ACO is paid.

Does anyone who has worked with the administration of a large hospital or an insurance company really think that the typical ( or atypical ) physician is going to "determine" much of anything."Freedom to redesign" ? More like freedom to follow the rules and guidelines of the organization or seek employment elsewhere.

Some of us may have been fooled or seduced or coerced by the HMOs , fool me twice...

Surveys have indicated a number of physicians will leave practice early because of Obamacare.I guess the prospect of greater autonomy is just too frightening.

Monday, February 13, 2012

Another comment on the "controversy" over HHS dicta regarding reproductive services

A minor political storm emerged over the ruling of the Department of HHS regarding the mandatory inclusion of certain reproductive services in health insurance. Obamacare has made the HHS Secretary the final arbiter of many things in health care including what health insurance plans must cover so this is likely the first of many such mini-storms.

Much of the ensuring public discussion has veered off on tangents which while being perhaps of interest and worthy of discourse per se miss the main point here.

Now to the main issue here .

Those in control of health insurance, which since Obamacare was passed is the HHS Department who answers to the President and is seeming beyond any appellate measure, are not really concerned with the arguments over the particulars of their latest dictum which is only one of very many to come .They do not care so long as those who disagree concede the legitimacy of the power of the central government to make those dictates in the first place.

In fact they may relish the furor over the details of this particular ruling as long the anger is not focused on the legitimacy of the governments authority in this regard. At least they relish it as long as the political fall out seem minor and controllable although it is not clear that is either at this juncture.

Much, if not most, of the outcry have focused on a "battle" between the administration and the Catholic church, or on an alleged great unfulfilled need of women to have access to birth control which they say should not be left to the caprice of employers .Folks who make that latter argument seems clueless as to the obvious caprice of the HHS decisions.

So the major issue is should the government have that power to decide what we must pay for in our health insurance . However, frighteningly, it may get worse that that. This idea is expressed in the following quote from Dr. Richard Fogoros's blog The Covert Rationing Blog .

DrRich has pointed out many times that the real battle we will face as Obamacare is being rolled out is the battle over whether American citizens will retain individual freedom sufficient to be permitted to spend their own money on their own healthcare. Indeed, DrRich has written a series of posts that spells all this out in painful detail. If you need to know why limiting individual prerogatives is so critically important to Progressives, and why Obamacare must be the vehicle for establishing these limitations, simply read the first post in that series.

I see it this way; Once we loose the battle over whether the government has the legitimate power and authority to dictate what health care must contain,it is a short jog down the road for a government with that power to determine what health care may not consist of even if paid for by the patient herself. Could that happen? It happened in Canada. Must it happen? It did not happen in Great Britain?

I hope DrRich's and my fears are wasted and individual freedom will persist in this regard. However, when I see some of the reaction to the latest Obamacare dictum and people are talking about things like whether the Catholic Church ought to modernize its archaic views or the sudden mysterious shortage of birth control methods which must be alleviated by the government while there is so little commentary on the fundamental issue (should the government have that power in the first place),my worry titer goes back up.

Friday, February 03, 2012

Obamacare: "anger and division are inevitable consequences of the Law"

The title is a quote from Michael Cannon of Cato.See his commentary .

His current comments are in regard to the latest decree from the HHS Secretary regarding the mandate for the details of the health insurance that Obamacare mandates with the threat of a fine for non compliance. This time the Catholic Church is the focus of attention with the insistence that that organization will, in fact, have to provide insurance that covers among other things,certain reproductive services including control pills.

When the government, this time a single high ranking government presidential appointee, decides what you shall have and shall not have in your health insurance, there is bound to be anger and division as Cannon said.

Some folks with a more progressive mind set that I have might be pleased that the enlightened HHS secretary will force a program so that women can afford contraception,but the government control knife cuts more ways. I quote Cannon again

The same apparatus that can force Americans to subsidize elective abortions can also be used to ban private abortion coverage once the other team wins. The rancor will only grow.

Thomas J. Sargent said the following in his address to graduates at UC Berkeley in May 2007.

"Other people have more information about their abilities,their efforts and their preferences that you do."

I suppose even progressive planners would admit that but with a "Yes,but". Yes but we know better what is best for other people.


Of course, with the power of HHS mandates and the reach of IPAB,the apparatus of government health care control system can force certain things and ban others regardless of the wishes and the particular circumstances of the "other people".

The social justice bestowed on us rolls on. It just gets better and better.