It was then I realized an HMO would probably be the death of me — since it could be so difficult to get specialist care. ANd what would it be like to try to get such a referral is one were really sick and unable to keep pushing, calling, demanding???

I seem to recall Congressional hearings about the awful repercussions for some people.

Thank you for the history lesson, Kip Sullivan. Well written, to the point.

Some of the “reforms” (such as hiring more nurses to help chronically ill patients learn to manage their diseases better, a reform all gussied up with the pointless metaphor “medical home”) will improve the health of some patients, but the cost of the intervention (in this case the hiring of more nurses and other activities that are supposed to go on in “homes”) have already been shown in most pilot projects to match or exceed the savings due to improved health of patients.

Other “reforms” Scarecrow cites are just new forms of managed care. “Payment models,” for example, no doubt refers to some form of “capitation,” the payment method that HMOs popularized in the 1970s and 1980s. Or perhaps it refers to the latest rage in establishment health policy — “pay for performance” — which means bureaucrats prepare crude report cards on doctors and hospitals (much as Bush prepared crude report cards on schools) and reward “good” providers and punish “bad” providers. ACOs refers, I presume, to “accountable care organizations,” a new euphemism for HMOs. The “measurement tool” that will be used to inform doctors about how many tests they order compared with the average for their location is just a reincarnation of “profiling,” something the HMOs pioneered.

These Managed Care 2.0 “reforms” will probably work the way traditional managed care worked — they will drive up the administrative costs of the system, reduce access to medical care for some patients (especially services to more vulnerable patients and services for which guidelines are hard to write, such as home care services, stroke rehab services, and treatment of mental health problems), damage quality of care more than they enhance it, and have no net effect on costs or even raise costs.

The House bill and the Senate HELP committee bill are already riddled with with numerous expressions of Managed Care 2.0 theology. I’m surprised Waxman felt he had to burden the House bill with even more experiments in unproven managed care tactics.

America is going through a hideous deja vu experience. We’re seeing the old HMO experiment recycled with all the same rhetoric and false diagnoses of the problem we endured between 1970 and 1973 when the modern health care reform debate began, and when the Nixon White House and Congress cooked up the doomed experiment with HMOs. The unholy alliance that persuaded Nixon and the Democrats back then to promote HMOs(the insurance industry, big business, and some policy entrepreneurs like Paul Ellwood and Alain Enthoven) looks very much like the unholy alliance promoting Managed Care 2.0 today.

If we don’t stop it, we will look back on the days of Managed Care 1.0 as a picnic. During the heyday of Managed Care 1.0 — about 1970 to 1995 — it was the insurance industry that wielded the basic tools of managed care (financial incentives to doctors to deny care, utilization review of doctors by HMO bureucrats when financial incentives didn’t “work,” and limited choice of provider). The unholy alliance promoting Managed Care 2.0 today wants the government, especially Medicare, to play a much more active role in creating financial incentives to deny care and in meddling in the doctor-patient relationship.

There are so many reasons to dislike the House and Senate HELP bills. It’s hard to say which ranks as my most important reason for disliking these bills. I guess the fact that both bills funnel hundreds of billions of dollars to the insurance industry and almost no dollars to the pathetic little “public options” is my number one reason. But right behind that is my horror at the brave new world of managed care that is being cooked up for us while we sleep.

On the other hand, maybe my number one reason for disliking these bills should that when the Managed-Care-2.0 tactics fail and infuriate the public, Americans won’t just point the finger at insurance companies. They will point them at “government,” and in particular the Democrats who promoted this stuff.

Kip Sullivan

SENIOR DEATH WARRANTS:

The actress Natasha Richardson died after falling skiing in Canada. It took eight hours to drive her to a hospital. If Canada had our healthcare she might be alive today. In the United States , we have medical evacuation helicopters that would have gotten her to the hospital in 30 minutes.

In England anyone over 59 cannot receive heart repairs or stents or bypass because it is not covered as being too expensive and not needed.

Obama wants to have a healthcare system just like Canada ’s and England’s.

I got this today and am sending it on.

If Obama’s plans in other areas don’t scare you, this should.

Please do not let Obama sign senior death warrants.

Everybody that is on this mailing list is either a senior citizen, is getting close
or knows somebody that is.

Most of you know by now that the Senate version (at least) of the “stimulus” Bill includes provisions for extensive rationing of health care for senior citizens.

The author of this part of the bill, former senator and tax evader, Tom Daschle was credited today by Bloomberg with the following statement:

Bloomberg: Daschle says “health-care reform will not be pain free. Seniors should be
more accepting of the conditions that come with age instead of treating them.”

If this does not sufficiently raise your ire, just remember that our esteemed Senators and Congressmen have their own healthcare plan that is first dollar or very low co-pay
which they are guaranteed the remainder of their lives and are not subject to this new law if it passes.

Please use the power of the Internet to get this message out. Talk it up at the grass roots level. We have an election coming up in one year and nine months. And we have the ability to address and reverse the dangerous direction the Obama administration and its allies have begun and in the interim, we can make their lives miserable. Lets do this!

If we don’t insist on this now, down the road we will have the same bracket creep that undid the alternative minimum tax. And probably also the estate tax.

CBO Chief says Reform Bills Won’t Lower Health Care Spending Rates….

BUT,

This is true, but it’s also more complicated than that. First of all, the CBO has analyzed two bills so far: The Senate HELP Committee’s bill and the House’s so-called tri-committee bill. But, crucially, the HELP Committee doesn’t have jurisdiction over Medicare and Medicaid where many of these savings can–and likely will–be found. And, just as crucially, the CBO hasn’t scored those parts of the House bill either.

“The analysis issued today does not take into account other parts of the proposal that would raise taxes or reduce other spending (particularly in Medicare) in an effort to offset the federal costs of the coverage provisions,”

sounds to me like Chairman Conrad invited him just for sound bite purposes, hope to goodness the WH gives him the Kyl treatment