Wednesday, June 17, 2009

CBO score slows down drive to health care reform

Maybe because I have two teenage daughters who dream about a big wedding with all of the bells and whistles (way, way in the future . . . of course!), the Congressional Budget Office reminds me of the frugal father who adds up the tab and is forced to put the brakes on a beloved daughter's plans for the "perfect" wedding.

The Congressional Budget Office told the Senate that the cost of their health reform legislation could be about 2.6 trillion dollars over the next decade - and still leave tens of millions without health insurance. The CBO also told Congress that plans to expand coverage to more Americans could cause an unsustainable increase in the federal deficit - unless offset by enforceable cuts in spending - and expressed skepticism that investments in prevention would achieve substantial savings. It acknowledged that primary care is associated with lower costs, but suggested that increasing the numbers of primary care physicians would help only if linked to policies to curb the numbers of non-primary care specialists:

"One study of the relationship between Medicare spending and the composition of the workforce of physicians found that, with the total number of physicians held constant, states with more general practitioners had lower spending. Achieving that outcome, however, involves reducing the number of specialists in line with increasing the number of primary care physicians, and the mechanism for accomplishing that change (for example, the appropriate adjustments in payment policies) is unclear. Savings would be less likely if the number of specialists remained the same while the number of primary care physicians increased."

The CBO report is causing Congress to hedge on its plans to have legislation passed before the August recess. The Democratic majority also is looking for ways to scale back how many would be covered, to find more revenue (tax) increases, and to find other measures that to save money - such as more cuts in payments to hospitals and other providers. The problem, though, is that tax increases and provider cuts will increase the level of opposition.

As Congress looks for ways to trim the cost, I worry that it will look in the wrong places. For instance, plans to spend more money to increase payments to primary care physicians and to train more of them could be at risk. One can anticipate the "we wanted to do more, but we couldn't find the money" excuse.

On Thursday, the leaders of the American College of Physicians, American Academy of Family Physicians, and the American Osteopathic Association are coming to Washington to make the case to Congress that failure to fund primary care will inevitably cost the country far more in the longer run . . . even if the CBO won't "count" such savings in the budget.

Today's questions: do you think Congress should scale back its plans because of the cost? How?


DrJHO7 said...

Do you think Congress should scale back its plans because of the cost? How?

No, I think they should do what we elected them to do, which is to make the changes that are necessary in the budget/expenditures of the government, the regulation of Big Pharma and Big Insura, and the revenue souces of the government, so that our health system provides a legitimate/reasonably attainable form of health coverage for every citizen in our country, be it private or public.

Yes they will have to grow some balls to do this, they will have to be innovative, put on their thinking caps, and take some time and energy away from their personal scandals, and the investigations there-of, work in the spirit of compromise and get it done.

President Obama said to AMA:

"To say it as plainly as I can, health care reform is the single most important thing we can do for America's long-term fiscal health. That is a fact."

Denying the writing on the wall, looking the other way and hoping it gets better is an outdated and ineffective modus. The free market, which we rely upon to fix significant fluctuations in our economy, does not work when it comes to health care, and is part of the reason things are as bad as they are, now.

Jay Larson MD said...

This is a classic pay now or pay later scenario. Everyone knows that paying later is much more expensive. It will take some time for the president and the congress to digest the CBO report. Talk about sticker shock.

With all the special interests having the resources to keep their share of the pie, it does not bode well for primary care. On a positive note, the sooner the system collapes the better for primary care. Primary care is relatively inexpensive compared to procedural based medical care. Primary care is less expensive than hospitalizations and ER visits. To top it off, primary care results in better quality and outcomes. So if the goal is to have a health care system that is cost effective and associated with improved quality and outcomes, perhaps the best thing to do is to do nothing and let the system tank.

Robert J. Sobel, M.D. said...

The focus on cost reduction should be on the "second trillion." I would not add any bureaucracies yet. I would order a cease and desist on pharmacy benefit operations, as there is an obvious conflict of interest with patient care. Regulated royalties for drugs (price controls, sanity, whatever you want to call it) should be instituted now, so we do not have to pay extra and Walgreen's and local pharmacies can get their fair margin. They can keep me informed efficiently. No more harassment.

While penalties would be fair, we are not here to punish but just to fix. A brand only environment with limits on marketing would allow me to get my patients back. That alone will save $ 200 billion dollars almost immediately, and not hurt front line caregivers.

My type 1 diabetic patients are currently harassed and accused of hoarding (guilty for safety reasons) and some sort of desire to forego co-pays by cheating. Enough of this nonsense. Let me enjoy seeing the new sensors and whether they work without financial coercion spoiling all the fun.

I can even bring down charges if honest reimbursement is negotiated/set/paid/whatever (public or private). Quit increasing my overhead with mandates and let me focus on patient care.

Simplify the pharmacopeia. A statin is a dollar a pill; go from there on your comparative analysis pricing.