A plan actually designed to fix American health care
Published December 4, 2013
by Mitch Kokai, The Locker Room, December 3, 2013.
Becky Quick devotes her latest Fortune magazine column to sharing the results of a conversation with Mark Bertolini, “chairman, CEO, and president of insurance giant Aetna.”
He has a simple three-point plan to heal our ailing health care system:
Eliminate fee for service: His first priority is to change the way we pay for care, which currently encourages doctors and hospitals to order as many tests and procedures as Medicare and other insurers will allow. A 2009 report from the Institute of Medicine estimates that 30% of all spending on health care is squandered. Apply that to the $2.7 trillion we spent last year, and you get $810 billion of waste. Of that, the Institute of Medicine says, 27% is due to unnecessary services. Instead of fee for service, Bertolini says, hospitals and doctors should be paid for a good outcome. “It would have to be partnered with Medicare,” he says. “That starts to get after all that inefficiency and fraud.”
Focus on the heavy users: Bertolini points out that 5% of Medicare patients are responsible for 43% of the $550 billion spent on the program — and says that trend is similar in the broader population of patients. To find big savings, you have to target where the big money is being spent, and you can do that by focusing on one disease: diabetes.
Aetna is encouraging its employees to stay healthier by offering a $300 premium reduction if they pass a test that measures vitals like waist size, glucose levels, and blood pressure. If a worker’s spouse passes the test, the employee gets another $300 incentive. (Research shows that a healthy spouse encourages good habits at home.) That and other programs have helped. Aetna’s employee health care costs fell by 7.5% last year, while the national average has been closer to a gain of 5% to 6%.
Restructure the delivery system: “Send all the hearts to the Cleveland Clinic. Send all the cancers to Memorial Sloan-Kettering,” he says, laying out a plan to develop regional centers of excellence around the country. And reward the institutions that produce better outcomes.
Without assessing any of Bertolini’s proposals, this observer notes with interest that none of these ideas has anything to do with access to insurance.
December 4, 2013 at 10:15 am
Norm Kelly says:
Before it's even fully implemented, Obamacare is a complete, total, utter failure. Conservatives knew it would be while it was still being discussed in Congress. Liberals are finding out now: the proof is in their willingness to back away from it, reduce their support for it, postpone parts & pieces of it's implementation. Care to argue that? Base on facts, of course. (which automatically eliminates argument from liberals!)
So, the fact is that Obamacare/socialized medicine part 1 is a failure in trying to get insurance to everyone. (referring to the closing statement in this post.) Some would say that the biggest impediment to making insurance affordable to more people is the high cost of said insurance. What the Aetna guy explains are steps to reduce the cost of medical care delivery, thereby reducing the cost of insurance. If it cost me less to see a doctor, either I can pay for it out of pocket & maintain simple major medical insurance, OR the regular insurance I pay for will be less costly because it's only paying for services I need rather than for 'everything' coverage.
Currently, 'experts' contend that somewhere between 40 & 50 million people have no insurance in America. Some of that is voluntary, like young people. After socialized medicine/the DemoncRAT plan part 1 is fully implemented, these same 'experts', who told us the lie that Obamacare would cover everyone, now estimate that somewhere around 30 - 33 million will remain uninsured. So the cost of insurance will sky-rocket under DemocRAT plan part 1, not everyone will be covered as they told us, and those of us who wanted to keep our existing plan won't be able to. First we were lied to by this administration, and most DemocRATS in Washington, about being able to keep it. Second, we are told by these same central planners that our existing plan, that we selected, that we pay for, is sub-standard and should be eliminated. The Central Planners have decided what I MUST pay for, forced the plan I wanted to buy/pay for to be eliminated from the market, used the force of government to change the marketplace to REDUCE my choices. So when King Barack tells me once again that Obamacare's role is to expand options, reduce costs, increase coverage, and that it will not cause the federal deficit to explode, on what grounds should I believe him. The only part of his claims that shows any level of truth is that Obamacare expands coverage, because it forces me to carry benefits that I can't use but must PAY for.
So, the conclusion is that socialized medicine, forced participation, does not work. Why would it be such a disaster to try some of what this guy from Aetna mentions? Doing what we are doing, getting the central planners more involved in medical care, is ruining the health care system in America. Why are liberals so afraid of trying something else? Is it because it will prove the liberal/socialist/central planner agenda is wrong? Yes. Is it because it will remove some power from the central planners? Yes. Is it because it would reduce costs & improve health care delivery to more people? No, that can't be why liberals are opposed to trying something else. Could it? If improving the system comes at the cost of power & control by the central planners, I say this is THE MAJOR reason that Obamacare was forced down our throats by a party-line vote, with barely a majority. The major thrust of Obamacare is, has been, will continue to be concentrating power in Washington, not in improving health care delivery. Is it possible to prove me wrong? I'd be interested in your efforts.
December 4, 2013 at 10:14 pm
Tom Hauck says:
Thank you for a good column Mr. Kokai.
Very few have picked up on the IOM study of saving over $750 billion per year for our healthcare. The study also says how to save the money.
Another expert to say the same thing was Dr. Donald Berwick, the head of CMS (Medicare and Medicaid) for 17 months, who gave an interview to the NY Times on 12/3/2011, as he was walking out the door after resigning.
Dr. Berwick listed five ways to reduce the extremely high level (20 to 30%) of waste or $150 to $250 billion per year -- just for Medicare and Medicaid.
Here is the link http://www.nytimes.com/2011/12/04/health/policy/parting-shot-at-waste-by-key-obama-health-official.html?_r=0&pagewanted=print
