Skip to content

Economic Rules

16 comments

Rule #1: If you subsidize a thing, people will use more of it.

Rule #2: When the cost of the subsidy inevitably becomes prohibitive, ration it. So that, you know, the people you initially wanted to use the service, can’t use the service as often as you promised them.

Rule #3: If rationing doesn’t cut costs, then slash payments to the people providing the services.

This is where we’re headed with our health care, folks.

Post to Twitter Tweet This Post

Posted by on March 31, 2010 • Filed under: Uncategorized
  • http://thehappymedic.com the Happy Medic

    And that is exactly what happened to the oil industry, banks and General Motors, but what about the Medicare my grandmother demands, yet claims in unconstitutional? Is it being abused by the elderly or is it balanced on a broken system that puts profit before patient?

    If both sides actually stayed at work after 2PM maybe we could solve some of these problems.

    Respectfully,
    HM

  • Old_NFO

    yep… sigh… And guess who suffers- The Elderly…

  • totwtytr

    Medicare (and Social Security) were passed on the premise that people would pay into them during their working years and then be able to draw on them (with an assist from the government) when they retired. Obamacare is based on taxing one group for the benefit of another. Many of the 30 million people who don't have health care don't have it because they don't want it and don't think that they need it. There is a huge difference in morality and possibly constitutionality between the two.

    None of which was explained very well, if at all, during the debate over the bill. It's a bad law that if not repealed or revoked will result in reimbursement cuts across the board. I hope no one thinks that EMS as a whole is going to see more money. Chances are that with the Medicare cuts being projected, we'll see less money. None of which will be made up by the expansion of Medicaid that is being proposed.

    Of course the medical equipment industry is going to be taxed too, which will kill innovation. I hope you like the equipment you're using now, because you'll be using it for a long time.

    Of course the IRS will have it's budget and staff increased tremendously since it is the agency charged with enforcing much of the new law.

  • Ambulance_Driver

    And the fact that it happened to the oil industry, banks and GM didn't make it right, or even a workable solution.

    In my experience, most Medicare patients are not abusing the system. I see far higher evidence of system abuse among the uninsured and Medicaid users than those on Medicare, but I will stop short of saying that a majority of Medicaid users are abusing the system.

    The problem is, how do you devise a system to aid people who can't provide for themselves, without creating a class of people who won't do for themselves?

    That's a delicate balance that most governments have been unable to strike, and I hold out little hope that our government will do any better.

    Let me ask you this, however. Do you think the healthcare payment reform that just passed will decrease abuse and lessen the burdens on EMS and the ED, or make it worse?

    Because I see no viable way of steering people toward more appropriate avenues of care than the ED, when for many of them, there are no other options. Of what use is insurance for everyone, if you can't find a doctor to accept it, or even worse, find a primary care doctor, period?

    That's where we're headed.

  • http://thehappymedic.com the Happy Medic

    I think the most hilarious part of the arguments was the assumption that the 35 million uninsured will suddenly flood into the system. They're already there, in the waiting rooms of the local ER, where the most costly of preventative care makes those needing urgent interventions wait.

    No, this bill will not help EMS, I knew that going in, it's not the best bill but makes important steps towards more sensible reforms.

    I think more important than the minor cost of TORT reform would be the elimination of perceived liability in EMS not transporting. Call it 2.0, APP or just a return to critical thinking, but if other countries are beating us on every health score except cost with less, maybe we could learn something.

    But, until then, the threat of the lawsuit is more powerful than defending the truth in court.

    But was the outrageous increase in premiums and out of pocket expenses while decreasing payouts to providers, that was happening before the bill, the solution as well?

    The “free market” solution has failed in health care, so what next?

    Rhetorical. The bill isn't perfect, but I like a lot of the things it will bring to others since it will do squat for me, except let Blue Shield raise my rates another 14% next year.

    I have no answer.
    HM

  • Pingback: Thursday…Meandering thoughts and linky stuff « MaddMedic

  • totwtytr

    Many of the 35 Million uninsured are young, otherwise healthy people who don't use the ER. It's fallacious to think that all of them are the “working poor” that we are being told will benefit from this. IF it were necessary to insure those people, there are far more effective and less expensive means than taking over 1/6 of the US economy and effectively turning it over to the government.

    I'm not sure what scale you're using HM, but I don't see every other country beating us in every medical area except cost. If that were so, Canadian politicians wouldn't be coming here for surgery. In fact, I think you read it backwards, the US beats the other countries in every area except cost.

    Not to mention that the majority of voters are 1) happy with their health insurance and 2) very unhappy with this law. If that holds through until November a lot of Democrats are going to be unemployed.

  • TexasDad

    Dear All,

    Any thoughts how the “best” and “most expensive” health care system still manages to have a infant mortality rate higher than that of most European nations with socialized medicine, and why we tie nations like Poland and Slovakia?

    What metric are we using to determine out success in delivering health care in this country?

    The Clinton administration attempted to address the issues of health care and its costs, and the Republicans ignored it for the last 16 years, and the Democrats refused to bring it to the table again. I do wonder what would have happened if the Republicans had decided to actually cooperate with the President on addressing this issue 16 years ago.

    If the medical industry were to do better job of quality assurance, this would go a tremendous way to lowering costs. We shouldn't compensate hospitals for the mistakes they make. I don't know of an insurance plan that refuses to compensate for care for a patient that comes down with a secondary infection requiring additional hospitalization.

    Hand washing, the useless wearing of ties covered with resistant bacterial infections, the over reliance of delivering babies through c-section, medication errors, gross negligence that is covered up, these are all examples of practices that are killing the system. I would love to see a hospital that used Sigma Six practices in their delivery of treatment. This would lower costs, improve outcomes, decrease pain and suffering, and improve quality of life.

    Why do health insurance companies need different forms? Why can't there be a common form and code for everything?

    It is horrible that we have an entire industry in the USA that is so unresponsive in addressing its own shortcomings that we must rely on the legislative efforts.

  • Ambulance_Driver

    I second TOTWTYTR's comments. Most of the 35 million uninsured are the healthy young who see no need for insurance.

    Now they're going to be required to buy it, and by many estimates, the premiums of the lowest risk insured (the healthy young) are going to rise 17-20% to cover the cost of subsidizing everyone else.

    This bill is going to be a boon to the insurance industry, even with the (much needed) reforms of outlawing denials based on pre-existing conditions, etc. What's not so clear is whether it will be a boon to the patients, and it's highly doubtful it will be a boon to the people who provide the care.

    And yes, I think tort reform is necessary to lessen the fear of treatment and referral, or make treatment without transport a reality. But education standards will have to increase (already on the way with the new National EMS Education Standards), because it's not going to just be Mark Glencorse or Justin Schorr or Kelly Grayson making these decisions, it's also going to be that monosynaptic, booger-eating moron we've all worked with making them, too.

    You, my friend, are an outlier. As much as we like to think well of our profession as a whole, you are a cut above the average medic. Everyone that watches Chronicles of EMS, participates in these forums, blogs, goes to conferences, etc… are outliers. We represent a small minority of EMTs in this country. And until the rest of the profession is as engaged and passionate as you, EMS 2.0 is never going to be a reality.

    Keep going, though, because we'll never get there unless people start the conversation.

    But you seem to miss my earlier point. Even if every EMT in this country were somehow magically able to render treatment and make referral/no-transport decisions, where are we going to send the patients to?

    Primary care is dying, and the new health reform did nothing to address the reimbursement inequity and onerous regulation that is killing it. In Massachusetts, transit cops make substantially more than primary care physicians. The same is true in many other parts of the country.

    So I ask again, once everyone is insured, what will it matter if, in ten years, there are no doctors that take their government-subsidized insurance? The people who pay their own (much higher) premiums will still seek care in the same ways they've always done, and the people who have their insurance provided for free will go to the only place required by law to take care of them: the Emergency Department.

    And a bunch of them will call an ambulance to get them there.

  • Ambulance_Driver

    “Any thoughts how the “best” and “most expensive” health care system still manages to have a infant mortality rate higher than that of most European nations with socialized medicine, and why we tie nations like Poland and Slovakia?”

    Short answer: because they count them differently.

    You cannot objectively compare infant mortality rates between the U.S. and other countries because we use different metrics to measure them. In the U.S., if an infant is born with a heartbeat, even those considered too small to live, like the preemies weighing less than 500 grams, that is counted as a live birth.

    I'm not sure exactly what criteria they use, but in many European countries, many infants are declared stillborn that the U.S would consider viable.

  • Ambulance_Driver

    And by the way, Medicare does not pay for “never” events like falls or hospital-acquired infections, or hospital-acquired bedsores. Many private insurance companies tie their standards to Medicare's.

    Still, it's a sledgehammer solution to a tackhammer problem.

    Let's say you have an elderly patient with dementia, not an uncommon type of hospital inpatient. And that patient tends to get up and wander, and on their chart, they are marked as a “fall risk.”

    Now, the staff is not going to be allowed to routinely restrain even a demented patient in bed, and in the rare circumstances they are, almost always requires additional man hours, documentation, and sometimes even one-on-one care to satisfy the current regulations.

    So what if that patient manages to get out of bed, fall and break a hip? Medicare's not going to pay for it, and the only viable solution is to assign one nurse to watch patients like that – thus increasing the cost of care substantially.

    And since you're touting other, socialized medicine systems as being able to avoid all that, need I dredge up all the reports I've read of the sorry state of cleanliness in many UK hospitals, or the patients who have died of thirst while hospitalized? There are plenty of media reports of the horror stories you decry in U.S. hospitals, occurring in just the type of medical system you want.

    This is a tougher problem than you or I can solve. The difference is that you think our politicians are smart enough to draft legislation that can solve those problems. I don't hold our politicians' intelligence in nearly so high regard – on either side of the aisle.

  • TexasDad

    AD,

    One of the failings of the written word, is that it takes a more crafted wordsmith than I am to do a good job of explaining what they mean. Medicare and medicaid are legislative issues because they are funded by the taxpayers of this fine nation. I even feel legislation has a role in regulating industries that sell services (hospitals/insurance companies) to residents of the USA.

    I don't know how medicare reimburses. My gut feeling, given the theft and fraud that takes place in medicare, is that a lot of reimbursement takes place that shouldn't.

  • Ambulance_Driver

    You're right, fraud is a problem in Medicare reimbursement, but not in all health care industries. Much of the fraud comes from ambulance transport.

    The biggest problem with Medicare reimbursement is the inequity against primary care physicians. Medicare pays most for the most expensive care, which simply means that more doctors lean towards providing the most expensive procedures to maximize their profits. Profits aren't a bad thing, you need them to keep the doors open.

    But the problem with paying premiums for the most expensive care is that we get more of it. Meanwhile, primary care physicians are going broke. Give it another 15 years, and it won't matter that everyone in the U.S. is insured – there won't be any doctors outside of Emergency Departments and the lucrative specialties that will take insurance – private or medicare/Medicaid – anyway.

    Of course, the health reform legislation did nothing meaningful to address that particular elephant in the room.

    There's an essay you should read that illustrates the point. I don't link to him because I think he's a horse's ass, but you should read Happy Hospitalist's “Life in the Medicare Tomato.”

    http://thehappyhospitalist.blogspot.com/2009/06…

  • TexasDad

    AD,

    I loved the tomato analogy, and best of all his comments about transparency of costs.

    I had been briefed that the change to the Medicare laws on reimbursement for extended hospital time for preventable complications when compared to the patient's diagnosis related group hadn't actually impacted the bottom line of hospitals.

    My reading of the regulations indicated that the reimbursements covered preventable infections and events that were generally not life threatening, and rely on hospital billing systems to accurately record that the event was in fact a hospital acquired infection or injury.

    Again, when I look at the list, I don't see that it covers the more severe hospital acquired infections, and from my reading of the regulations, the hospital is covered fully by Medicare for treatment provided if the event progresses into a more serious infection or injury.

    The legislation has been in place since 2006, and at this point there should be metrics that indicate a measurable drop in injuries and infections at hospitals across the United States. As of yet, the death rate from hospital acquired infections seems to show no standard deviations from what is was in years prior to the legislation being enacted.

    This begs the question, if you can't legislate morality, can you legislate better medical care?

    The autopsy, which used to be routine in-hospital deaths doesn't seem to be practiced except in the rarest of cases. An organization invested in providing superb care would want autopsies to see if they were doing a good job.

    AD, keep having these discussions. We may disagree on politics, but I never doubt that my more conservative colleagues aren't as equally concerned with striving each day to make this nation better, and to always have it be the best place to live.

  • http://scottfactor.com Scott Factor

    Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it.
    Ronald Reagan said that…..and it applies to health care.

    http://scottfactor.com

  • http://scottfactor.com Scott Factor

    Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it.
    Ronald Reagan said that…..and it applies to health care.

    http://scottfactor.com

Vote for me! Click Here

Polarized sunglasses, Flashlights, and Hiking boots.