Money Flow, Medicare, Private Insurance, Waste

Interesting Economix by Uwe Reinhardt on money flow in health care:

He notes:

In fairness, it must be added that traditional Medicare basically sets prices and then just pays bills. It makes no active attempt to manage care (utilization controls, disease management, coordinating care and so on), because it has not been allowed by Congress to do so. It is almost as if Congress did not want traditional Medicare to be a prudent purchaser of heath care for the elderly. (Medicynical emphasis)

From the viewpoint of prudent purchasing, most economists would probably judge these prices too low. On the other hand, the fact that traditional Medicare just pays bills more or less passively may be precisely the reason that it is still so popular among the elderly. Traditional Medicare still offers beneficiaries completely free choice of providers and therapy — a degree of freedom that many younger Americans in insurance plans with limited networks of providers no longer enjoy.

Medicynical Note: Until we approach the issue of value in medicine (What works? Bang for the buck?) we’ll have the most expensive least efficient health care non-system in the world. What’s bugging us, the US, now is how to get to such a system.

Is health care part of the package of being a US citizen? Providing Medicare to the elderly and many with chronic illness implies such a commitment. Does required access to ER care for all, whether they can pay or not, point to a civic responsibility to assure access to care to the rest of the population?

If our republican friends really believe that health care is not a “right” then a large swath of citizenry are going to be in trouble as republicans follow through on this philosophy. Interestingly these rightist purists for some reason tout ER access for all as adequate health care in our non-system. Why they would choose the most expensive, least efficient care in the world as their means of providing health care is unknown.

If there is an explicit right to health care in our country, more efficient ways to provide it must be found. It should assure affordable care to citizens, including the elderly and those with illnesses. One problem has been that private insurers, ironically, want little to do with either of those populations.


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