Charlie Rose

CSRealist  01/14/2010 11:16 PM Report

@ EyesOnYou

I'd agree that it is a waste of money. In terms of cost-benefit, it's one of the most wasteful and fruitless areas that need reform. Unfortunately (this one goes @cotb), those who get the majority of their news and information from one or two partisan sources are easily frightened or confused. So what you have are critical issues that need to be addressed, but rather than there be solutions proposed, there's politics of fear. The end of life counseling issue is only one area of an enormous set of overlapping issues that needs attention.

The fact remains that these reforms will not reduce costs, but is a crucial step towards such a goal in a country as slow to change as the US. Change might happen a bit quicker if people had as great a proclivity for critical thinking and rational analysis of key issues as they do now for repeating talking points from their favorite talking heads on television and radio.

* Digression: Reimbursements, as you've suggested, would have major issues being implemented. 1st issue involves the subjective nature of any grading system, which is what Peter Orszag had alluded to. There are too many different "ways" of addressing a similar problem and trying to adopt such a standardized method to something as unpredictable as the human body would produces system wide problems. 2nd. The political-populist backlash to simply "cutting off grandma" wouldn't allow this to go through, even if it saves money and opens new avenues to more effective treatments.

* I think there needs to be education reform, to weed out the growing population of jackasses whom are first frightened/confused and are later convinced to vote/act against their own best interests.

I also think there needs to be a combination of P4P, caps on medical treatments, limits on technology diffusion, and an increase in the medicare/medicaid reimbursement rates. Essentially incentives should involve getting the doctors interested in serving the patient, not just coming "to work" or doing "a job", so that innovation can be the result of a motivated population of physicans who have access to less but recognize the challenges of health care delivery.

cotb  07/28/2009 09:11 PM Report

Obama: "I heard one Republican strategist..."

blah blah blah

Somebody needs to cut Obama down from his soap box. The presidency is a non-partisan office. Every time I hear President Obama invoke the anonymous straw man defense I get sick. I need a break from bending over the toilet. Please just execute the laws and stop using the presidency for political gain.

EyesOnYou  07/24/2009 12:37 AM Report

Orzag: "We don't know how to design the financial incentives yet".

A neighbor in her mid-80s just had heart surgery, complications ensued and her rather poor health has her spending the last several weeks in the hospital. At the risk of sounding heartless, I will say this is a total waste of money.

Medicare should have a range of reimbursement amounts based on a grading system. Age, general health condition should all be used as input to such system. Reimbursement for a procedure on someone in their 80s or 90s and in poor health gets much lower reimbursement than say someone in their 50s. It's a simple cost-benefit analysis. I'm not sure why this would be so hard to implement. Doctors can always submit their view as part of an appeal to justify the unusual cases.

REMant  07/23/2009 02:17 PM Report

Like Clinton, Obama has, at least, put it backwards. Rising health care costs are a result of our rising deficits, individual and corporate, tho ultimately, Federal and Federal Reserve, not the deficits, the result of rising costs. Even the insurance-attorney mutual-benefit society can only be tackled by ending our proclivity for putting bandaids on every public oo-boo. The way to tackle greed and monopolizing behavior is to cut off the funds that make it possible. Otherwise, the only way I can see to actually create the kind of competition we need is to put an overall cap on medical expenditures. It is not sufficient for the govt to offer cheaper insurance. As it is now, we are perpetually being kept at full capacity, and that's no way to get competition. Either way, we must live within our means. However, as in every other economic activity, what matters in the end is efficiency and that is a matter of productivity, or as Cortese put it later, the quality or value of care. And bandaids not only make possible, but encourage, just the opposite. What makes the Mayo Clinic different is simply that it has high-quality, honest and dedicated people interested in health, not profit, and this also being recognized by patients, they are trusted, resulting in lower insurance bills. Now the amazing thing is that they DO make more money that way, as Deming demonstrated many years ago.

TRICARE is a single-payer system offering a number of payment and provider options to provide healthcare for select military personnel and retirees in the private sector, in order to both extend and regularize their care, as well as, alleviate the burden of handling them in military care facilities. It has its origins in the 1950's.

tartufe  07/23/2009 01:37 PM Report

Tis a pity that two opposing systems can't be run side-by-each. I would love to compare laissez faire systemic outcomes to bailouts. The natural cleansing would be hard to deny. Defying this may prove more costly long term. Remember, no one has gone to jail as yet, which will prove just as detrimental long term as letting natural consequences run their course. The big banks should have been left to collapse of their own doing. Better off long term. The big boys are just as or more culpable than Madoff, and should be treated proportionately (200+ yrs).