After five years’ experience with the ACA, we now know that insurers themselves are a major barrier to achieving the kind of access to affordable care that our population so desperately needs.
The proposed legislation casts in concrete an almost laughable complex and expensive clinical record-keeping regime, while preserving the very volume-enhancing features of fee-for-service payment that caused the SGR problem in the first place. The cure is actually worse, and potentially more expensive, than the disease we have now.
“Although the past decade has witnessed a fair amount of experimentation with performance-based payment models, primarily P4P programs, we still know very little about how best to design and implement value-based payment programs to achieve stated goals and what constitutes a successful program.” – 2014 Rand report
by John Geyman, M.D. Author of How Obamacare is Unsustainable. Now that Obamacare (the Affordable Care Act or ACA) is just turning five years since its enactment in 2010, it is time to assess its progress and shortfalls. This is the first of three posts that will deal with its experience toward its major goals—expanding […]
While there may be merit in some of these proposals, Brill’s brief prediction of how they would reform our system is unpersuasive and comes across as only wishful thinking, uninformed by evidence. His “plan” would just add another layer to our flawed system…
by John Geyman, M.D. http://www.copernicus-healthcare.org Having just finished reading Bob Herbert’s excellent book, Losing Our Way: An Intimate Portrait of a Troubled America, I am struck by the parallels between trends in public education and in health care. Herbert, opinion columnist for the New York Times for 18 years and now a Distinguished Senior Fellow […]
The prices and costs of cancer care in the United States have been growing so fast, for so long, that they are now a “canary in the coal mine” of an unaccountable health care system. Many cancer patients are now forced by their increased cost burdens to forego necessary care and die earlier without adequate care. There is a fix—single-payer financing that eliminates profits and waste to the detriment of patient care.
The V.A.’s failures are a failure of its delivery system, not its financing system (except to the extent that it is probably underfunded to meet expanded needs}. Contrast that with our civilian health care system, based as it is not on service but ability to pay, which continues to be a failed system on both the financing and delivery sides. Its failures have been documented in my latest book Health Care Wars: How Market Ideology and Corporate Power Are Killing Americans, and many of the posts from my fellow Health Care Disconnects panel members over the last year.
Ten of the 25 largest health systems in the U.S. are now Catholic-sponsored. As many Bishops interpret Ethical and Religious Directives (ERDs) for Catholic Health Care Services more rigorously, health professionals often are unable to provide evidence-based reproductive and end-of-life care based on religious grounds. This blog summarizes some of the problems and harms to patients.
“Premium support” or voucher proposals for Medicare are a mainstay of conservative health policy. They have been defeated for over three decades, starting with President Reagan’s FY 1981 budget proposal. They are a key feature of “managed competition” — type reform proposals. Although President Clinton embraced managed competition in his ill-fated health reform bill, he vetoed the 1995 Balanced Budget Act which would have turned Medicare into a voucher program. Premium support proposals were defeated again in 1997 and 2003.
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