As Kip Sullivan explains, MACRA is bringing us considerable administrative complexity and grief without evidence that it will achieve its goal of containing costs while improving quality. You may want to use the link above to read the rest of his article, including the footnote on CMS not being forthright.
The mantra today is to pay for quality instead of quantity, and the government and private sector are rapidly moving ahead with administratively burdensome programs to implement this vision. But they left out a step. As this GAO report reveals, they have not developed a program that can adequately measure quality.
The authors note that “most physicians are not explicitly racist and are committed to treating all patients equally,” but, importantly, “they operate in an inherently racist system.” Further, “structural racism is insidious, and a large and growing body of literature documents disparate outcomes for different races despite the best efforts of individual health care professionals.”
One of the major concerns with the implementation of the Affordable Care Act is that many of the exchange plans have narrow to ultra-narrow provider networks. Since it is difficult to determine the breadth of providers included, CMS is providing a network rating system to provide more transparency, as if the problem of narrow networks wasn’t much more serious than simply lack of adequate information.
Yesterday’s message described how insurers were using the deductibles to avoid paying anything for covered drugs while collecting a significant proportion of the patient’s payment for the prescription. Today’s shows how UnitedHealth is establishing co-payments much larger than the retail value of many of its authorized prescriptions, then requiring a kickback of the balance of the co-payment.
Private health insurers may argue that they should be rewarded for negotiating drug discounts for patients. But scooping up the entire discount and running away with it?
Many public option supporters have this concept that the government would create a public insurance plan that would successfully compete with private insurance plans, eventually displacing them and becoming a single payer national health program. Is this realistic?
California’s aggressive implementation of the Affordable Care Act has made it one of the more successful states in expanding the numbers of individuals with insurance coverage while reducing, for the previously uninsured, the financial burden of health care. But what if California had had a better designed health care financing system with which to work?
Churning – moving in and out of health plans, whether or not there are gaps in coverage – is clearly bad for the patient’s health. In this study, the rate of churning did not differ between states with different approaches to implementing the Affordable Care Act.
“Healing Health Care” by Sen. John Marty is not only a description of a health care reform proposal for Minnesota, more importantly it is a discussion of policies that all of us desperately need to improve the functioning of our health care financing and health care delivery systems.
Physicians for a National Health Program's blog serves to facilitate communication among physicians and the public. The views presented on this blog are those of the individual authors and do not necessarily represent the views of PNHP.
PNHP Chapters and Activists are invited to post news of their recent speaking engagements, events, Congressional visits and other activities on PNHP’s blog in the “News from Activists” section.