Conservative leader David Cameron on the NHS

Quote of the Day
August 17, 2009
“One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you. That’s why we as a Party are so committed not just to the principles behind the NHS, but to doing all we can to improve the way it works in practice.”
(Since this quote, Conservative David Cameron was elected Prime Minister.)
https://pnhp.org/blog/2009/08/17/conservative-leader-david-cameron-on-the-nhs/

And…

NHS shake-up grants new powers to doctors and patients

By Rebecca Smith
Telegraph.co.uk
July 12, 2010
GPs are to be handed £80bn of the NHS budget to buy care from hospitals and other doctors for patients in their area, as hundreds of middle-management organisations are swept away.
Family doctors will be responsible, in consortiums, for commissioning the care for patients in their area by buying treatment from hospitals, charities and other doctors.
Under the new Coalition government’s health white paper, ministers will step back from the day-to-day running of the health service and hand power to the front line.
Andrew Lansley, Health Secretary, said the white paper represented a “vision based on the principles of freedom, fairness and responsibility”.
However, there was immediate criticism from Labour and the unions, saying handing £80bn to GPs who are private contractors was a mistake and that the plan was a ‘Trojan horse’ for widespread privatisation.
The document entitled Equity and Excellence: Liberating the NHS includes wide-ranging reforms covering all aspects of the NHS and healthcare.
Mr Lansley said ‘process-driven’ Labour government targets, such as the 18-week waiting time between GP referral and hospital treatment, will be scrapped and the focus will instead be on quality of outcomes for patients.
All hospitals are to become a Foundation Trust or part of one, giving them far greater freedoms from Whitehall and allowing them to earn more money from private patients.
Management costs are to be cut in half but the Government has already admitted that the NHS would be forced to make staff redundant. It is estimated that around 25,000 jobs could be lost.
Nigel Edwards, acting chief executive of the NHS Confederation, which represents all NHS organisations, said the changes would represent a huge upheaval.
“It is hard to stress just how radical this is. The NHS will look much more like the gas, electricity or telecom’s market than it will the monolithic state bureaucracy we have come to understand,” he said.
Dr Jennifer Dixon, director of the think thank, the Nuffield Trust, said handing billions of pounds of taxpayer’s money to GPs was ‘risky’ and is a significant change from their current role.
Andy Burnham, Shadow Health Secretary, called the white paper a ‘giant political experiment’ and warned that the government were taking an ‘£80bn gamble with the great success story that is out National Health Service today’.
“At a stroke, you are removing public accountability and opening the door to unchecked privatisation; you are demoralising NHS staff at just the time you need them at their motivated best,” he told Mr Lansley in the House of Commons.
David Fleming of Unite, said: “This is an untested, expensive Trojan Horse in political dogma that will give private companies an even greater stake in the NHS – this way of operating has already happened in the USA.
“Before the election, the Tories promised no major reorganisation of the health service – within three months that pledge to the British people, the majority of whom did not vote for further privatisation of the NHS – has been broken. So much for the ‘new politics’.”
http://www.telegraph.co.uk/health/healthnews/7885753/NHS-shake-up-grants-new-powers-to-doctors-and-patients.html

And…

Equity and excellence: Liberating the NHS

Department of Health (England)
July 2010
5. Cutting bureaucracy and improving efficiency
The scale of the NHS productivity challenge may prompt calls during this Parliament for even bigger increases in NHS resources; but the reality is that there is no more money.
So our first task is to increase the proportion of resource available for front-line services, by cutting the costs of health bureaucracy. Over the past decade, layers of national and regional organisations have accumulated, resulting in excessive bureaucracy, inefficiency and duplication. The Government will therefore impose the largest reduction in administrative costs in NHS history. Over the next four years we will reduce the NHS’s management costs by more than 45%.
The Department will shortly publish a review of its arm’s-length bodies. Subject to Parliamentary approval, we will abolish organisations that do not need to exist. We will streamline those functions that need to remain, to cut cost and remove duplication and burdens on the NHS. In future, the Department will impose tight governance over the costs and scope of all its arm’s-length bodies.
The Government will cut the bureaucracy involved in medical research. We have asked the Academy of Medical Sciences to conduct an independent review of the regulation and governance of medical research. In the light of this review we will consider the legislation affecting medical research, and the bureaucracy that flows from it, and bring forward plans for radical simplification.
We are moving to a system of control based on quality and economic regulation, commissioning and payments by results, rather than national and regional management. Within that context, we are committed to reducing the overall burdens of regulation across the health and social care sectors. We will therefore undertake a wide-ranging review of all health and social care regulation, with a view to making significant reductions.
Equity and excellence: Liberating the NHS (61 pages):
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117352.pdf

The British National Health Service (NHS) is one of the most effective health care systems in the world. That is a remarkable achievement considering that they devote only half as much funds to their health care as does the United States (percent of GDP in 2008: UK 8.7% versus US 16.0%). Yet in their white paper, “Equity and excellence: Liberating the NHS,” the Conservative government of Prime Minister David Cameron states, “the NHS productivity challenge may prompt calls during this Parliament for even bigger increases in NHS resources; but the reality is that there is no more money.”
No more money!? Excuse the vulgarity, but… bullshit!
The Cameron government is using this false claim to dramatically pull back the government’s role in the NHS, and to push privatization. They are not only cutting back on essential government administrative functions (as opposed to the profound administrative waste in the U.S. system), but they are also failing to honor their duty as stewards of the taxpayers’ funds to maintain adequate regulatory oversight of their public health care system.
They are even going so far as to reduce the government’s role in medical research. Could you imagine the Congress of the United States defunding our National Institutes of Health merely because it is a composite of government bureaucracies?
Is this really what the people of England voted for?

Conservative leader David Cameron on the NHS

Quote of the Day
August 17, 2009

“One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you. That’s why we as a Party are so committed not just to the principles behind the NHS, but to doing all we can to improve the way it works in practice.”

(Since this quote, Conservative David Cameron was elected Prime Minister.)

https://pnhp.org/blog/2009/08/17/conservative-leader-david-cameron-on-the-nhs/

And…

NHS shake-up grants new powers to doctors and patients

By Rebecca Smith
Telegraph.co.uk
July 12, 2010

GPs are to be handed £80bn of the NHS budget to buy care from hospitals and other doctors for patients in their area, as hundreds of middle-management organisations are swept away.

Family doctors will be responsible, in consortiums, for commissioning the care for patients in their area by buying treatment from hospitals, charities and other doctors.

Under the new Coalition government’s health white paper, ministers will step back from the day-to-day running of the health service and hand power to the front line.

Andrew Lansley, Health Secretary, said the white paper represented a “vision based on the principles of freedom, fairness and responsibility”.

However, there was immediate criticism from Labour and the unions, saying handing £80bn to GPs who are private contractors was a mistake and that the plan was a ‘Trojan horse’ for widespread privatisation.

The document entitled Equity and Excellence: Liberating the NHS includes wide-ranging reforms covering all aspects of the NHS and healthcare.

Mr Lansley said ‘process-driven’ Labour government targets, such as the 18-week waiting time between GP referral and hospital treatment, will be scrapped and the focus will instead be on quality of outcomes for patients.

All hospitals are to become a Foundation Trust or part of one, giving them far greater freedoms from Whitehall and allowing them to earn more money from private patients.

Management costs are to be cut in half but the Government has already admitted that the NHS would be forced to make staff redundant. It is estimated that around 25,000 jobs could be lost.

Nigel Edwards, acting chief executive of the NHS Confederation, which represents all NHS organisations, said the changes would represent a huge upheaval.

“It is hard to stress just how radical this is. The NHS will look much more like the gas, electricity or telecom’s market than it will the monolithic state bureaucracy we have come to understand,” he said.

Dr Jennifer Dixon, director of the think thank, the Nuffield Trust, said handing billions of pounds of taxpayer’s money to GPs was ‘risky’ and is a significant change from their current role.

Andy Burnham, Shadow Health Secretary, called the white paper a ‘giant political experiment’ and warned that the government were taking an ‘£80bn gamble with the great success story that is out National Health Service today’.

“At a stroke, you are removing public accountability and opening the door to unchecked privatisation; you are demoralising NHS staff at just the time you need them at their motivated best,” he told Mr Lansley in the House of Commons.

David Fleming of Unite, said: “This is an untested, expensive Trojan Horse in political dogma that will give private companies an even greater stake in the NHS – this way of operating has already happened in the USA.

“Before the election, the Tories promised no major reorganisation of the health service – within three months that pledge to the British people, the majority of whom did not vote for further privatisation of the NHS – has been broken. So much for the ‘new politics’.”

http://www.telegraph.co.uk/health/healthnews/7885753/NHS-shake-up-grants-new-powers-to-doctors-and-patients.html

And…

Equity and excellence: Liberating the NHS

Department of Health (England)
July 2010

5. Cutting bureaucracy and improving efficiency

The scale of the NHS productivity challenge may prompt calls during this Parliament for even bigger increases in NHS resources; but the reality is that there is no more money.

So our first task is to increase the proportion of resource available for front-line services, by cutting the costs of health bureaucracy. Over the past decade, layers of national and regional organisations have accumulated, resulting in excessive bureaucracy, inefficiency and duplication. The Government will therefore impose the largest reduction in administrative costs in NHS history. Over the next four years we will reduce the NHS’s management costs by more than 45%.

The Department will shortly publish a review of its arm’s-length bodies. Subject to Parliamentary approval, we will abolish organisations that do not need to exist. We will streamline those functions that need to remain, to cut cost and remove duplication and burdens on the NHS. In future, the Department will impose tight governance over the costs and scope of all its arm’s-length bodies.

The Government will cut the bureaucracy involved in medical research. We have asked the Academy of Medical Sciences to conduct an independent review of the regulation and governance of medical research. In the light of this review we will consider the legislation affecting medical research, and the bureaucracy that flows from it, and bring forward plans for radical simplification.

We are moving to a system of control based on quality and economic regulation, commissioning and payments by results, rather than national and regional management. Within that context, we are committed to reducing the overall burdens of regulation across the health and social care sectors. We will therefore undertake a wide-ranging review of all health and social care regulation, with a view to making significant reductions.

Equity and excellence: Liberating the NHS (61 pages):
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117352.pdf

The British National Health Service (NHS) is one of the most effective health care systems in the world. That is a remarkable achievement considering that they devote only half as much funds to their health care as does the United States (percent of GDP in 2008: UK 8.7% versus US 16.0%). Yet in their white paper, “Equity and excellence: Liberating the NHS,” the Conservative government of Prime Minister David Cameron states, “the NHS productivity challenge may prompt calls during this Parliament for even bigger increases in NHS resources; but the reality is that there is no more money.”

No more money!? Excuse the vulgarity, but… bullshit!

The Cameron government is using this false claim to dramatically pull back the government’s role in the NHS, and to push privatization. They are not only cutting back on essential government administrative functions (as opposed to the profound administrative waste in the U.S. system), but they are also failing to honor their duty as stewards of the taxpayers’ funds to maintain adequate regulatory oversight of their public health care system.

They are even going so far as to reduce the government’s role in medical research. Could you imagine the Congress of the United States defunding our National Institutes of Health merely because it is a composite of government bureaucracies?

Is this really what the people of England voted for?

By Louise Kertesz
America’s Health Insurance Plans
July 12, 2010

“Despite many challenges, health plans are well positioned to drive improvements” in care delivery through collaborations with providers. “Health plans have an enormous amount of assets” in the form of data and relationships they can leverage to improve care, said Jeremy Nobel, MD, adjunct lecturer, health policy and management, Harvard School of Public Health.

To drive improvement, plans can contract with providers to deliver value-based care, with reimbursement linked to performance. Plans can help establish medical homes, accountable care organizations, and episode pricing, he said.

They can also offer providers online tools to improve care delivery effectiveness and efficiency, such as e-prescribing, registries, computerized order entry, and electronic health records. Plans can “be an active infomediary between members and providers, supporting collaborative and value-based care through care gap alerts and shared personal health records.”

Rushika Fernandopulle, MD, a principal at Renaissance Health, has been involved in installing disease management processes for patients with chronic conditions in physician practices in Seattle and Atlantic City. His group has used predictive modeling to identify patients, brought in health coaches, and set up a three-tier payment model (in Seattle) and global budgets (in Atlantic City).

Putting DM processes – usually reserved for health plans and DM vendors – into physician offices is “next-generation disease management,” he said.

“This sort of close payer-provider partnership is not easy, but it is very rewarding when done right. It’s a very active process—more than writing a check and walking away. Plans need to be willing to invest enough, and be patient. There needs to be strong, ongoing connections at multiple levels, including personal relationships; one person needs to own this and go between” physicians and plan, he said.

http://www.ahiphiwire.org/News/Default.aspx?channel=HealthIT&doc_id=617027&utm_source=7/12/2010&utm_medium

Comment:

By Don McCanne, MD

Now that Congress has codified a permanent role in health care for the private insurance industry, what will be the next entrepreneurial innovations of the private insurance/managed care industry? “Plan-provider collaborations” that are “not easy” but “very rewarding when done right.”  Be afraid. Be very afraid!

Plan-Provider Collaborations Promise Improved Care Delivery

By Louise Kertesz
America’s Health Insurance Plans
July 12, 2010

“Despite many challenges, health plans are well positioned to drive improvements” in care delivery through collaborations with providers. “Health plans have an enormous amount of assets” in the form of data and relationships they can leverage to improve care, said Jeremy Nobel, MD, adjunct lecturer, health policy and management, Harvard School of Public Health.

To drive improvement, plans can contract with providers to deliver value-based care, with reimbursement linked to performance. Plans can help establish medical homes, accountable care organizations, and episode pricing, he said.

They can also offer providers online tools to improve care delivery effectiveness and efficiency, such as e-prescribing, registries, computerized order entry, and electronic health records. Plans can “be an active infomediary between members and providers, supporting collaborative and value-based care through care gap alerts and shared personal health records.”

Rushika Fernandopulle, MD, a principal at Renaissance Health, has been involved in installing disease management processes for patients with chronic conditions in physician practices in Seattle and Atlantic City. His group has used predictive modeling to identify patients, brought in health coaches, and set up a three-tier payment model (in Seattle) and global budgets (in Atlantic City).

Putting DM processes – usually reserved for health plans and DM vendors – into physician offices is “next-generation disease management,” he said.

“This sort of close payer-provider partnership is not easy, but it is very rewarding when done right. It’s a very active process—more than writing a check and walking away. Plans need to be willing to invest enough, and be patient. There needs to be strong, ongoing connections at multiple levels, including personal relationships; one person needs to own this and go between” physicians and plan, he said.

http://www.ahiphiwire.org/News/Default.aspx?channel=HealthIT&doc_id=617027&utm_source=7/12/2010&utm_medium

Comment:

By Don McCanne, MD

Now that Congress has codified a permanent role in health care for the private insurance industry, what will be the next entrepreneurial innovations of the private insurance/managed care industry? “Plan-provider collaborations” that are “not easy” but “very rewarding when done right.”  Be afraid. Be very afraid!

Plan-Provider Collaborations Promise Improved Care Delivery

By Louise Kertesz
America’s Health Insurance Plans
July 12, 2010
“Despite many challenges, health plans are well positioned to drive improvements” in care delivery through collaborations with providers. “Health plans have an enormous amount of assets” in the form of data and relationships they can leverage to improve care, said Jeremy Nobel, MD, adjunct lecturer, health policy and management, Harvard School of Public Health.
To drive improvement, plans can contract with providers to deliver value-based care, with reimbursement linked to performance. Plans can help establish medical homes, accountable care organizations, and episode pricing, he said.
They can also offer providers online tools to improve care delivery effectiveness and efficiency, such as e-prescribing, registries, computerized order entry, and electronic health records. Plans can “be an active infomediary between members and providers, supporting collaborative and value-based care through care gap alerts and shared personal health records.”
Rushika Fernandopulle, MD, a principal at Renaissance Health, has been involved in installing disease management processes for patients with chronic conditions in physician practices in Seattle and Atlantic City. His group has used predictive modeling to identify patients, brought in health coaches, and set up a three-tier payment model (in Seattle) and global budgets (in Atlantic City).
Putting DM processes – usually reserved for health plans and DM vendors – into physician offices is “next-generation disease management,” he said.
“This sort of close payer-provider partnership is not easy, but it is very rewarding when done right. It’s a very active process—more than writing a check and walking away. Plans need to be willing to invest enough, and be patient. There needs to be strong, ongoing connections at multiple levels, including personal relationships; one person needs to own this and go between” physicians and plan, he said.
http://www.ahiphiwire.org/News/Default.aspx?channel=HealthIT&doc_id=617027&utm_source=7/12/2010&utm_medium

Now that Congress has codified a permanent role in health care for the private insurance industry, what will be the next entrepreneurial innovations of the private insurance/managed care industry? “Plan-provider collaborations” that are “not easy” but “very rewarding when done right.”  Be afraid. Be very afraid!

Plan-Provider Collaborations Promise Improved Care Delivery

By Louise Kertesz
America’s Health Insurance Plans
July 12, 2010

“Despite many challenges, health plans are well positioned to drive improvements” in care delivery through collaborations with providers. “Health plans have an enormous amount of assets” in the form of data and relationships they can leverage to improve care, said Jeremy Nobel, MD, adjunct lecturer, health policy and management, Harvard School of Public Health.

To drive improvement, plans can contract with providers to deliver value-based care, with reimbursement linked to performance. Plans can help establish medical homes, accountable care organizations, and episode pricing, he said.

They can also offer providers online tools to improve care delivery effectiveness and efficiency, such as e-prescribing, registries, computerized order entry, and electronic health records. Plans can “be an active infomediary between members and providers, supporting collaborative and value-based care through care gap alerts and shared personal health records.”

Rushika Fernandopulle, MD, a principal at Renaissance Health, has been involved in installing disease management processes for patients with chronic conditions in physician practices in Seattle and Atlantic City. His group has used predictive modeling to identify patients, brought in health coaches, and set up a three-tier payment model (in Seattle) and global budgets (in Atlantic City).

Putting DM processes – usually reserved for health plans and DM vendors – into physician offices is “next-generation disease management,” he said.

“This sort of close payer-provider partnership is not easy, but it is very rewarding when done right. It’s a very active process—more than writing a check and walking away. Plans need to be willing to invest enough, and be patient. There needs to be strong, ongoing connections at multiple levels, including personal relationships; one person needs to own this and go between” physicians and plan, he said.

http://www.ahiphiwire.org/News/Default.aspx?channel=HealthIT&doc_id=617027&utm_source=7/12/2010&utm_medium

Now that Congress has codified a permanent role in health care for the private insurance industry, what will be the next entrepreneurial innovations of the private insurance/managed care industry? “Plan-provider collaborations” that are “not easy” but “very rewarding when done right.”  Be afraid. Be very afraid!

How The Center For Medicare And Medicaid Innovation Should Test Accountable Care Organizations

By Stephen M. Shortell, Lawrence P. Casalino and Elliott S. Fisher
Health Affairs
July 2010
The Patient Protection and Affordable Care Act of 2010 directs the Centers for Medicare and Medicaid Services (CMS) to create a national voluntary program for accountable care organizations (ACOs) by January 2012. ACOs are provider groups that accept responsibility for the cost and quality of care delivered to a specific population of patients cared for by the groups’ clinicians.
Accountable Care Models
Accountable care organizations will be largely based on physician practices that, in turn, may be organized as patient-centered medical homes. Many ACOs will also include hospitals, home health agencies, nursing homes, and perhaps other delivery organizations. There are at least five different types of practice arrangements that could serve as ACOs. These are the integrated or organized delivery system, multispecialty group practices, physician-hospital organizations, independent practice associations, and “virtual” physician organizations, all described below.
1. Integrated Delivery Systems
Integrated delivery systems involve a common ownership of hospitals, physician practices, and—in some cases—an insurance plan. Some examples are Kaiser Permanente, Group Health Cooperative of Puget Sound, and Geisinger Health System. These systems typically have aligned financial incentives, electronic health records, team-based care, and resources to support cost-effective care.
2. Multispecialty Group Practices
Multispecialty group practices usually own or have a strong affiliation with a hospital. Examples of this type of arrangement include Mayo Clinic and Cleveland Clinic. They usually do not own a health plan but, rather, have contracts with multiple health plans in their areas. Most have a long history of physician leadership and highly developed mechanisms for providing coordinated clinical care.
3. Physician-Hospital Organizations
These organizations are a subset of the hospital’s medical staff. One example is Advocate Health in Chicago. Most were formed in the 1990s in response to managed care pressures to negotiate with health plans. Some function like multispecialty group practices, focusing on reorganizing the delivery of care to achieve more cost-effective coordination. Although they may be less well suited than integrated delivery systems or multispecialty practices to qualify as ACOs, many could structure themselves to meet the criteria for that type of organization.
4. Independent Practice Associations
Independent practice associations consist of individual physician practices that came together largely for purposes of contracting with health plans. Over time, however, many of these have evolved into more-organized networks of practices that are actively engaged in practice redesign, quality improvement initiatives, and implementation of electronic health records. One example is Hill Physicians Group, in Northern California. Such organizations could qualify as ACOs, and that might encourage other independent practice associations to evolve similarly, given sufficiently strong financial incentives and technical assistance.
5. Virtual Physician Organizations
Finally, a number of small, independent physician practices, many located in rural areas, can organize to become “virtual” physician organizations, such as Community Care of North Carolina. This process can be led by individual physicians in rural areas or by a local medical foundation, state Medicaid agency, or similar organization that can provide the leadership, infrastructure, and resources to help small practices develop disease registries; implement electronic health records; share information; and provide better-coordinated, cost-effective care. These virtual networks could qualify as ACOs and serve as models for other groups of small practices.
Physicians can choose one or more of the above models, depending on what best fits their needs and local circumstances. But because there are so many options, the payment systems that the CMS creates for ACOs should evolve with the models chosen. Specifically, the more-integrated forms of accountable care, such as integrated delivery systems and multispecialty group practices, are capable of assuming the greatest risk. This would make them natural candidates for capitation or bundled payments, in which providers assume a relatively greater share of risk.
In contrast, less structurally integrated forms of ACOs, such as virtual physician organizations and more loosely organized independent practice associations, are best suited—at least initially—to low degrees of risk. For them, a form of limited, partial capitation for selected illnesses may be most appropriate.
To facilitate delivery system transformation and focus attention on desired health outcomes, payment systems need to change. Payment based on outcomes achieved, rather than on volume of services provided, will be the motivation for providers to focus their attention on improving the underlying systems of care.
Considerable technical assistance will be needed to implement the learning system for the development of ACOs. This will be particularly true for loosely organized independent practice associations and virtual physician networks, which currently lack the size and resources to become ACOs.
http://content.healthaffairs.org/cgi/content/abstract/29/7/1293

And…

Analyzing Shifts In Economic Risks To Providers In Proposed Payment And Delivery System Reforms

By Jeff Goldsmith
Health Affairs
July 2010
Conclusion
These innovative payment methods all share the assumption of broader responsibility — either formally or informally — by hospitals or physicians for reducing Medicare expense through better coordination and management of care. Sadly, these diverse approaches do not appear to fit together seamlessly to encompass the entire continuum of health care.
Policy makers are unlikely to find a single “silver bullet” they can use to replace Medicare fee-for-service payment. They might have to tolerate multiple, overlapping, and partial solutions, and substantial regional variation in the mechanisms that are feasible.
Nonetheless, for better or worse, hospitals are going to play a much larger role in organizing or reorganizing care in their communities. The most promising innovations are those that build on hospitals’ existing information technology and organizational infrastructure. The key to successful innovation will be extending risk assumption to follow suit.
http://content.healthaffairs.org/cgi/content/abstract/29/7/1299

“Accountable care organization” (ACO) is an abstract concept of organizing health care providers into single entities that are responsible for delivering a broad continuum of care for specific patients, while bearing financial risk for the care provided. Moving beyond that abstraction, there really isn’t much new on the policy front.
Most of the types of entities that might actually be able to serve as ACOs already exist, ranging from independent practice associations to fully integrated delivery systems. Even the concept of bundling payments already has applications ranging from Medicare’s DRG prospective payments (diagnosis related groups) to capitation payments for comprehensive health care services.
So what is new? Would payment systems be designed to require that all reimbursement be provided through ACOs? If so, what would happen to the sector of the health care delivery system that would be excluded from the ACOs that controlled the health care delivery in a given region? Would those providers simply become bankrupt and shut down? Could we afford to lose them, especially with the existing deficiencies in our primary care infrastructure?
Shortell, Casalino and Fisher suggest that the establishment of “virtual physician organizations” would address that concern, but here “virtual” seems to refer to the computer term of “not physically existing as such but made by software to appear to do so.” Of course, the providers would actually exist, but they would never function as a unified ACO providing the full range of services, including hospital services, for a given population requiring at least 5000 patients with accountable care protocols for each clinical entity.
Basically, the concept of the accountable care organization is merely a relabeling of various existing policy efforts to try to control inappropriate spending in our dysfunctional health care system. Since our goal is to provide health care for everyone while slowing the growth in spending to sustainable levels, clearly these policies have failed us.
Let’s go with a system that actually works to achieve the goal of affordable health care for everyone – a single payer national health program.

Health Reform Subsidy Calculator

Kaiser Family Foundation

An example for a 50 year old with a family of four, with income at 401% of federal poverty level:

$93,934 – Projected income in 2014

$16,858 – Unsubsidized health insurance premium in 2014

N/A – Maximum % of income the family has to pay for the premium

$16,858 – Actual family required premium payment

$0 – Government tax credit

$12,500 – The maximum out-of-pocket costs the person/family will be responsible for in 2014 (not including the premium)

$29,358 – Premium plus out-of-pocket costs

31% – Percent of income for premium plus out-of-pocket costs

http://healthreform.kff.org/SubsidyCalculator.aspx

Comment: 

By Don McCanne, MD

This calculator is useful for determining anticipated individual and family costs for insurance premiums plus out-of-pocket expenses for plans obtained through the insurance exchanges, if execution of the program is optimal.

Uncertainties arise since 1) premiums are not guaranteed and could be much higher if private insurers fail to restrain cost increases, and 2) out-of-pocket costs could be much higher based on plan design, limitations of provider networks, and expenses for disallowed services and products.

Furthermore, most individuals and families will not even be allowed to purchase plans through the exchanges.

What kind of reform is this? We could have covered everyone without the need to create personal financial hardship had we adopted a single payer national health program. In fact, we can still do that.