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View Diary: Health Care Reform as a House Member: What's Worth Fighting For And What Isn't (77 comments)

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    I'm glad you pimped it, no complaints on that.

    I wish that you weren't so dismissive of the points that I was trying to make.

    To say that they are slippery would be a huge understatement. If something acceptable comes out of this, it will be a huge accomplishment. We aren't there yet. There isn't the money. Thats what it all comes down to, you can't do it the insurance way, thats going to make affordability impossible.

    There is no "self sustaining" way, without single payer, not with all the giveaways. If they want to preserve their insurance barbarity so much, make the politicians pay for it..

    Just kidding, but hopefully I'm making my point that we need to see the impossibility of this without putting affordability and quality and the people first, not LAST.

    There's a good 2002 article comparing the US's models to Britian's NHS thats worth reading.. It all holds true..

    America sneezes, we catch a cold

    "What the NHS can learn from the US is that its healthcare system is in crisis. The US healthcare industry is big business, but the 40 million poor, including 10 million children, have no insurance. Healthcare bills result in 40% of personal bankruptcies annually.

    Consumer websites and organisations like Physicians for a National Health Programme have detailed how providers pass risk back to doctors and patients. Sometimes they refuse access to specialist and emergency care through rigorous medical necessity tests. Other times they resort to fraudulent advertising and unfair business practices.

    The government and Kaiser may well argue that its not-for-profit status engenders different behaviour. But in the US, the not-for-profits use the same tactics as the for-profits when the environment gets competitive. Kaiser actively seeks younger, healthier members and imposes different rates for employer groups based on their history and risk of healthcare.

    Sometimes their competitive behaviour gets them into trouble. The California branch of Kaiser has had cumulative fines of $1.6m, 63% of all the fines levied by the Californian department of managed healthcare. The activities for which they have been fined include denial of care, use of unqualified staff and inadequate staff-patient ratios.

    In Britain, the government argues that it does not matter who provides health services so long as they remain publicly funded. But the crisis-ridden US healthcare industry is also heavily dependent on government funding and there are striking similarities between its model of health maintenance organisations (of which Kaiser is one example) and Britain's primary care trusts, which replaced district health authorities in April and which will hold 70% of the NHS budget.

    American health maintenance organisations integrate insurer (funding) and provider functions, rather like Bupa or PPP healthcare. This builds in an incentive to pass the risks and costs of care down to the patient. Primary care trusts also integrate funding and provider functions and are established as trading bodies or business units. Their statutory duties require them to break even and when there is insufficient funding they must find more income or pass risk back to patients.

    There are four ways of doing this: excluding high-risk groups; limiting the range of services; redefining some NHS care as non-NHS care; and income generation through private healthcare. The first option is difficult since primary care trusts can't actively exclude high-risk and high-cost individuals, but they will have a strong incentive to restrict the services available to groups such as the mentally ill and those with chronic disease.

    Primary care trusts may also seek to redefine NHS care as personal care by implementing Department of Health guidance issued last year which recommends limiting NHS care to a maximum of six weeks. Primary care trusts could use this to redefine elements of NHS care as personal care (rehabilitation after a stroke, say), which would then be subject to means testing and patient charges.

    There is nothing to stop primary care trusts promoting the use of private insurance and sale of top-up services to NHS patients. A recent BMJ article which purported to show that Kaiser delivered cheaper healthcare at higher quality has been discredited. The NHS provides cover to all 60 million residents but Kaiser California covers fewer than 6.1 million of the 34 million in California and excludes the 20% uninsured. Even so, Kaiser's crude costs are more than 40% higher per capita than the NHS. Healthcare costs rise while access and quality fall when private providers come on the scene.

    The government's modernisation plans for the NHS have all the hallmarks of the US model in which the government devolves the risks and costs of care to doctor and patient. The success of the NHS has been due to its dual role as universal payer and provider. If the government persists in uncoupling this by importing US models of care, they will import the US care crisis and all the inequities which follow."

    We basically give up everything important that we might be able to salvage for America out of its corporate destruction if we let the neocon Obama administration and the insurance industry's million dollar a day PR campaign turn our nations dreams and future into a nightmare for the sake of plausible denial and blood profits for the insurance industry just so some politcians can finish helping their pals loot the nation without worrying about money being tied up in health and education. Thats what its really about. They are trying to nullify the people's wish in 2008. Health reform postponed till 2014 is a gift to the GOP, probably the payback for help in the primaries. Reform will never arrive, too many bad things can and will happen between now and then. Americans are tired and they want to lie down in the snow. But that is death. They are liars. Its tempting to allow evil people to have the benefit of the doubt but they will just laugh and continue the murder.

    They are trying to prop healthcare costs up, NOT lower them.

    by Andiamo on Wed Jan 13, 2010 at 07:45:48 PM PST

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