On Friday on Robert Reich's blog How Pharma and Insurance Intend to Kill the Public Option, And What Obama and the Rest of Us Must Do
I'ved poked around Washington today, talking with friends on the Hill who confirm the worst: Big Pharma and Big Insurance are gaining ground in their campaign to kill the public option in the emerging health care bill.
You know why, of course. They don't want a public option that would compete with private insurers and use its bargaining power to negotiate better rates with drug companies. They argue that would be unfair. Unfair? Unfair to give more people better health care at lower cost? To Pharma and Insurance, "unfair" is anything that undermines their profit
As I have been advocating for the last year that a patient centered medical home model combined with technology actually allows medical providers more time to spend with patients, lets them provide better care that is patient focused and results in higher quality outcomes while increasing their incomes in most cases.
Today on the front page of the business section of the New York Times is a great article discussing many of the same topics.
If All Doctors Had More Time to Listen
doctors spend more time with patients, emphasize prevention and education to keep them healthy and can handle many medical problems without referrals to specialists.
Here in Seattle I belong to a clinic (flat fee $45 a month) that uses the Medical Home model for unlimited primary care visits and my former employer Group Health Cooperative is rolling out the same model to all of their primary care Physicians and Providers across the State. Since my insurance deductible is $500 a year I both contribute to my own care and get far better access (email, same day visits, 45 minutes per visit if needed) Other models like Qliance (also in Seattle) have sliding scales to see their providers of from $39 to $149 for an Internist and they often treat taxi drivers, artists even the unemployed and other people who lack any insurance at all and have chronic conditions like depression and kidney disease. For 7 doctors they only have 2 admins vs the typical 2 per provider in other models.
It allows the typical doctor to cut their practice panels down to 1000 patients and at $45 a month it works out to be about $500 per person or a gross of $500,000 per provider (the average primary care income is $240,000). I am sure that each of us could afford $50 a month (and a sliding scale for those in low income but everyone should pay at least something) who wanted to use this type of system.
You can read about those two models in a great article in the Seattle Timesearlier this year.
The stimulus bill includes 48 billion for health IT and we have another 2 billion set aside for clinical effectiveness studies so why not allow run a test and combine then with a public option for primary care so that small practices can eliminate the 40% of costs that go to admin and insurance overhead. They could compete with larger multi-speciality centers by putting the tools right into the hands of providers at the point of care, increase both patient and provider satisfaction and draw more doctors into primary care. In the last graduating class only 4% of residents chose it.
With big pharma and insurance pulling out the stops to block the public option perhaps it would make sense to provide everyone with primary care under this new model and leave insurance to cover the high cost episodic care. Rather then shifting up front costs to patients we need to cut those costs for anyone with a chronic condition and compensate providers for outcomes not procedures or visits. This would be a great place to start.
Investing in Patient Centered Primary Care and combining that with the 46 billion in Health IT will allow doctors and other providers to give high quality, patient centered care that is effective and compassionate.
Healthcare Reform Should Start with Primary Care and let big pharma fight over the high cost part of it.