I was asked recently, how will we pay for reform?
Sen. Tom Coburn, on Sermo.com, asked physicains to support him not supporting us physicians in asking for repeal of SGR with its $250 billion dollar price tag. I don't know when he had this sudden change of heart, feeling physicians should not get paid more for Medicare patients, but hey...
The other question was about the overall price tag of HR 3200, somewhere in the neighborhood of $100 billion a year, or $1 trillion over ten years. (OK, $871B and $87.1B )
No problem. First and best answer: REPEAL THE BUSH TAX CUTS!
http://www.usnews.com/...
They were bad economics, bad public policy, and bad morally.
I'd advise listening to the two EXCELLENT "This American Life" episodes on HC reform:
http://cmhmd.blogspot.com/...
Follow the links, download the MP3's and you can make audio CDs for the car.
There are lots of answers in there, but I'll give you a few easy ones:
1.) McAllen, TX and EOL Care:
http://cmhmd.blogspot.com/...
That's actually two, practice variation and EOL care. Emulate the practices of the high performing systems like Mayo, Geisinger and Grand Junction and not McAllen, Miami and other over-utilizers. Provide excellent end of life care, giving people the CHOICE of spending their final days/weeks/months in an ICU or hospital or getting "salvage" chemothereapy versus going home with hospice to die in peace.
2.) Prescription co-pays: $10 for a $20 prescription, $30 for a $600 prescription. (Unless you have a coupon from the manufacturer to make the $30 copay $0.00 - the second TAL episode explains this.)
The example given on TAL actually occured to my niece. She was given a prescription for doxycycline, twice a day, for her skin, $4 at my Wal-Mart, free at my Giant Eagle. Dermatologist asked if she had a drug benefit, gave her a script for the non generic, once a day version, $600, but only a $30 co-pay. $10 with a coupon.
3.) George Lundberg has a few ideas:
http://cmhmd.blogspot.com/...
4.) Uwe Reinhardt has a modest proposal:
http://healthaffairs.org/...
5.) Wendell Potter, too:
http://www.time.com/...
6.) Administrative costs:
http://cmhmd.blogspot.com/...
Bottom line is, as has been suggested before, passing the bill is going to be half the battle, implementing reform in a way that is most beneficial to patients at the least cost to us as a society is next up.
But let's get everyone taken care of first, and avoid the 18K to 45K people dying EVERY YEAR due to lack of access to health care and THEN we'll deal with reducing costs. Turns out, if you read the Gawande article, they may be by doing the exact same things.
And finally, $1 trillion over ten years is $100 billion a year, and we spend $2.5 trillion a year on HC already, so that is very little money in the grand scheme of national economics. So, as Uwe would say, "Go explain to God why you cannot do this. He will laugh at you."
Cheers,