Wednesday, December 09, 2009

Laws and Suggestions

Despite the track record of not finding any, I keep looking for signs that there are actually any reductions of health care costs in the current discussion of “health care reform” legislation. I keep getting my hopes lifted by a headline such as “Finding the Nerve to Cut Health Costs” in the New York Times today.

It starts out disappointingly with such things as “commission to reduce Medicare waste” and a “tax on plastic surgery.” The first is Medicare, so it affects government cost not general health care cost, and the second is not actually cost reduction at all.

Then it goes all vague about “waste” and says that the bill will “increase the typical family’s income $2,500 a year” but doesn’t says how it will do that. Since other articles boast of reducing insurance premiums, that could very well be what’s at play in this “income enhancement,” so I’m still not seeing any “health care cost” reduction.

Then it launches into a discussion of the “Medicare Payment Advisory Commission” and how it has suggested reducing payments for home health care. Except that the reduction discussed is only for Medicare, so we are again only talking about government cost, not costs borne by the general public for their health care, and the Senate has even rejected this reduction in government cost.

Then we get the entirety of the non-Medicare portion of cost cutting,

The day before the Senate defeated the home health care amendment, Senators Collins, Lieberman and Specter introduced an amendment with some measures to push medicine away from the insidious fee-for-service payment system. The cost-cutting momentum continued on Tuesday, when 11 of the 13 freshman Democratic senators announced their own package of measures. Neither proposal is earth-shattering, but both would make a difference.

Among other things, the freshmen’s proposal would do more than the current Senate bill to push insurers to use a standardized payment process. Right now, doctors and hospitals often have to fill out different forms for different insurers. “There’s a lot of money there,” Len Nichols, head of health policy at the New America Foundation, says.

Notice this is an amendment offered by freshmen Senators, which has not been accepted by the Senate.

It’s not clear whether the “some measures” that are “not earth-shattering” to “move away from” fee for service payment are limited to Medicare, as I have seen elsewhere, or if they are for medical service at large, which is implied here. In addition to those tentative measures we have a measure to “push” for common forms. So if this proposal is accepted, then legislation will contain measures that "push" for "movement toward" cost reduction.

For health insurance we are passing actual, you know, laws. For cost reduction we are making suggestions, maybe, and tentative ones at that.

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