Has anyone heard about in the section in the Obama’s stimulus plan that authorizes $600 million ‘to address shortages and to prepare America for Universal Health Care.’? That seems like an enormous amount just to prepare. Does this mean that the decision to proceed with a Universal Plan has been made?
I’d guess that Obama is going to to do something to try and cover all Americans one way or another.
It looks like not only has he set aside that $600m, but a further $1.2b for comparative effectiveness research to set up something similar to NICE in the UK who determine what treatments will or will not be covered.
The evaluation that NICE make, contrary to the right wing scare mongerer quoted is that they look at the clinical efficacy of a treatment, the FDA approval testing process and the cost / benefit.
Its going to be an interesting 2 years in US healthcare.
***The evaluation that NICE make, contrary to the right wing scare mongerer quoted is that they look at the clinical efficacy of a treatment, the FDA approval testing process and the cost / benefit. ***
Cost to whom vs benefit to whom?
cost to the consumer / benefit to the consumer.
here you can now have any treatment that you want (so long as it is legal), in the first instance it will be covered by the NHS, but if they’ve deemed it ineffective / not value for money (such as the high court case around Alzheimer Drugs with little proven efficacy) patients are now free to pay for it themselves.
Its simply no different from an insurance company saying they will cover one thing but not the other, the difference in this instance being is that they are attempting to make these determinations on the basis of evidence, something that medicine in general has not been particularly good at doing.
What cost to the consumer?
The retail cost of the drugs or procedures that are not considered to be the best available course of treatment be it due to a lack of evidence or providing value for money.
A single course of a certain cancer drugs can cost upwards of $100k / year.
So in those instances where the evidence does not support the use of those treatments, they will not be funded but patients are free to pay for them on their own.
Just to clarify, no one limits your choice on where you get seen, who you get seen by (2 of the 5 choices that most patients are presented with will be from the private sector, either hospitals, surgeries or independent sector treatment centres, this obviously does not apply to the outer hebrides with a population of perhaps 10, but elsewhere where choice is realistic it is made available) or even what procedures are completed. Treatments that have not been shown to beneficial will not be funded and if a patient on the advice of their doctor still wants to have that treatment they are free to fund it themselves.
This obviously presents an issue if you can not afford it, but no more so than an insurance company denying a claim or attempting to get treatment with no coverage at all.
Going back to my first question re: cost vs benefit.
It sounds like the determination isn’t based on cost vs benefit to the patient, but rather cost to the government vs *their *perceived benefit to the patient.
Therein lies the problem…and yes, there is a similar relationship between the insurance companies and those they insure, but they’re not trying to provide simultaneous coverage to people who aren’t contributing to the pot.
Sorry…there are very few things that government does better than the free market. Of course, liberals and conservatives tend to define “better” differently with respect to some items, such as healthcare.
Jus Treatments that have not been shown to beneficial will not be funded and if a patient on the advice of their doctor still wants to have that treatment they are free to fund it themselves.
Hey we get to politicize every individual drug and procedure, this means less trying to sell to the consumer, but even more buying of pols! The govt will like this. A realistic result will be less choice, but I've seen a study that bore out that people are often happier with less choice...we're lazy, less effort in the decision process.
The government is not making the determination. I’ve posted ad-nauseum here about NICE decisions.
NICE have nothing to do with government funding. They could approve billions of pounds worth of drugs that the government could not afford, it is a separation of Church and State, the Department of Health receive their budget from the Treasury and determine how it should be spent. NICE determine what treatments / procedures and interventions should be provided.
As to it being NICE’s perceived benefit to the patient, NICE is not a bunch of civil servants sitting around determing what a drugs clinical efficacy is. NICE is staffed by professionals, MD’s, Surgeons, Pathologists, Pharmacists and everyone with some skin in the game gets to play, arguably unlike an insurance company where it is likely that a claims approval or denial is likely to be done by some clerk.
As to the government doing something better than the free market. How in gods name is some private sector organisation going to get together, be funded and become the gold standard for evidenced based medicine.
So who would fund it? big Pharma? J&J who’s largest division is ortho? Seimens? GE? private hospitals? physicians?
Who is best placed to determine what treatments provide best outcomes and value for money? I’m not sure I’d want J&J or Pfizer determining which drugs or implants are the best to use?
As to “better”, I want any physician or surgeon to know what the gold standard procedure or treatment is, and I want them to use it, that is not the case at present in any system, not one, all you have to do is look at things like appendectomy rates from country to country to see how variable treatment is.
I do not care who makes the determination, just that someone is evaluation the best clinical evidence available and the costs and costs and making a determination. At present it does not happen, you only have to look at outcomes between the best and worst hospitals in any system to see this.
So you tell me how you fund it privately without those doing the funding getting to influence whats approved. I’d guarantee that whats approved would be correlated with who funds…
Its interesting that here, the governments big thing has been choice, choice of schools, doctors, hospitals and so on and so forth.
The evidence suggests people dont want choice, they want all schools, doctors, hospitals to be equally good. Now I’m all for choice, if they don’t want to evaluate different providers thats on them, I do, the evidence is beginning to suggest even when people know a alternative is better they don’t always take it for a variety of reasons.
As to Pols limiting the choice, thats not the way it works here, NICE is an independent body, not appointed by the Department of Health or Treasury, it is staffed by MD’s Surgeons, Physicians, Pharmacists and so on and so forth, all from medicine (public and private) or academia and they evaluate things such as cost, FDA results, all of the materials submitted in the approval process and they simply determine on a case by case basis whether a procedure, drug or treatment provides good outcomes.
As to the government doing something better than the free market. How in gods name is some private sector organisation going to get together, be funded and become the gold standard for evidenced based medicine.
The American “NICE” should be funded via the health care payment that shoul be paid by the private citizen.
I wholly agree with the idea of a NICE’esque organization and that the idea of a “Single pool” is far better approach than what we currently have. I completely disagree with the idea that NICE should be funded in anyway by the government or that the funding for the insurance should go thru the government.
As stated before I think the only time it would be feasible for the government to fund “NICE” in the US is for the initial setting up of the system. Once the system is in place the “Cost” for the US “NICE” should be funded thru an additional charge added to every policy. Those policies should be provided by private companies and paid for by private citizens.
As soon as one entity starts telling another entity how to spend it’s funds they become inexorably linked. That “Link” should be between the entities providing the money and the entities recieveing the benefits from the money. Not between a seperate entity that is simply spending the money.
~Matt
I’m hoping someone somewhere along the line will have the balls to vote against it. Again it’s something that is being “Slipped” in as part of something that is completely unassociated. WTF happened to “Change”? Looks like the same old back door crap to me.
We NEED health care reform. It NEEDS to be something we FOCUS on not something we try and slip thru the back door. It NEEDS to be openly and nationally discussed and agreed upon, not just another “Trick” that one party or the other tries to foist onto the American people.
~Matt
If you can find a way to mitigating bias, then I, again, do not care how it works. The fear is that so long as those payments come via insurers, that they have preferred treatments, lets say Viagra as opposed to “competitor X” that given they will sending a big check on behalf of their customers that this would influence the outcome.
I think it would be incredibly difficult for the private sector to get together to set this up, if only because there are so many vested interests. Someon needs to decide that they want the best treatments made available and that they need to be evaluated. I do not see consumers doing this (they have no power to make it happen), the insurers or hospitals or MD’s doing it (to many vested interests) which leaves little chance of it happening.
The evidence suggests people dont want choice
Actually I’m not sure what your quoting as your source for this but it’s not that people don’t want “Choice” it’s that they don’t want too many choices or too few choices.
I remember reading a story on “Grocery store” theory, or something like that. The reason grocery stores don’t carry EVERY brand is because it actually causes people to buy less. OTOH if the store doesn’t carry enough brands they also sell less.
If a consumer is overwhelmed by too many choices they are turned off. OTOH if they aren’t offered enough choices they are also turned off.
I think we are looking at a similar issue with health care. I can get a choice of a gagillion different policies from a half a gagillion different providers. It’s burdensome, time consuming and pain in the ass. OTOH if I was offered one policy it more than likely wouldn’t be anywhere near what I wanted and I would end up paying more than I needed to for coverage I probably didn’t need.
I think with the implementation of an American “Nice”'esque organization we would probably knock down the number of providers. Since we now have a “minimum policy” we would also knock down the options from each provider.
~Matt
Sorry…there are very few things that government does better than the free market.
The question is, is health care one of those few things.
The fear is that so long as those payments come via insurers
I don’t see this as a problem and if it becomes a problem then you simply have the money sent directly to the panel. A single annual payment or seperate monthly payment. In short having it come via the insureres is done only for conviencance sake. Personally I don’t see this as being anymore of an issue than having your insurance payment and tax payment being combined with your mortgage payment. The bank puts the money in an escrow account and when the taxes come due they pay the bill.
I think it would be incredibly difficult for the private sector to get together to set this up
100% agree and thus why I think the only acceptable time for government funding would be the initial “Setup” phase.
However once it’s set up and agreed upon, ratified by the states, the “insurers” have a choice. Comply or go bye bye.
At that point of the insurers can’t come up with a way to compete then indeed the “Market” can not compete. I don’t see that happening but am willing to concede that if it does that “Government” run health care is a better choice. But unless given an “Apples to Apples” chance we simply won’t know.
~Matt
The question is, is health care one of those few things.
Exactly and this is why I’m proposing that a panel similar to the UK’s NICE be set up. At the point that the “Baseline” is set and ratified by the states the requirements and regulations would be supplied to the current private providers.
If they feel they can “provide” at similar prices as the government is claiming or at realistic prices compared to other systems then they should be given a shot. If not, then they are not competitive and should be eliminated.
~Matt
Cant deny the consumer choice 
how dare you limit the number of policies being offered…
Actually, I think they are finding with respect to health care that people are not that interested in finding out whether Dr Bob or Joe or Jane are better at procedure A than each other. People want to go to their PCP who tells them they have a bad knee, hip or lung, that he thinks they should see Bob, but that he’ll offer then 4 alternatives, they see Bob, he says he can do A but could alternatively do B, C or D, they ask him what he thinks they should do, they say A…
I cant remember which book, Better or Complications, but Gawande talks about his kid being sick with a heart problem I think, now he’s a cancer surgeon, but he says that as soon as he rocked up at the hospital with his sick kid, he wanted to be told what to do, that he became, a patient. Now he obviously understood exactly what was going on, but he still said he looked to the other professionals to provide the best advice to help them make informed decisions…when you are chronically ill, you want care not choice…or some combination of both…
Now, I think there are issues with people being to “patient like” and not necessarily questioning something when it seems wrong, but on the whole people trust MD’s and look to them to look out for their own best interests…what do you call someone who graduated bottom of their class in medical school? doctor…
Obama has consistently mentioned updating healthcare records keeping and putting that information into digital formats. Perhaps this money is for that?