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    Thursday, July 22, 2004

    All That Money Can Buy: My take on the Kerry Health Plan at Tech Central Station. In brief: it's folly to be willing to spend the entire -or even the majority - of the federal budget on healthcare, because today's healthcare market is insatiable. My profession is constantly expanding the treatments available and the definition of disease (and health) without regard to the cost. As long as the healthcare consumer bears no responsibility for the bill, there's no hope of reining in the monster.

    And here are some other thoughts on Kerry's plan that wouldn't fit into the column:

    1) The idea that the middle class will be well-served by Medicaid is misbegotten. Medicaid reimburses so poorly, it's hard to find doctors who will accept it. Those who do, do so as an act of charity. For the poor. No one's going to be willing to do that for their middle class compatriots. So, either no one would sign up for it - which would save the Kerry plan from being the disaster it has the potential to be, or the reimbursement levels would have to go up, which would mean it will be much more costly than the $650 billion estimate it currently carries.

    2)Kerry mentioned in the Times interview that money could be saved by making people with chronic diseases participate in disease management programs. The current conventional wisdom holds that these programs save money in the long run by improving the control of chronic diseases and thus reducing complications. This hasn't been the experience in my practice. One of the major insurers in our area uses this sort of service. In addition to paying me to care for and monitor the progress of my diabetics, chronic lungers, and depressed patients, they also pay an outside consulting firm to call them up every six or eight weeks to see how they're doing. In the case of diabetics, they also send them a home testing kit to check their urine and blood for the same routine tests that I check. But, the nagging and the tests never seem to change anything. The non-compliant remain non-compliant and poorly controlled. The well-controlled remain just as well-controlled as they were before they entered the program. My chronic lungers are about the same. Those with severe disease still get wheezey when the environmental conditions are right or if they get a respiratory infection. And there's absolutely nothing gained with the depressed patients, most of whom have chronic, well-controlled depression. No one's been saved from suicide by those frequent phone call check-ups. From where I stand, these programs just increase the cost to the insurance company, and eventually to the patient through higher premiums.

    I will add that there is one chronic disease program that seems to make a difference, but it isn't one that's offered through the insurance company and run by an organization 500 miles away. It's the congestive heart failure monitoring done by one our local hospitals. Patients report their weight and their symptoms periodically (in some cases daily) and have their medication adjusted by their physician accordingly. That has kept one or two of my formerly frequent fliers out of the hospital for several weeks at a time. Until they get tired of participating.

    UPDATE: here's a detailed point-by-point analysis of both the Bush and the Kerry plans for healthcare financing.

    posted by Sydney on 7/22/2004 09:50:00 AM 0 comments


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