The latest issue of Health Affairs is all about Mental Health Issues. Needless to say, I'm thoroughly excited to see what they have to offer. As soon as I have some time I'll be writing about the articles I find interesting. YAY.
People often wonder why our health care costs are spiraling out of control in America. Studies like these lend insight:
Since its inception 13 years ago, the Children's Health Study has
indicated that air pollution in Southern California communities reduces
lung growth and development, raises the risk of developing asthma, and
increases school absences due to respiratory illnesses. The latest
finding from the study team zeroes in on the impact of exposure to
traffic-related pollutants at home, and shows that kindergarten and
first-grade students who lived near busy roads experienced a higher
prevalence of asthma.
Asthma is a costly disease to treat and the American lifestyle of driving everywhere and delivering goods in smoke-belching 18-wheelers, with its attendant air pollution, is a driver of asthma in kids. My favorite part of California Healthline's Reporting of the story is their last line:
Study leader Rob McConnell of the Keck School of
Medicine at the University of Southern California said it is unclear
what residents living near busy roads can do to reduce their risk of
Good luck guys, you're on your own. Unless of course you can afford to move to a higher-priced home that's further from a major freeway.
Throw in the diabetes epidemic caused by diets rich in refined carbohydrates and sedentary lifestyles, and it's easy to see why we spend so much on health care for such poor results. We live horrible lifestyles that make us sick. Single payer can help, but the underlying outlook is still poor, no matter how well-coordinated care is or how much more efficient the system of treating these illneses becomes. As studies like these show, we have a lot of work to do from a public health standpoint before single payer will deliver us to the promised land.
The Houston Chronicle reports that an increasing number of doctors are opting out of accepting managed care contracts and going "off the grid" so to speak. The typical such doctor has been in practice for over 20 years, is in a 1- or 2-doctor office, or is not board certified in their specialty, making them less desirable to managed care networks. Currently, over 11% of all providers does not belong to any managed care networks.
A main reason these doctors are not interested in managed care is because of the administrative burden membership presents. The average doctor who is contracted with more than one health plan is contracted with 12. 12 health plans!! That's 12 different credentialing applications that need to be submitted, 12 different contracts to maintain, and 12 different sets of claim idiosyncracies to master. No wonder your average doctor dreams of the nirvana of not having to deal with all that hassle. But only the doctors who have been in practice long enough to develop a large patient base and an outstanding reputation can survive on patient payments alone.
Hmm... how could we reduce the administrative burden placed upon providers? I know! How about a single-payer system that is completely uniform? Maybe the government could contract with providers in a single point of entry into the system. Then the government could also fund 5 or 6 health plans with uniform benefit designs which compete for members based on service.
People who are opposed to single-payer say that competition is vital to improving the system as a whole. But this study comes as compelling evidence that the competition itself creates so much inefficiency that the system is losing some of its best providers. There will always be some doctors who will take payments only from the patients themselves (plastic surgeons come to mind), but 11%? Add this to the costs of a disjointed healthcare system loaded with inefficiencies.
I haven't posted in a while, it's been a busy week. Luckily, I've been storing up posts I wanted to make.
First, Sen. Olympia Snow, (R-Maine) is considering an amendment to the Association Health Plan Bill that might address some of the concerns mentioned in my previous post on the subject, namely that the bill would allow AHPs to be exempt from state regulations which provide protections to health plan members. Snow's amendment would mandate that all offered benefit packages would have all benefits offered in at least two thirds of the states. Snow says that this amendment would help attract Democrats and moderate Republicans (they still exist?) to approve a bill that has received heavy opposition from the American Cancer Society (becauses mammograms wouldn't be mandated) and AARP (because the bill allows discrimination against older and sicker workers).
The only problem now is Joe Paduda's comment at Managed Care Matters. Joe thinks that because there is such a pervasive oligarchy in health care, bargaining power is something of a mirage in healthcare today. If there is only one major insurer in your market, it doesn't matter how much clout you have, the insurer knows you're a captive audience and doesn't have to bargain down to get your business. Accordingly, the only benefit keeping prices down is the economies of scale that might result with a larger contract compared to a smaller contract. But then, the small companies would still have to be administrated separately, thus eliminating many of the economy of scale benefits as well.
So... this amendment may kill the ability for AHPs to save small businesses money in the insurance market (though I still think there would be small savings), but without it, it likely won't get passed. We'll have to see how it plays out.