Health Care; John McCain’s Way

John McCain gave some details regarding his healthcare plan at a speech in Iowa back in October. The entire speech can be read here. I didn’t find a separate link on his website leading to a formal outline, so this is all we get.

Things I liked about McCain’s “proposal”; coverage for all; tort reform; idea of coordinated care; emphasis on personal responsibility for our health and prevention of chronic diseases;

Things I didn’t like; health benefits instead paid to employees as wages then give them a tax credit; emphasis on payment for “quality” without defining how to measure it or account for complications or comorbid diseases; almost no emphasis on reducing waste in government run programs; coordinated care(more detail for the contradiction below);

Overall, McCain’s approach is from a conservative point of view that doesn’t disrupt the “staus quo” very much. It seems to focus more on an oversight role to ensure the quality and accountability he repeats over and over again. Corporate greed and profit certainly aren’t mentioned as places to trim fat from healthcare expenditures.

Notes;

1. Like Hillary, McCain is suggesting that instaed of employer funded insurance benefits, the employee should be paid wages, have the wages taxed and then get a tax credit from the government. For low wage earners this will seem like they hit the lottery. Receiving an additional 6-8K per year as wages, a low tax rate AND a tax credit, who wouldn’t vote for that? As income increases, the tax rates increase and a smaller portion of those wages come to you. Don’t forget that you also pay 7.625% (along with your employer’s matching contribution) as Medicare and Social Security Tax. And you still have to buy your health insurance. Again the less you make the better off you are. Another form of redistributing income, except now the government wants it’s share though increased taxation.

2. Paying for quality is not a new concept. As I mentioned in the Hillary post, Medicare 646 was designed to look into better ways to provide quality, explore the benefits of paying for chronic disease management and also, disease prevention. Insurance companies are doing this already. The government may be ready to participate AFTER they review the results of their 5 year study that won’t conclude until 2012.

3. Coordinated care IS a great concept. Care must be taken to make sure that there can be some variability based on a patient’s “severity of illness” and their complicating or comorbid conditions. For example, it would cost MUCH less to care for a 55 year old female, who only has high cholesterol and needs cardiac bypass surgery than it would be to take care of a frail, 68 year old male with high blood pressure, diabetes, high cholesterol, chronic kidney disease, anemia, tobacco use and emphysema, who needs the same bypass. It may sound extreme, but the male patient is pretty typical for someone with heart disease, more so than a 55 year old female.

4. Medicare has started looking at “severity of illness scores”, physician’s practice patterns in regards to specific diseases comparing them to their colleagues and resource utilization. The problem is that Medicare is only looking at the claims that come to them with specific diagnoses. They are not fully taking into account the patient’s complicating and comorbid conditions. The Inspector General has recommended that Medicare use all of this data as a measure of quality and payment for that quality, but only after the data reports what it is supposed to. They aren’t there yet.

5. Medicare, nor anyone else for that matter, should have to pay for medical errors, but at what point does an action constitute an “error”? And what is the definition of an error? In most people’s minds an error is anything that doesn’t go as expected. Dictionary.com also defines error as “a wrong action attributable to bad judgment or ignorance or inattention”. I think this is the definition of error we should use for healthcare. If granny is in the hospital, gets out of bed to go to the bathroom, and in her usual, at home, confused state, falls and breaks a hip, does that constitute an error? Medicare thinks so and won’t pay for the treatment of her broken hip. And Medicare won’t allow granny to be restrained, even if it is for her protection. Perhaps the presidential candidates should all spend a week in a hospital watching all the grannies, then when they fall, the error can be theirs.

Overall I think McCain’s healthcare plan is a less painful alternative to Hillary’s. But McCain doesn’t give us enough detail, isn’t addressing government waste and inefficiency in the Medicare and Medicaid programs, neglected to speak to insurance company profiteering, forgot to tell you about the additional taxation and forgot to mention how much this thing will cost.

Sounded good in the speech though.

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.

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