I watched an interesting hour-long panel discussion on CNN last night. The moderator was Maria Bartoromo and the panelists included: Michigan Governor Granholm, Michael Milkin, two doctors who head major clinics (Cleveland Clinic was one), CEO's of two insurance companies, former Senator (and doctor) Bill Frist and the CEO of a major drug company.

After an hour of active and knowledgeable debate, there didn't seem to be very many specifics that the panel agreed on. Those that they did agree on were couched in terms that were difficult (for me anyway) to understand. If I had to summarize the main conclusions that the panel reached, they were:

• The U.S. must reform it's healthcare system or be at risk of the cost of care overwhelming the country.
• Doctors should be compensated based on "results", not the frequency of service.
• Americans should be incented by the re-formed system to live healthier lives.
• The re-forming must result in healthcare coverage for all Americans.
• There are tremendous opportunities for cost reductions in the current system.
• Whatever the solution is, it almost certainly should include both public and private options for healthcare.

Some of the discussion was predictable. The "corporate types" on the panel and Bill Frist resisted the idea of a "public option" vigorously, arguing that a re-formed system should be based solely on for-profit providers, not the government. The other panel members were equally effective in defending the need for a cooperative system, including a public option, not significantly different than we have today with Medicare.

Ever the politician, Bill Frist defended that massive expenditures on advertising by drug companies as their "first amendment right". He was also critical of Medicare or the idea that any public option should be included in a new plan. Among the panelists, he seemed to have the fewest specific ideas on what should be done.

Predictably, the two insurance company CEO's defended the current system. The drug company CEO similarly defended their business model, drug prices, and even the need for the extensive advertising of prescription drugs.

Michael Milkin kept hitting on the idea that Americans must live a healthier lifestyle and that alone would reduce healthcare costs dramatically. He noted that we are "too fat" and "smoked too much". His suggestion was to "incent Americans to live healthier". To me, that was a thinly-veiled suggestion that people who were overweight and/or smoked would pay dramatically higher insurance premiums than those that did not. He argued that the funding of healthcare should be placed on those who contributed most to it's cost.

Governor Granholm repeatedly used the experience of the auto companies as an example of why healthcare reform is needed. She argued that failure to act now would weaken our entire economy even more in the not too distant future. She noted that about $1,500 of the cost of every GM car was for healthcare benefits for workers and retirees. One of the panelists related the story of a phone call from Lee Iaccoa when he was Chrysler CEO. He was bemoaning the fact that the cost of healthcare for his employees and retirees had reached the point where he was spending more for insurance premiums than for the steel, glass, plastic and other materials used to build the cars and trucks. He observed that he knew how to cut materials costs, but was clueless on how to control healthcare costs.

The doctors argued that physicians should be paid more for the quality of care than the frequency. Both noted that, while it would be difficult to achieve legally, there was a distinct advantage to having doctors work as salaried employees rather than "independent contractors". They noted that doctors in some of the best healthcare facilities in the world--Mayo Clinic, Cleveland Clinic and a couple others they named--had worked for salaries for years. Of course, they noted, doctors in almost every other country in the world worked for salaries as government employees and were producing results superior to the U.S. They also noted the need to compensate primary care physicians more generously, as they were the only doctors who could be effective in providing preventative care.
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The bottom line was that this group of knowledgeable panelists didn't present anything close to a consensus set of solutions. In fact, some of the solutions they did present were couched in words that are difficult for the public to understand ("pay doctors for quality not quantity"--sounds good, but what the hell does that mean?)

I shudder to think what will come out of a Congress which is far less knowedgable and which has a greater commitment to their own self-interest and those of the special interests who pay them than to the public. And when they get finished, who's going to explain it to us in understandable terms?

Interesting synopsis, VK. Thanks. I did not see that on CNN, but I will look for it now. CNN sometimes repeats things.

I have to admit that you sent me scurrying to Google when I saw Michael Milken's name. I thought, "Are we talking about Michael Milken, racketeer?" Yes, I know he is a financial genius. And when I looked at his website and quickly glanced through his biography, I saw no mention of that incident from his past. Did I just miss it on my quick read or was history rewritten a little? But I suspect that I really am living in an Orwell novel.

About Big Pharma, I could weigh in on that one from a couple of different angles. Big Pharma has buttered my bread and so it could be seen as ironic that I think the way I think about what Big Pharma has been up to. (And I just bought a little jnj.)

But about those drug prices........

Remember when we used to save our receipts and send them in to our insurance companies. We paid for our prescriptions up front. No big deal.

And then.......

Enter the little card. So convenient. Slap it down on the counter and pay the co-pay. No pesky receipts in a shoebox. No envelopes and stamps and trips to the post office necessary. How convenient???? That's all consumers cared about. Convenience.

Remember the Trojan Horse. The drug card was a Trojan Horse. We were slaughtered in our sleep after we passed out from the celebration of the convenience of not spending our "own" money up front. The prices went up and up and we did not pay attention and we did not know. No reason to know or even think about it. We had our little cards and our co-pays. We had consumer convenience.

I want to see affordable access to health insurance for Americans. I do not want socialized medicine.

Why can't they just take baby steps. Allow those who want or need to retire before age 65 to BUY in early to Medicare when they have no access to good affordable plans. That would not only save on the costs of stress related illness but would open jobs for younger people. Seems like a good step to me. Maybe because I know so many people who could benefit.

But they just can't seem to take it a step at a time. It is a quagmire. And both sides of the aisle are up to their ears in lobbyists.

Anyway, I will look for this program to be repeated on CNN. But I will probably end up yelling at the television like I used to yell at Alan Greenspan when he started giving money away.

Boomer

And btw, I heard a book title the other day, "It Takes a Pillage." I know nothing about the book. I just thought the title was right on the money.

Originally Posted by Boomer

Interesting synopsis, VK. Thanks. I did not see that on CNN, but I will look for it now. CNN sometimes repeats things.

I have to admit that you sent me scurrying to Google when I saw Michael Milken's name. I thought, "Are we talking about Michael Milken, racketeer?" Yes, I know he is a financial genius. And when I looked at his website and quickly glanced through his biography, I saw no mention of that incident from his past. Did I just miss it on my quick read or was history rewritten a little? But I suspect that I really am living in an Orwell novel.

About Big Pharma, I could weigh in on that one from a couple of different angles. Big Pharma has buttered my bread and so it could be seen as ironic that I think the way I think about what Big Pharma has been up to. (And I just bought a little jnj.)

But about those drug prices........

Remember when we used to save our receipts and send them in to our insurance companies. We paid for our prescriptions up front. No big deal.

And then.......

Enter the little card. So convenient. Slap it down on the counter and pay the co-pay. No pesky receipts in a shoebox. No envelopes and stamps and trips to the post office necessary. How convenient???? That's all consumers cared about. Convenience.

Remember the Trojan Horse. The drug card was a Trojan Horse. We were slaughtered in our sleep after we passed out from the celebration of the convenience of not spending our "own" money up front. The prices went up and up and we did not pay attention and we did not know. No reason to know or even think about it. We had our little cards and our co-pays. We had consumer convenience.

I want to see affordable access to health insurance for Americans. I do not want socialized medicine.

Why can't they just take baby steps. Allow those who want or need to retire before age 65 to BUY in early to Medicare when they have no access to good affordable plans. That would not only save on the costs of stress related illness but would open jobs for younger people. Seems like a good step to me. Maybe because I know so many people who could benefit.

But they just can't seem to take it a step at a time. It is a quagmire. And both sides of the aisle are up to their ears in lobbyists.

Anyway, I will look for this program to be repeated on CNN. But I will probably end up yelling at the television like I used to yell at Alan Greenspan when he started giving money away.

Boomer

And btw, I heard a book title the other day, "It Takes a Pillage." I know nothing about the book. I just thought the title was right on the money.

I wish I had the little card.....still have to pay up front and send in the receipts

Originally Posted by Boomer

..."Are we talking about Michael Milken, racketeer"

Yep. Milken was the inventor of junk bonds and did almost all of the financing of the leveraged buyouts during the 1980's. He was convicted and did jail time for insider trading having to do with his (actually Drexel Burnham Lambert's) underwriting of the junk bond portion of financing of companies being purchased or taken private. Kind of a long way from being a "racketeer", but he was guilty in much the same way as Martha Stewart was, but on a much bigger scale.

Milken made gazillions of dollars for himself and his firm. He was always a very generous philanthropist and continued that after he got out of prison. Sometime in the middle of all his legal travails, he got prostate cancer. He was cured, or put in remission, and began to accelerate his philanthropy.

Milken co-founded the Milken Family Foundation in 1982 to support education and medical research (http://www.mff.org/index.taf); he is chairman of the Milken Institute, which hosts the annual Global Conference, which is attended by more than 3,000 thought leaders and decision makers from nearly 60 nations; and he is the founder of the Melanoma Research Alliance, FasterCures (Center for Accelerating Medical Solutions), and the Prostate Cancer Foundation.

I'm guessing he was included on the panel because of his involvement in medical research and his involvement with so many opinion-makers thru his annual Global Conference.

http://www.youtube.com/watch?v=NxNXv...layer_embedded

Listen to the doctors! They are on the front lines & know what works. There is no need for some huge new program as the facts are right in front of us, but it seems no one wants to see them. There are many large institutions that have only salaried physicians. Mayo Clinic, Cleveland Clinic, Kaiser-Permanente, the armed services (including the VA), to name a few. All have at least as good an outcome record as anyone, some a lot better. All also have a lower cost per patient than any fee for service practice. The physicians are paid by performance (outcome) not by how many tests and procedures they order & perform. Only a physician can practice medicine and order all of these procedures. It is estimated that 30% of all medical procedures are not necessary. I am a retired physician and I believe that it is much closer to 50% that is not necessary. I have seen the way it works in real life- put the physicians on a salary and per patient costs will drop 40-50% almost immediately. There are many additional issues involved, but there will be no meaningful cost reduction under the existing fee for service system.

Steve S

It's really a lost cause. Some are, have and will turn their lives willingly over to the government. Thank God there are still some fighting the good fight for those of us who want to remain free and don't buy into the pack of lies from the BO administration and the far left Democrats. Especially the propaganda on CNN and the other state run media outlets.

BO's health care takeover along with Cap-n-tax, trillions of debt and God only knows what other programs they will ram through will crush the economy.

We are still loosing hundreds of thousands of jobs every month and they just don't give a damn.

It doesn't take a rocket scientist to understand the government is already broke, tax receipts to the government are down 50% and we will never climb out of this massive debt BO and dropped on our backs.

For the first time in my adult life, I am disappointed in my country.

BO is not fixing a thing or even trying. He's getting even with America and people stand by, make excuses and even cheer. It's disgusting.

Yes, and BO is wanting everything pushed thru very quickly, for reasons we are all aware of, yet it took him months to decide what dog to choose for his family. hmmmmm.

Originally Posted by Keedy

You Tube "Prove to me it'll work video"

That's a decent argument, Keedy. But unfortunately, the question "prove to me it'll work?" has no real answer. The entire system won't be known until well after the reform legislation is passed. As has been said, the details will be created well after the fact by career bureaucrats. How can one "test" something that doesn't exist?

But we know quite well what doesn't work. Our current healthcare system costs roughly twice as much as those of the other developed countries and still leaves 40-50 million people without healthcare insurance. That cost is growing at a rate that will require that money be spent on healthcare in the future that otherwise should be invested in growing our economy. The cost is high now, and will be impossible to afford in a decade. Having said all that, our system has produced health of the population that ranks around 25th among the developed countries, even though it costs twice as much! We know what doesn't work.

So, as much as we have hesitancy, we're going to be faced with trusting both our elected government as well as the career bureaucrats who will actually design the details of the reforms of our healthcare system. Unless our Congress chooses to do nothing--which will "break" our economy in ten years or so and doesn't appear to be either a political or economic alternative--we will have to have some trust without a "proof" that it works.

Originally Posted by clod

Listen to the doctors! ....I am a retired physician...put the physicians on a salary and per patient costs will drop 40-50% almost immediately. There are many additional issues involved, but there will be no meaningful cost reduction under the existing fee for service system.

Assuming that our principal purpose here is to understand more about what is going on politically, your response, Steve, is very valuable. It is essentially what the doctors on the CNN show were saying, and they were both salaried physicians.

The doctor-panelists did say that there were some "legal impediments" to moving from a fee-for-service physician business model to a salaried model. I'm assuming that would have to do with "forcing" physicians who were "sole proprietors" or had only 1-2 partners in a practice to become salaried. That wouldn't be a small problem, but I suspect it could be resolved with a payment schedule that would essentially force physicians into a salaried form of business organization.

But it's good to hear confirmation of something we've all suspected from a doctor who knows first-hand what the potential savings might be.

One question: would the "salaried doctor" model be what is meant by "paying for quality, not quantity"? I've heard people discuss needed reforms and use a term like that and I have no idea what they mean.

Originally Posted by Keedy

For the first time in my adult life, I am disappointed in my country.

Be careful, Keedy. Michelle Obama said something like that and was pilloried for months.

But if you're not running for office or married to someone who is, don't worry about it.

Originally Posted by dklassen

BO is not fixing a thing or even trying. He's getting even with America and people stand by, make excuses and even cheer. It's disgusting.

This should be interesting, getting even for what?

Originally Posted by Xavier

This should be interesting, getting even for what?

Hmmmmm.....Your back..I thought your alter ego was through with us?