Thursday, March 20, 2008

Recommended reading 

I spent a segment of this morning's show on KNSI reading through Craig Westover's column on the Governor's Health Care Transformation Task Force. My first reaction: Any time you hear the words "government" and "transformation" in the same sentence, you can bet the outcome will include the use of coercion. Craig and I are on the same page.
"Successful transformation of Minnesota's health care system will require active participation and engagement from consumers, employers, health care providers, health plans and government," declares the Task Force Report. The obligations the Task Force envisions for the first four groups require fundamental behavior change; government's obligation is to "enact the necessary changes to law to implement the transformation plan." In other words, supply the muscle, the force, the coercion.
Craig has just posted part II of this essay. The report from the task force calls for competition and patient-centered care, but it cannot deliver:

"Competition" logically means individual health care providers competing for individual patients on quality and price based on the individual's conception of value � much like Lasik surgery works today. Independent Lasik surgeons have had to innovate, improve their procedures, upgrade their technology and lower their prices to attract patients. Lasik surgeons operate outside the managed care payment system.

In the task force world, "competition" is "managed." Under the task force payment reform plan, health care providers must bid as low as possible for a contract to serve a population of patients offered by a managed care organization. Think of it like putting out a bid to provide computer maintenance: The task force approach is health care on an industrial model where we carbon-based units are maintained and repaired according to the manual. Unfortunately, we are not all the same make and model.

In the task force health care system, a provider's profit depends on how "efficiently" it provides medical treatment. The provider can be "efficient" by developing innovative treatment methods or by rationing the treatment it provides. Which method the provider chooses has great consequences for the patient, but from the task force's perspective of keeping costs down, either approach would yield "high value health care."

And, lest the Transformation Task Force leave any minor detail of your life untouched, it would require every Minnesotan to have a minimum amount of health insurance, dictate to health plans whom they must cover for what at what price, and create a health insurance exchange that effectively would eliminate the role of private insurance brokers.

The beginning is HF3391, a bill wending its way through the Legislature now. The Lady Logician highlights the backdoor to universal care. All four of these links should be on your reading list.

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