[ . . . ]
Gawande is right that one of the major problems in our health care system is that we run it as an enormous cottage industry: “No one is in charge.” But to suggest that insurers have “proved repeatedly that they can’t manage care while local medical communities have proved that they can” contradicts what he has just told us. *All of the accountable care organizations that he lists are affiliated with non-profit insurers*—non profit insurers have shown that they can achieve dramatic improvement in care along with savings. Very few physician groups have done this on their own. They need a payer who helps organize the framework for accountable medicine.
[ . . . ]
While she highlights the payer side, the provider side is pretty screwed up too in McAllen. While only around 12% of hospitals in the US are investor-owned, McAllen is home to both for-profit UHS as well as a physician-owned hospital owned by "entrepreneurial" docs. Not mentioned in the Gawande article is the fact that UHS unlawfully paid physicians for patient referrals in McAllen, a big no-no under Medicare regs, with the idea that such payments would wastefully lead to overutilization. The doc-owned facility is immune from such concerns under the Stark "whole-hospital" exemption -- physicians who have an ownership stake in a hospital are free to admit whomever to their own facility without being troubled by the perverse financial incentives that drive overutilization. I forget too if the doc hospital in McAllen is a full-service facility or a specialty hospital -- docs like to build hospitals without ERs, so that they're not forced to treat and admit uninsured patients who present to the ED under EMTALA (aka anti-patient dumping act).
On Mon, Jun 22, 2009 at 2:04 AM, Joanna <123hop at comcast.net> wrote:
> Michael wrote
>
> "This is the article that Obama cited recently as so important for his own
> perspective:
>
> http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande "
>
> Yes, I read it. What was odd about it was that it purports to show that the
> problem is not for-profit medicine, that there are other issues that play a
> part....but it winds up showing that the profit motive (on the part of
> doctors rather than insurance companies) plays a part both in bad and in
> expensive medicine.
>
> So, though I appreciated the scholarship, the overall argument didn't make
> much sense.
>
> Joanna
> ___________________________________
> http://mailman.lbo-talk.org/mailman/listinfo/lbo-talk
>