Friday, April 27, 2007

Dems Emphasize Cost Control and Prevention in Debate

While the first democratic presidential debate last night correctly focused on the war in Iraq, in the middle of the forum, some leading candidates had an opportunity to put forth some ideas about health care reform. Here is the transcript of the debate in case you missed it.

All 4 candidates who had a chance to speak on Health Care emphasized cost control and prevention!

John Edwards,who to his credit,set the mark on health care reform by releasing a detailed plan a few months ago, also spoke about one of my favorite topics-mental health parity-undoubted a re-energized issue after the tragedy at Virgina Tech on Monday a week ago.I wrote about mental health parity last year on this blog -see Tues.April 4, 2006

Barack Obama said straight out and forthright " The second thing,I think,that we're going to have to do is make sure that we control costs" since he notes in U.S. we spend much more and get less!

Hillary Clinton said "we have to control and decrease costs for everyone... We have to cover everybody but we've got to improve quality...We can save money within the existing system. I am not ready to put new money into a system that doesn't work until we've tried to figure out how to get the best outcome through the money we already have" said Hillary- not being afraid to harken back to 93/94 when the insurance companies and pharmmaceutical companies made the american public "nervous" about her and Bill Clinton's plan.

Bill"no new taxes for health care" Richardson said flat out "I would focus on prevention... We need to focus more on deterring these diseases like diabetes that is 30 percent of our Medicare cost"

Now mind-you the phrase "cost-control" scares people because they automatically believe that means less care. It does not! We are at a point on the U.S. bio-medical technology curve where more is not always better! It actually might be harmful. Cost control can mean better-"first do no harm"-care and prevention.

Yet we have the paradox of some segments of our population getting no to minimal basic care? These fellow citizens need basic care now!

The demographic destiny of 77 million U.S. baby boomers beginning to utilize a high tech expensive economically unsustainable "disease care" system and gobbling up more and more expensive medications, many of which are unsafe, is indeed a freightening economic prospect. The head of the U.S. GAO Comptroller General David Walker calls it an "economic tsunami" - especially his Medicare cost projections.

I personally support a modified HR 676 - The Conyers/Kucinich, single payer- "Medicare for all" bill.But not in its present form. The bill must be modified to include a hefty dose of both individual AND institutional prevention! The prevention strategies must be implemented with fairness and compassion

Good for the Dems last night. Some of the leading candidates got it right on Health Care Reform- the domestic issue that could very well elect one of them to the U.S. presidency in November of 2008.

Dr. Rick Lippin


Blogger Maggie said...

I couldn't agree more. I was particularly impressed by Hillary's statement and her emphasis on not wanting to put new money into a broken system.

In other places I have read that she is saying that it will take time to put together health care reform legislation--she doesn't except to get it done until the end of her 1st term.

While this may sound disappointing, I think she's right. This will be a fierce battle and it's important to get it right. I'm concerned that reformers will be so eager to push something through that they will compromise with lobbyists in ways that mean that we end up with only the semblance of reform-- universal access, but no cost-containment or improvement in quality. . .

In the meantime there are things that could be done before we have a health care reform bill in place--like funding Medicare to do comparative-effectiveness research. And then we should let Medicare make coverage decisions based on that reserch.

Medicare also needs to put together an indepdent group to review the fee schedule for specialists--they're being overpaid for some procuedures. And Medicare should consider using the savings to pay primary care docs more if they can show that they are providing preventive care that keeps patients out of the hospital . .

We also need to let Medicare compete with private insurers in offering the drug benefit-- and Medicare should be able to discounts with drug-makers.

Finally, we need to revise the medicare advantage legislation--we're overpaying private insurers.

All of this could help pave the way for something like the Conyers bill . . .

10:47 AM  
Anonymous Dr. Rick Lippin said...

great comments maggie :).

It sounds like you are a very serious student of Medicare-so I hope you will consider doing a guest post on our blog?

I am an impatient type by temperament so I hope we get some real meaningful health care reform soon.

My strong bias is for prevention.

Be Well,

Dr. Rick Lippin

12:58 PM  
Blogger esolt said...

I also agree with Hillary's concern about dumping money into a broken system. However, I am not convinced she comprehends how broken it really is based on her healthcare reform ideas of 93/94.

Dumping Medicare, Medicaid, work comp, military and private pay indiviuals into one big swamp would create chaos. It would be the equivelent of the flood in New Orleans post Katrina; deep, smelly and uncontrollable.

As a nurse having been on both the payer and provider side it appears that the cry shouldn't be "more money" but money wisely spent.

The lack of a "gatekeeper" function prior to managed care is what began to drive all payers to "the brink".

Inevitably the payers and providers should determine how they are going to manage healthcare expenditures to the benefit of all because quite frankly, the patients are the usual losers. As for the nurses, nothing really changes for us in terms of "benefit". We continue to deal with sick patients and healthcare politics until we get fed up and "leave the game."

7:41 PM  
Anonymous Dr. Rick Lippin said...


Thanks- Good input from a front-liner who is a good thinker- YOU!

esolt- WHere do you stand on prevention- both individual and institutional? Implemented fairly and with compassion meaning treatment doesn't go away overnight or ever for those who really need it

Rick Lippin

7:56 AM  
Blogger esolt said...

Prevention, wellness and chonic condition management (or disease management) have proven to provide positive results in managing healthcare resources (which payers figured out some time ago). I am for evidence based practice. However, evidence based practices and managing outcomes requires DATA. And hospitals and physicians have been very slow, even resistant to adopting healthcare information tehcnology.

The issue is now being forced by HRSA in its Healthcare Information Technology initiative. But how do you manage your patients or practice if you don't even know of what it is comprised; in otherwords, the case mix?

I happened to be a board certified case manager so this is all a subject near and dear to my heart.

4:15 PM  
Blogger Bart said...

I cannot offer the evidence provided by Dr. Lippin, but I can say that I have seen more comparisons of the US "health care" system and other industrialized countries in the past 6 months than in the previous 6 years.

For years there was some kind of journalistic taboo against making such comparisons. Thanks to Paul Krugman and Nick Kristof, such comparisons are part of the national dialog.

A truly hopeful straw in the wind

8:43 AM  
Anonymous Dr. Rick Lippin said...

Thanks Bart

Rick Lippin

9:38 AM  
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