Viewpoints: Health Care's Hidden Consensus; Examining The Fee-For-Service Payment System

The New York Times: A Hidden Consensus On Health Care
The politicians' consensus is that health care reform shouldn't alter or disrupt the way the majority of Americans get their insurance today. ... The policy consensus, though, is that the status quo is actually the problem, and that it deserves to be threatened, undermined and replaced as expeditiously as possible. Wonks of the left and right disagree on what that replacement should look like. But they're united in regarding employer-provided coverage as an unsustainable relic (Ross Douthat, 7/6).

The Wall Street Journal: Another Obamacare Tax That Is Bad for Your Health
On Jan. 1, manufacturers of medical devices in the U.S. were hit with a new 2.3% tax on revenue, one of the many sources of money tapped to pay for Obamacare. This tax will likely cut into the profits of large medical-device manufacturers, a cost that will almost certainly be passed on to health-care consumers. But its effect on U.S. medical-device startups—the small companies that fuel innovation—may prove devastating (Fred Burbank and Thomas J. Fogarty, 7/7). 

Los Angeles Times: An Obamacare Insurance Exchange Gap
Covered California, the state's new marketplace for health insurance policies, has positioned itself as a powerful advocate for consumers and small businesses. But in a disputed move, it threatens to raise costs for one group of Californians: parents of young children who aren't covered by group plans at work. Against the advice of lawmakers and regulators, the insurance exchange has barred policies that include both medical and pediatric dental coverage. As a result, parents could face not only higher monthly premiums but also larger deductibles. That's wrong, and the exchange should reverse its stance (7/5). 

USA Today: Fee-For-Service Rewards Volume: Our View
Much more pervasive are the unnecessary surgeries (and tests and other procedures) that occur every year because of the way most Americans and their insurers pay for health care. This fee-for-service model rewards volume rather than outcomes. The more procedures that physicians, hospitals and other providers perform, the more money they make. Ideally, doctors do no more than a patient needs. In practice, with incentives pointing exactly the wrong way, it's just too easy to do more, whether it's to pad a bill or simply to resolve a judgment call where surgery might not be the best answer (7/7).

USA Today: Fee-For-Service Isn't The Problem: Opposing View
A lot of people think the great problem in health care is that we pay doctors and hospitals on a fee-for-service basis. They reason that the payment system encourages these providers to perform too many services — the more they perform, the more money they make. ... But consumer-driven health care, in which consumers are responsible for the first few thousand dollars, has been reducing the rate of inflation of the entire health care system for the past 10 years. It can be, and is being, done (Greg Scandlen, 7/7). 

Boston Globe: Unverified Science
In the debate about the impact of drugs on health care costs, most people focus on the end of the spectrum that hits closer to home: rising drug prices. But we must also think of where it all begins, and of the hundreds of millions that are wasted on scientific research that is unreliable. The National Institutes of Health invests $31 billion a year in medical research, a significant portion of which goes to funding preclinical studies at academic centers across the nation. That work is supposed to be the cornerstone of drug discovery, since it is used by biotechnology and pharmaceutical companies to design the drugs of the future (Sylvia Westphal, 7/8).

St. Louis Post-Dispatch: Trying To Unravel The Mysteries Of Medical Billing
While my heart is strong, my memory is weak. How much did I pay in the past for stress tests? Certainly not $1,328. At any rate, I wrote about the bill. Medical costs seem to be skyrocketing. What’s going on? (Bill McClellan, 7/7).

JAMA: For Physicians, A Choice Between Health Care Rationing Or Delivering Health Care More Rationally
The most important health care news of the past year has been the slowdown in the growth of total health care spending. Before the slowdown was apparent, there were repeated calls for massive payment cuts in Medicare and Medicaid and angry debates about the affordability of universal health care. Slower cost growth has allowed even the government to relax a little bit (David Cutler, 7/3).

The Wall Street Journal: NBA With The Assist
Health and Human Services Secretary Kathleen Sebelius disclosed recently that the Administration wants the National Basketball Association and other major sports leagues to promote the Affordable Care Act. We weren't aware LeBron James specialized in public policy, but HHS seems to believe his interest should be shared by pro athletes in football, golf, hockey, NASCAR and the "variety of sports affiliates" with which Ms. Sebelius claims HHS is having "active discussions" (7/5).

The New York Times: Diagnosis: Insufficient Outrage
Recent revelations should lead those of us involved in America's health care system to ask a hard question about our business: At what point does it become a crime? ... Medical care is intended to help people, not enrich providers. But the way prices are rising, it's beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufactures — are the ones benefiting (Dr. H. Gilbert Welch, 7/4).

USA Today: Retail Clinics Carry Benefits, Drawbacks
For retail clinics to be viable for primary care, they should not compete with doctors by siphoning off patients, but join local practices so that patient records can be easily shared and follow-up care coordinated. Patients should also have the explicit option to fill prescriptions at any pharmacy where prices might be cheaper. Until that ideal is realized, retail clinics are fine to treat your sore throat but should not substitute for your primary care provider (Kevin Pho, 7/3). 

The New York Times: The Gap In Medical Testing
An alarming number of diagnostic medical tests have never been tested for safety and accuracy. That's because the federal government has a two-tier system for regulating such tests. If a diagnostic test is made by a traditional device manufacturer, the Food and Drug Administration reviews its safety and effectiveness before approving it for marketing. However, if a test is developed by a clinical laboratory for use at its own facilities, it can be sold without a premarket review (7/7).

The New York Times: Painkiller Overdoses In Women
Every month the federal Centers for Disease Control and Prevention turns its spotlight on a public health problem that merits attention. This month the C.D.C. has focused on a problem that is rapidly getting worse: the rise of prescription painkiller overdoses, especially among women. Dr. Thomas Frieden, director of the C.D.C., said that women are dying from prescription painkillers at "rates that we have never seen before." He called it "a sleeper problem," underrecognized by doctors and patients (7/7). 

Los Angeles Times: Alluring But Risky Medicine
But alternative medicine shouldn't be given a free pass. Just because something sounds harmless doesn't mean that it is harmless. If we are to take our healthcare seriously, we should insist that alternative products — many of which are made by large pharmaceutical companies — be held to the same standards of safety and effectiveness as any licensed product. Unfortunately, because of the 1994 Dietary Supplement and Health Education Act, dietary supplements are not regulated by the Food and Drug Administration, so companies are under little obligation to support their claims or admit their harms (Paul A. Offit, 7/6).

Detroit Free Press: How You Vote To Expand Medicaid And Oppose Obamacare
Last month, the Michigan House passed a bill that will make key changes to Medicaid. The fate of the bill in the state Senate may still be in question, but the positive impacts of the reforms are not. House Bill 4714 will give more people health insurance, modernize our Medicaid program to produce better results and make significant long-term reforms to this outdated federal program, all at a lower cost to taxpayers than the status quo (Joe Haveman, 7/6).

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