Physicians Practice - July/August 2008 - (Page 31)

vate health insurance paid for by a 10 percent value-added tax (VAT) — in essence, a federal sales tax. Cost-control elements in Emanuel’s plan include a standardized list of covered services (based on those currently enjoyed by members of Congress), an outcomes and technology oversight board to ensure appropriate care delivery, and a dispute-resolution center to supplant the malpractice system. Moreover, if consumers want beneﬁts that cost more than VAT-generated revenues, they’ll have to lobby Con- is on nearly everyone’s lips. Under a true consumer-directed system, explains Heritage’s D’Angelo, “Insurers would need to work collaboratively rather than confrontationally with providers to deliver better value.” Like D’Angelo, many analysts favor gradually moving toward a system of individual tax credits, which people would use to purchase their own plans, and divorcing coverage from employment. Indeed, the concept is slowly becoming conservatives’ conventional wisdom on health reform; Republican presidential candidate John McCain • Tools to enable employees to compare provider quality; • Premium differentials for participation in health management; • Plan decisions based on claims analysis; and • Health-risk appraisals and disease management. Other cost-control strategies are more radical and include performance guarantees for prescription drugs, which would move pharmaceutical companies toward riskassumption, and paying physicians for outcomes rather than treatments. “We cannot pay merely for services provided,” says Emanuel. “This idea that we pay fee-for-service is very bad vis-à-vis integration.” THE UNINSURED Massachusetts’ new health insurance mandate has led to wait times for a new-patient or well-patient appointment running between four months and 10 months on average. BAY STATE WAIT gress to increase the tax or pay more out of their own pockets for supplemental coverage. Emanuel cites two Medicare-covered colon-cancer drugs that don’t cure the disease, extend patients’ lives by only a matter of weeks, and cost up to $50,000. No one wants to talk about the rationing of care, but the implication is clear: Such a use of resources is not value-added and wouldn’t be paid for by taxpayers. Consumers could, if they wanted, pay extra for a plan that does cover such drugs, experimental procedures, and anything else, but this will inevitably lead to wrenching decisions over what “potentially life-saving treatment” is worth spending tax dollars on. Although the reforms favored by conservative groups like the Heritage Foundation are in many ways the polar opposite of plans like Emanuel’s, a cost-beneﬁt argument WWW.PHYSICIANSPRACTICE.COM has proposed such an idea. (Read more about the candidates’ proposals on page 36). Fewer than 60 percent of employers currently offer healthcare coverage, and many of those that do offer it restrict enrollee choice to a single (usually managed-care) plan. These observers argue that health insurers would be more responsive to consumers if consumers had more power to choose their health plan, notwithstanding their employment (or lack thereof). But some feel that corporate contributions remain essential. Depending on whom you ask, businesses pick up the tab for as much as 60 percent of American healthcare. To keep that money rolling in, employers are being advised to consider proactive programs such as: American healthcare seems locked in a death spiral: Observers on all sides agree that our reliance on employer-based health insurance is one of the factors driving costs up, and those ballooning costs are forcing more employers to cut back on, or eliminate, health beneﬁts. With no healthcare safety net for most Americans and a market for individual insurance that prices most people out, is it any wonder we have 47 million uninsured? Add a slowing economy that is shedding jobs quickly — nearly 50,000 in May alone, the biggest single-month jump in unemployment since 1986 — and the uninsured problem seems likely to grow. MASSACHUSETTS EXPERIMENT But not, it seems, in Massachusetts, where two years ago lawmakers enacted a controversial plan to require all residents to get health insurance, with subsidies available for low-income citizens, and penalties imposed on the noncompliant. The Bay State is the only one in the country to impose such a mandate so it’s worth an examination. Is it working? That depends on whom you ask, but doctors in Massachusetts generally support the legislation because it increases access to primary healthcare, despite the JULY/AUGUST 2008 | PHYSICIANS PRACTICE | 31 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - July/August 2008

Physicians Practice - July/August 2008 Contents The Bigger Picture: Battle Royale in the EMR Market Letters Physicians Practice Pearls: Hire Right Noteworthy Cover Story: Healthcare Reform: Voting for Change Patient Relations: Dealing with Problem Patients The tech Doctor: Is Self-Service Medicine Inevitable? Technology: Do EMRs Make You a Better Doctor? The Guide Idealab: Cash-Only Care Still Works The Administrators Desk: Who’s in Charge? Ask The Experts What Went Wrong: ‘Why Our Great Idea Didn’t Work’ Coding Start It Up: How to Launch a Practice: Operations Partnership: Don't Let Partner Conflict Destroy Your Practice Appraisals: What’s Your Practice Worth? Getting Advice: How to Hire a Consultant Classifieds Advertiser Index

Physicians Practice - July/August 2008

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