All Things in Moderation

I wanted to put this post up last week, but got distracted by work and my one month old son (he’s great by the way). So some of this is a week or two old and I don’t have much time to add a bunch of analysis, but I thought some of these may provoke some discussion or just be informative to those who are interested.

The American College of Physicians encourages physicians to take into account the cost-effectiveness of their treatment decisions. In their ethics manual (which you can access for free), the ACP does more than just argue that physicians should take into cost effectiveness with regard to exposing patients to excessive, unnecessary or potentially harmful treatments. The manual encourages physicians to think about how cost effective care can increase the availability of health care to more people. Now I’m all for more cost-effective health care, but I’m not sure I want my physicians worrying about how a treatment they are ordering for me may somehow reduce health care resources available to the community as a whole.

USA Today recaps some of the provisions of the ACA that have already had an impact. It’s not exactly a critical look at the law (OK, it’s pretty much a puff piece), but the government’s success in fighting fraud has gotten more attention lately and the article leads with that aspect of the ACA. While the Obama Administration deserves some credit for the crackdown on fraud, I would also point to the increased use of electronic medical records as a reason for the increase in fraud prosecutions.

The Washington Post has a depressingly humorous article about doctors complaining that the Medicare “doc fix” was closer to becoming a reality than ever. So they’re complaining that the perpetually scheduled reimbursement cut that they know Congress will never pass was closer to passing this time than in the past. Boo-freaking-hoo. The refusal of Congress to pass the cut in physician reimbursement under Medicare is of great amusement to me and NoVa, but it’s emblematic of why we need to fundamentally change our health care system.

The Detroit Free Pressdiscusses all the merger activity between solo hospitals and larger health systems. One of the criticisms of the ACA and programs like ACOs was that they would lead to mergers which would lead to less competition and higher prices. To a large extent mergers were occurring before the ACA so it’s a bit difficult to determine to what extent the ACA increased that activity. It’s also difficult to determine whether or not the mergers will lead to higher prices. The argument that they won’t is that consolidation will lead to increased efficiency which will lower health care spending. It remains to be seen whether or not one or both of those theories will be true.

Lastly, here’s a link to the government’s anti-trust complaint against Blue Cross Blue Shield of Michigan (BCBS). It provides an interesting (albeit one-sided) read. As a brief summary, BCBS entered into most favored nation (MFN) agreements with hospitals throughout Michigan that required the hospitals to charge other insurers as much or more than they charged BCBS. Since BCBS has such a large share of the insurance market here in Michigan that made it hard, if not impossible, for some insurers to compete. And obviously it drove prices up for everyone, including BCBS. Both Michigan and the Feds are in on the suit and several private insurers have filed similar suits.

Filed under: health insurance, healthcare | 20 Comments »