AIG
If you are legally obligated to pay someone a bonus, even if the company basically goes bankrupt, is it really a bonus?
A blog about the city of Los Angeles, the Green Party, and green politics in L.A.
The Budget establishes a reserve fund of more than $630 billion over 10 years to finance fundamental reform of our health care system that will bring down costs and expand coverage. The reserve is funded half by new revenue and half by savings proposals that promote efficiency and accountability, align incentives toward quality, and encourage shared responsibility. In addition, the Budget calls for an effort beyond this down payment, to put the Nation on a path to health insurance coverage for all Americans. However, additional funding will be needed. This effort must be open, and must consider all kinds of approaches as part of this process. Some major strides have already been made in the American Recovery and Reinvestment Act of 2009 [AKA the stimulus bill], including $19 billion for health information technology, $1 billion for comparative effectiveness research, and subsidies for the newly unemployed to maintain their health insurance. These initiatives put the Nation on the path toward health reform.The key phrase is probably "a path to health insurance coverage for all Americans." That is a rather watered-down goal, in my opinion, leaving a lot of wiggle room.
Yes, American health care is an appallingly patched-together ship ... but hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions... There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it... If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have.Gawande calls the need to start with what we have "path dependence," and he argues that every major universal health care system around the world was built this way.
Of course, pragmatism is the theme of Gawande’s article. He cites path dependency as the natural model to achieve reform. Use what we have, and build on it to bring us closer to our goals.
But what is it that we do have? We have an expensive, dysfunctional health care delivery system that needs extensive repair along with adoption of efficiencies so that we can pay for it. Within the health care delivery system, we need to build on what is working, and replace that which isn’t.
But what else is it that we have? We have a health care financing system that is wasting tremendous resources, while impairing access to much needed health care, and exposing individuals to financial hardship or even financial ruin. Gawande’s major error in framing is that he conflates our health care delivery system with our health care financing, as if they were one and the same. Since we need to build on our existing delivery system, he includes as a given that building on our current fragmented financing system is an integral part of the process.
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The pragmatic approach to financing reform is to follow a path dependent program that works, and discard those that don’t. With improvements, Medicare would work well for all of us; private health plans would work for those of us who are relatively healthy and have good incomes, like Dr. Gawande.
Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.
The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.