Tag Archives: medicare

Healthcare Reform: Managing What You Measure

The Affordable Care Act (Obamacare) expanded health coverage to millions of people. It did little or nothing to control costs, and is just the tip of the iceberg in improving the quality of care. Think about how you select your … Continue reading

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Health Care Costs: Is Medicine a Market?

There is an excellent article in The New Yorker comparing the production and quality control methods of the Cheesecake Factory to certain advances in “Big Medicine.”  It focuses on the savings available from large health systems through standardization and quantity purchasing. In reality, … Continue reading

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One Response to Health Care Costs: Is Medicine a Market?

  1. Mimi Grant says:

    John, loved your post. Here are a few more issues to factor in: most “customers” (folks who actually pay the bill) don’t see the doctor. Why? Because these customers are typically the employers and governments that are paying the insurance premiums. Only those few truly paying “cash” for services, or those in the “individual market,” where they’re paying their own premiums, are the true customers who have a better idea of the actual cost of healthcare.

    Of course, the government, through the Affordable Care Act, is trying to give more individuals “greater access” to care. This in turn has accelerated another phenomenom: consolidation. As hospitals hire physicians directly, where they can, or indirectly through Foundations, in the states where they can’t, prices are going up – simply because hospital-based services receive a higher reimbursement.

    The other trend we’re seeing is the increase in “direct pay/concierge” physicians. With rates typically starting at $2000/year and going up from there, these doctors “limit their panel” of patients they see, a win-win for the doctor (smaller patient panel for the same or more money) and the patients who can afford this perk (easier access). The only problem is – now that the doctor’s panel has decreased, let’s say, from 3000 to 600 patients – the 2400 Former Patients need to find a new doctor. Play this out, as we hear is happening in Massachusetts, and the unattended consequence of providing for greater access, is greater expense and/or longer waits to see your same (or a new) doctor.

    Clearly we need to “bend the cost trend” to bring down the unsustainably growing high cost of healthcare. But who among the 18% making their living from this 18% of the GDP spent in healthcare (the ultimate “service” business), is going to “volunteer” to cut their compensation? After all, when you have burgeoning demand from the Medicare population (and the 10,000 Boomers a day joining it), and a society – starting with our children – increasingly prone to obesity and all its attendant ills, due to their eating/lack of exercise choices, what “magic bullet” is going to bend this trend?

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Socialized Medicine, or Capitalized Medicine?

In 2000 I was asked by a client to make a single business prediction for the new millennium. It was “By 2011, we will have some form of national health care plan, and small business owners who have been priced … Continue reading

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A New Tax

I dislike taxes as much as anyone. I have a copy of Davey Crockett’s speech “Not Yours To Give” and I think it is true, albeit completely ignored since 1933. But taxes are a fact of life, and some serve … Continue reading

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