You might not agree with them, but you can’t ignore them. The history of health care in the United States is filled with those who identified the system’s failings and offered new, unproven ideas. Is it time for a single-payer system? Are accountable care organizations unworkable? Will CMS go under? Read on.
“As a result of the exchanges and the transparency they bring to the marketplace, insurers’ profit margins will be squeezed under the [Affordable Care Act],” says the industry watchdog. That means that “not-for-profits may benefit more than the for-profits do from health care reform.”
We could be back in the 1990s, with providers learning the hard way that they don’t know how to measure — and therefore manage — risk. ACOs hate the concept of utilization management “so much they don’t even want to admit to themselves that management of utilization is necessary.”
Because it has two conflicting missions, says the former IT “czar” under President George W. Bush. “Not only does it run Medicare, the biggest insurance company in the world, but also it’s a regulatory authority for the health care industry. Imagine if the Federal Communications Commission … also operated the nation’s largest cell phone company.”
Despite the Affordable Care Act, we’ll still have about 31 million uninsured in 10 years and still be saddled with a system that cannot control costs, says the nationally known proponent of a single-payer system. Out-of-pocket costs, especially for cancer care, are enough to bankrupt many families.
Value-based insurance design will change the conversation in health care from how much we spend to how well we spend. Fendrick says that “when you couple VBID carrot programs with VBID stick programs, you decrease access to medical services that have no proven medical benefit.”
Years ago, he thought for-profit insurance companies were evil. But now, “I’ve seen plenty of not-for-profit organizations behave badly, and I’ve seen for-profit entities behave well. The bigger problem is that we have a broad set of rules that don’t make any sense.”
“We don’t know for certain whether there’s cost shifting going on, but it’s unlikely that people are turning around their health status so quickly” and the savings have to come from somewhere — most likely from low-earning, and unhealthy workers. Some 50 million Americans are enrolled in such programs.
November is the cruelest month for politicians who want to duck and weave when it comes to the Affordable Care Act. The public remains divided. Four experts discuss the points of contention as well as common ground, such as allowing young adults to stay on their parents’ plans and providing coverage for pre-existing conditions.
This is a problem with all medications, but especially so for these new products that are expensive and require following a strict schedule. Patients also, for the most part, don’t like injecting themselves, and will often abandon the regimen once they feel better.
Conflicting findings from the huge phase 3 ALTTO trial and the NeoALTTO trial, the neoadjuvant counterpart to ALTTO, stole the spotlight at the annual meeting of the American Society of Clinical Oncology.