John McCain and outcome-based healthcare: How to kill healthcare in America

The BBQ Pit
1

That’s it. John McCain is Ron Paul-level crazy. Maybe even Lyndon LaRouche-level crazy:

This level of blithering idiocy should come with a gigantic black-box warning: “Not to be taken internally. May cause high blood pressure, screaming, and verbal leakage.” A lot more should have been made of this when he said it.

McCain’s plan, apparently, is to base payment for healthcare on how well the patient does. This is utterly, utterly wrong and suicidal for three reasons:
[ul]
[li]Some things aren’t curable. We have no cure for some common forms of diabetes. If your pancreas is shot, losing all the weight in the world isn’t going to bring it back from the dead. If you have cancer and it isn’t operable and it isn’t responding to chemo or radiation, you’re not going to get better.[/li][li]Some patients are morons. Yes, read that again. Some patients directly get in the way of their own care. Some patients will smoke themselves into an early grave, some will sit in a hot tub for six hours to get a cast off, some will gorge on pork rinds and candy, and some will drink themselves blind. The physician has no control over this. (Even prison docs have their limits.)[/li][li]Some patients want to die. Does the doctor get paid based on saving the patient’s life or based on how painless the death was? Is it different if the patient has inoperable brain cancer? (I know some ghoulish perverts answer ‘no’ to that second question. They can kindly excuse themselves and find some torture porn to get off on.)[/li][/ul]John McCain is not a sane choice for president if he can be this dangerously wrong about anything. His position on this issue is useful in one way, however: Agreeing with him is prima facie evidence you don’t know shit about healthcare.

2

While I’m no major McCain supporter, a one-liner tossed off is not sufficient information. In fact, most of the quotes you give seem reasonable and common-sense to me. And your flaming outrage seems just a little cute, love.

3

The only blithering idiot I see in this thread is the OP, despite the gratuitous Latin.

First off, like **SM **said, that one liner has very little information in it. Besides, “well” ≠ “cured”, as you are assuming. You need more than this to get me on board…

4

I don’t have a cite handy and I’m in a rush right now, but I saw Michael Moore’s Sicko, and a British physician (general practitioner, IIRC) stated that, in addition to their regular pay, doctors get extra incentives/bonuses if their overall patient group is healthier/becomes healthier (i.e. the number of patients who quit smoking, lose weight, etc…).

5

Sounds like capitation to me, which is already well-established in our health care system.

So who is it again that “doesn’t know shit about health care”?

6

There’s nothing revolutionary or crazing about endorsing the idea of financial incentives for certain outcomes (“cures” for chronic diseases are not realistic, but meeting objectives that relate to a healthier patient is reasonable). It’s debatable how well this would work on a grand scale, but it’s not insane.

“Ron Paul-style crazy” should be reserved for true nuttiness, like Ron Paul’s opposition to mandatory vaccination programs with great proven value, on the grounds that they are a nasty Federal Intrusion into our lives.

7

I work in the healthcare industry, and as others have pointed out, this is hardly new and not at all idiotic. In fact, the Leapfrog Group has had strong influence in this arena.

Another good article here.

8

[QUOTE=EddyTeddyFreddy]
Sounds like capitation to me, which is already well-established in our health care system.
So who is it again that “doesn’t know shit about health care”?
[/QUOTE]

That would be you. Capitation works because an insurer can average the costs of treating a large number of patients, and give that to the doctor. The quote from the OP (which I can’t find in the link) says that a particular patient will be given a set amount for treatment.

Even McCain says that a special fund might have to be set up for chronic diseases. Anything that starts off with the mantra that we have the best healthcare in the world (because we just do, darn it, no matter what the data says) I don’t trust. There is also a stupid quote from Reagan about how no one ever washes a rental car. If we were renting our bodies, I’d agree.

The wellness stuff makes sense, and is something being done in the present system - when people can afford it. When all Americans are clever enough to know that over-eating makes you fat, and have the gumption to stop eating, then I’ll agree that hectoring will work. But I’ll be busy ice skating in hell at the time.

9

I think the larger point is that McCain thinks that the market can solve the health care problem. For example, I’m continually puzzled by tax-deductible medical savings accounts. So what we’re basically doing is subsidizing spending on medical care – in the same way that the mortgage interest deduction effectively is a subsidy for home ownership – and then we’re shocked! shocked! that subsidies don’t actually do a good job of controlling costs.

10

Everyone planning on voting for McCain if Obama loses needs to seriously contemplate his ideas for healthcare reform. I think George W. Bush could come up with better ideas.

“To make the recipient of the health insurance much more responsible in health-care costs.”

Isn’t this the problem? Recipents are already so “responsible” for health-care costs that that many get done in by crazy co-payments, premiums, and deductables. I worry what he has planned if he wants recipients to be even more responsible than they are now.

11

If I misread and the practice is common, McCain is an idiot for making a big deal over it. On the other hand, if my initial reading was correct, McCain doesn’t have the intelligence to know whether condoms reduce the risk of AIDS transmission. Well, lookie here! McCain’s a moron.

12

I would disagree that the practice of encouraging health care providers and patients to both make better decisions about wellness with a financial “carrot/stick” is well-known or practiced. In many cases, providers are given financial incentives to perform poor care, and are rewarded for having sick patients.

And this:

Recipients are absolutely NOT responsible for their own health care costs currently. As a very simple exercise, compare the attitudes and behaviors of Americans towards their health care insurance, and their auto insurance.

John McCain is on the right track with what he says, and this comes from someone who does not like him much at all.

13

[QUOTE=Derleth]
If I misread and the practice is common, McCain is an idiot for making a big deal over it. On the other hand, if my initial reading was correct, McCain doesn’t have the intelligence to know whether condoms reduce the risk of AIDS transmission. Well, lookie here!
[/QUOTE]
I did look there, and it doesn’t at all say what you trying to suggest it does.

If you think that contraceptives (note that the word “condom” wasn’t mentioned) helps stop the spread of HIV than we all know who the moron is. Continuing:

Lookie there. The reporter specifically says that McCain believes that condoms do stop the spread of diseases, and asks him if he supports government programs that provide condoms. So, suspecting a “gotcha,” McCain asks his aide to get him his voting record to make sure that he doesn’t get caught in a trap. Weaselly, sure, I’ll grant you that. But show me where he says what you say he says.

Pathetic. You’re 0 for 2 on McCain bashing so far in this thread.

14

[QUOTE=Necros]

Recipients are absolutely NOT responsible for their own health care costs currently. As a very simple exercise, compare the attitudes and behaviors of Americans towards their health care insurance, and their auto insurance.

[/QUOTE]

Please expand on this. Do you think having auto insurance makes people worse drivers? If people were allowed to not get auto insurance, would they be better drivers? I was in an accident with someone who didn’t have it (or a license.) He was certainly not a better driver.

Anybody have data that insurance leads to people using healthcare uselessly? I’ll buy that an insured person may make more necessary visits than an uninsured one.

15

[QUOTE=Voyager]
Please expand on this. Do you think having auto insurance makes people worse drivers? If people were allowed to not get auto insurance, would they be better drivers? I was in an accident with someone who didn’t have it (or a license.) He was certainly not a better driver.

Anybody have data that insurance leads to people using healthcare uselessly? I’ll buy that an insured person may make more necessary visits than an uninsured one.
[/QUOTE]

Ah, perhaps I was unclear. People look at their auto insurance (or homeowner’s for instance) as something they comparison shop for, and when they need the insurance, it’s for something like “A tree fell on my car” or “A drunk driver hit me and my car is totalled”. And when they go to get their car fixed/replaced, they shop around, because they see a car repair cost as tangible thing. Auto insurance companies give discounts to people who avoid accidents.

Drivers do not use their auto insurance because their car got a scratch, they are aware what the real bill is when they go to the body shop, and understand the costs on a body shop bill. And they try to avoid damaging their own car because they know that they will have to pay for the repairs themselves, and their insurance company will jack up their rates.

I am actually saying that the way auto insurance is structured provides incentives for people to be good drivers, and also encourages people to shop around (both for insurance and for the services that insurance pays for).

Right now in the healthcare system, insurance is tied to employment, so there is no competition, except in the wrong place (on the employer or group level). People use their insurance for all sorts of mundane crap. Get a cold? Go to the doctor. Worry about your weight? Screw that, give me another value meal. If you are a doctor or hospital, and an insurance company pays you for every test you do, and every extra day a patient is in the hospital, and you make a profit on it, the incentive is less to increase your quality of care.

I am in complete agreement that the US healthcare financial model is completely bonkers. But to say that one of the reasons is that people are TOO responsible for their own healthcare costs is ridiculous.

16

[QUOTE=Voyager]
Anybody have data that insurance leads to people using healthcare uselessly? I’ll buy that an insured person may make more necessary visits than an uninsured one.
[/QUOTE]

Have you not read the cite I provided to you here: http://boards.straightdope.com/sdmb/showpost.php?p=9382648&postcount=57

17

[QUOTE=Renob]
Have you not read the cite I provided to you here: http://boards.straightdope.com/sdmb/showpost.php?p=9382648&postcount=57
[/QUOTE]

And you’re using that to justify your position? The pay health care compared to free health care in the study was very reasonable, with they pay care ceiling $1,000 or 15% of income, which ever is less. (This was in 1984, so the amount would no doubt change today.) Even so, for hypertension 10.5 out of 1,000 men of age 50 would be alive in the free plan who would be dead in the costed plan. The authors say that directed programs would be more cost effective - maybe so but there isn’t evidence that other things would affect the result. There was no difference in cancer and mental health outcomes. Actually I’d be against free mental health coverage, since I’d think paying would be a motivator.

On page 26, btw, they say differences between outcomes were greatest among the poor.

I don’t think anyone disputes that poor people are going to go to the doctor less if they have to pay. More generous insurance resulted in one or two more visits to a physician a year - which is not exactly the camping out in the waiting room behavior that is implied. 24 years ago I don’t remember advice nurse systems like we have today, which give a way for people to get simple care without seeing a physician. I have absolutely nothing against that kind of screening.

The plight of the uninsured, and their number, is much worse today. So, it all boils down to how many people are going to die as a result of the crusade against “socialized medicine” which of course isn’t anything of the sort.

18

[QUOTE=Necros]
I am in complete agreement that the US healthcare financial model is completely bonkers. But to say that one of the reasons is that people are TOO responsible for their own healthcare costs is ridiculous.
[/QUOTE]

Depends on how you define “responsible”. The problem with the healthcare system is not that people are overusing it. It’s that the insurance part of it is profit-driven. Making recipients more “responsible” only shifts the burden of fixing things away from the fundamental cause of the problem. A sick person doesn’t have the time or energy to be shopping around for the best quotes on their treatments and diagnostics. Asking someone who is in pain to comparison shop as if they are dealing with an inanimate automobile is loonytunes.

And so is McCain if that is what he’s suggesting we do.

19

[QUOTE=you with the face]
Depends on how you define “responsible”. The problem with the healthcare system is not that people are overusing it. It’s that the insurance part of it is profit-driven. Making recipients more “responsible” only shifts the burden of fixing things away from the fundamental cause of the problem. A sick person doesn’t have the time or energy to be shopping around for the best quotes on their treatments and diagnostics. Asking someone who is in pain to comparison shop as if they are dealing with an inanimate automobile is loonytunes.
[/QUOTE]

I completely disagree with you that the problem with the US healthcare system is that the insurance companies are profit-driven. In case you didn’t notice, everyone in our current system is profit-driven from the provider side (ins. companies, hospitals, doctors, equipment manufacturers, pharmeceutical companies, etc. etc. etc.). In addition, the consumers of healthcare are more or less capitalist, in that they want the best value for their healthcare dollar. Right now, though, the attitude and the system are not set up so that consumers can get the best value for their dollar, and no one is rewarded for providing that value.

Our system cannot continue for too much longer as it has been, and so you are basically looking at one of two things happening in the next five years or so: A “socialized” or single-payer government-run system which provides a certain level of rationed care to everyone, or a capitalist, profit/value-driven CDH model. John McCain just probably prefers the latter.

20

[QUOTE=Voyager]
And you’re using that to justify your position?
[/quote]

Yes, because it proves that people who have their health care paid for by someone else use more care and have basically the same health care outcomes (outside of the poor). That was the question you asked, and it was answered.

Except for the number of health insurance companies that are non-profit, such as Kaiser Permanente and many of the Blues.

Most health care isn’t emergency care. Most health care is on things that certainly allow the consumer to comparison shop. Even big things, like heart surgery, would allow enough time to look for the best treatment at the best price. But with our current system there is no incentive to do so. Someone else is paying for it, after all, so why not use as much of it as you can?

No, our system doesn’t give them any reason to do this. With someone else paying for both health care (the insurance company) and the insurance (your employer), consumers have little reason to make good economic choices when it comes to health care.