Sunday, August 1, 2010
Increase Government Involvement in Quality/Cost of Health Care, Watch Public Trust Go Down. Here's Why
It would be ironic, wouldn't it? While the federal government's involvment in health care is increasing, the level of public trust is likely to go down.
The Disease Management Care Blog explains.
Remember the Patient Self Determination Act (PSDA)? When it was passed twenty years ago, the federal requirement that institutional health care providers and managed care insurers provide information about "advanced care directives" was largely a non-event. At the time, there was very little government visibility over issues of quality and cost, so there was no basis to doubt the Feds' intentions. Consumers and voters interpreted the PSDA as righteous and noble thing. Hospitals and insurers complied and that was the end of it.
In the meantime, however, managed care insurers were meddling in the thousands of quality/cost decision points involved in benefit design, adjudication of the benefit, determining medical necessity, precertification, concurrent review, network development, denials of coverage and appeals. As readers will recall, that often boiled down to denying coverage. Healthcare consumers quickly learned to distrust their insurers because they discerned that there was a huge conflict of interest between making a profit (by denying coverage) and serving a patient (by paying for medically necessary treatment). Through it all, Medicare and Medicaid were the role model and above suspicion: they paid for everything.
Things have obviously changed. From President' Obama's red pill/blue pill remarks, to the Fed's interest in "comparative effectiveness research," to the fixation on the Dartmouth Atlas to rising concern over ballooning deficits, the government's insistence on showing leadership over quality and cost has a down side. Just like with the commercial insurers, persons now have a reason to question the intentions of the Affordable Care Act's (ACA) evolving laws and regulations that could - correctly or not - be interpreted to mean that saving dollars will come before saving lives.
This is why the DMCB thinks the lingering radioactivity of the "death panels" controversy is unlikely to go away anytime soon, and why trying to bend the cost curve by decreasing spending in the last year of life is dead in the water. While the President's supporters can blame underhanded partisan politics, unscrupulous Tea Baggers, AM radio talk shows and poor messaging, an under recognized ingredient is the inevitable link between having to manage cost/quality and consumer suspicions that you're doing it at their expense.
On behalf of all health insurers out there, the DMCB wishes CMS a hearty welcome to their world.