Wednesday, August 22, 2012

More on the Corporatization of Health Care

In yesterday's post, the Disease Management Care Blog correlated an apparent White House policy preference for public-private health care "coporatization" (or corporate nationalism?) with the early death of government-run "public option," the conspicuously large role of large commercial insurers in Obamacare and the astonishing faith in unproven accountable care organizations (ACOs).

If the DMCB has it right, that:

1. ... might make Obama Administration officials think that they already have the tools they need to control coordinate health care costs. 

2. ....would explain Obamacare's myriad committees, councils, panels, offices and task forces staffed by bureaucrats, experts and insiders. Someone has to reconcile the numerous and complicated private and public dimensions of a top-down approach to health reform.

3. ....ironically risks, despite the greater involvement of a democratically elected government, less transparency. Think Congress delegating responsibility to consensus meetings populated by appointees who make the Big Decisions behind closed doors. Recent examples include mammography, Avastin, coverage of oral contraceptives and the EHR meaningful use criteria. More are on the way.

4. .... could lead to new versions of crony capitalism, where getting your way depends less on the merits of your idea or what patients want and more on how familiar you are with the decision-making process and the mandarins who are calling the shots. HIMSS may be an early example.

5. .... the states' role "as laboratories of democracy" is significantly diminished.

6. ... means single payer "Medicare-for-all" has a far worse prognosis than generally appreciated by conservatives and progressives alike.  Someone should break the bad news to these guys.

7. ...that this is the medical-industrial complex on steroids.

Consider this front page Aug 22 Wall Street Journal article on the recent rescue of a Philadelphia oil refinery by the coordinated efforts of an Obama Administration official, a "well connected" D.C. private equity firm, a labor union and a Governor who leveraged personal relationships, subsidies, loosened environment regulations and union concessions to keep a failing business model afloat. The DMCB knows nothing about the petroleum business, but predicts the same kind of shenanigans are in store for health care big time.

You read it here first.

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