Here’s an exceptionally well written, on-target email from Claudette, an occupational therapist from Michigan, in response to my post Physical Therapist in NY Chimes in on Health Care Costs.

Claudette wants to “Put the Patient in the Driver’s Seat“.

Claudette writes …

Hello Mish

I do not disagree with the PT who wrote to you about consolidation of hospital systems resulting in increases in cost of care, but there are other pertinent problems to consider.

For example, in the current system, the physician and hospital make more money if they perform more services…so there is an incentive to order more tests, do more therapy and generally “do more to make more”.

Under the ACA, there should be one bundled payment per diagnosis/incident.

What I suggest is not new, or radical. Medicare instituted DRGs or Diagnosis Related Groups with inpatient day and dollar limits per diagnosis 38 years ago (I was just beginning to work as an OT then).

DRGs drastically cut the cost of inpatient care and spawned the development of new service models including inpatient rehabilitation centers, Homecare and rehab in nursing homes, none of which fell under the constraints of the inpatient DRG.

Was this good? Yes, getting out of the hospital earlier is less expensive and healthier. There is no better place to get really sick than in a hospital.

Healthcare will not be truly competitive or cost effective until the patient is the one in the drivers seat. The patient should be informed, empowered to make care decisions and should pay the bill.

The bill should be discussed and agreed upon before service, whenever possible. Service prices should be posted so that consumers can comparison shop.

Right now patients are the point of service but are not part of the decision process. ACA did not change that and, in my mind, that is its greatest shortcoming.


Obamacare, the Worst that Money Can Buy

As I reflect on all the emails that I received, it is readily apparent that numerous healthcare professionals understand precisely what is wrong with the current system.

So, how come none of the numerous existing problems were fixed?

Five Reasons Obamacare Legislation Failed

  1. Lobbyists wrote the ACA legislation. When Nancy Pelosi stated “We have to pass the health care bill so that you can find out what is in it“, she was referring to you , me, and Congress. An extremely tiny number of people knew what was in the bill: lobbyists for hospitals, lobbyists for insurance companies, lobbyists for HMOs, and lobbyists for major pharmaceutical companies. 
  2. President Obama was more concerned about his legacy than anything else. He wanted Obamacare at any and all costs and was willing to sign any piece of legislation, no matter how poor.
  3. Politicians in general do not have the public’s vested interest in mind. They have their own reelection efforts in mind. That statement holds true regardless of which political party you support. 
  4. Lobbyists and industry PACs donate massive amounts of money to politicians from both parties. That is why we do not allow drug imports from Canada. That is why there is an explicit law that prevents government from bargaining with drug companies on prescription drugs. That is why the US pays the highest drug costs and highest healthcare costs of any nation on the planet. 
  5. Republicans for the most part were more concerned over stopping Obamacare than improving the healthcare of citizens of the United States. The irony here is Obamacre is essentially the same as Romneycare.

So here we are, stuck with the worst legislation imaginable.

As Claudette suggests, we need to put the patient in the driver’s seat. Unfortunately that is in the vested interest of only the patient.

Who speaks on behalf of the patient? The sad answer is all too apparent: no one that the president or Congress listens to. They are all beholden to lobbyists, their legacy, and their reelection campaigns.

Mike “Mish” Shedlock