https://www.wsj.com/politics/policy/warren-hawley-health-insurers-pbm-bill-c8cdeb85?st=os8mZx
Bipartisan bills would make healthcare companies with pharmacy-benefit managers divest their pharmacies
A bipartisan group of lawmakers introduced legislation to break up pharmacy-benefit managers, the drug middlemen that have now faced yearslong scrutiny from Congress and the Federal Trade Commission.
A Senate bill, sponsored by Sens. Elizabeth Warren (D., Mass.) and Josh Hawley (R., Mo.), would force the companies that own health insurers or pharmacy-benefit managers to divest their pharmacy businesses within three years.
While this legislation was in the works long before the killing, it didnât stop Wall Street investors from saying that any discussion of health care reform was a de facto endorsement of murder.
These kinds of discussions are always done in bad faith, since people who make a lot of money from killing people with spreadsheets like to pretend to be very offended when anyone points out health care is a matter of life and death.
Everyone agrees on the basic problem with U.S. health care, which is that we spend too much and have poor outcomes. The disagreement is about why. Smith thinks the heart of the health care problem is that Americans over-consume, due to âmoral hazard.â We get a tax-break to buy health insurance, which we pay in premiums, but we donât pay at the counter when actually getting services. Itâs like paying upfront for an all-you-can-eat buffet, you then have an incentive to take as much care as possible. And doctors have an incentivize to over-order it because they are paid under the much-maligned âfee for serviceâ model. In that model, clinicans were paid per serviceâan office visit, a x-ray, a procedure. But that led, in the âover-consumptionâ way of thinking, to waste.
Deductibles are utilized to mitigate the moral hazard of patients.
There is no such limit on providers.
Atul Gawandeâs 2009 piece in The New Yorker titled âThe Cost Conundrumâ* that articulated the rationale behind the ACA. In it, Gawande argued that Americans spend too much on health care because doctors over-order it. âThe most expensive piece of medical equipment, as the saying goes, is a doctorâs pen,â he wrote. It is the âaccumulation of individual decisions doctors makeâ that drive health care costs. âAnd, as a rule, hospital executives donât own the pen caps. Doctors do.â*
The obvious way to fix this dynamic would be to publicly ration care.
Oh God now Iâve done it!
Back when ACA was under debate I argued for the use of evidence based medicine. That for a procedure to be in the providerâs handbag. It needed statistical proof that the patient would benefit from it .
I have bought many books written by Dr Nortin Hadler.
He explain Type II medical malpractice. Type II medical malpractice is doing something to patients very well that is not needed in the first place.
He went after the coronary artery bypass grafting as a prime example.
Three studies were made in the late 1970âs and mid 1980âs. Bypass surgery vs conventional treatment death rate comparison.
âFor 97% of the CABG patients in all three trails there was no survival benefit from the surgery.â A subset in all three trials involving the left main coronary artery (left main disease), experienced a benefit.
Those patients did have a significant survival benefit.
âCABGs should have been relegated to the archives fifteen years ago, but they have not. In fact, some 500,000 are still done annually in the United States.â
The above quotes are from his âThe Last Well Personâ book published in 2004.