Three items of note in the morning papers:
- A staff editorial in this morning’s NY Times charges says the Republicans are dangerously clueless about how to preserve Medicare.
Republicans claim to be deeply worried about the deficit — their favorite political target, followed closely by President Obama’s relentlessly demonized health care reform. So why are they so determined to overturn one of the central cost-control mechanisms of the new reform law?
Republicans in both the Senate and the House have introduced bills that would eliminate the new Independent Payment Advisory Board, which is supposed to come up with ways to rein in excessive Medicare spending — and stiffen Congress’s spine.
More fodder to demonize now CMS head Donald Berwick, the NYT says: Republicans are also eagerly, and shamefully, pillorying Dr. Donald Berwick, the new head of the Centers for Medicare and Medicaid Services. There are few figures who command greater respect for uniting health professionals and institutions to improve the quality of medical care while reducing costs. That is not stopping these critics from implying — baselessly — that he will introduce socialized medicine and death panels in this country.
The truth is that Dr. Berwick has praised the socialized British health care system, especially for its emphasis on primary care. This country certainly needs to do more to develop its primary care system. And he has, rightly, called for an open discussion of the health care rationing that is already widespread in our system. When insurers decline to cover procedures, or high prices screen out low-income people, that is rationing.
Dr. Berwick has endorsed the use of “comparative effectiveness” research to determine which treatments work best. He would use such research to judge whether a new drug or procedure is worth the cost of coverage, a step the reform law shies away from. He does not have the power to change that law. But the issue will have to be addressed at some point if there is to be any hope of restraining medical spending.
Democrats have to counter the Republicans’ demagoguery with facts. Americans need to understand that if Senator (John) Cornyn (of Texas) and others get their way, runaway health care costs will only get worse.
- And an editorial in the Globe says the state needs to scrutinize the sale of the Caritas hospitals to a group of investors to make sure it’s a good deal for everyone:
THERE ARE good reasons to support the proposed sale of Boston-based Caritas Christi Health Care to New York private equity firm Cerberus Capital Management. In addition to protecting over 12,000 in-state jobs, Cerberus has promised to pay off the non-profit hospital chain’s debt, permanently secure employees’ pensions, earmark $100 million for hospital renovations and expansions, create up to 4,300 new jobs, and increase the system’s footprint by 117,000 square feet. With promises like that, it’s no wonder elected officials including Senators John Kerry and Scott Brown are urging Attorney General Martha Coakley to approve the deal. But before Coakley signs off, she must obtain from Cerberus a clearer sense of how it plans to achieve these goals, and a new commitment of a longer time period before the firm can back out by selling the hospitals.
- WIth that — and Partners — in mind, check out this story from The Washington Post on the pros and cons of large health care systems, including one in with Roanoke, Virginia.
Carilion owns the two hospitals in town and six others in the region, employs 550 doctors and has set off a bitter local debate: Is its dominance a new model for health care or a blatant attempt to corner the market?
Carilion says it represents an ideal envisioned by the nation’s new health-care law: a network that increases efficiency by bringing more doctors and hospitals onto one team, integrating care from the doctor’s office to the operating room. The name for such networks, which the new law strongly promotes with pilot programs, is accountable care organizations, or ACOs — providers joining together to be “accountable” for the total care of patients, with incentives from insurers to keep people healthy and costs down.
“We need to fundamentally get off a transaction system where you’re paid for what you do to patients to being paid to care for them,” says Carilion chief executive Edward Murphy.
But skeptics apply a more old-fashioned term to networks like Carilion: monopolies, which they say will make health care even more expensive.
“The only way to decrease costs that truly works is increasing competition, but for some reason in health care, we’re supposed to believe that competition drives up costs,” said ophthalmologist Frank Cotter.
The gap between those two views is at the heart of whether the law succeeds in controlling costs. Meanwhile, the question is creating a schism in the Roanoke Valley, a region of more than 250,000 people that depends on Carilion’s 12,300 jobs but also worries about health-care costs out of proportion to the area’s cost of living.