Just A Little Something.......On Health Care Reform in MN

HF 3391 & 3390 are health reform bills in the MN House getting a lot of attention from lawmakers lately.

HF 3391 & 3390 concentrate on a few erroneous assumptions. The first erroneous assumption is that preventative care saves money. Would that it were so easy! Studies have actually shown that while preventative care in some instances may save money in the long run, most preventative care actually costs more. (Expert characterization on Feb. 13, 2008, edition of the New England Journal of Medicine: "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.")

The second is doctor & patient overutilization. In order to address this, the new legislation proposes an extremely confusing third layer of “managed care.” This would force patients to once again have PCP’s (didn’t we prove managed care didn’t work in the 80’s?) These bills would also require physicians’ to absorb the risk that insurance companies typically do, by paying physicians not fee-for-service but with an annual fee per patient loosely determined by a risk algorithm not yet known.

What does this mean? Hypothetically, your physician would receive $2000 to provide you primary care services for the year. Should your care cost more than this, your physician loses money. Should your care cost less than this, your physician will earn money. This seems to me like an excellent incentive for physicians to avoid chronically ill and underserved populations.

Health care reform is important, but it is also important that we approach health care reform in a way that is not based on popular “myth” but on fact. Senator John Doll’s comparative cost analysis bill, which studies the major reform bills in the Legislature, would help us do just that.