I agree that the point is a bad one.

I'll just add that the "Health Partners did never events first three years ago" is a little misleading. That may be technically true for something called "never events." But there have been several other important attempts by private insurance companies to stop paying fee-for-service, and instead do flat contracting, capitation, etc.

Experimentation with cost control methods is something that Medicare compares horribly with private insurance companies. Effectiveness is a separate and related question, but Medicare hasn't even tried cost controls for the most part

PS Your posts today reminded me to say that while I'm biased, I think your blog stands out more against the crowd with more health care posts than you've had the past few months. I know there's been a lot to say on the campaigns and the financial crisis, but there's a million other bloggers to shout about that stuff. A mix more like today's was how things used to be on this blog. Perhaps your pageviews have increased with less health care, but I'd suggest doing one of those "What do you guys want me to blog about?" check-in posts that you did a year or so ago.

I would just point out that I live in Ontario, by far the largest province in that bastion of socialized medicine - Canada. Ontario's doctors are overwhelmingly non-salaried, and are paid on a fee-per-service basis.

I watched this correspondent's report last night...
http://www.abc.net.au/lateline/content/2008/s2398606.htm

It's about a flying doctor service that flies into remote parts of the Amazon where people otherwise couldn't get access to a doctor.

They now do the same thing in West Virginia and are overwhelmed.

It should also be noted that when Group Health Cooperative was founded the Michael Cannons of its day relentlessly attacked it. Because unions and labor-liberals provided the seed money to get GHC started, the organization was red-baited for paling around with the wrong sort of people and starting us on the road to socialism. (The more things change...) The Washington State Medical Association attempted to ban its docs from practicing on the grounds that, well, it was un-medical to do stuff with unions and stuff.

well it also hasnt nec. SOLVED anything, although it is a response. It still remains to be seen what the reponse of the effected hospitals will be.

Will they charge the patient the difference? Will they raise rates to self insure against these events? It remains likely that the best reponse of actually charging the responsible physician for his own mistakes wont happen.

Please be careful with this Medicare policy. The "never events" are 1 grouping (the least common) of the 9 ostensibly-"preventable adverse events" that medicare is now not funding. Of the other 8, only vascular bloodstream infections are actually totally preventable. The others are partly preventable, but no one knows how much and at what may be greater adverse effects than what they're stopping. Good idea, but this policy is not as clear as it seems.

Did you hear Hawaii dropped their universal health plan....turned out most of the people that signed up for it allready had coverage they were paying for but hey, why not a freebie.

""HONOLULU (AP) — Hawaii is dropping the only state universal child health care program in the United States just seven months after it launched.
Gov. Linda Lingle's administration cited budget shortfalls and other available health care options for eliminating funding for the program. A state official said families were dropping private coverage so their children would be eligible for the subsidized plan.""

Notice these Democrats went through years of study and legislation to finally pass a program any right headed person would have told you would end up subsidizing people who could allready afford it.

So do most other socialized systems around the world.

While that may be true, it's worth pointing out that there aren't all that many socialized systems. The UK is certainly socialized, but I don't believe their physicians are salaried. I'm not sure about Singapore. Canada and most, if not all, continental European systems have doctors and doctors' groups acting as independent contractors just like the Good Ol' US of A.

I agree with you that salaried physicians working in large, multi-specialty groups are a much better way to organize the work flow, but I would prefer that you be more precise about the term "socialized medicine". Most European countries actually have socialized medical insurance.

That Hawaii health care plan for kids was covering about 2,000 kids; the state was paying in $25.50 / month per child to the Blue Cross / Blue Shield of Hawaii, the Hawaiian Medical Services Association. Even supporters of the approach had warned that the bill in its current language would not cover the "gap" children between those who already could afford children's health insurance and Medicaid qualifications.

In any case:

The Hawaii Medical Service Association (HMSA) today announced it will continue to provide the HMSA Keiki Care Plan at no cost to parents through the end of the year. HMSA and the state had been sharing the cost of the plan’s monthly dues since April 2008. Yesterday, the state notified HMSA it was withdrawing its funding for the plan, effective Nov. 1.

"We’re disappointed in the state’s decision, but we feel we have an obligation to the children and their families," said HMSA Senior Vice President Cliff Cisco.

"Parents with children currently enrolled in the HMSA Keiki Care Plan can rest assured that we will continue the plan without changes at least through the end of the year."

http://www.hmsa.com/mediacenter/press/2008/081016_keikicare.aspx

About Hawaii's plan:

In Hawaii, HMSA, an independent licensee of the Blue Cross and Blue Shield Association, and the state had been sharing the cost of the HMSA Keiki Care Plan’s monthly dues since April. HMSA will now assume funding for the program.

Reports place the cost to the state at about $50,000 per month, or $25.50 per child, an amount matched by HMSA.

That seems astonishing -- both that you could get anything for $25.50 a month, and that the (Republican) governor would cut a program that costs a mere $50,000 a month. What's going on there?

...it seems as though the Hawaii Blue Cross/Blue Shield already charges $55/month to cover children. Under this plan the state and HMSA were splitting the cost for kids. It really seems astonishingly Scroogelike to cut this.

And perhaps it would subsidize people who already could afford it. Who gives a fuck? It's deeply screwed up to care more about whether someone is getting something they don't deserve than whether someone isn't getting something they need. As Davis X. Machina says, "there are usually enough people in this country to elect a [government] who would volunteer to live with their family in a cardboard box under a bridge, and eat sparrows toasted on an old curtain rod, if you could promise them that the... guy in the next box over doesn't even get the sparrow."

The UK is certainly socialized, but I don't believe their physicians are salaried.

The Google is your friend.

Well there you go, the Google is my friend. Some UK docs are salaried and some are not.

Many general practitioners (GPs) are self employed and hold contracts, either on their own or as part of a partnership, with their local primary care trust (PCT). The profit of GPs varies according to the services they provide for their patients and the way they choose to provide these services. Most GPs would expect to earn between £80,000 and £120,000.

So the average UK GP earns $129K-$194K at today's exchange rate while a US primary care doc averages around $160K. Specialists, not surprisingly earn more (doctors in training make a lot more in the UK!) IMHO doctor compensation in the US is a relatively small part of the health care cost in this country. I know some disagree.

Um, actually, Blue Cross has recently announced it will follow Medicare in this--said never events will have to be paid for by the hospital/dr., depending on circumstances, not the patient. And follow up care will be paid for...the surgery to get the sponge out, etc. The patient will not be in additional danger, but the hospital/doctor will not be able to send anyone else the bill.

And that seems fair for something like transplanting the wrong organ or cutting off the wrong limb.

good link here: http://healthblawg.typepad.com/healthblawg/2008/06/no-pay-for-never-events-massachusetts-edition.html

The question is, why are doctors not on salary.

Some theories that I have heard:
1. Shamanism
2. Restrictive licensing gives doctors too much power, and the doctors prefer not be on salary.
3. People have an irrational fear that doctors on salary will avoid difficult cases.
4. Peaple like to select their doctor, rather than a team.

What's happening, Ezra starts believing right-wing propaganda? Doctors are mostly not salaried in advanced countries that I know of. Some doctors are salaried in some countries but nowhere is the whole health care sector completely controlled by the state. You can make the case that this would be the best solution but you'd have to turn to Cuba for real world examples.

As to the question of "never events", the question really is whether the victims will be treated for free without having to hire a lawyer. Is there any evidence that this policy will actually benefit anybody? I mean, there are already ways of addressing malpractice, especially in the US, one would think there is sufficient disincentive for medical sloppiness. Who will really be affected by this change in reimbursement policy?

wow Ezra you almost made it an entire healthcare post without a bone headed gaffe to remind us of your ignorance.

"When government simply pays for health care on the private market, as with Medicare, it does not salary the physicians because it does not employ them. Instead, it pays them under private market norms."

Your claiming now Medicare reimburses at private market norms, could you find one doctor in this country to agree with you on that? How can you talk about healthcare so much and still know so little?

Uh, Nate, many health insurers consider Medicare plans their cash cows. They pursue Medicare enrollees because they bring in a LOT of dough. Why do you think everyone and their dog created a Medicare Part D plan?

I don't know where your information is coming from. Seems like you might be confusing Medicare and Medicaid, the latter being a notorious under-reimburser.

M.S. are you a sock puppet trying to distract us from Ezra's bone headed comment. What you said makes no since. It's like you randomly put words together. There is not a single insurer in the world with a medicare plan idiot. They sell Medicare supplement plans. Did you see anyone mention medicare supplements?

Medicare reimburses artifically low rates. Congress is considering a double digit increase to reimbursement rates becuase they are currently so low.

How are people like you allowed to vote?