NOW COUGH AND FEEL THE PAIN - AT 9:21 A.M. ET:  Writing in Newsweek, Ted Kennedy and Robert Shrum say this:

We also need to move from a system that rewards doctors for the sheer volume of tests and treatments they prescribe to one that rewards quality and positive outcomes. For example, in Medicare today, 18 percent of patients discharged from a hospital are readmitted within 30 days--at a cost of more than $15 billion in 2005. Most of these readmissions are unnecessary, but we don't reward hospitals and doctors for preventing them. By changing that, we'll save billions of dollars while improving the quality of care for patients.

Writing in Weekly Standard, Bill Kristol shreds that argument:

Now first of all, if there are problems with Medicare, the laws and regulations governing Medicare--a government program--can be changed, without a government take-over of the rest of the system. Second, given that first diagnoses are often wrong or that hospital treatments lead to unanticipated complications, it’s not so clear on the face of it that an 18 percent readmission rate within 30 days for elderly patients is unreasonable. And third, even if the whole $15 billion worth of hospital readmissions were unnecessary (which can’t be case), $15 billion per year is less than 1 percent of our health care spending.

But the most important implication of the Kennedy-Shrum claim--“Most of these readmissions are unnecessary, but we don’t reward hospitals and doctors for preventing them. By changing that, we’ll save billions of dollars.”--is this: The government is going to decide--ahead of time, obviously, since deciding after the fact wouldn’t save any money; and based on certain general criteria, since the government isn’t going to review each individual case--what kinds of hospital readmissions for the elderly are “unnecessary” and what kinds aren’t. And it’s going to set up a system “to reward hospitals and doctors for preventing” the unnecessary ones. That is, the government will reward hospitals and doctors for denying care they now provide, care the government will now deem “unnecessary.”

COMMENT:  Excellent diagnosis.  This is the kind of discussion we should be having about health-care "reform" - not the shove-it-down-their-ignorant-throats approach of the liberal Democrats in Congress.

Fortunately, there are signs that the runaway freight train of "reform" may be stopped before something reckless is passed, if opponents keep up the fight.

We need improvement in the system.  It would be nice to discuss the changes before they wind up costing lives.

July 20, 2009