Mr. Klepper: I live in a semi-rural area of Colorado. All of the factors you mention are prominent in my area, plus one not mentioned, and that is the use of non-compete clauses by major health care providers. These clauses force health practitioners who wish to change jobs to move hundreds of miles from their practice regions. The use of this device puts a clear constraint on the medical "trade" and should be outlawed in a society who holds free enterprise as one of its most -- if not the most --- sacred ideals.
Mr. Newman, I agree that this is an important problem in American HC, and an issue directly related to its corporatization. It could have been included as another example of how we're sacrificing medical care at the altar of profits, but I was trying to cover a lot of ills that characterize the large issue. BTW, I believe that Ronald P's information is correct, and that non-competes will no longer be binding in clinical environments.
I firmly believe that public schools, public parks, public utilities, public transportation, public health care and public medical services are important to our competitive future.
Mr. Klepper's analysis I fully agree with, but his reasons for optimism, I'm skeptical. First, in terms of using the CAA, give us an outline of how to do this and how it is working. I'm on the Physicians for a National Health Plan Board of Advisors and and active student of health care policy for 20 years and have not heard of this before. 2nd, I am highly skeptical of new "value based" "high performers" hold any promise. Most of the current take over of medicine hides behind the language of value based care, which is really a failed health economics concept.
I completely agree with the need for more transparency which could result in more competition. In addition, the US has the lowest spending of any high-income nation on family medicine, primary care and prevention. Without a shift in financial reward toward prevention and first-line care, we will continue to suffer from the lowest quality healthcare when compared to other nations.
You are spot-on, Kathleen. That problem is largely the result of a longstanding sole source arrangement between CMS (and HCFA before that) that designated a secretive AMA committee, the Resource-Based Relative Value Scale Update Committee (RUC), dominated by specialists to define the value of every medical procedure. The process was a sham, methodically and opaquely undervaluing primary care and overvaluing specialty services. Moving to value-based arrangements will eventually make it obsolete, but it's been a key driver of unnecessary care and cost since the late 1980s, working to the benefit of everyone in healthcare except patients, purchasers and primary care physicians. (See https://www.healthaffairs.org/content/forefront/ruc-health-care-finance-s-star-chamber-remains-untouchable.)
My dear friends, I'm concerned that you are advocating for a health system of capitalist competition that literally has worked nowhere in the world and takes us far from our best traditions of robust non-profit healthcare delivery and Medicare.
It will take a political movement to make the changes we need.
Dudley,, it is a mystery to me how this piece could be interpreted as advocating for a health system of capitalist competition. Instead, I tried to show that 80 years of increasingly concentrated corporate power in healthcare has taken a terrible toll on the US and its people. Getting from here to somewhere better will require not only a political movement, but one that can overwhelm the system of legalized bribery though which we now make our laws and regulations. So I've concluded that the more logical path is to focus on working with the true high value performers, who seek to win by consistently delivering better health outcomes and/or lower cost. I'd be much happier if we moved to a different system of financing, but trying to get more transparency and better results seem like a lot to tackle for the moment. Glad to discuss this in more depth offline.
Mr. Klepper: I live in a semi-rural area of Colorado. All of the factors you mention are prominent in my area, plus one not mentioned, and that is the use of non-compete clauses by major health care providers. These clauses force health practitioners who wish to change jobs to move hundreds of miles from their practice regions. The use of this device puts a clear constraint on the medical "trade" and should be outlawed in a society who holds free enterprise as one of its most -- if not the most --- sacred ideals.
Mr. Newman, I agree that this is an important problem in American HC, and an issue directly related to its corporatization. It could have been included as another example of how we're sacrificing medical care at the altar of profits, but I was trying to cover a lot of ills that characterize the large issue. BTW, I believe that Ronald P's information is correct, and that non-competes will no longer be binding in clinical environments.
Biden's FTC is in the process of killing most non compete agreements. https://www.nbcnews.com/politics/economics/biden-ban-non-compete-agreements-health-care-industry-rcna70099
Thanks for the article! Any idea on the progress made? The article is about a year old.
Thanks for chiming in, Chris. The article was written over the past couple weeks, so its current as far as I know.
Chris is referring to my comment, which links an article about the Biden FTC trying to kill noncompetes.
Ronald P
just now
I guess we probably find out in April. Took some digging, but I found this article that seems to say where we are and what's going on. https://www.natlawreview.com/article/update-status-non-competes-and-what-expect-2024 They have sued 3 companies for how they use them already.
I firmly believe that public schools, public parks, public utilities, public transportation, public health care and public medical services are important to our competitive future.
Agreed. With regard to healthcare, you might be interested in this essay from William Bestermann MD: https://williamhbestermannjrmd.substack.com/p/health-care-should-most-closely-resemble?utm_source=post-email-title&publication_id=251447&post_id=139406014&utm_campaign=email-post-title&isFreemail=false&r=6ck0j
Mr. Klepper's analysis I fully agree with, but his reasons for optimism, I'm skeptical. First, in terms of using the CAA, give us an outline of how to do this and how it is working. I'm on the Physicians for a National Health Plan Board of Advisors and and active student of health care policy for 20 years and have not heard of this before. 2nd, I am highly skeptical of new "value based" "high performers" hold any promise. Most of the current take over of medicine hides behind the language of value based care, which is really a failed health economics concept.
Dr. Stone, The provisions of the CAA have been an open topic of discussion for a couple of years now. Here's an older article by Leah Binder, who leads The Leapfrog Group, which assesses and rates hospital quality and safety.. https://www.forbes.com/sites/leahbinder/2022/02/28/this-federal-law-will-completely-overhaul-company-health-benefits-nobody-is-ready/?sh=5d48ccd216b6.. If you'd care to have a deeper, evidence-based discussion on value-based arrangements and high performing health care management firms, feel free to get in touch at bklepper@hcperform.com.
Transparency in health care is an oxymoron. Good luck with that.
We'll get there eventually. There will be no other choice.
I completely agree with the need for more transparency which could result in more competition. In addition, the US has the lowest spending of any high-income nation on family medicine, primary care and prevention. Without a shift in financial reward toward prevention and first-line care, we will continue to suffer from the lowest quality healthcare when compared to other nations.
You are spot-on, Kathleen. That problem is largely the result of a longstanding sole source arrangement between CMS (and HCFA before that) that designated a secretive AMA committee, the Resource-Based Relative Value Scale Update Committee (RUC), dominated by specialists to define the value of every medical procedure. The process was a sham, methodically and opaquely undervaluing primary care and overvaluing specialty services. Moving to value-based arrangements will eventually make it obsolete, but it's been a key driver of unnecessary care and cost since the late 1980s, working to the benefit of everyone in healthcare except patients, purchasers and primary care physicians. (See https://www.healthaffairs.org/content/forefront/ruc-health-care-finance-s-star-chamber-remains-untouchable.)
My dear friends, I'm concerned that you are advocating for a health system of capitalist competition that literally has worked nowhere in the world and takes us far from our best traditions of robust non-profit healthcare delivery and Medicare.
It will take a political movement to make the changes we need.
Dudley,, it is a mystery to me how this piece could be interpreted as advocating for a health system of capitalist competition. Instead, I tried to show that 80 years of increasingly concentrated corporate power in healthcare has taken a terrible toll on the US and its people. Getting from here to somewhere better will require not only a political movement, but one that can overwhelm the system of legalized bribery though which we now make our laws and regulations. So I've concluded that the more logical path is to focus on working with the true high value performers, who seek to win by consistently delivering better health outcomes and/or lower cost. I'd be much happier if we moved to a different system of financing, but trying to get more transparency and better results seem like a lot to tackle for the moment. Glad to discuss this in more depth offline.