Health Care Option Shows Promise at a Cost - WSJ.com

Q&A: Health Care Option Shows Promise at a Cost - WSJ.com

William writes, "....the 'medical home' is a site where more than the traditional gatekeeper primary care activity can happen. The goal is to create a place where most care can be delivered in the right way, at the right time, and at a reasonable cost....Many of the monitoring and reimbursement schemes weren't possible when HMOs were first conceived. "



Response:
Hi William, thanks for all the particularly thoughtful comments on the medical home.

I recognize your parallel with new technological options - but, I'd still argue that in both cases, the Medical Home and HMO are quite parallel.

The biggest difference (which was brought out in the article) is that the Medical home is currently more expensive than standalone care plans.

However, all of the objectives of the medical home are there for HMOs with the added bonus that the HMO is targeting cost control. Competing HMOs let patients evaluate cost and quality of care tradeoffs to some extent.

My experience is more with healthcare and health insurance from the 1980's and early 1990's (in California).

I saw that incentives to have people pay more of a bill (50/50 vs 80/20 for example or the use of a health savings account) had a measurable impact on the cost of their insurance. The individual health care buyer made their own tradeoffs. Some wanted to save up front (insurance) and some wanted a higher insurance payout. Others took a look at different and modified versions of HMOs.

My concern is that we are giving away the store and to think that without a pricing component to balance out supply and demand and economic utility, the country will never be able to rein in healthcare. More and more is a cost borne by the government through taxes.

Thus, someone else is paying for a person's healthcare.

Our economy isn't growing (read the Laffer article on the liklihood of a double dip recession) and it needs to cut back consumption if it is going to have the wherewithal to invest capital into businesses that can create real jobs.

I have friends in the US closing their businesses to get a government job. This means their employees are out of work and they in fact often make more money with far fewer hassles.

There's the old economic maxim called "economic utility". The dreamers think society can afford whatever it takes to meet the utility desires of the poor, retired and out of work. Sadly, the net left for society to function and create jobs and wealth was too little under Bush (obfuscated in part by the housing bubble). Now it's evident in a jobless rebound with unspeakable budget deficits.

I know I'm not going to change anything. It's just interesting to see what happens when one goes on record and looks back years hence.

Cheers.