Re: [Marxism] NYTimes.com: In the Treatment of Diabetes, Success Often Does Not Pay

["acpollack2@xxxxxxxx" <acpollack2@xxxxxxxx>]

This article is a perfect example of what I was saying yesterday about
the irrationality of our marketized health system and its latest
"reforms," including Pay for Performance and consumer Health Saving Accounts. I 
want to say a little about the diabetes example because 
it's a new twist on the old contradictions of capitalist anarchy and a 
good example of how things could be done differently.

The Times article explains clearly the contradiction between the small
relatively amounts required per patient to discover and manage chronic 
diabetes,  and the huge amounts required to pay for surgery and 
treatment of acute conditions and illnesses that arise when diabetes 
is not managed. It also makes clear that it's still logical for 
insurers not to pay those small amounts because: a) you're talking 
millions of people; b) more importantly, you can simply not enroll 
them and let another insurer -- or no insurer -- pick up the tab for 
the later, superexpensive surgery or treatment. And to sweeten the pot 
you, the insurer (and the employers you deal with) can then rant and 
rave about the trillions "wasted" on health care without admitting you 
helped cause that waste.

Then you can claim to be providing a solution by paying doctors to
monitor more closely the blood sugar levels and other indicators
of your patients. That's right -- under Pay for Performance you
pay bonuses to docs if they keep good records of their diabetic
patients' conditions, and even threaten to drop them if they
don't. But you still don't have to pay for the services and equipment
the Times says are needed by the patients themselves to manage
their diabetes. And even the bonuses to the docs don't come close
to capturing the cost of hiring staff so they have the time to do
the education, checkups, etc. needed by all your patients.

Meanwhile -- and weirdly enough the Washington Post reports on this
today, not the Times, which is doing the multiday diabetes series --
the city of New York is beginning to compile numbers on all diabetes
patients and their lab results, with the stated goal of figuring
out how to get a grip on the problem. The end result is likely to be
just more advice to docs and hospitals about the need to pay better
attention to specific types of patients, what kind of tests to do,
etc. But no, or little, new funding to pay for doing so.

Now here's the rub: if you pool that NYC database, and similar ones
which could be created by every city, with all the private insurers' 
and Medicaid/Medicare databases, you have a complete national
registry of everybody who has or is likely to develop diabetes, and
you would know how much it would cost to pay for all the testing
strips, counseling, education, etc., etc. to manage diabetes
nationwide. And you'd have a single price tag for that, which could
then be compared to a price tag developed from the same database 
showing how much you're spending every year on bariatric surgery, 
amputations, etc., etc. for patients whose diabetes could have been 
prevented or the consequences of it minimized.

You therefore have a single figure proving how much society as a whole
saves by managing diabetes early on, AND THEREFORE YOU CAN ALLOCATE
THE MONEY TOWARD EARLY MANAGEMENT WITH THE SAVINGS FROM NOW UN-NEEDED
SURGERY ETC.

Obviously this would only happen under a socialized health 
insurance system. But the key word here is "insurance." As the Times
makes clear, a fragmented insurance market forces each insurer to
minimize their risk by dumping patients. In the current setup,
that's rational and logical, and it's not going to change until
the insurers are done away with. A unified, socialized insurance 
system, on the other hand, makes rational and logical for the first
time the nationwide calculation of risk, and makes rational and
logical for the first time the allocation of money to prevention.



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