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Month: January 2008

POLICY: It’s official–2 Trillion Dollars

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For everyone who’s been going on about our (adopt Dr Evil voice) 2 Trillion Dollar health care industry, it’s now official. The 2006 data is out and we’re at 16% of GDP, $2.1 trillion and $7,000 and change per head. Growth, somewhere at the bottom of the trough, is around 6.5%. That’s nominal not real of course, but it’s still way over the economy’s growth rate, and that gap will grow if/when a recession hits.

The major change of course was the introduction in 2006 of Medicare Part D which mean that drug spending increased at over 8.5%. But then again, they’re telling us that Part D was less than originally projected. Although I bet you no one in CMS (or now out of it) will tell you what really was originally projected, and in fact which of the many revised projections the $41 Billion costs of Part D was really below!

And of course assuming that cost increases were stable in 2007, we’re actually already at 2.1 trillion + 6%, or 22.35 trillion!

PODCAST: Interview with Michael O’Neil GetWellNetwork

This podcast I did with Michael O’Neil who is the founder of GetWellNetwork. Michael had an episode of cancer relatively early in his adult life and although he was the recipient of great medical care from one of our nation’s leading academic medical centers, he was also very upset about the quality of the in-room patient experience. The result is a new system of using the TV to improve patient care in hospitals. You can hear much more in the interview.

On a technical note: this interview was conducted in the middle of a significant California winter storm, so there will be occasional tricky patch. Thanks for your patience and thanks to Michael too for his.

POLITICS: More on the Presidential plan comparison

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Long time THCB friend Steve Beller tells me this:

We’ve created a Comparative Analysis of Presidential Health Care Plans, which analyzes much of the details of Susan Blumenthal’s and Kaisers’ work in order to identify top candidates based on voters’ wants and needs. We’ve taken a unique approach in which the complex details are distilled into categories of strategies that simplify comparisons between the candidates, and we’ve included comments on the key factors (with several quotes from Maggie Mahar’s blog and input from Barry Carol). It then groups the candidates on whether they propose universal healthcare, and it  ranks them by the amount of attention they give to quality improvement and cost control. Then it matches the candidates to 18 types of consumers, which take into account their current insurance and health situation, their income level, and their support of good care for all.

Here’s the link.

Take a look and feel free of course to give your comments to Steve over on his blog or here.

Meanwhile as major bloggers are dropping like flies from the stress, (get soon well Om!), I feel good about the fact that I took the weekend off to go snow-boarding in some of the best powder the Sierras has seen in a while. And that’ll be all from me today!

Health Care’s Cold Truth: An Iowa Perspective – Michael Millenson

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Obama_webI am writing this blog from Cedar Rapids, Iowa, grateful that the
temperature has warmed from brutally
cold to pleasantly sub-freezing.
Fortunately, the warm feelings left by the extraordinary victory of
Sen. Barack Obama, the candidate for whom I was knocking on doors and
making phone calls these last few days, has trumped the temperatures.

Talking to real voters in the suburbs and rural areas surrounding this
small city provides a nice change from  the insular health care policy
world. For one thing, it reminds you that most people don’t care about
“policy,” per se, of any kind. Successful candidates connect first with
the heart and then the head. We instinctively believe that if we trust
a candidate’s values and broad beliefs, we will trust that candidate’s
detailed policy decisions.

Yet the sad reality is that a vast number of citizens won’t even make
that small emotional investment, and they don’t hesitate to proclaim
their apathy when you knock on the door or call. As much as you may
have heard about voters disenfranchised from the Iowa caucuses,
many more simply didn’t care enough to participate. That, alas, makes
Iowa quite representative of the nation as a whole. While Democratic
turnout at this year’s caucuses was double that of four years ago, that
merely turned a “tiny” slice of registered voters into a “small” one.

Continue reading…

On Medical Miracles – Brian Klepper

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Now and then, amid the stories of financial conflict, medical errors
and political intrigue that so often undermine health care, comes a
story of the miraculous, where patients in impossible conditions not
only survive, but thrive, due to the skill and resources of many
dedicated clinicians, due to luck and due to who knows what
extraordinary circumstances that are still beyond our understanding.

The New York Times has a story like this today.

On December 7th, Alcides Moreno and his brother Edgar, window washers,
fell 47 stories down the side of the Upper East Side apartment building
they were working on. His brother was killed instantly, but Alcides
survived, consuming 24 units of blood and 19 units of plasma. In a
coma, he went through 9 orthopedic operations, and then amazingly – I’m
not making this up – awoke on Christmas Day.

More
incredible still, Mr. Moreno is now on a path to full recovery, at
least from the looks of it, walking and talking as he did before his
fall. This has prompted Dr. Philip Barie, the chief of the Division of
Critical Surgery at the hospital where Mr. Moreno is being treated to
comment, “If you believe in miracles, this would be one.”

A David Bowie movie, anyone? Check out this story.

POLITICS: The Crystal Ball – Healthcare reform in California

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I’m up over at Spot-on discussing why the opinion of 32 corn farmers in Iowa may not matter quite as much for health insurance as what’s going on in my fair state. The piece is called: A Californian Crystal Ball.

As ever come back here to comment.

Pretty much anyone interested in U.S. politics is focused today on
what 32 corn farmers in the middle of the country have to say about the
20-some people currently hoping to run the world by becoming President
of the United States.

And while health care concerns have figured in many of the
conversations the U.S. political press has had – or overheard – with
Iowa Caucus voters, it’s been a wild holiday season for California’s
health care system. The impact on what type of health care reform
legislation will eventually come to national attention is probably just
as great.

On Christmas Eve a California appeals court unanimously decided that
the way insurers have been practicing in the state for many years is illegal.
The case involving retroactive cancellation of policies was one that
the nice well-behaved non-profit California Blue Shield had fought in
the courts while its aggressive for-profit competitor, Wellpoint’s Blue
Cross unit, had settled.

Blue Shield maintained it had the right to retroactively cancel
those insurance policies for which it says that policy-holders had lied
on their applications. At first the series of stories, which started coming out last year and ended up making an appearance in Michael Moore’s Sicko,
seemed cut and dried. People who’d received expensive care were having
their insurance canceled for pre-existing conditions that they’d either
clearly disclosed on their applications, or couldn’t possibly have been
expected to remember. Meanwhile the behavior of the health plans was
shown to be particularly cynical, with one, HealthNet, actually paying out bonuses to staff doing "recissions" based on how many expensive policy holders they kicked off their rolls.Continue reading this post o ver at Spot On.com

THCB Reader Mail: Maggie Mahar On That Checklist Decision

Frequent THCB contributor Maggie Mahar did a little detective work on the Office of Human Research Protection’s (OHRP) mysterious decision to suspend a trial designed to reduce medical errors by requiring that hospitals follow standardized safety and infection control procedures, a story that Atul Gawande wrote about over the weekend in an op-ed piece for the New York Times.

The logic behind the ruling – namely that patients should have been required to provide their express written consent before participating in a clinical trial, even one involving hospital staff and not some radical new experimental drug or treatment – struck Maggie as slightly, shall we say, strained. Particularly for an administration which boldly ran for office on a campaign platform of vanquishing bureaucratic incompetence and embracing scientific innovation.  Maggie writes:

I read the letters that OHRP sent to Johns Hopkins and Michigan. They are dense with bureaucratic language, but make no sense whatsoever. So then I looked into OHRP and who runs it.Continue reading…

The Politics of Publicly-Funded Health Care – Brian Klepper

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Over at Health Care Policy and Marketplace Review, the always insightful Bob Laszewski walks us through the mechanics of the just-passed federal budget and its health care financing implications for SCHIP, physicians, hospitals, Medicare Advantage plans. This clear, common sense analysis is a must-read for anyone interested in how the budget process actually works.

The final bill had 12,000 earmarks,
testimony to continuing special interest domination over the public interest. Everyone facing
a cut got a reprieve, but all the same issues (and cuts) will be on the
table in the near future. Here’s one of Bob’s summary paragraphs.

 

Late in 2008, the docs will be facing
a 15% Medicare fee cut on January 1, 2009, SCHIP will be out of money a
few months later on March 1, 2008, the extra payments to Medicare
Advantage plans will present the same plump target, and we will know
who won the November elections.

So the cuts were held off. Nothing really changed. And once again,
our Congressional representatives on both sides of the aisle made
decisions that accrued much more to the interests of their contributors
than those they claim to represent.

THCB Reader Mail

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In response to Matthew’s take on California Governor Arnold Schwarzenegger’s Massachusett’s-style plan to require that all state residents purchase insurance ("California Not Really Uber Alles" 12/26 ) contributor and friend of THCB Jeff Goldsmith writes: 

"Isn’t it interesting that the projected California budget deficit
and the cost of the health reform program are both about $14 billion.
So to fix both of them would thus requires the state to find a mere $28
billion? That’s the real reason it isn’t going to happen, not provider
lobbying or employer intransigence. No state can really do something
like this by itself without wrecking its economy. It is what we have a
national government for.

It isn’t really that hard conceptually to construct an affordable
benefit. Remember the large majority of the uninsured are young people.
A stripped down package which covered primary care MD services, dental
care, chronic care type drugs like insulin, and catastrophic
hospitalization coverage (w/ some type of negotiated deep discount for
the patient’s part of the hospital bill) would do the trick.

The problem is stopping one’s ears for all the sob stories from the
chiropractors, podiatrists, aromatherapists, etc. who want to force you
to insure for their services. Your suggestion that the real problem is
retaining employer based coverage still dodges the question that
somehow, somewhere, a legislative body still has to define what
coverage is mandated.

Why do you think employers are so resistant (a 7.5% payroll tax
might be part of the explanation)? It is because thirty years of
legislative history suggests our elected representatives, like that
easy woman in the musical Oklahoma, "cain’t say no". Mandated in vitro
fertilization, breast reconstruction after cancer surgery, etc. – all
worthy goals in a resource unlimited world, but death to an affordable
universal benefit.

Oregon’s John Kitzhaber, an emergency physician by training, seems,
so far, to have been the only political leader of either party to have
figured out that making these types of hard choices is the real problem
in health reform- not "play or pay", tax deductions or hard subsidies,
employer or individual mandate, or all the other comparatively trivial
choices. Listen to all the pervarication from the Presidential
candidate poseurs on what actually gets covered. It’s enough to turn
you into a New Zealander."

EDITOR’S NOTE:  Jeff Goldsmith is the president of Health Futures Inc.  From 1982 to 1994, Jeff served as National Advisor for Healthcare
at Ernst & Young. From 1980 to 1990 he was a lecturer at the
Graduate School of Business at the University of Chicago. He currently
serves on the editorial board of Health Affairs. His past pieces for THCB have included "The Perpetual Healthcare Crisis" and "Employers’ Health Cost Growth Continues to Moderate:  Ain’t It Awful?"

 

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