Welcome To Health Wonk Review – 1/09/09

Well, here we are at the beginning of 2009. On TV we’ve learned that the unlimited spending and brilliant, if socially pathological, heroics of Dr. Gregory House, unfailingly saves his patients from unknowable complexity and the abyss of death.

Meanwhile, the rest of health care, aided largely by really excellent lobbying, continues to be buoyed, defying the relentlessly corrosive gravitational pull of waste, corruption, and a tanking economy.

Still, health care’s troops are beginning to feel, in Tom Lehrer’s words, like a Christian Scientist with an appendicitis. Things definitely are not going well, and this longstanding run of great good fortune could be on the downswing. Is it possible that exorbitant pricing and massive waste are NOT entitlements!

Which brings us to the far-ranging insights, jabs, diatribes, rants and enthusiasms of this edition of Health Wonk Review, which features analysis and exegesis as entertainment.

Once again, the number of submissions was overwhelming, showing just
what desirable wonks we are, at least in our own minds. It’s important
to note that, when serving as guest editor, I don’t accept all
submissions. Some are straight sales or promotional pieces. Some don’t
have much, if anything, to say. And some are simply poorly written. I
cheerfully set them aside and move on. But the pieces included ARE
worth reading and contribute to our ongoing discussions about how
health care needs to evolve.

The pleasures of playing host are real, though. While some stalwart
submitters are here whose works are reliably superb, I thoroughly
enjoyed reading through the submissions and finding some gems from
folks I was unfamiliar with before. It is a pleasure to
present them here. Thanks for joining us.

So here we go.

Health Care As The Source Of Political Capital
At Managed Care Matters, Joe Paduda makes the political case for
universal coverage, noting that this particular element of national
health care reform is the key to re-establishing the Democratic party’s
brand among middle-class and blue-collar workers. That said, he also
argues that it would be good for business, for providers, for patients
and for society. A particularly compelling piece!

What If We Could All Buy In To Medicare?
Louise at Colorado Insider wonders “what would happen if the government
did decide to open Medicare up to anyone who wanted it and was able to
pay for it? If the premiums were lower than what you pay right now,
would you switch?” Her answer: “I would guess that for people who by
their own health insurance, or for people who are unable to qualify for
health insurance because of pre-existing conditions, government-run
health care doesn’t sound too bad at all.” (I suspect Louise is right.)
A particularly wry and admirable piece, given that Louise is a health
insurance broker.

OOOH! Stop Talking About It!
Glenn Laffel at Pizaazz laughs at the idea of Big Insurance crashing
the Obama health care reform parties, an indication that they’re
nervous about the outcomes. He quotes the Blue Cross and Blue Shield
Association’s lobbyist Alissa Fox, who says “Why do you [we] need a new
public program?”

The Elusive Ideal
At eCareManagement, Vince Kuraitis and David Kibbe review Clayton
Christensen’s long awaited new book, The Innovator’s Prescription,
about achieving disruptive innovation in health care.  They find it’s
strong in some areas, weak in others.

Why We’re In CrisisMy good friend Dick Reece MD at Medinnovationblog asserts that many of the issues that have led to America’s health care crisis arise from our peculiar national cultural fabric. He thinks it’ll take way more than well-intentioned policy changes to turn these characteristics around. I don’t know that he’s right, but its certainly a provocative idea!

A McLuhan-esque Choice for Surgeon General?
Anthony Wright at Health Access California ponders whether CNN’s Dr.
Sanjay Gupta, a practicing neurologist, might become the next Surgeon
General and a celebrity advocate for the Obama reform efforts. It
really boils down to the same idea as having your favorite sports star
on the Wheeties box. Whatever works.

Cost Growth Slowed, But Still Outpaced The Economy
On the Health Affairs blog, Jane Hiebert-White summarizes the new data
showing that medical inflation dropped in 2007 (from 6.7 to 6.1
percent), but that it is still outpacing the economic slowdown. At $2.2
trillion, health care moved up slightly to 16.2 percent of GDP. Even
so, drug expenditures grew at the lowest rate since 1963.

Growth That Is 1.5x General Inflation. That’s the Good News?!
In “Making Sense of the Latest Health Numbers: Answers…and Questions,”
Richard Eskow at The Sentinel Effect explicates the dynamics that
undergird the findings of the recent federal report on 2007 health cost
growth, and groans that we haven’t seen the data on 2008 yet, when
inflation kicked in.

Managing Care
Are Rapid Response Teams A Worthwhile Investment?
Tom Emswiler at the New Health Dialogue Blog has a fascinating post
recounting that, despite making good intuitive sense and gaining the
promotional support of the Institute for Healthcare Improvement, the
data accumulated so far on Rapid Response Teams – special units focused
on saving hospital patients in high distress – do NOT show that they
are more effective than simpler, less expensive approaches. He argues
that its time to step back and get more research done.

Will A More Sensible, Effective DM Emerge?
Over at the Disease Management Care Blog, Jaan Sidorov plays soothsayer
on the changes that will unfold in 2009. Among other things, he
predicts that disease management will expand, disease management "lite"
will make an appearance, the Patient Centered Medical Home will
experience some set backs and blogs will assume increasing importance
in the evolving health care policy debate.

A Beautiful Day in the Neighborhood
Joanne Kenen on the New America Foundation’s New Health Dialogue Blog –
Whew! Say that 12 times fast – provides a nicely detailed review of the
Dartmouth Atlas’ Elliot Fisher’s remarks on the “medical neighborhood,”
a vision of what might happen when a community of medical homes

Regulation & Governmental Management
Will “Bio-Similars” Follow The Same Path As Generics?
On the Health Business Blog, David Williams argues that regulating
biologics pricing once their patents expire would work to nearly
everyone’s benefit.

Medicaid Needs Better, Not More, Care
On Medicaid Front Page, Brady Augustine suggests that the reimbursements
associated with Medicaid make “choice” models onerous for providers
without improving quality for beneficiaries. He says we need better,
not more, care, and that the goal should be to “simplify, simplify,

From the "You Can’t Win" DepartmentAt Healthcare Economist, Jason Shafrin reviews a new study showing that cigarette taxes reduced smoking, but increased obesity. This called into question the actual health benefits associated with the taxes.

Big Bucks For Hip-Hop Health
On Canadian Medicine, Sam Solomon offers a short, strange but
entertaining story, with even stranger photos, about the Canadian
government spending an enormous sum to try to improve the health of
children above the Arctic Circle by setting up hip-hop workshops.

Workplace Health
Workers’ Comp Insider Favorites
Julie Ferguson at Workers Comp Insider closes out the old year and
rings in the new
with a retrospective look at 2008’s top 20 reader
favorite stories, covering the turf from AIG’s problems and the ADA
Restoration Act to disability and workplace safety issues.

A Bold Wellness Experiment
Fiona Gathright at Wellness/Corporate Insights describes a Safeway
program that ties a hefty financial reward – up to $800 rebate on the
employee’s health coverage premium – in exchange for remaining within
limits on four common medical risk factors: smoking, obesity, blood
pressure and cholesterol. Safeway hasn’t been able to show yet that its
wellness approach produces a return on investment, but this bold kind
of incentive-based experiment is at the leading edge of employer-based
health innovation.

Bad Behavior
WellCare In Hot Water
David Hamilton at BNET Healthcare Insights details the complaints in a
major class action suit that’s been filed against WellCare, the
Medicaid health plan that got caught red-handed engaged in a slew of
unwholesome shenanigans in a raid on its Tampa offices in late 2007.

When Sacred Cows Settle
Roy Poses at Health Care Renewal chews on Yale’s settlement of
governmental allegations of mismanagement of federally-funded research
grants. Dr. Poses notes that, somehow, it was the system that has been saddled
with the blame at this revered institution, never the individuals
overseeing the projects.

Health IT
Does Health IT Sometimes Get In The Way?
In what nearly constitutes a review article, Sandy Szwarc at Junkfood
Science mounts considerable evidence that Health IT can often be
disruptive to clinical processes and detrimental to patient care. Very

Sometimes We Bloggers Are Not Just Hollering At One Another
Finally, on The Health Care Blog, David Kibbe and Brian Klepper took
issue with
the Obama Health Team’s proposal to drop $50 billion on
Electronic Medical Records. In An Open Letter to the Obama Health Team,
Kibbe and Klepper argue that, as they’re currently constituted, EMRs
are bloated, way too expensive and, despite what the vendors claims,
not interoperable. Their argument was picked up by The Boston Globe, by
ZDNet and elsewhere, and appears to at least have obtained a hearing by
the Obama Health Team as well as a variety of Congressional staffers.

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  4. A Congressional Budget Office report comparing health care reform options found that a plan to allow Americans to buy into Medicare before turning 65 would lead to more people with health coverage and lower costs than private insurance coverage. The report comes at a time that seniors face a Dec. 31 cutoff date to enroll or switch plans.
    The CBO studied a limited Medicare buy-in option for those between 62 and 64 years old.
    According to estimates from the CBO the annual premium for single coverage in 2011 would be about $7,600 including drug coverage. While comparatively, a private insurance policy premium for a 64-year-old can easily cost $12,000-$16,000 a year not including copays and deductibles and after excluding coverage for those with even minor health problems.
    In 2006, Medicare spent about $10,200 on average per beneficiary, which currently includes an older and sicker population than that envisioned by the buy-in program.
    “The report emphasizes an important point for policy makers to keep in mind as they grapple with fixing our nation’s health care: Medicare provides more affordable coverage because it eliminates the waste and profiteering of the private market,” says Jerry Flanagan of Consumer Watchdog. “Polls show that seniors are also happier with their coverage than those of us with private insurance policies because they have better access to health care.”

  5. It sounds like it’s tough for Tufts. It appears much of the economic crisis, and its impact on health care has more to do with politics than economics. Still, middle class America takes the brunt of it.
    I tried to speak out for the poor in a couple of original Christmas songs I wrote for my CD, Ice and Snow. They were called Billy Wants a Job for Christmas and Long Road to Christmas.
    I wanted to use some of the profits for those most directly impacted by the economic crisis, but little attention was paid to the songs, or to my charitable plans. So I’ll try again on Valentines Day with this song:
    It’s Valentines Day
    Dr BLT
    Words and music by Dr BLT copyright 2008
    It’s Valentines Day
    It’s valentines Day
    And Billy and Kay are struggling
    Their livin’ on love
    They both lost their jobs
    They can’t sleep a wink at night
    But hey, what can I say
    It’s Valentines day
    But hey, what can I say
    It’s Valentines day
    They’re mortgage is due
    They ain’t got a clue
    About how they
    Are gonna make it
    They had a yard sale
    And sold all their goods
    Their cupboard is empty too
    Money is tight
    But they’ve got tonight
    And they are so deep in love
    They worry all day
    But then stop to pray
    They know it will be alright

  6. I’d love to have your thoughts on the current battle going on in Boston between Tufts Medical Center and BCBS of Massachusetts. BCBSMA reimburses Partners Hospitals physicians (a competitor of Tufts with size and clout) as much as 40% more than Tufts physicians, for the same procedures. When BCBS failed to met Tufts in the middle (Tufts asked for reimbursement rates that were equivalent to the average that BCBS pays academic medical centers in the Commonwealth) negotiations fell apart.
    Tufts is an inner city hospital that handles the toughest, sickest cases. Over the last five years, it has lost $25 million on its Blue Cross Blue Shield business. It is just struggling to survive. Meanwhile BCBSMA made $209 million in net income in 2007 (the last year we have numbers for) on $6.7 billion in premiums. That same year they paid their President and CEO $3.6 million in total compensation. The prior year (2006) BCBSMA chairman and CEO William Van Faasen was paid more than $16 million as part of his overall retirement package in 2006. So they don’t mind compensating their own executives richly, just not the docs who work at smaller, inner city hospitals like Tufts!
    Our system is seriously broken when health insurance companies like BCBSMA and their executives get rich while hospitals go broke trying to meet the healthcare needs of the underserved populations within our cities.
    For reference, the battle has been covered in The Boston Globe.

  7. I aspire to one day be in the prestigious HWR. In the meantime, I think Dr. Reese has nailed it. We can throw money at the system all we want. We can create slick IT systems and cost shift until we’re blue in the face. When the smoke clears, we have a culture that is not the same as that of France and all of the other comparison countries. We want more, we want it fast, and we want it all to ourselves. We also don’t want to be told what to do because we already know it all. Those other countries are starting to show these same characteristics, but the U.S. has been that way for many generations and it is reflected in our health costs.
    None of the things we all talk about regularly are the true source of the problem. This is at a depth most are not comfortable going. The Russian schmuck that predicted the downfall of the U.S. was way over the top, but I think he recognized that we are not on a good path.
    Now that I have successfully bummed myself out, I think I’ll go to Starbucks because that always cheers me up. They’ve got the more, faster, and my way down to a science!

  8. Brian….thanks for the post and HWR summary….i selected and reposted several vignettes on Twitter under @2healthguru, with primary source THCB tracking link.

  9. Glad to see their other health care blogs and I really like the fact that you mentioned Health IT. I like that you mentioned the question. Does Health IT Sometimes Get In The Way? Health IT can often be disruptive to clinical processes but it doeesn’t have to be detrimental to patient care. As a consultant, I out here trying to assist health care providers with making this transition run smoothly.

  10. Brian – congrats on the legs for the EMR piece. It is truly gratifying to see that intelligence does win out at times.
    Joe Paduda

  11. As Brian knows, I am a skeptic when it comes to high -in-the sky EMRs as the Holy Grail, new Medicare polcies as sustainable solutions, and specialty bashing, monitoring, and compliance as workable. That said, I like Brian’s pragmatism towards Big Business and work site clinics in multiple corporate settings as a step in the right direction. Brian is a mensch – a good guy to have around in a health care pinch. I just hope he keeps firmly in minde that a good doctor , unencumbered by rules and regulations and pronouncements from on high, is a good person to have around when you’re sick.

  12. Wow that Klepper guy is a tough reviewer, none of my pieces made it into HWR on my own darn blog! I guess they’re all in the category of “straight sales or promotional pieces. Some don’t have much, if anything, to say. And some are simply poorly written”