By BRIAN KLEPPER

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.

Reform
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
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
flourish.

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,
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
strong!

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.