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Month: April 2010

Are The Attorneys General’s Constitutional Claims Bogus?

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By MARK W. HALL

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Immediately after passage of health care reform, over a dozen state A.G.s sued to declare it unconstitutional, as violating states’ rights. The Florida complaint is here, and Virginia’s here. Reminiscent of southern governors in the 1960s blocking their state universities’ gates, these legal officers in effect are saying “not on our sovereign soil.” Since the constitutional issues have already been hashed through so thoroughly, what’s new to talk about?

First, the Florida complaint, which a dozen other states joined (AL, CO, ID, LA, MI, NE, PA,SC, SD, TX, UT, WA), focuses mainly on the financial burdens of expanding Medicaid. This is challenged under the “commandeering” principle, as requiring states to devote sovereign resources to achieve federal aims. But, as we know, states are free to withdraw from Medicaid, so the argument seems to fall entirely flat. The complaint makes a bait-and-switch type of estoppel argument , that states got into Medicaid without any expectation of this expansion, and now it’s too damaging for them to withdraw. So, in effect, states argue that the Constitution allows them to keep the federal carrot but refuse the federal stick. Good luck selling that to an appellate court.Continue reading…

It’s Easier to Beat Up the Insurers

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By PAUL LEVY

Things are playing out just as one might predict in the Massachusetts small business and individual insurance market. The Insurance Commissioner turned down proposed rate increases, the state’s insurers appealed to the courts, and now they can’t write policies.

Meanwhile, policy-makers ignore the underlying causes of the problem:

Just a few weeks ago, the Attorney General issued a report, after months of study, that explained that insurance price increases in the state were the result of two factors, the underlying increase in health care costs and a disparity of reimbursement rates that paid some providers substantially more than other providers.

As noted by my colleague Ellen Zane, in remarks consistent with the findings of the AG, “The funneling of dollars disproportionately among hospital and provider groups serves to warp the overall system balance.”

Taking a page from the debate on national health care, local officials seem to have decided that it is easier to beat up on the unpopular insurance companies rather than address the root cause of the problems. Here, though, the insurers are non-profits. If they are forced to charge prices below those that are based on actuarial determinants, there are no shareholders to absorb the losses. The most direct result is a reduction in capital reserves, a key metric the Division of Insurance is statutorily charged to protect.

Health 2.0 Europe, a fabulous end to Day 1

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By MATTHEW HOLT

(posted early Weds 7th April, Paris time!)

We had quite the fabulous time at Health 2.0 Europe Day 1. Other than my personal fouling up of the final presentation about Health 2.0 in Haiti, things went very smoothly. (We will record and repeat that segment for a wider audience, as it’s a remarkable story and Roni Zeiger told it very well despite the technical difficulties).

I think that the panel on patient communities was the best ever at any Health 2.0 Conference, and Susannah Fox told me it was the best she’s ever been on—and she’s been on a lot!

Then we had a fabulous night out at a fabulous location, Les Invalides. And there’s much much more to come today! Follow #health2eu on Twitter.

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(Photo from supergelule.fr)

Myths and Facts About Health Reform

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By MAGGIE MAHAR

This is the first in a series of posts that will try to pierce the myths and reveal the facts about the reform legislation. This first post focuses on the impact that reform will have on the private insurance industry–and on the industry’s customers.

MYTH # 1: Health Care Reform represents a “boon” for private insurers.

FACT It is true that, beginning in 2014, virtually all Americans will be required to buy insurance, or pay a fine. But while insurers will pick up a boatload of new customers, many will be refugees who have been battered by a health care system that rationed care according to ability to pay. Think of the boat as a life raft. These could be very expensive customers.

Moreover, between now and 2014, insurers will face some serious financial hits. These new rules will  make our health care system fairer and more affordable  But the rules also suggest that for-profit health insurance may not be a viable business unless insurers learn far more about what is best for patients.Continue reading…

Health 2.0 Europe today; take a deep breath

By MATTHEW HOLT

I’ve been careening around the Paris metro getting the flavor of this amazing city, and tomorrow the preparation stops and Health 2.0 Europe finally happens. (Just to be clear this blog publishes on California time where it’s still the 5th but the conference starts Tuesday April 6 Paris time!!)

More than 500 people will gather to hear about search and content, online communities, patients & consumers using tools with & without connecting to doctors and hospitals, and much more. We’ll hear from leaders in online health in the Netherlands, Denmark, Hungary, the US, the UK, Germany and more. We’ll find out the reaction of the health care system, including hospitals, payers, physicians and pharma, to these new technology advances. We’ll try to see if we can figure out if there is a distinctly European version of Health 2.0–-at least we’ll be arguing about that (and Indu, I and Denise Silber have been doing lots of arguing about that!).

The conference is officially sold out, but our stellar registration meisters (Hillary McCowen & Miles Denison) tell us that they’ve found a space or two (hanging from the rafters?) and that a very limited number of tickets will be sold on site. Best to get there before 11.30 tomorrow if you still want one.

So see you at Cite Universitaire tomorrow (Tuesday). Officially it starts at 1pm, but please get there early to pick up badges and get yourself a seat!

If you can’t be there follow the tweets at #health2eu and wait for the videos that will be coming out in the weeks after the conference…..

Should We Let The Death Issue Die?

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By PAUL LEVY

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Did you read yesterday’s New York Times article by Anemona Hartocollis, entitled “Helping Patients Face Death, She Fought to Live“?

It was about a palliative care doctor who faced her own end-of-life issues in a very different manner from the way she would have advised many of her patients.

An excerpt:

[A]s the doctors began to understand the extent of her underlying cancer, “they asked me if I wanted palliative care to come and see me.”

She angrily refused. She had been telling other people to let go. But faced with that thought herself, at the age of 40, she wanted to fight on.

While she and her colleagues had been trained to talk about accepting death, and making it as comfortable as possible, she wanted to try treatments even if they were painful and offered only a 2 percent chance of survival.

It is never right to be judgmental about these matters. Each person faces this kind of situation in his or her unique way, and we have no right to dispute the choices people make.

But I was struck by how this doctor personified the public policy debate that surrounds terminally ill patients. Here’s a an example of that kind of discussion from Canada (single payer, government run system!):

The high cost of dying has more to do with soaring health care costs than the aging population does, according to the Canadian Institute of Actuaries. In its submission to the Romanow commission on the future of health care, the institute said that 30 to 50 per cent of total lifetime health care expenditures occur in the last six months of life. Noting the sensitivity of the subject, the group suggested greater use of less expensive palliative care and living wills.

Dr. Pardi’s experience shows how hard it is to go from a policy-level discussion of such matters to the decisions made by individual patients and their families. Without giving credence to the nasty and politically inspired debate about “death panels,” the ambiguity in such situations suggests the difficulty in adopting formulistic approaches to the decisions around end-of-life care.

Besides abortion, it is hard to think of a part of medical practice that is more likely to be politically divisive and personally uncomfortable. Given that, is it worth the debate? Alternatively, how can we best have a productive discussion about it?

Are We Adequately Securing Personal Health Information?

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By BRIAN KLEPPER and DAVID KIBBEBrian Klepper, MD

In a discussion about electronic health records (EHRs) a couple weeks ago, one of the Human Resource team members at a prospective client said, “I don’t believe it’s possible to secure electronic health data. It’s always an accident waiting to happen.”

There is some truth to that. More and more, our Personal Health Information (PHI) is in electronic formats that allow it to be exchanged with professionals and organizations throughout the health care continuum. It is highly unlikely that each contact point has the protections to wrap that data up tightly, away from those who would exploit it.

Of course, PHI is among the richest examples of personal data, often with all the key ingredients prized by identify thieves: social security number, birthday, phone numbers, address, and even credit card information. This should give health care organizations considerable pause.

Then consider that, while paper charts contain the same information, electronic files often aggregate hundreds of thousands or even millions of records, information treasures troves for someone really focused on acquiring, mining and making use of the data.

Continue reading…

Health 2.0 Europe–My Take

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By MATTHEW HOLT

I’m back in San Francisco after a fabulous Health 2.0 Europe Conference in Paris. We were welcomed wonderfully to Europe by our partner Denise Silber, her colleagues at Basil Strategies and all the fabulous people we met there. We’ve since heard lots of great comments and feedback from conference attendees, speakers and sponsors. Going to Paris in the spring sounds like a lot of fun and it is. But putting on any conference is a great deal of hard work, and Indu & I would like to thank Denise and her team (Miles & Rhys), as well as our colleagues Lizzie Dunklee who ran the production and Hillary McCowen who ran registration, sponsorship and front of house. We had help from some great volunteers (thanks for all the coffee Pauline!), excellent simultaneous translation, and Alex, Raphael & Stephane from Image Media did a great job with AV. We even (eventually) tracked down all the IML Voting devices (including the one that went to Boston!).

I’d also like to thank all of our speakers, sponsors and attendees—especially the speakers whom we put through our rigorous demo training program, the sponsors who took a chance on us, and the regional ambassadors and media partners. There were nearly 550 attendees once all was said and done (all squeezed into a venue that seats 500)! We sense that the conference signaled the emergence of a real Health 2.0 community in Europe. Of course all the great work that we demonstrated on stage has been going on for some time, but perhaps this was the first time that it’s been gathered together—not to mention gone drinking at Les Invalides!

So as is almost traditional, here’s a few thoughts from me about my impressions. (By the way, Denise has extensive thoughts over on her blog too). As ever these are not definitive—there were many many great contributions that I won’t mention for reasons of space, and every speaker worked really hard and contributed to a great conference, but here are a few thoughts that stuck out for me.

Continue reading…

Paris in the Springtime

By MATTHEW HOLT

While we were rehearsing for Health 2.0 we had to take a quick break to look out the window at this. Not bad, eh? You may recognize the building in the bottom left.

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