Author Archives

Matthew Holt

Health Care Reform: Ideology, Self-Interest and Rhetoric

Mar 24, 2009• 55

By Humphrey Taylor and Ian Morrison

Thirty years ago, one of us asked the retiring CEO of one of the largest drug companies what was the worst mistake he had made as CEO. Without hesitating he said, “Opposing Medicare. We were so ideologically hostile to a big new government program that we lost sight of our own self-interest. All the major drug companies except Syntex opposed it. Luckily we lost. We have made billions of dollars because of Medicare.”

The White House “summit” on health care reform was a nice start but as the as the reform debate unfolds, public and congressional opinion and the positions of the powerful interests involved – pharmaceuticals, insurers, device manufacturers, physicians, large and small employers, and technology companies – will be swayed by their ideology, perceptions of self-interest and the rhetoric used in the debate.

At one level, there is a broad consensus in America that we need to reform healthcare to expand coverage, improve quality, and make healthcare affordable. Public opinion polls show broad agreement and large majorities in favor of fundamental change. Even among specific stakeholder groups, from employers to hospitals and doctors, there seems to be widespread agreement that healthcare needs to change. But, the combination of a deep ideological divide, self-interests that are mutually exclusive, and rhetoric that is capable of turning public opinion against change may end up creating an environment of inaction.

Drug war lunacy–Connecting the Dots

Mar 24, 2009• 9

By Matthew Holt

Next month the Supreme Court will be given the chance to redress one minor the lunacy of the last thirty years of the so-called “war on drugs”. It will get to decide whether in the name of "zero tolerance" a thirteen year old girl can be strip searched in the quest to find some OTC ibuprofen. Oh, and she was an honor student falsely accused by a former "friend". Given the current make-up of the Supreme Court—yes Clarence Thomas still gets a vote—we can probably expect nothing sensible.

On the other hand nothing sensible, and much worse, is going on south of the border. My former colleague Paul Saffo points out that Mexico is on the verge of collapse. He notes a major signal—the cops are wearing masks while a major drug dealer stands proud.

Narrow Networks – Part II

Mar 24, 2009• 8

By CHARLIE BAKER

For the past six years, Harvard Pilgrim has offered a limited
network product to our New Hampshire members called “New Hampshire
NetOption.” Simply put, all New Hampshire providers are Tier One
providers – lowest co-pays – and so are all Massachusetts community
hospitals. Tier Two providers are MA-based teaching hospitals (members
have a higher co-pay for services there). That’s it. Two tiers – one
for NH hospitals and MA community hospitals, and a different one for
MA-based teaching hospitals.

There is, however, one catch. All NH hospitals and their physicians
and all MA hospitals and their physicians are “in network” for this
product – except Partners. When we set the product up, Partners chose
not to participate because the plan design treated teaching hospitals
differently than it treated community hospitals. That’s their call.
NBD, as my kids would say.

The Public Program Impasse: A Proposal

Mar 23, 2009• 14

By ROGER COLLIER

Health care reform proponents could find encouragement in recent Obama administration comments on the issue of taxing health care benefits. The President, having adamantly rejected the concept during last year’s campaign (thereby violating a cardinal rule of politics: “never say anything you can’t later on claim was misinterpreted by your enemies”) indicated through White House budget director Peter Orzsag that he considered the issue very much on the table.

Since passage of health care reform is likely to require almost unanimous support by the fifty-eight Senate Dems—or maybe fifty-nine, depending on the eventual emergence of a winner from the long Minnesota winter—the President’s willingness to back down is a positive step (although sophisticated financial thinkers will note that shuffling funding sources will do nothing to reduce total costs).

What the administration’s openness to compromise also does, however, is move the spotlight onto another issue with the potential of sinking health care reform: the inclusion or otherwise of a public program option in a reform structure.

Commentology

Mar 22, 2009• 3

JR wrote to us with an interesting question:

“Given the attempt to recover bonus payments to AIG, can you envision a scenarios where CMS attempts to recover payments from physicians that they retroactively deem too high? What if a new national standards board establishes a rate for hip replacements that is lower than what it is today? Similar situation? Not at all? I’d like to see a discussion on this.”

CCHIT President Mark Leavitt likes the Obama administration’s pick for National Health IT Czar. He left this comment on Matthew’s post on the selection.

I had the opportunity to work with David Blumenthal recently when I served on an expert panel for the health IT adoption studies. He has a deep understanding of applied health IT and, even more important, how clinicians interact with these systems in the real world. This is great news for everyone interested in advancing the use of health IT to improve quality, safety, and cost efficiency.

Commentology regular Christopher George thinks the courts missed the underlying point in both of the cases that Tobias Gilk discusses. “Pharma vs. Devices – FDA, Supreme Court and Liability Whiplash“

“In both of these [instances] the product was mis-administered. The
Medronic balloon was inflated above the pressure for which it was
rated; the drug was mis-administered by the nurse. In both cases, the fault lay with the doctor or nurse using the
product, not the product. There is no “failure to warn” here. The
balloon was over inflated. Every balloon, when overinflated enough will
burst. The injection was made into an artery.”

Health Wonk Review, up and intense at HealthBlawg

Mar 21, 2009• 5

By Matthew Holt

David Harlow did a great job, go see.

Life in the Goodman bubble

Mar 20, 2009

There’s reality, and then there’s the world John goodman lives in

Health Care Reform: Do Other Countries Have the Answers?.

Bluementhal is new health IT czar

Mar 20, 2009• 10

By Matthew Holt

David Blumenthal, known slightly more for being a policy wonk than a geek (or perhaps known best for being a wonk about geek issues!), has been appointed the new Director of the Office of the National Coordinator for Health IT. No official word on Rob Kolodner’s new role, although John Halamka suggests that he’ll stay on to run the stimulus package. Don’t forget that ONC gets $2 billion as part of the HITECH bill, so someone needs to be there to manage the bureaucratic part of that.

And no, none of the five candidates pimped on THCB by Kibbe and Klepper got the job…I’m sure we’ll hear from them about Blumenthal shortly.

Don’t think anything is certain on the reform front

Mar 20, 2009• 5

By Matthew Holt

And in more from the “is it really bad enough out there to guarantee health reform?” front…

Pew Research is out with a poll showing that the numbers in favor of a major health care system reform are growing abut nowhere near as large as they were in 1993.

For those of you who are real survey geeks it’s (almost) worth noticing that Harris, which asks a similar three questions about appetite for reform never got above 40% for its “rebuilding” category back in 1993. I’m not sure why these are different numbers, but the last one I saw from Harris in favor of “complete rebuilding” was at 33%.

But the answer is that support from the public is no more a dead cert than it was in 1993–4.

Those Goody Goody Canadians Not So Good

Mar 19, 2009• 12

By MICHAEL MILLENSON

C’mon admit it: you’re sick of hearing how those goody-goody Canadians provide comprehensive health care to all, while we let an estimated 22,000 Americans die each year (http://www.urban.org/publications/411588.html ) because they don’t have coverage. Or the way their cost of prescription medications is so much lower than ours that Congress finally threw up its hands and legalized the equivalent of small-scale (prescription) drug smuggling. Heck, Canadian provinces even do comparative effectiveness research without anyone calling them Nazis.

Now comes word from the Fraser Institute in Toronto that Canadians are not so goody-goody after all. The institute puts out a peer-reviewed and risk-adjusted report card comparing hospitals in Ontario, the nation’s largest province. Last year, the first for the report, just 43 of 136 acute-care hospitals agreed to participate. This year, though, the number of participants plunged 60 percent, to just 17 hospitals, according to a story in Healthcare IT News.