Author Archives

Matthew Holt

Obama health plan, silliness

Jul 23, 2008• 16

By Matthew Holt

Enter David Cutler. Result is more silly meaningless numbers

<sigh>

It is truly worrying when the single most sensible quote in the whole damn article comes from AEI’s Joe Antos.

How is this worth the NY Times’ attention? And what happens when the Obama bill comes up in Congress and somehow there isn’t a $2,500 check to be mailed to each household?

I thought this guy was going to treat us like grown-ups. After 8 years of insanity that would be nice.

If Cutler, who doesn’t exactly strike me as a major league populist, thinks that Obama has to “find a way to talk to people in a way they understand” how about he steers him to talk more about some insurance reforms that are both possible and very understandable. Like stopping this.

Cost containment is the missing link in Obama’s health plan

Jul 23, 2008• 2

By Robert Laszewski

Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.

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The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.

That the Obama health care reform plan would cost between $50 and $65 billion a year is highly doubtful. Obama claimed his plan was nearly identical to Hillary Clinton’s and her plan was projected by her to cost more than $100 billion a year.

Doubtful McCain’s health plan would accomplish any real cost savings

Jul 23, 2008• 3

By Robert Laszewski

John McCain is now the presumptive Republican nominee for president. As a result, what he thinks about health care policy will be out front in the presidential campaign this fall.

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McCain’s thinking couldn’t be more different from Democrat Barack Obama.McCain very rightly points to health care costs as the biggest health care issue. "We are approaching a ‘perfect storm’ of problems that if not addressed by the next president will cause our health care system to implode," he has said.

Therefore, his focus is on the health care costs that make health insurance so expensive that many individuals can’t afford it for themselves, employers can’t afford to provide it to their employees, and government can’t afford a wider safety net for the poor and long-term solvency for senior benefits.

He also reminds us that costs can’t be improved without dealing with quality in tandem.

Information therapy goes beyond evidenced-based info

Jul 23, 2008• 1

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By Joshua Seidman

Joshua Seidman is the president of of the Center for Information Therapy
that aims to provide the timely prescription and availability of evidence-based health information to meet individuals’ specific needs and support sound decision making.

I had a fun meeting recently with some smart folks from the Robert Wood Johnson
Foundation that raised questions about Ix that could use some clarification. When we talk about information therapy (Ix), we often drift into “evidence-based information” to help with some specific health condition.

That certainly is an important component of Ix, but it’s too limiting in many circumstances. When we talk about the “proactive delivery of the right information to the right person at the right time,” that has to encompass whatever the information needs of the consumer are.

Mega Life parent “hurt a lot of people”

Jul 22, 2008• 13

By Matthew Holt

Is this what Blackstone, Credit Suisse & Goldman Sachs want said about their investment?

"The severity of their actions certainly warranted that level of penalty. They hurt a lot of people," says Washington Insurance Commissioner Mike Kreidler, whose state and Alaska led the investigation.

Today a group of insurance commissioners handed down a $20-million fine to parent company HealthMarkets for the behavior of Mega Life & Health, and also its corporate siblings Chesapeake Life and Great West

$20 million isn’t exactly a huge fine, and it doesn’t put HealthMarkets out of business. It’ll be interesting to see whether Mega changes the quasi-fraudulent structure of its benefit plans. After all, they’ve been ruled legal in California, and my sources tell me that the medical-loss ratio is around 30 percent.

My guess is that they know that eventually they can’t stay in business this way. So they face the choice of either changing the business completely to become more worthy and less profitable, or instead to try to bleed every last dollar out of their subscriber base and semi-trained sales team. I wonder which they’ll try.

Health Systems’ Ferocious Challenges

Jul 22, 2008• 3

By Brian Klepper

Lately, I’ve had interesting discussions with a thoughtful exec. at a
major Western health system about the ferocious challenges facing
hospitals and health systems. Her organization’s internal conversations
at the moment are centered, in part, on what they should do to become
"reform ready," not only for policy changes that could be in the wings,
but more importantly, for emerging market dynamics that will change the
ways hospitals work. She asked me to catalog some of the trends I think
health system managers will have to deal with, along with five
recommendations for action. Here’s some of what I told her.

Hospitals face dramatic financial stresses on a range of fronts.
Over the last 25 years, health systems’ average total margins have
remained reasonably stable at around 5 percent. As you’d expect, some
organizations have performed better, and others worse. About
one-quarter of all US hospitals, many of them safety nets, have
reported negative margins, and continually teeter toward failure.

Now the pressures are ramping up considerably. Perhaps most
profoundly, the balance has eroded between more profitable
privately-covered patients, and patients with public coverage –-
Medicare, Medicaid and other governmental sources –- that may not cover
cost.

Using professional societies to advance participatory medicine

Jul 22, 2008• 6

By Daniel Hoch Epatients

Dan Hoch is a neurologist based at Massachusetts General Hospital
and an assistant professor at Harvard Medical School. An early
developer of online resources for patients, Dan helped found Braintalk.

Professional medical societies are not quite like the secret society Skull and Bones at
Yale University, but they may well look that way to many patients.

In most cases, their sole reason for being is to serve their members in a pretty narrowly defined way. These services generally include continuing medical education programs, an annual meeting, promoting research, advocating for public and political awareness of the value of the specialty, providing resources to support clinical practice, and more mundane perks like access to group insurance (malpractice and otherwise).

If you define the mission of the society a little less narrowly, and it’s not hard to see how that mission can be aligned with that of participatory medicine. We often argue on the e-patients blog that full participation of all parties in health care will yield better, more efficient care. Such care will benefit the members of a professional society. Further, patients are taking part in research not just as guinea pigs, but as organizers and directors. This benefits the societies’ research missions. But, are medical societies poised to understand this, and if so, how do we guide them?

Good and bad health consequences of high gas prices

Jul 22, 2008• 2

By Jane Sarasohn-Kahn

The price of gas is a headache for every consumer. But the health impacts of high Gasprices
fuel prices go beyond that metaphorical symptom.

Consider medical supplies and home health. But it’s not all bad news: on the positive side, higher fuel prices could positive impact the obesity epidemic and the rate of motor vehicle fatalities. Read on.

Latex gloves and med-surg supplies. Think about one of the most ubiquitous medical supplies: gloves. Walgreens recently said a box of 120 private-label latex gloves has nearly doubled in price. In 2007, a consumer could purchase two boxes for $9.99; today, the store has a sale price of $7.99 for a single box. There’s a lot of oil in those protective goods.

Hospitals use petrol-intensive supplies ranging from gloves to bed pans and tubing, according to a column in the Youngstown Vindicator. A 200-bed hospital can use 16,000 gloves per day (6 million a year).

Primary care crisis is HERE

Jul 21, 2008• 24

By Bob Wachter Robert_wachter

I recently heard from a UCSF physician who was flabbergasted when he sought an
appointment in our general medicine practice and was told it was “closed.” Turns out we’re not alone: there are also no new PCP slots available at Mass General. The primary care crisis has truly arrived.

I’ve written about the roots of the problem previously, and won’t restate the sad tale of woe. But I hope you’ll take the time to listen to two very powerful NPR reports on the topic – the first, a WBUR special by healthcare journalist Rachel Gotbaum called “The Doctor Can’t See You Now,” is the best reporting on this looming disaster I’ve heard (here is the MP3 and the show’s website). The piece is long (50 minutes), so I’ll summarize a few of its moments that really hit home.

First, it is true – MGH is not accepting any new primary care patients. Like UCSF, therefore, getting “a regular doctor” at MGH now takes the combination of cajoling, pleading, and knowing somebody generally referred to as “working the system.” In other words, the process of finding a primary care doc is now like getting a great table in a trendy restaurant. Obviously, this is horrible for patients, but it is also no fun for doctors. For example, in the NPR special, MGH’s director of Emergency Medicine laments:

“If you really want to give me heartburn, you can say, excuse me but I know you work at Mass General and I would like a primary care physician please.”

Determination of need rule only goes partway

Jul 21, 2008• 1

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care, Inc., a nonprofit health plan that covers more than 1 million New
Englanders. Baker blogs regularly at Let’s Talk Health Care.

I usually spend some time throughout the year visiting with accounts, physicians, hospitals, and brokers (among others), just to hear what’s up and what’s going on. Earlier this week, I was out visiting the leadership at a community hospital in Massachusetts, and asked them if they appreciated the MA Department of Public Health’s (DPH) decision to require academic medical centers to prove they weren’t duplicating existing clinical services in the community when they opened new operations in the suburbs around Boston.

For the uninitiated, this issue has been percolating in Massachusetts for the past couple of years, as a number of well known teaching hospitals have broken ground on some pretty big outpatient facilities in the suburbs around Boston. The service suite in these places varies, but it’s basically day surgery, cancer treatment, cardiac care, high-end radiology, and assorted other high-margin outpatient services that many community hospitals in Massachusetts argue they were already doing, and may now lose to these new facilities.