A recent Wall Street Journal editorial strongly challenged the notion that there is enormous waste in American health care. In the article the editors acknowledge that dramatic variation in health care spending exists across the country–but point out that the precise reason for that variation remains uncertain. They also note that much of the data about regional variation comes from the Dartmouth Atlas–and that work, they point out, is limited in that it only examines Medicare data. And they cite work from Richard Cooper at the Wharton School that directly challenges some of the Dartmouth Atlas conclusions–essentially arguing that the Dartmouth observed regional variation is actually simply an artifact of Medicare. They conclude that “Dr. Cooper’s assault on the Dartmouth Atlas is controversial but compelling. He argues that the less-is-more theory is based on the flawed premise that when a region’s outcomes did not improve as spending increased, the difference is simply classified as ‘waste’ – even if it isn’t.”
What “reform” legislation will achieve
This from single payer advocate Don McCanne whose quote of the day is a rich source of nuggets. He gave a talk in Orange County (California’s equivalent of Kansas)
Health Care Council of Orange CountyJune 11, 2009Annual MeetingKeynote: “Health Care Reform – What Has to Be Done”By Don McCanne, M.D.Opening questions directed to the audience:How many here believe that it is probable – not certain, but probable – that Congress will pass health care reform and President Obama will sign it this year?(Most individuals raised a hand)How many believe that the legislation will provide insurance coverage to everyone or almost everyone?(Not one hand went up)How many believe that the legislation will be effective in slowing the rate of health care cost increases?(Not one hand went up)
Sounds about right to me.
On a side note, I had a great talk with Hal Luft yesterday which will be on THCB next week. Hal had an interesting perspective on whether we should aim for 100% coverage or slightly less. Basically if we get to 100% of citizens covered, then it’ll be easy to cut the funding to safety-net providers who are looking after the homeless, the mentally ill, the destitute and many undocumented aliens (and lots of documented ones too). If we aim for say 98%, then we could justify keeping the safety net providers in a separate system and the 10 million or so (2–3%) of undocumented aliens in the country would at least have somewhere to go for their care.
Can’t say it’s my preferred solution, but it’s an interesting point.
Health Care Cooperatives–An Old New Idea–So What’s a Blue Cross Plan?
As opposition to a Medicare-like public health plan option grows, there has been a lot of talk about the compromise idea of creating not-for-profit health insurance cooperatives
that would compete on a level playing field with existing private
insurers. The reasoning goes they would keep the existing insurers
"honest" by introducing a new element of competition.That's a great idea.And it was a great idea 60 years ago when the first Blue Cross plans were established.
Problems with IE? Try Firefox or earlier versions of I.E.
For those of you using certain versions of Internet Explorer, we’re having some significant problems in the last day or so on THCB getting things like the right hand margins to appear, getting videos to appear and play properly, etc. (Issue seems to be limited to I.E. 8.) For now, these appear to be resisting the easy fix, BUT the good news is that everything is working fine in FireFox. So to those of you having trouble, can we suggest you use FireFox for the moment to view THCB and we hope to have regular service resumed soon.
A Special Reform Edition of Health Wonk Review
by BRIAN KLEPPER
Over at Managed Care Matters, the always thoughtful and energetic Joe Paduda has, once again, done us all a service. Tasked with hosting this edition of Health Wonk Review, he has assembled a great range of pieces on the current reform process, which make for enlightening, entertaining and sober reading. This one is useful, provocative and very educational. Check it out!
Gawande Nails It on Healthcare Costs
I just finished reading Atul Gawande’s June 1st New Yorker piece – it’s the Talk of the Health Policy Town – on healthcare’s “Cost Conundrum.” Like most of Atul’s work, the article is lyrical, powerful, insightful, and correct.
As you’ve probably heard, Gawande profiles the town of McAllen, Texas, whose healthcare costs are nearly double the national average. He swats away the usual explanations (our patients are sicker, more obese, more addicted, more Mexican; our lawyers are nastier; our quality is better…) to unblinkingly zoom in on the real culprit: a culture in which providers’ greed trumps the patients’ interests. He contrasts McAllen’s healthcare culture with that of El Paso, just 800 miles up the border, a town with similar demographics but whose healthcare costs are exactly half as high. He also describes the Mayo Clinic, which manages to deliver the best healthcare in the country, perhaps the world, at a fraction of McAllen’s costs.
His main point is that policymakers need to focus less on who pays (i.e., should there be a “public plan”?) and more on creating physician-led accountable entities that manage the dollars and possess the wherewithal and incentives to make rational choices about how to organize care – the ratio of primary care docs to specialists, the number of MRI scanners, the algorithm for the workup of chest pain or gallstones. Atul understands that we can’t snap our fingers and change culture, but that culture will change when structure and incentives are lined up correctly.Continue reading…
Commentology: The President’s Letter to Kennedy and Baucus
THE WHITE HOUSE Office of the Press SecretaryFor Immediate ReleaseJune 3, 2009
Dear Senator Kennedy and Senator Baucus:
The meeting that we held today was very productive and I want to commend you for your leadership — and the hard work your Committees are doing on health care reform, one of the most urgent and important challenges confronting us as a Nation.
In 2009, health care reform is not a luxury. It's a necessity we cannot defer. Soaring health care costs make our current course unsustainable. It is unsustainable for our families, whose spiraling premiums and out-of-pocket expenses are pushing them into bankruptcy and forcing them to go without the checkups and prescriptions they need. It is unsustainable for businesses, forcing more and more of them to choose between keeping their doors open or covering their workers. And the ever-increasing cost of Medicare and Medicaid are among the main drivers of enormous budget deficits that are threatening our economic future.
Alex Drane — Engage with Grace
Alex Drane is at AHIP in San Diego and she’s talking not about Eliza, or health plans, but is talking about Engage with Grace. It’s a wonderful interview, although Alex knows that associating end of life care with reducing costs makes me very nervous. BUT the point is, talk about it, give people the tools to make the choice. And people’s choices will as she says dovetail in general with less rather than more care at the end-of-life. And if they want more rather than less, that’s fine—so long as it’s a purposeful decision.
Listen to Alex describe the movement, and what the topic’s meant to her family. And then visit the web site at Engagewithgrace.org.
Click here to watch the interview.
Launch! LiveStrong.com Calorie Tracker
LiveStrong is the second in our series of companies that presented at Launch! at the Health 2.0 Meets Ix conference in Boston in April. With the help of the Lance Armstrong Foundation, LiveStrong.com has created a way of setting goals and tracking calories on the go. And yes it’s new (which is the point of Launch!). Watch the short video below to get an idea and investigate further over at LiveStrong.com
HIT Adoption – Alignment & Simplification
David Hartzband is a Lecturer in Engineering
Systems at MIT, teaching courses in large-scale software systems and Director of Technology Research at the RCHN Community
Health Foundation. In his role at the Foundation, Dr. Hartzband spearheads the
organization’s continued evaluation, assessment and findings
dissemination related to health information technology.
As
if we didn't know already, most of the leadership of Health and Human
Services has now weighed in on the importance of health information
technology (HIT) in realizing goals for health care improvement and
reform. HHS Secretary Kathleen Sebelius said in a House Ways and means
Committee hearing on May 6th that “health IT is critical
to health reform”. To her credit, she also said that “just shifting
our paperwork to computers won't work, unless we make sure they can
talk to each other.” We also know that substantial amounts of money
will be available through the ARRA and other sources for acquisition
of electronic heath care records systems (EHR) as well as incentives
to Medicare and Medicaid providers for meaningful use of such systems.
Those of us who have worked in HIT, for even short amounts of time,
realize that there is a step missing in this progression: acquisition,—–,
meaningful use. That missing step is the adoption of technology, and
adoption is considerably more difficult than either of these other steps.
