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POLICY/POLITICS: Bush’s Health Plan

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I’m up over at Spot-on discussing the basics of Bush’s Health Plan. Go read and return to comment.


I was awakened during my slumber through the State of the Union by a
mention from President George Bush of a health care proposal that I
almost agreed with.


No, I haven’t come around on health savings accounts, and association health plans.
Nor did I join the Republicans in their standing ovation for
malpractice reform. The Bush proposal that woke me up was the creating
a tax deduction for health insurance that would apply to everyone.
Potentially this really matters, and inside it is the germ of the right
idea. But I guarantee you that most Americans won’t have a clue where
this came from, and why it made it into the president’s speech.

Let me explain a little. Health insurance for the vast majority
of Americans (60%+) comes from their employers. 99.9% of Americans
think that this is a natural relationship that costs them nothing and
they, in general, have no idea what it costs their employer. This is
though a historical accident, with its roots in a wage freeze policy
during WWII when employers added benefits to attract workers because
they couldn’t raise pay rates. The idea became fixed after the Supreme
Court ruled that health benefits didn’t count as taxable income.


So, today, you’re better off getting insurance paid for by your
employer than taking the cash, getting taxed and buying the same
insurance yourself. Lately self-employed people have also been able to
deduct their health insurance costs so the only saps left paying for
health insurance with post-tax dollars are those who are not
self-employed, don’t get it from their insurers and actually buy it
themselves.


You may think that’s not very fair, and you’d be right. Which is why Bush’s proposal is interesting.Go on, Continue …

POLITICS: Obama seems to be coming at Clinton from the left

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Although he’s regarded as a sell-out by Harpers, Obama seems to be taking the sensible tack that Hillary Rodham Clinton won’t survive the Democratic primaries based on her pro-Iraq war vote and her incrementalist health care strategy. Today he called for universal care by the end of the next Presidential term.

The AP report seems to think that makes him the same as Hillary and Dennis Kucinich. That’s just ignorance of the press. Clinton has been explicit about doing this incrementally and Kucinich has been explicit about wanting single payer. Obama is, my guess, too smart to lay out any specifics. But an incremental reduction over 10 years in the uninsured rate (as AHIP favors, for example) is not the same as universal insurance by 2010.

PHARMA/PHYSICIANS: Big joke-Free CME: Pharmed out doesn’t impress The Industry Veteran

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THCB regulars will be missing the delicate tones of The Industry Veteran. But never fear, he’s back and none the less caustic for his lay-off from these hallowed electrons. Here’s his take on the new CME for doctors.

No doubt you saw this article in the Washington Postdescribing the efforts of PharmedOut to make no-cost, continuing medical education sessions available to physicians.  As pharmaceutical companies sponsor a large proportion of CME sessions for physicians, the ostensible purpose of PharmedOut’s campaign lies in removing Pharma’s undue influence on prescribing behavior.It seems PharmedOut.org was created through a $21 million grant from Warner-Lambert (now Pfizer).  The money represents part of Pfizer’s 2004 settlement of the whistle-blower suit involving W-L’s off-label promotion for Neurontin.

Now it’s inevitable that if pharmaceuticals are discovered and distributed through a competitive market and a gatekeeper system, the competitors will try to influence the decision makers and compromise the latter’s fiduciary responsibilities in the process.  Is it too simple to suggest, however, that regulation should remove CME as a means for undue influence over prescribing by making the damn physicians pay their own way?  Do any of the influentials who peruse THCB see a sick absurdity in the fact that physicians need to receive their CME free if they are to remain current?  I’m not aware of settlement grants going for the continuing professional education of lawyers, accountants, or other self-employed professionals.  Instead of using that $21 million to pay for health care programs for the indigent, someone thought it a good idea for six-figure physicians to receive free CME. I’ll wager a used examination glove that physicians will irrationally offer more resistance to paying for their own CME than to many other things that have a far larger impact on their wallets.  The reason is their sense of entitlement. The boys and girls who cloak their black souls in white gowns feel they’ve worked so hard and “sacrificed their 20s” (as one cardiologist told me), that society owes them and should cover their CME.I’ll say it again.  At some point genuine health care reform will require breaking the power of organized medicine, making the profession overwhelming female, and reducing it to the status of government paid professionals akin to school teachers.  Until then, efforts to control cost, increase access and improve quality will have marginal results at best.

POLICY/PHARMA/HEALTH PLANS: Michael Cannon doesn’t understand market incentives

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Michael Cannon (sensible libertarian, Cato Institute) has noted that Those Who Sell Out Will Eventually Be Punished.  What he means is that once the pharmaceutical industry did the “deal with the devil” in 2003 for the creation of Medicare part D, it was only so long before real price controls will be instituted by the government. That’s because at some point the seat of power will be inhabited by those working on behalf of constituencies who dislike having their faces ripped off, as opposed to those looting the Federal treasury on behalf of the rippers-off of faces. Now that a mealy mouthed effort at negotiation has been passed by the new Democratic Congress—one that will be quickly vetoed anyway—the first signs of this “punishment” are coming.

Of course he could have said this about 1965. In fact many members of the AMA & AHA said just that at the time and bitterly opposed Medicare. Then they enjoyed 15 years of incredible rising incomes with no efforts to stop them before DRGs et al in the 1980s. And even then their incomes continued to rise for another 15 years, and haven’t rally stopped. So punishment can take a long, long time in coming.

And that is just the point. Who was the MMA passed in aid of? It was passed for the senior management at the companies it benefited—people like Hank McKinnell, Bill McGuire, Larry Glasscock. And what did they see after it was passed? Their stock prices rise when the program cut in for them (04 for United and the managed care cos, 05 for Pfizer and the pharmas) which of course sent the value of their retirement packages go through the roof ($200 mill for McKinnell, $1.6Bn sh for McGuire, I believe). That’s a pretty good market incentive if you ask me! I’m surprised Michael’s one of those Keynsians worried about the long run. After all none of the people “selling out” gave two hoots about it; they believe in the power of market forces.

Of course, there will be a long run, and Michael is kind of right. But it’s not those doing the selling out who will be punished. It’s the successors of McKinnell, McGuire et al who will have some cleaning up to do.

QUALITY/INTERNATIONAL: More confusing international comparisons

I don’t know much about medical care, but I do remember that in Lynn Payer’s Medicine and Culture the most amusing factoid was that German doctors put people whose blood pressure was too low on medication to raise it. Does that mean that the study of blood pressure control reported on by the AP, which suggests that it’s lower here because of more aggressive prescribing than in 4 other countries, means anything in terms of reducing poor health outcomes? I doubt it. What about in increasing or reducing costs? I suspect you can guess my answer!  Here’s the abstract.

This stuff always reminds me of the Philip Morris study of the costs of smoking in the Czech Republic. Hint: smoking lowers societal costs cause the smokers pay more taxes than anyone else then die off quick before they cost the taxpayers much!

TECH/BLOGS: Case preaches open health care

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This I like. Steve Case has his own blog at Revolution Health, called The Revolution Manifesto.

There was lots of interest about him on the Webinar I did this morning. And no, Indu, I’m not going to declare a winner between Revolution and Google Health right now. That’d be like saying who’s going to win the 2010 World Cup!

HEALTH PLANS: Does this sound in the least familiar?

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From Government News of the Week:.

Connecticut Attorney General Richard Blumenthal (D) said his office has received complaints that Assurant, Inc. denied claims based on questionable conclusions about patients’ pre-existing conditions. The AG’s office said it received 20 complaints against the insurer over the past few years, and that 15 of those claims involved denials for health conditions that allegedly existed before the policies were effective. The claims that were denied came from individual policyholders, Blumenthal’s office said. Also, the Connecticut Insurance Department said it received 111 complaints over the past four years related to Assurant’s denial policies and that only 16 of them were deemed justified by the department. The insurance department started investigating the insurer’s claims-denial practices last year. Assurant Health spokesperson Phillip Chang said the plan is committed to working within all applicable legal and regulatory guidelines of every state it does business in, but could not comment on individual cases.

Of course, it’s unlikely that this type of thing was going on only in California. Meanwhile, long-time THCB readers might be amused to know that Assurant was the company whose HSAs and HDHPs were being pimped continuously on this channel by commenter Ron Grenier. In other words they were among the most underwritten of all policies—and apparently they still had to cancel them after the fact!

THCB: Advert

Business of Healthcare Conference
Saturday Feb 3, 2007
Haas School of Business, UC Berkeley

Panels will include topics on Health Care IT, Health Care Policy, Payor/Provider, and more.
For further details, and to register please go to http://www.haashealthcareconference.org/

 

QUALITY/TECH: A nice conversation with Brent James

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This is possibly the most interesting podcast yet on THCB. And it’s certainly the longest. if you didn’t have the time to listen to the interview with Brent James, here’s the transcript. I really recommend this one–there are so many amazing nuggets that if you care about health care in the US at all you owe it to yourself to read!

Matthew Holt: This is Matthew Holt with The Health Care Blog, and I’m back with yet another podcast and this time it’s really very exciting for me that we have one of the pioneers of the entire medical safety and industrial process of medicine movement in the U.S., Dr. Brent James, with us this afternoon. Brent, good afternoon. How are you?

Dr. Brent James: Good afternoon. It’s a delight to be here.

Matthew: Great, great. Just by way of introduction for those who don’t know, and I’m sure most of my readers will know—I hope they do—given that it comes up enough in the blog. Brent, your official title is VP of Medical Research for Intermountain Healthcare? Is that correct?

Brent: That’s correct, and I’m the Executive Director of the Intermountain Institute for Healthcare Delivery Research.

Matthew: Great. And I would say that that sounds very well and good, but in fact that is really understating Brent’s impact. He’s both at the regional level in Utah with Intermountain been largely responsible with his team for some really dramatic change in the entire way  clinical care is being delivered on the in-patient side, and has had a lot of great information published and distributed out of that. On the national level, Brent, you’ve been involved in both the Institute of Medicine and the more recent Citizens Working Group in Healthcare, and there’s probably some other things you’ve been involved with. I don’t have them on the tip of my tongue, but certainly you’ve been a very visible player on the national level. In addition, and we’ll touch on this at some point in the conversation, you’re currently involved with the Institute for Healthcare Improvement’s — Don Berwick’s organization — new campaign which was announced last week for the Five Million Lives. Is there anything else big and important I’m missing from what you do? [laughs]

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