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POLICY: Wyden’s health care plan

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Wyden_smile
Oregon Senator Ron Wyden’s health plan is announced with a flourish and a call with a gaggle of bloggers. Best quick explanation is by Ezra

The bill is a replacement of employer-based health care with the purchase of individual insurance via regional pools, which look very like Clinton-style regional health alliances–except they’re now called “health help agencies”. No underwriting, guaranteed issue, community rating and an individual mandate with subsidies up to 400% of poverty and a minimum benefits package equivalent to the BCBS plan in the FEBHP. All very similar to Enthoven circa 1984

From the call. Some notes…

Wyden said that the Hillary bill was too big in 1994 and you can’t expect the Senate to consider a bill that has to be moved around in a wheelbarrow. His is “only” 160 odd pages.

Maggie Mahar asked if the plans just wouldn’t pay the providers for the cheapo plan way way less to the things they provide for the more expensive plans. Wyden says that there’ll be a “floor of decency,” and that all those commercial plans will pay a better rate than Medicare—so he sees the end of Medicaid and second class health care citizens. No global budgets, because the plan would reduce costs  also be a slightly barer plans than some employers provide now. Cost reductions would come from increased competition as people trade down to less rich plans, and through reduced administrative costs—he has a Lewin report to prove it (something else that smacks of 1993!)

Max Sawicky asked whether relying on consumer choice and market competition to hold costs down will work. Here’s what Wyden said. From the first paycheck, employees will see the added health benefits in their paycheck right now, and they’d be required to go out and purchase the basic package. (It would be a wash from tax standpoint for now, as they’d get a new deduction). After the first two years, there’s no longer a requirement that employers would have to pay the salary “increase” but employers would keep the wages up because otherwise the good workers would leave. But after that every employer would be required to make a payment based on their size—and that tax would total more than $100bn) a year. He was asked if that looks like an extra tax which penalizes the employers who were already good citizens and were providing rich insurance already. His response was that overall employers will pay less because in the first two years, the employers will not pay for the growth in health care costs over those two years, they’d just pay the cash amount they were paying in Year Zero. (That does presumably mean that any cost increases will be paid by consumers). Employer wins on day 1 because they don’t pay the increase. Then in 2 years they pay the tax. …..but they haven’t quite figured out that transition for the employers that had very rich benefits. How do you have real consumer choice? How do you make a market? Right now we don’t have one—he thinks his transition will help it.

I asked, so if that works, how are you going to get the provider and supplier industry to not object with extreme prejudice? After all, if we’re going to spend less money they’ll be less industry income! His argument is that primary care docs are going to get a boost in reimbursement; there also be a boost in chronic care preventative spending (although to be honest I missed the details). The doctors will also be bought off with malpractice reforms and all doctors will get paid commercial rates for all patients. He didn’t mention anything about the rest of the industry beyond primary care docs. So I think that he knows he’s in for a big fight! And of course if the plans actually do compete on not increasing costs to consumers in years 1 & 2 with a fixed benefit package, by definition less money will be flowing providers’ way.

Wyden ends by saying that elected officials have been way too timid, and nothing much has happened about health care for far too long. He wants a specific bill to force the debate so that Presidential candidates will have to engage in the debate. And that I suspect is the point, although I fear that he’s 4 years too soon. (And of course given the condition of S. Dakota Dem Senator Tim Johnson, there may not even be a Democratically elected Senate to introduce the bill into!)

POLITICS: Students interrupt Iran president

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Students interrupt Iran president

The president’s speech was interrupted several times by students, ADWAR reported. Ahmadinejad responded by accusing the protesting students of having no shame and being on the payroll of the United States, according to ADWAR. But he added that he loved each one of them and said, "You insult me but I will respond to you calmly.

Given that he’s a complete nut, it’s good to see that some very brave protestors are letting him know that fact. But I thought it was kind of ironic given that the current American President went through his entire first term (and most of is second) having protestors removed from his speeches before he got there, and the few that ever did get in were roughed up by the Secret Service. The Iranian President apparently spoke to some of the protestors after his speech (presumably so they could be identified and dragged off to jail…).

HEALTH PLANS: Embarrased non-profit insurers still trying to hide the money

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A long time ago (1993)  in a universe far, far away pharma companies were somewhat concerned about public perceptions of their profits. Bob Leitman (long time at Harris, now at Greenfield) told me how, on a visit to a pharma company long subsumed into a bigger one, he went to the bathroom in the new building. He was staggered at the quantity of marble inside. When he remarked as much to his client, the reply he got was “well we had to hide the money somewhere!”

Apparently lots of non-profit insurers are now having the same problem

Blue Cross of Northeastern Pennsylvania said it will spend $175 million to bolster health care systems in the region and support a proposed medical school in Scranton, though the use of the money drew fire from critics of the health insurer’s expected $420 million surplus.

HEALTH PLANS/TECH: PHRs–Can this woman ever tell the truth?

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Time for the Karen Ignagni lie of the day.

It comes in a session during which AHIP and the Blues talk about their sponsorship of a common model for PHRs (or at least for payer-based PHRs). It’s hard to know how she manages to slip in a whopper during a session that’s relatively non-controversial—or at least one supporting an initiative that most of us think is a good idea. (Even if there are grave doubts as to whether health plans really believe in portable health data or records that can be moved from plan to plan, or even could put it together if they did believe it—it’s clear that Kaiser, which is way, way ahead of these guys, has no idea about portability).

Here’s the lie. She says that there are 70m people using online PHRs now. When called on it, she doesn’t bother to justify her numbers. She then says that soon 100m will have access to these from health plans. That number is so wrong, it’s just amazing. Harris and Forrester both think that much fewer than 5% of the population (e.g. less than 15 million) have got PHRs, and Markle and Manhattan disagree but both say that the potential market is between 20m and 60m. So how does she come up with 70m people having one already? Who the hell knows? It must be a derivative of the number of members for whom their plan has a web site they can create an account on (most of those Wellpoint members with WebMD, by the way). I’m prepared to bet her annual salary that the total number of people who have ever actually visited a health plan web site is less than 70 million. After all that would constitute more than 50% of all Internet users.

And would it really hurt her to tell the truth? Which is that health plans have been really weak about creating PHRs and could have done it 5 years ago and chose not to! (Yes, I know I’m bitter). Is their record thus far really that embarrassing? (It is, actually, but no where near as embarrassing as the rest of the industry’s performance in the last 5 years!) What’s changed is that now they realize the time has come to do something before it gets done too them, and now they say they will get us to the PHR land there very quickly. I happen to think that they have a good shot, but can’t for once Ignagni just tell the truth about the progress so far? I guess we know the answer.

(Note: slight edits to end para made 12/15 when I noticed it didnt make sense!)

HEALTH PLANS/POLICY: Kaiser Permanente’s plan to cover all Californians

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Kp
The plan is interesting in that it seems to basically contradict the AHIP plan that Halvorson was touting last week. That one called for subsidies for low income workers to buy into private health plans. This one calls for a state sponsored first dollar coverage plan in addition, plus an individual mandate plus a pay or play tax, plus two different pools for the non-poor to buy high deductible plans from (again both state sponsored). At least I think it’s what they’re saying. The major problem with this plan is that it’s so damn complicated I couldn’t figure out which special interest group was going to get the angriest, as it gets ignored by the rest of the public. It is worth noting that pay or play was turned down at the ballot box (2004) recently in this state and the version that was turned down had an exemption for small businesses. No such exception would exist under this plan. So maybe some anger (read: opposing political contributions) there…(are you watching WalMart?)

It’s also worth noting that they, like the Mass guys and everyone else look at the Medicaid and SCHIP enrollment levels, say “why don’t all those poor people just enroll in the plans that they’re already entitled to enroll in?” They seem to see that as a source of free (Federal) money. Well if they all did, then that money would actually have to come from somewhere…which is why those programs are under-enrolled to start with.

Still this is a serious effort. They’ve even done sums and everything. And we’re starting to count these policy documents by weight now, which indicates that it’s all getting somewhat serious and is picking up as a political issue.

OFF-TOPIC: Which side of the great divide is more intelligent and civilized?

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Gp
Apparently Gywnny’s dissing her heritage

But the question remains: was Gwyneth Paltrow on to something when she noted (or didn’t) that “the British are much more intelligent and civilized than the Americans,” and that “people here don’t talk about work and money; they talk about interesting things at dinner”? Whether Britons are objectively cleverer and more amusing than Americans, or whether they just sound that way, is one of the deep mysteries of British life for expatriates like Ms. Paltrow, who lives in London with her husband, the British rock star Chris Martin, and their children, Apple and Moses.

Of course I have my own opinions and can legitimately talk out of both sides of my mouth on this one. But then again, I can introduce you to some extremely uncivilized and unintelligent citizens of both nations!

TECH/PHYSICIANS/INDUSTRY: Communists in press stirring up trouble

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Cypho
So a disgruntled reporter is stirring up trouble by daring to question the way medical advances happen in this great nation. Apparently this Joel Rutchick character is suggesting that when respected surgeon Dr. Isador Lieberman and his organization the Cleveland Clinic began pushing a new type of back surgery, we are supposed to be surprised he didn’t plaster memos about his stock options and holdings in the company that made the device all over the foreheads of his patients.

Lieberman did not tell his patients about his financial conflict of interest unless asked, the Clinic acknowledged. According to Plain Dealer research, he also did not reveal his stock holdings in numerous articles he wrote about kyphoplasty.

Bunkum! Does every computer come with a message that you’re making Bill Gates richer every time you turn it on? Of course not.

And when he (Lieberman) testified to the treatment’s benefits at a government hearing last year, he did not divulge past stock interests in Kyphon Inc. and other device makers – even when explicitly asked to disclose such holdings.

Well he was correct. He had apparently sold the last of his stock a few months before the Congressional hearing. Like any good capitalist Dr Lieberman is onto the next pony. As he told the commie rag The Plain Dealer

"I strive to be transparent in my disclosures and believe that I have disclosed my interests within the guidelines and policies of the Cleveland Clinic," Lieberman said in a written statement. He declined to be interviewed.

Who needs an interview in the face of that transparency!

Didn’t Rutchick know that unlike a bum masquerading as a reporter Dr Lieberman had been to medical school and therefore knew all about ethics? And didn’t Rutchick also know for there to be great inventions like this it’s required that not just the inventor but anyone who uses it gets rich? Otherwise what incentive would physicians have to help patients and save lives! After all who except some communist would disapprove of such a system?

When Kyphon officials took their company public in May
2002, they disclosed in a filing with the Securities and
Exchange Commission that they had offered stock options to
the eight members of their advisory board. All took them
except Dr. Joseph Lane, a New York orthopedic surgeon who
teaches at the medical school affiliated with Cornell
University. "I felt it was very awkward for me to be honest about
these things if I owned stock in the company," Lane
said last week.

Yeah, and we know what color state this Dr. Lane character is from, don’t we?! Enough said on that topic. Honestly, virtually every great medical advance absolutely requires this kind of capitalist incentive for those using them. After all, most other medical advances come about the same way. The important thing is that there’s clear evidence of an improvement.

On the SpineUniverse Web site, Lieberman, Kyphon co-founder
Reiley and three other doctors published a four-paragraph
synopsis of their initial experiences with kyphoplasty
involving 26 patients. "These results support further
use of kyphoplasty," the March 2000 summary concluded.

What possible other evidence than this initial, non-per reviewed disinterested study could be needed? None, of course! The important thing is to get the new procedure into as general use as quickly as possible for the betterment of patient care and to save lives!

Before 2004, there had been only one reported death
associated with kyphoplasty and seven with vertebroplasty.
Since then, the numbers have changed dramatically. From 2004
through September, 16 deaths involving kyphoplasty were
reported to the FDA versus three vertebroplasty-related
fatalities. Experts agree that vertebroplasty is used more
frequently than kyphoplasty, although the gap has closed in
recent years. “These sorts of complications are extremely rare,” said
Julie Tracy, a Kyphon vice president. “These are procedures
that are very safe and do a lot of good for these patients.”

In a study published two years ago, researchers at the Johns
Hopkins Hospital in Baltimore also concluded that
kyphoplasty was more closely associated with serious
complications than vertebroplasty. Lieberman led the rebuttal for kyphoplasty proponents,
challenging the methodology of the study and completeness of
the data. However, those deaths and other complications underscore a
fundamental flaw of kyphoplasty: the risk of subjecting an
elderly patient to trauma and a general anesthetic, said Dr.
Kieran Murphy, one of the authors of the Hopkins study.
Murphy has disclosed that he receives royalties from one of
several manufacturers of the equipment used in
vertebroplasties.

Exactly, it’s clear that the naysayers are paid off by the communists. And at least we know that the insurance industry and the government are getting better value for money from the new procedure.

Murphy and other critics of kyphoplasty say hospitals need
the fees from general anesthesia and admission to recover
the costs of the equipment used in the procedure. That
equipment averages $3,500 to treat a single fracture,
according to Kyphon; vertebroplasty kits generally cost $500
to $600. Costs vary, but all told, vertebroplasty was found
to be $6,000 cheaper for each fracture treated, according to
a research report.

Well obviously those insurers must think it’s a better deal! Who could imagine insurers or Medicare just paying more for a new procedure without careful vetting it. After all they’re the end payer aren’t they? And they’re really strict about containing costs, as anyone paying insurance premiums knows! And if they weren’t so tough on containing costs for consumers and taxpayers, then why would we have a national clinical cost-benefit analysis center researching all these new treatments and being "transparent" about which ones cost what?

Answer me that, you Cleveland commie reporter, eh!

The only slightly disquieting aspect of this whole article is that the procedure concerned was invented in France. I know it’s a free market and all that, next time I hope that a red-blooded American like Dr. Lieberman could have been a little more patriotic. We don’t want those people with nice new backs only able to run backwards, do we?

 

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