The big insurers now seem to be doing anything they can to prevent a Medicare-equivalent public plan
being launched to beat them up. Yes AHIP has apparently decided to throw the schlockmeisters off the boat, and more or less agree to end medical underwriting.
Those of you who listened to my interview with Tom Epstein of California Blue Shield will recall the cognitive dissonance he was suffering when he had to defend Blue Shield and other insurers’ behavior in the individual insurance market (hey, it’s the man’s job), while at the same time calling for policies that would essentially end the individual market and create a near-universal purchasing pool. By definition, that would require some level of uniformity of benefits and some risk-adjustment mechanism, and consequently it would put several currently profitable lines of insurers business out of business—yes I am talking about Tonik and Mega Life & Health among others. In general this might be a good trade for the bigger plans as they’d add a bunch more younger healthier lives at a higher price point (although what Wellpoint’s actuaries and accountants really think about it is yet to be determined—note their opposition to the similar ArnieCare legislation).
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.
A couple of weeks ago the PR company for Blue Shield of California contacted me asking if I wanted their take on health reform. I somehow suspect that the PR flack concerned wasn’t as familiar with the California rescission issue as I am, or hadn’t checked on THCB’s extensive coverage of it
But Blue Shield of California is an odd case. CEO Bruce Bodaken has been a leader among health plans in looking towards a regulated utility model, and supporting both Arnie-Care and now Obama/Baucus-care. On the other hand, as we’ve discussed numerous times on THCB, Blue Shield has not only been as bad as the rest in terms of bad behavior in the individual market–but has also been the most aggressive of all insurers in defending its right to that behavior in the courts.
Tom Epstein, is an old Clinton White House hand who’s now running Public Affairs at Blue Shield of California. Tom was brave enough to come on THCB, discuss the good, the bad and the ugly, be frank about what they want to happen and to forecast what he thinks might happen in terms of reform, and the potential role of health plans in it. Here’s the interview and I think you’ll find it very interesting.
Jonathan Cohn has started blogging almost daily on the politics of health care at The Treatment. And it's a treat to read. Jon is a member of the recently exposed vast left wing conspiracy (so am I, but that’s because Ezra’s soft), but the difference is that instead of being a San Francisco based ranter with an unfocused cynicism, Jon actually knows the inside Obama players and cares what they do. And he’s an optimist.
His latest piece at TNR, Stayin' Alive describes the inner story of why the Administration decided to come up with the $65bn a year number in the budget for health reform, rather than just brushing it under the rug. And the somewhat surprising (to me) answer is that the member of the Obama team who would not let health care die was Obama.
Now I know I’m very cynical about both the chances of any reform passing and the value of said reform, but there is the (ever so slight) chance that I might be wrong. So paying attention to Jonathan is a smart idea.
CODA: BTW, why are health care reform costs always quoted as “$1.5 trillion” or whatever. Why are they not quoted like everything else, in annual terms?. After all $1.5 trillion over 10 years is a pretty small fraction of the $30+ trillion we’re going to spend on health care in the next 10 years.
Maher’s being funny (at least he thinks he is!), but he’s tapping into a meme that I think that many in DC including any Democrats are missing. I was watching CNN on Sunday and Sanjay Gupta brought up the question to Bill Clinton and (and Bill Frist, John Podesta & Mehmet Oz) about whether single payer was really off the table. The answer is, it’s not if they get this wrong (and they will). If we have a mealy mouthed reform this time (a la Massachusetts) then single-payer will be back with a vengeance in a few years.
Last week (Tuesday to be precise) Chris Rauber, the health care journo at the SF Business Times calls me to talk about health care IT. But he ends with a question that’s not about Health care or IT, but aimed at me as a blogger. He says “what do you think is the future business model for journalism”
I’ve been mulling this a little bit and my response went something like, media is now disaggregated. Craigslist and Google have destroyed the advertising model for most media, and blogs and social networks have democratized the commentary/opinion playing field (to some extent—I’m not as rich as Tom Friedman yet!). The problem is that not many “new” media outlets—such as THCB—can afford to take on the interesting part, which is paying real investigative journalists to investigate. Something I would love to be bale to do—as there’s lots of muck to be raked in health care.
Brian Klepper and David Kibbe have written a terrific piece on how and why health care is in a handbasket and wondering where it’s going. But as we ex-futurists know, there’s lots of luck required to make a good forecast.
When I met Brian five years ago he told me that the sky would fall within five years, and at the time he was trying to persuade players in the health care system to self-reform. He suggested to them that the alternative would be soon be much worse.
I said, “no no, it'll take longer (10-15 years) and the system players will never self reform”. Instead I thought “reform” would be be done to them by the government when the system hit crisis. My guess was a combination of Medicare with 5 years of baby boomers on board and a middle class with 80 million uninsured would arrive around 2012–15. And then the brown stuff would be hitting the whirly object soon after that when the Chinese wanted their money back.
As it turns out we were both wrong and both right.
Most of the Health care geek squad is in DC as I write, at a press conference conducted by Health Affairs which has an entire issue out today about IT in health care. Here’s the table of contents. And for those of you who don’t have a subscription, well here are four articles for free including those from David Brailer and John Halamka.
As you might guess KP’s HealthConnect is featured prominently with academic articles about the impact of its installation on physicians & the system (office visits down 25%) and patients (they love it).
There’s lots and lots more, including an article that makes stars of nerdy docs Jay Parkinson, Danny Sands and Ted Eytan—if “star” is the right word for this rarefied environment. (Oh, and somehow Bob Coffield got in there too!) My early tweetings on that one (which is the only one I’ve read so far) were captured and blogged by e-Patient Dave. Converting tweets into a blog post and making it make sense may be the new art form. Be warned that despite the words “Facebook & Twitter” in the title, this is about using Health 2.0 tools for patient to physician communication not about the social networking side of Health 2.0. Still I guess there’s room for another article in the next Health Affairs about that.
Today’s news is that there is now a double header running health care with the addition of the
(notably all-female) team of Sebelius & DeParle joining Orzsag, Zeke Emmanuel and a host of others with influence on the health care policy tiller. We await a CMS leader, and probably multiple other appointments quickly down through the ranks.
However, I remain convinced that not much is going to happen, and that even if Obama’s “plan” gets enacted, it’s a limited reform that is not the big bang we need to do the job.
Thankfully rather than me having to explain why, Bob Laszewski (who makes me feel like an inadequate noobie every time I read his stuff) details the problems over at Health Affairs blog. The Bob L summary?
- Obama’s team has not aggressively gone after the hard cost problems as part of Medicare & Medicaid, preferring to trifle around the edges with modest cuts
- For the (these days relatively modest!) $120 billion a year the reforms are going to cost it’s only looking to the health care system to pony up around half of it—the rest (c. $65bn a year) will come from the taxpayer.
- The details of the plan are being left to the Congress which means that it’ll be watered down.
As I said in the looooong comment thread on Maggie Mahar’s piece on THCB yesterday—BTW Maggie’s comment on her own piece may be the longest comment I have ever seen on any blog!—there’s no reason that the rest of the economy should contribute more to the health care system. As John McCain might say (albeit with disapproval), we need to redistribute the wealth within the system.
So I’m in
DC figuring out how the East coast medical policy elite tries to change the world. While the rest of DC is buzzing about Obama’s speech and budget, The Institute of Medicine is having a conference on Integrative Medicine. But most people think it should be called integrative health.
What is integrative health, you ask? Good question.
The majority of the panelists are mainstream health care players like Bill Novelli (AARP), George Halvorson, (Kaiser Permanente), Ralph Snyderman, (Duke). They’re talking about integrating coordinated allopathic health care and information across an individual’s personal health plan. Snyderman, said we need to move from “find it, fix it” to a “personal health plan”. Halvorson said (surprise, surprise) that we need electronic health data on every patient, and to not just replicate the current silos of care in our new data strategy. Novelli went straight at the environmental factors—smoking, fast food et al. And to not ignore them. Mehmet Oz (he of the Oprah show) said that