….is up over on my barely used personal blog. It’s a record of an email I send out about charities and causes I support (with a little bit of news about me and mine). If you’re interested it’s here
The five things to pay attention to in 2010
There’s no doubt that despite my thoughts that Obama wouldn’t (and shouldn’t) have pushed health reform in 2009, it was a very big year for health care. Death panels, public options et al—one hundred thousand visits to THCB in August don’t lie.
So what should you look for next?
- The finish is the start: It looks like some version of the Senate bill will be a done deal by sometime late January. That means that there’s about two years of health care industry players figuring out what it all means. The biggest two questions are; what will the types of plan sold in the exchanges look like? (high deductible with some preventive care thrown in is most likely), and what will the cuts and changes in Medicare payment actually look like in practice? (More of the same or real re-alignment around some kind of bundling). All these changes need reactions from the incumbents to reorganize around the new revenue streams.
As I’ve always suspected, Health Care = Communism + Frappuccinos
Nothing new today from me, but if you’re stopping by THCB looking for some post-Xmas inspiration, I thought you might like this essay I’m rather proud from back in THCB’s past (back in the dark days of 2005). It concerns the eternal battle between government/private funding in the provision of health care, and it’s one of the more fun ones I’ve written.
It’s called As I’ve always suspected, Health Care = Communism + Frappuccinos
Senate passes bill, more to come
By
It’s Christmas Eve and the Senate just passed a major health reform bill. Personally I think the reforms in it are relatively minor, but the passage of the bill itself is a screaming big deal. When I say minor, what I mean is that we’re leaving in place the inefficient employment-based health benefits system, and we’re expanding insurance mostly by putting more people into the separate but equal Medicaid program.
But this bill is a statement, and an important one.
For the first time we’re acknowledging that everyone ought to have health insurance and that those unable to afford it should be subsidized by the government. We’re also saying that insurance companies should take all comers at a consistent price without respect to health condition (and hopefully we’re implying that their job is to manage care not risk-select). Finally we’re saying that the majority of the cost can be paid for by redirecting inefficient spending within the health care system, and by taxing benefits that are only tax-free because of historical accident.
Enthoven beats up Gawande
I finally got around to reading Atul Gawande’s New Yorker piece on why the current reform bill mirrors early 20th century agriculture. I learned lots about the role of the Department of Agriculture in teaching farmers what to do. In post-war Britain the radio soap opera The Archers did much the same thing.
I was actually encouraged to remember that in almost every industrialization process, intelligence, leadership, and usually money, from the government was a key factor.
But I felt very uncomfortable with the analogy. First, the incentive for the farmers was to be more productive—even if in the long run productivity meant a relative fall in the price of food and eventually the rise of agri-business decades later. If they did things right there was an immediate market reward. Whereas we know that (from the Virginia Mason and Intermountain examples) increasing quality and productivity in health care leads to negative financial consequences.
Secondly, Gawande seems to be fine with saying that “we don’t know how to be more efficient, productive and effective, so let’s do pilots for years and figure it out.” This is just crap. We’ve both done pilots for decades, and have examples of organizational forms (you know who I mean!) that get it right. It’s just made no sense for most of the health care system to adopt those techniques and organizational forms because they make more money by doing what they’re doing—and government and employers keep paying them.
I was going to write a long piece detailing my complaints blow by blow, but luckily Alain Enthoven has done it for me!
This doesn’t mean I’m against the current bill as I suspect Enthoven is. There is some hope that ACOs and other modern terminology for the types of organization he’s espoused over the years, will arise more quickly from the “pilots” in the bill than Enthoven suspects. But more importantly, I support the bill because the saving money part is the second of my “two rules to judge a bill.” The first and most important rule is
Rule 1 A health care reform bill needs to guarantee that no one should find themselves unable to get care simply because they cannot afford it. Neither should anyone find themselves financially compromised (or worse) because they have received care.
And the current bill just about does that….although Maggie Mahar is pretty doubtful, especially for near-seniors in the first few years.
Interview with Alan Greene MD, author of “Raising Baby Green”
One of the most remarkable talks I heard this year wasn’t about health care. It was about food. Of course, food is very, very closely related to health and health is at least tangentially related to health care.
So I invited Alan Greene of drgreene.com (who is a friend and has spoken at a couple of Health 2.0 Conferences) to tell me about the new book, Raising Baby Green. It really is a potential way to change how Americans (and everyone else) eat, and to use the most important years (the ones we can’t remember!) to do it.
Most importantly Alan is starting a viral campaign to get this information into the hands of expectant mothers. For anyone who knows an expectant mum or someone who might be one someday, this book is very important. And the message needs to get out and get mainstream quickly.
Here’s the interview in which Alan explains how to feed kids right, and we do a little plotting in how to get this into mainstream child-raising.
Senate Deal on Health Care Bill Done
As it's a work day for the Senate worth reporting here that Ben Nelson’s vote has been bought for more Medicaid spending for Nebraska and a complex formula for States to opt out of exchanges being able to fund abortions. So presuming there’s no problems in reconciliation we can expect the reform bill to be done relatively soon. Full details on what’s in the new bill on Think Progress’ The Wonk Room.
The netroots left has been complaining loudly over the last couple of days since Lieberman was bought off by dropping the public option and the Medicare buy-in. Howard Dean and Markos of Daily Kos both called for massive changes to the bill, or killing it and the debate between the “sensible left” and the “this is a sellout to insurers” has got a little silly. However, (unless Bernie Sanders pulls fast one) none of the more left wing Senators (Sherrod Brown et al) are going to vote against the bill, so what we see now is what we get.
The real issue will be when the voting public finds out that nothing happens for 3 years.
Interview with Paul Taylor, renegade hospital CEO
Paul Taylor is CEO of Ozarks Community Hospital, a teeny 2 hospital system catering to the poor and senior populations in rural Missouri and Arkansas. He thinks that he’s figured out a way to deliver health care at government rates and is incensed that every other hospital claims it can’t make it on what Medicare pays. (That’s they I call him a renegade–I don’t mean that his hospital is called “Renegade”!) He also gets much less from the local Blues than he does from Medicare for the same services.
I wrote about Paul a while back and he sounded like a guy with interesting ideas on how to fix health care. So I called him up to see if he would be a good interview–and he didn’t disappoint!
Joe is kicking them when they’re down
From a deeply depressing survey of the unemployed in today’s NY Times:
Nearly half of respondents said they did not have health insurance, with the vast majority citing job loss as a reason, a notable finding given the tug of war in Congress over a health care overhaul. The poll offered a glimpse of the potential ripple effect of having no coverage. More than half characterized the cost of basic medical care as a hardship.
Meanwhile what is Joe Lieberman concerned about? Playing politics against liberals who, correctly, think he erred terribly in his support for Bush’s war and McCain’s candidacy.
And even if we pass legislation, when does the help arrive for these unemployed? 2013.
Making (sh)it up as they go along
So today’s news is that the gang of ten have come up with something. (If you haven’t been following along, the gang of ten are the five “liberal” Democrats and the five DINOs asked by Harry Reid to come up with something to break the deadlock and get some type of compromise that will pass the Senate). More details are here from Brian Beutler at TPM
So it might vanish like a Clinton-era trial balloon, or it might be a stayer, but the core of the new concept is to allow the 55–64 crowd to buy into Medicare, and to ask/allow/mandate a non-profit insurer(s) to provide a substitute public option. Exactly what the second point means is unclear to me. It may turn out to be some collapsing of Kent Conrad’s notion of the cooperative with an extension of the Federal Employees’ Plan (presumably minus the for-profit carriers) and somehow cramming that into the exchange. Of course providing something like the choice among private plans that Federal Employees now get was at the heart of Ron Wyden’s plan. We’ll see if it can last a couple of days scrutiny, or the wrath of the House Democrats.
The Medicare buy-in seems both sensible politics and half-decent policy.
