Category: Uncategorized

Winners and Losers – Strategy in a Post-Reform World

Sep 4, 2009• 29

By BILL KRAMER

Kramer

Most health policy experts are focusing
on the daily ups and downs in the political battles over health reform.
Within the health care industry, however, there is a
buzz about who will be
the winners and losers after health reform passes. A.M. Best’s U.S. Health and HMO Insurance Index has been
volatile since last November, reflecting high uncertainty about the
effect of health reform. Earlier this summer, there was some speculative
analysis about the potential impact
of reform on health care stocks. Will health insurers come out as winners?
What about hospitals, doctors, drug manufacturers, and insurance agents?

It’s good to look ahead, but I think
most people are asking the wrong question. Each of these health
industry sectors – in aggregate — will probably do just fine in the
post-reform world, as Bob Laszewski points out in his recent blog post. The more important question is: who
will be the winners and losers within each sector?

Getting Rid of “Friction” in Health Care

Sep 4, 2009• 10

By FLETCHER LANCE

Main Friction occurs when an object moving through space encounters resistance, slows down and has its forward energy diverted. In the world of health care, friction is a term that has become synonymous with paperwork.Today, the U.S. spends $2.3 trillion on health care, and the U.S. Health Care Efficiency Index estimates that we could reduce this cost by $30 billion if we could eliminate the friction of phone-based and paper-based systems.¹ This is a significant savings, and the American Recovery and Reinvestment Act is an attempt to realize that savings with a very targeted focus on Electronic Medical Records (EMRs). If all of the physicians in the country used EMRs, the argument goes, we would dramatically improve the efficiency of our health care system. The only problem is that only 17 percent of physicians are using EMRs today, so we’re talking about converting 83 percent of physicians to a computerized system for maintaining patient records, and while we absolutely must move in that direction, it is going to be a long and time-consuming process.²

“Low-hanging Fruit” Meanwhile, there’s a much quicker fix that is not getting much attention in the current debate, and that is the savings that could be realized by full conversion to electronic health care claims. Unlike EMRs, electronic claims aren’t slowed down by privacy issues and other barriers that arise with business-to-human transactions. They offer billions of dollars of savings. According to the Center for Health Transformation, 90 percent of claim payments are still made in the form of a paper check. By eliminating these paper-based checks, the U.S. could reduce the overall cost of health care by $11 billion.³ Every paper check that is eliminated and replaced with a wire transfer saves the payer $.78, according to a study by Yoo and Harner.⁴ And given the fact that a few large payers – United, Aetna, Cigna and BlueCross BlueShield – are responsible for a majority of claims checks written in this country, making the switch to electronic health care claims may be easier than you think. Continue reading…

Our President is on the Ropes

Sep 3, 2009• 39

By DR. STEPHEN KARDOS

Recent pictures of President Obama suggest he is battered and on the ropes. Our President can recover if he chooses to change his fighting strategy to improve health instead of budgeting health. There is clearly emerging consensus against yet another health plan sponsored by the federal government.

There is already much oversight at federal and state levels of all insurance programs, yet all of these programs experience unsustainable cost trends. Medicare, Medicaid and the Federal Employee Health Benefit Plans are modeled after private insurance plans and they do not work for our country. In the instances where profit incentives have been removed from government-run programs such as the federal employee health plans, the trends in these plans are not significantly different from private insurance plan trends.Continue reading…

Betsy McCaughey’s Infected Advocacy

Sep 3, 2009• 14

By MICHAEL MILLENSON

A while back, before her stardom on Jon Stewart, the PR wallah for Betsy McCaughey–she of the death panels–emailed me offering an interview about the evils of Obamacare. After I took her up on the offer, the emails stopped coming. Funny that. However, in preparation I asked someone who knows how to do real journalism about what Betsy actually did in her day job. And Michael obligingly found out: -Matthew Holt

Betsy McCaughey’s extravagant claims of eager Democratic euthanasiasts hiding behind health care reform have been exposed, eviscerated, and enshrined as just plain evil.

Of course, that’s the kind of behavior you’d expect from Bad Betsy, the hyper-partisan political pit bull. But what about Good Betsy, the founder and chairman of the non-profit Committee to Reduce Infection Deaths (RID)?

As someone who’s been involved in the patient safety movement since the mid-1990s, I’ve admired her pugnacity and plainspokenness. Unfortunately, when I decided to look a lot more closely at RID, it turned out that Good Betsy was not quite “the real McCoy” either. The assertions she makes about herself and her organization teeter at the border between exaggeration and being deliberately misleading.Continue reading…

Capitol Shortage: Can the Two Democratic Parties Get It Together on Health Reform?

Sep 3, 2009• 29

By JEFF GOLDSMITH

As an exceptionally grumpy American summer grinds to a conclusion, it is apparent that only a bipartisan solution will enable Congress and the Obama Administration to complete health reform. No, we’re not talking about co-operating with the Republicans. Other than a handful of contrarian Republican moderates on the Senate Finance Committee, at least one of whose votes might be needed for eventual passage, the Republicans are irrelevant to the final outcome.

No, the bipartisan solution we’re talking about is co-operation between the two Democratic parties represented in Congress: the “Safe-Seat” Democrats- the Pacific Heights/Beverly Hills/Berkeley Hills/Upper West Side/Harlem Democrats and the “Running Scared” Democrats from the western, southern and border states, who actually require independent and some moderate Republican support to get elected. These parties have very little in common other than the Capital D after their names.

The Right to Live

Sep 2, 2009• 14

By DAVID A. SHAYWITZ

After generations in denial, doctors and lawmakers are paying attention to
the importance of allowing sick people a dignified death, and to the value of
helping patients and their families let go and say good-bye. Aggressive medical
intervention in terminal cases is increasingly considered an avoidable cruelty,
inflicted on a suffering patient by someone — occasionally a doctor, but more
often a family member — unable to acknowledge the inevitable.

As an intern, I see this almost every day, and I’m grateful that most
physicians now go out of their way to emphasize to patients and their families
the limitations of medical technology. Medical students attend lectures on
caring for dying patients, and medical journals remind doctors of the importance
of letting patients die with respect and, as far as possible, without pain.

But as an experience in my own family made clear, this newfound concern for a
good death can be taken too far during a patient’s final days.

Health Panels are a NICE Way of Improving Care and Controlling Costs

Sep 2, 2009• 23

By ADRIAN BAKER

One of the proposals for health care reform is to have a panel of medical experts oversee Medicare, in order to improve quality and reduce cost. Butfalse accusations permeating the debate have scared people into thinking that would mean a government bureaucrat deciding what treatments you should or shouldn’t have, and would ultimately deny your grandma her vital drugs. Like any debate involving the future, fear of the unknown is going to be used by those who want to maintain the status quo for their own self interest. But health panels are not unknown. They have been used in Britain for ten years, and have proven to work.

Health panels are a simple enough idea: experts look at the evidence out there and make sure it’s the best that is available. They then make recommendations based on analysing hundreds of studies and consulting numerous stakeholders. The recommendations suggest the best form of treatment and care for a particular condition, or advise on areas your doctor may be unsure about.Continue reading…

Will Republicans Be Spoilers Or Problem Solvers on Health Care Reform?

Sep 2, 2009• 13

By BRIAN KLEPPER and DAVID C. KIBBE

In theory Congress’ return from recess next week could offer a new beginning to the health care reform process, giving everyone a chance to take a deep breath and recalibrate the components of change.

Nine months into the wrangling around a new Administration, the talk-show right has seemingly hijacked the discussion on health
care, Democrats’ signature issue, with the standard tools that demagogues have always used: leveraging popular prejudices with oversimplification, hyperbole, and distortion. The die-hard GOP faithful’s leaders – Gingrich, Palin and others (see this off-the-deep-end speech by Rep. Mike Rogers (R-Mich)) – are of course playing spoilers, independent of the cost. They hope to goad centrist voters into abandoning the Democrats so they can retake power. Witness South Carolina Republican Jim DeMint’s comment, “If we’re able to defeat Obama on this, it will be his Waterloo. It will break him.”

The problem with this approach is that we’re still early on in our national discussion about change and about health care. An increasing number of Americans may be frustrated with Democrats, but after 10 years of Republican rule, few Americans see them as a party of fresh ideas or having an interest in helping anyone but the wealthy and powerful. Americans may have short memories, but they likely still recall that Republicans were just thrown out for a multitude of significant sins. So if everyone you know sends around Obama-as-Hitler arguments, heckling and hoping the Dems will quickly self-destruct may seem like a reasonable strategy. It is doubtful, however, that the other 75 percent of us buy that thinking.