Category: Uncategorized

Obama vs Hillary at the AMA

Jun 15, 2009• 16

By Michael L. Millenson

Sixteen years and two days after then-First Lady and Health Care Czar Hillary Clinton went before the American Medical Association’s House of Delegates to sell her vision of national reform, President Barack Obama is treading the same path. I’m not sure how much greater eventual success Obama will have with the AMA, but having covered the Clinton speech as a reporter for the Chicago Tribune, I have three lingering memories.

The first was the invocation given before Clinton arrived. Its gist was, “Oh, Lord, you have taught us it is impolite to boo our guests, particularly in front of hordes of reporters.” The second memory was that Clinton finished her speech to a standing ovation. And the third is that she spoke fluently and passionately for 50 minutes without a prepared text, much to the chagrin of a national press corps accustomed to being spoon-fed a follow-along text before filing their stories. Fortunately, being a mere “regional reporter” (as the White House called us), I had taken notes.

Obama’s visit promises at least a few contrasts. He runs virtually no risk of being booed. He’s not only the President of the United States, and a very popular one, he’s also a president who has eschewed the perceived doctor-bashing engaged in at times by President and Mrs. Clinton. Obama most assuredly will not be speaking from notes, being as attached to the teleprompter as Ronald Reagan was to his 3×5 cards, but in the Internet Age anyone who cares to will be able to hear him live, anyway. A standing ovation? We’ll have to see.

To the amazement of her audience in 1993, Hillary went out of her way to hit all their hot buttons. For example, she praised the doctor-patient relationship and lashed out at the “excessive oversight” of insurance company reviewers and government bureaucrats who second-guess medical decisions. She talked sympathetically of the need for reforming malpractice laws and amending antitrust laws to allow medical professional societies to discipline poor-quality doctors on their own. (Here, I’m relying on a copy of my story I grabbed from an electronic archive.)

Obama, by contrast, prides himself on seasoning the obligatory political pandering with a soupcon or two of hard, cold reality. While reducing red tape and the need for defensive medicine are sure to be high on his list of promises, I don’t think he’ll hesitate to invoke the harsh global economic challenges that make health care reform so urgent. Look for Obama to remind the doctors how many more uninsured patients they’re seeing today and how much more involved Medicare has become in setting doctor pay scales.

One more contrast: in 1993, the AMA shoved forward Nancy Dickey, the one woman on their nine-person executive committee, to be its public face during the Hillary visit. Today, the organization’s elected president is Nancy Nielsen, the second woman to head the group (Dickey went on to the top job) and, though not publicized, the first who came to the post after holding a senior position in one of those dread health plans.

The Right to Share

Jun 15, 2009• 8

By JAMIE HEYWOOD

Jamie-headshot-casual We do not live our lives alone. We live our lives in collaboration
with others. We communicate our needs and our goals, and together we
work to achieve them. This is exceptionally true for families and
individuals dealing with illness. Whether you’re dealing with
depression, or pain, or perhaps the fear and stigma of HIV, or the
impairment that comes from MS, Parkinson’s or ALS, what helps us the
most is when those around us reach out and share their support and
advice.

Interview with Hal Luft, author of Total Cure

Jun 15, 2009

By Matthew Holt

Hal Luft is a veteran policy analyst who's been looking at all aspects of the health care system. He's Professor Emeritus at UCSF and now is director of the Palo Alto Medical Foundation Research Institute.

His recent book Total Cure had a fabulous review from JD Kleinke in Health Affairs and essentially presents a combination of a universal insurance pool for chronic care and hospital care, and choice between independent physicians for routine primary care. It's a mix of universal care, and market solution. In this (long) interview I ask Hal about the idea, and he also goes on to explain how the central core of the idea–a public body that essentially re-routes payments to care delivery teams might well be part of the emerging legislation. Given that (as Robert Samuelson points out in the WaPo today), we haven't seen much of a mechanism for cost containment from the legislation proposed so far, yet all agree that we need one, Luft's ideas are becoming become influential rather quickly.

THCB alum going gone places

Jun 15, 2009

By Matthew Holt

Sarah Arnquist left THCB earlier this year to go work at a newspaper with a slightly higher journalistic profile and somewhat longer history. I'm very proud to tell you that below is a link to Sarah's first byline in The New York Times—even if it’s not typical THCB material!

In Some Swimming Pools, a Nasty Intestinal Parasite, by Sarah Arnquist

Quick Sunday roundup or “OMG I agree with Tyler Cowen”

Jun 14, 2009• 2

By Matthew Holt

I can’t say that I often agree with libertarian Tyler Cowen and I think it’s pretty appalling that the New York Times gives someone with such, as Republicans used to say, “out of the mainstream” views a regular place to air them. Like this column saying that our health care system is better than those of other nations because we’ve got more Nobel prizes for example.

But today in his column Cowen basically says the we should pay for the expansion to the uninsured through reallocating current government spending (mostly on Medicare).

The House Tri-Committee Bill—The Playing Field Just Moved Back to the Middle

Jun 14, 2009• 10

By ROBERT LASZEWSKI

Just when people were getting ready to write-off the Baucus bipartisan approach to a health bill the debate has swung back to the middle on a number of critical issues.

Designing an Effective Insurance Exchange. Or Not.

Jun 13, 2009• 4

By ROGER COLLIER

If health care reform legislation is passed, it will almost certainly include provisions for Insurance exchanges. Theoretically, these could be key to controlling costs and expanding access to coverage. In practice (and in addition to assumptions about guaranteed issuance, community rating, and the elimination of medical underwriting) these goals will be achieved only if exchange design adheres to some basic principles:

The Story of Dr. Sidney R. Garfield

Jun 13, 2009• 4

By JON STEWART

“It’s about time,” declares Jay Crosson, MD, a recently retired physician executive at Kaiser Permanente, in his foreword to The Story of Sidney R. Garfield – The Visionary Who Turned Sick Care into Health Care (Permanente Press, 2009). “For too long,” writes Crosson, “Sidney Garfield has stood in the giant shadow cast by his more celebrated partner and friend, Henry J. Kaiser… (whose) name and fame live on, mainly in association with the only nonprofit organization ever incorporated by the builder of more than 100 for-profit companies – Kaiser Permanente. But the physician whose extraordinary vision and daring innovations in health care delivery gave birth to that same organization remains largely unrecognized beyond the select circle of medical historians and the heritage-minded physicians and staff of Kaiser Permanente.”

Sidney R. Garfield (1905-1984) is indeed one of the great under-appreciated geniuses of 20th century American medicine.

Starting out from the humble beginnings of a 12-bed hospital in the middle of southern California’s Mojave Desert, where he tended to injured industrial workers on the California aqueduct through the early years of the Great Depression, he not only went on to create the nation’s largest private, nonprofit, vertically integrated health care organization (Kaiser Permanente); he virtually reinvented the economics and organizational structure of health care delivery by envisioning and demonstrating the manifold advantages of the prepaid, group practice model – a model that many today view as a necessary element of effective health care reform.Continue reading…

Op-Ed: How I’ve Missed the AMA….

Jun 13, 2009• 17

By MATTHEW HOLT

Over at Dr Val’s Get Better Health site Evan Falchuk from Best Doctors is very grumpy about Steve Pearlstein’s column in the WaPo. Pearlstein rewrites Gawande’s rewrite of Shannon Brownlee’s Overtreated. Not much surprise here—everyone is doing it and despite my cynicism Gawande’s piece in The New Yorker has hit a nerve, not least because Obama told everyone to read it—showing that he’s way more influential than Orszag in the White House despite what we wonks all think. Orszag by the way has been hammering on about the Dartmouth stuff for years and even dragged me into his office at CBO back in 2007 to suggest THCB kept plugging away about practice variation. But obviously no one in the White House was heeding his back reading of THCB, until the boss came and told them all to read Gawande.

Op-Ed: It’s the Waste, Stupid.

Jun 12, 2009• 6

By MICHAEL PAINTER

A recent Wall Street Journal editorial strongly challenged the notion that there is enormous waste in American health care. In the article the editors acknowledge that dramatic variation in health care spending exists across the country–but point out that the precise reason for that variation remains uncertain. They also note that much of the data about regional variation comes from the Dartmouth Atlas–and that work, they point out, is limited in that it only examines Medicare data. And they cite work from Richard Cooper at the Wharton School that directly challenges some of the Dartmouth Atlas conclusions–essentially arguing that the Dartmouth observed regional variation is actually simply an artifact of Medicare. They conclude that “Dr. Cooper’s assault on the Dartmouth Atlas is controversial but compelling. He argues that the less-is-more theory is based on the flawed premise that when a region’s outcomes did not improve as spending increased, the difference is simply classified as ‘waste’ – even if it isn’t.”