Category: Uncategorized

The Perils of Play or Not Pay

Feb 5, 2009• 12

By ROGER COLLIER

Remember those heady days with a newly-elected Democratic President and solid Democratic majorities in both houses of Congress, when it seemed that national health care reform was just around the corner? Remember how, after the face-off between the liberals who wanted a single-payer system and the conservatives who wanted as little change as possible, the centrists took command? Remember the early 1990s, and play-or-pay as the magical way to universal coverage?

So you do remember play-or-pay? Be careful about admitting it. After the failure of the Clinton plan and the collapse of similar state reforms in Washington and Massachusetts, a mere mention of the term would cause political eyes to roll, while its inclusion in any reform plan was enough to kill the proposal dead, dead, dead.

Op-Ed: Why the Senate should be abolished, Parts 34-36

Feb 5, 2009• 22

By Matthew Holt

Irrelevant small states with no people in them that exist by an accident of history are chronically over-represented in this country — both in the electoral college and most obviously in the Senate. And those states are much more conservative than metro areas where people actually live, which means that even if they send Democrats to DC, they’re not exactly raging Trotskyites.

Hence we get Max Baucus, representing less than 1 million people, or one-sixth of an average state’s population, pushing moderate reform and saying that single-payer is a political non-starter. He’s right, but it’s only because of the political structure that guarantees him his power. If San Francisco, which has roughly the same population as Montana, sent a Senator to Congress I think the result would be somewhat different.

Two-year SCHIP fight over with Obama’s signature

Feb 5, 2009• 4

By Sarah Arnquist

After a nearly two-year ordeal that divided Democrats and Republicans and involved two presidential vetoes, President Obama signed a bill on Wednesday to reauthorize the State Children's Health Insurance Program.

SCHIP provides health insurance coverage to about 7 million children. This expanded bill will extend coverage to an additional 4 million children.

The WSJ Health Blog reports that doctor-owned hospitals were winners in the bill and big tobacco was a loser.

The bill will increase the national tobacco tax by 60 cents to about $1 per pack to fund the $33 billion expansion. This will please the tobacco control folks, who say the best way to reduce smoking is by increasing the price of cigarettes through taxes. It does mean, however, the expansion is funded through a declining revenue source.

Obama remains committed to health reform, White House official tells wonks

Feb 5, 2009• 35

By Sarah Arnquist

President Obama remains committed to comprehensive health care reform in 2009 and believes the declining economy emphasizes its urgency, a top White House official told hundreds of health policy experts Monday in Washington D.C.

“The current economic crisis has really highlighted the problems and put them under fluorescent lights," said Jeanne Lambrew, deputy director of the newly created White House Office of Health Reform.

The Academy Health conference is probably the wonkiest of meetings on the increasingly crowded health reform conference circuit. University PhDs and private sector policy analysts are here to discuss and assess the impacts of reform.

Mythology and Healthcare Reform

Feb 4, 2009• 43

By MONTE UYEMURA, MD

Successful healthcare reform is critical to the well-being of our nation. Who has the answers? As a rural family physician, I keep shouting in vain that they are backing the trailer up to the wrong barn. Reform proposals utilizing creative accounting keep conjuring up healthcare expenditure savings where they don’t exist, and even is we could attain this mythological information technology utopia, it will be mere cough medicine for our healthcare system’s pneumonia. It scares me to think that healthcare reform is being guided by myths.

Carmona could be logical pick for HHS job

Feb 4, 2009• 2

By Val Jones MD

Merrill Goozner
has been speculating about who will be nominated as the new Secretary
of HHS. He reviewed his most likely candidates (David Cutler or David
Blumenthal), and threw in a “dark horse” potential nominee: Ken Thorpe
(whom I’ve interviewed several times on this blog and spent time with during Obama’s inauguration ceremony).

Tommy Thompson told me that the nominee is likely to be a current or former democratic governor (such as Kathleen Sebelius or Howard Dean).

But I’ve been pondering the “long shot” question and think that
Goozner may have missed a more obvious choice – someone who works with
Ken Thorpe at the Partnership to Fight Chronic Disease: former Surgeon General Dr. Richard Carmona.

Calendar: The Haas Business of Health Care Conference Feb. 7th 2009

Feb 4, 2009

My Desktop Economic Indicators

Feb 3, 2009

By John HALAMKA

Economists track changes in the money supply, personal debt, consumer
confidence, and durable goods orders. My signs of economic health are
more subtle.

1. Email volume on nights and weekends

In
good times, people eat out at restaurants. They go to concerts, plays,
and movies. They take weekend trips with the family.

In bad times, they stay at home and email.

For
the past two months, I've received an average of 100 emails between
6pm-12am and another 50 between 12am and 6am. This is double the usual
volume for those hours.

Dr. Who?

Feb 3, 2009• 10

By BOB WACHTER

A study in this week’s Archives of Internal Medicine
by Vinny Arora and colleagues found that vanishingly
few hospitalized
patients could name any of their hospital doctors. Should we care?

I think we should. Vinny
is one of the nation’s up-and-coming researchers in the field of
hospital medicine, and a good friend. In this clever study, she and
colleagues at the University of Chicago interviewed over 2800
hospitalized patients over 15 months. Three-fourths were unable to name
even a single doctor caring for them; of those who “could” name a
doctor, the majority of names were wrong. Sobering stuff.

There
are multiple issues at play here.

At a place like the University of
Chicago Hospital, hospitalized patients on the teaching service are
cared for by gaggles of residents, students, and others who are
increasingly working in shifts and running for the exits because of
duty hours limits.

Cortese said to be candidate for CMS job

Feb 3, 2009• 1

By Sarah Arnquist

The Obama Administration has yet to announce an appointment for the director of the Centers for Medicare and Medicaid Services (CMS). We're not about to start any rumors, but the announcement must be near. The eventual appointee will confront an unenviable number of difficult problems, including state Medicaid programs feeling squeezed by the financial crisis, a Medicare trust fund facing insolvency in a decade, and competing interests in any reform proposal the Obama team may propose.

The folks at the industry newsletter RPM Report think Mayo Clinic CEO Denis Cortese may be at the top of the list. Analyst Ramsey Baghdadi notes:

"Cortese would be an intriguing pick to lead the agency
and seemingly has every qualification to lead the growing Medicare
programs: He's an outsider, he holds a medical degree, he manages a
large health institution and he's helped to implement a number of the
most talked about health reforms at Mayo and made them work. Cortese
also chairs the Institute of Medicine Roundtable on Evidence-based
Medicine."

A Mayo spokeswoman downplayed the idea,
telling the Minneapolis Star Tribune that the executive has not been offered
the job.